Risk and Consequences of Child Abuse in Attention Deficit Hyperactivity Disorder

Awareness about child physical and emotional abuse and ndash;as well as sexual abuse- is increasing day by day. It is stated that the physical or emotional harm given to a child can result in serious psychological problems both in short and long terms. In addition to this, it is known that, the traditional discipline styles, especially applied in developing countries, can be physically and emotionally harmful and sometimes abusive. The stress level of the parent determines the parent's choice of discipline style and psychopathologies such as attention deficit hyperactivity disorder seem to be riskfull for physical and emotional abuse because they increase the stress level of parents. This paper will review the literature related to the probability of exposure to physically or emotionally abusive discipline styles for children with attention deficit hyperactivity disorder and also the literarture related to the consequences of these abusive discipline styles on these children. [Psikiyatride Guncel Yaklasimlar - Current Approaches in Psychiatry 2015; 7(2): 166-177

Gender Differences In Defense Mechanisms, Ways Of Coping With Stress And Sense Of Identity In Adolescent Suicide Attempts

The main aim of this study was to investigate the gender differences in defense mechanisms, ways of coping with stress and identity formation in relation to adolescent suicidal behavior. This study involved 64 adolescents between 12-17 years of age, who were admitted to the emergency service with a suicide attempt. They were evaluated with a semi-structured clinical interview (K-SADS), Ways of Coping Inventory (WCI), Defense Mechanisms Inventory (DMI) and Sense of Identity Assessment Form (SIAF). 60.9% (n =39) of the adolescents were female, and 39.1% (n=25) were male. There were no statistically significant differences between the girls and the boys with respect to the clinical characteristics of the suicide attempt and the rate of psychiatric disorders. Of the 64 adolescents with suicide attempt, 47 (73.4%) had at least one, and 26 (40.6%) had more than one psychiatric disorder according to K-SADS. Disruptive behavior disorders were more frequent in males, whereas depression was more frequent in girls. The data indicated the importance of identity confusion, major depression and ADHD in adolescents with suicide attempt in both genders. 43.6% (n=17) of the girls and 36% (n=9) of the boys obtained scores higher than the cut-off point of SIAF indicating identity confusion. Professional help seeking and NSSI behaviors before the suicide attempt were more common in adolescents with identity confusion. While there were differences between genders with respect to the defense mechanisms used, no significant difference was found in terms of ways of coping. Evaluation of DMI scores revealed that the turning against object subscale score was significantly higher in boys compared to girls. While evaluating the adolescents at risk, their defense mechanisms, way of coping and sense of identity, as well as their psychiatric diagnosis should be assessed in detail in order to identify the suicidal thoughts and prevent possible suicide attempts.WoSScopu

Medicolegal Evaluation Of A Maternal Filicide Attempt: A Case Report

Filicide mainly refers to the murder of a child by his/her parents. Even though filicide is a rare event, outcome of filicide is more severe compared to other types of murders. In this report, we aim to discuss the factors in which the case of a woman who attempted to kill her 2.5-year-old daughter along with the demographical characteristics. Twenty-nine-year-old mother attempted to kill her daughter by hanging. Even though the victim did not die as the mother, regretted her action the triggers and the plot of the case discussed within the filicide framework. Therefore, the presented case report would contribute to the understanding of the nature of the filicide, and it might bring a different perspective, because of the different development process of filicide, sharing the disorder and interwoven motivations between the child and mother. In this respect, we aim to draw attention of pediatricians, child psychiatrists and forensic pathologists about the importance of filicide.WoSScopu

Home Accident Or Physical Abuse: Evaluation Of Younger Children Presenting With Trauma, Burn And Poisoning In The Pediatric Emergency Department

Most cases of physical abuse and neglect refer to pediatric emergency clinics, and these patients are diagnosed as only home accidents. Cases that cannot be diagnosed and managed correctly are again exposed to severe trauma and consequently, they may die. The aim of this study is to evaluate the physical abuse and neglect in children younger than three years of age, admitted to the pediatric emergency department with the complaints of trauma, burn, drug poisoning and/or caustic ingestion. This prospective study included 132 patients who were admitted to the pediatric emergency department. Children were classified into three groups as "no abuse", "suspected abuse" and "abused" after being evaluated with a standard form. Additionally, suspected abuse and abused cases were evaluated once again by "The Team of Child Abuse and Neglect Evaluation, Research and Treatment" in Hacettepe University, Ihsan Dogramaci Children's Hospital. The frequency of the suspected abuse or abused cases in all burn, trauma and poisoning cases was found to be 7.5%. It was noticed that 65 of the patients (49.2%) were physically neglected considering the mechanism of occurrence of events. Unplanned pregnancy, absence of prenatal follow-up, high number of siblings, previous physical abuse in the family, absence of witness during the event, and hospitalization were statistically significant differences between no abuse and suspected abuse or abused cases (p<0.05). Moreover, age group and income were significant risk factors in the logistic regression model for the patients who were thought to be suspected abuse/abused in univariate analyses (age group: Odds ratio (OR) 0.279, 95% confidence interval (CI) 0.085-0.723, p=0.0049; income: OR 2.323, 95% CI 1.052-6.198, p=0.0345). In conclusion, most cases of physical abuse and neglect are referred to the pediatric emergency clinics, and these patients are misdiagnosed as home accidents. The physicians working in the emergency department should be informed and trained in recognizing the cases of abuse and neglect, making the differential diagnosis, identifying the high-risk families and appropriate physical and psychological treatment for the abused and neglected children.WoSScopu

A Qualitative Study on Corporal Punishment And Emotionally Abusive Disciplinary Practices Among Mothers of Children With Adhd

OBJECTIVES: The present study aimed to investigate actual disciplinary behaviours of Turkish mothers' in the context of relational environment and to investigate ADHD as a risk factor on abusive disciplinary practices. METHODS: Totally 120 children (children with ADHD; study group and healthy controls; control group) - and their mothers were interviewed with this aim. The interviews were qualitatively coded and analysed. T-test and Odds ratio were used for descriptive statistics with the aim of supporting the qualitative results. RESULTS: According to the results of the study, emotionally abusive disciplinary behaviours (81% of all mothers 58% of all children) and corporal punishment (76% of all mothers and 65% of all children) were commonly used as a disciplinary method. Nevertheless, children with ADHD was shown to be at higher risk for both abusive disciplinary practices. The present study has also shown that children with ADHD and their mothers shared less positive activities compared to the control group. In addition to this, emotionally abusive disciplinary practices were found to be at least as hurtful as corporal punishment. CONCLUSIONS: To our knowledge, the present study was the first one investigating Turkish mothers' actual abusive disciplinary acts together with the relational environment between them and their children (including their relationship, positive sharing, problematic issues) by gathering information from both mothers and children of both study and control groups and then comparing these groups in terms of all these aspects. Qualitative nature of the study gave the opportunity of determining the actual disciplinary methods and the actual relational risk factors rather than attitudes and questionnaire scores about mother-child relationship. Therefore, it can be suggested that the results of the study provide important information about the abusive disciplinary behaviours of Turkish mothers and also provide the opportunity of predicting risk factors - keeping cultural context in mind - of these behaviours.WoSScopu

Cognitive And Behavioral Impairment In Mild Hyperphenylalaninemia

As elevated phenylalanine (Phe) is detrimental to brain functions, determining a safe upper limit of blood Phe is important for initiation of treatment plans and setting Phe targets in hyperphenlalaninemic patients. It is accepted that Phe levels below 360 mu mol/L does not impair brain function and hence does not require treatment. Therefore, we aimed to compare cognitive functions and attention-related problems among healthy children and untreated patients with hyperphenylalaninemia (HPA). This study included 41 hyperphenylalaninemic patients ("all HPA group") aged 6-16 years with untreated blood Phe between 240 and 600 mu mol/L and 29 healthy controls. "All HPA group" was further divided into 2 subgroups according to their lifetime median blood Phe levels as "Phe 360-600 mu mol/L" and "Phe 240-360 mu mol/L" groups. Wechsler Intelligence Scale for Children-IV (WISC-IV), Conners' Continuous Performance Test (CPT), Strength and Difficulties Questionnaire (SDQ) and Schedule for Affective Disorders and Schizophrenia for School-Age Children: Present and Lifetime Version (K-SADS-PL) were performed as a comprehensive neurocognitive, attention and behavioral assessment. The study illustrated that "all HPA" patients had significantly lower scores on all WISC-IV indexes compared to controls, except for Working Memory. Both "Phe 360-600 mu mol/L" and "Phe 240-360 mu mol/L" subgroups had lower Full Scale intelligence quotient (IQ) and Verbal Comprehension scores compared to controls. "All HPA" patients also had longer reaction times and more peer problems than controls, indicating attention deficits and behavioral problems. Since the results demonstrated that children with untreated Phe levels between 240-360 mu mol/L are at higher risk for cognitive and attention-related problems, lowering the "safe" upper Phe level should be considered.WoSScopu

Reliability And Validity Of The Schedule For Affective Disorders And Schizophrenia For School-Age Children-Present And Lifetime Version, Dsm-5 November 2016-Turkish Adaptation (K-Sads-Pl-Dsm-5-T)

Objective: The aim of this study was evaluate the reliability and validity of the Schedule for Affective Disorders and Schizophrenia for School-Age Children-Present and Lifetime Version, DSM-5 November 2016 -Turkish Adaptation (K-SADS-PL-DSM-5-T). Method: A total of 150 children and adolescents between 6 and 17 years of age were assessed with K-SADS-PL-DSM-5-T. The degree of agreement between the DSM-5 criteria diagnoses and the K-SADS-PL-DSM-5-T diagnoses were considered as the measure of consensus validity. In addition, concurrent validity was examined by analyzing the correlation between the diagnoses on K-SADS-PL-DSM-5-T and relevant scales. Interrater reliabilities were assessed on randomly selected 20 participants. Likewise, randomly selected 20 other participants were interviewed with K-SADS-PL-DSM-5-T three weeks after the first interview to evaluate test-retest reliability. Results: The consistency of diagnoses was almost perfect for eating disorders, selective mutism and autism spectrum disorder (K=0.92-1.0), substantial for elimination disorders, obsessive-compulsive disorder, oppositional defiant disorder, generalized anxiety disorder, social anxiety disorder, depressive disorders, disruptive mood dysregulation disorder and attention deficit hyperactivity disorder (K=0.67-0.80). Interrater reliability was perfect for selective mucism (K=1.0), substantial for oppositional defiant disorder, disruptive mood dysregulation disorder, attention deficit hyperactivity disorder, depressive disorders and social anxiety disorder (K=0.63-0.73). Test-retest reliability was almost perfect for autism spectrum disorder (K=0.82), substantial for attention deficit hyperactivity disorder, oppositional defiant disorder, disruptive mood dysregulation disorder, depressive disorders and generalized anxiety disorder (K=0.62-0.78). Conclusion: The results of this study show that the K-SADS-PL-DSM-5-T is an effective instrument for diagnosing major childhood psychiatric disorders including selective mutism, disruptive mood dysregulation disorder and autism spectrum disorder which have recently been added to the schedule.WoSScopu