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  • 1. Bayard, Frida
    et al.
    Abé, Christoph
    Wrobel, Nathalie
    Ingvar, Martin
    Henje Blom, Eva
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Barn- och ungdomspsykiatri. Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.
    Petrovic, Predrag
    Emotional Instability Relates to Ventral Striatum Activity During Reward Anticipation in Females2020Ingår i: Frontiers in Behavioral Neuroscience, ISSN 1662-5153, E-ISSN 1662-5153, Vol. 14, artikel-id 76Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Both non-emotional symptoms, such as inattention, and symptoms of emotional instability (EI) are partially co-varying and normally distributed in the general population. Attention Deficit Hyperactivity Disorder (ADHD), which is associated with both inattention and emotional instability, has been related to lower reward anticipation activation in the ventral striatum. However, it is not known whether non-emotional dysregulation, such as inattention, or EI-or both-are associated with this effect. We hypothesized that altered reward processing relates specifically to EI. To test this, 29 healthy participants were recruited to this functional MRI study (n= 15 females). Reward processing was studied using a modified version of the Monetary Incentive Delay (MID) task. Brown Attention-Deficit Disorder Scales questionnaire was used to assess EI and inattention symptoms on a trait level. We observed less ventral striatal activation during reward anticipation related to the EI trait in females, also when controlling for the inattention trait, but not in the whole sample or males only. Our study suggests the existence of sex differences in the relationship between reward processing and EI/inattention traits.

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  • 2.
    Berger, Vilma
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Pediatrik.
    Bromée, Linn
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Pediatrik.
    Lindam, Anna
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin.
    Hallin, Tove
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Pediatrik.
    Reynisson, Björn
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Pediatrik.
    Halldner, Linda
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Barn- och ungdomspsykiatri. Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
    Naumburg, Estelle
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin. Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Pediatrik.
    Adolescents on psychotropic treatment displayed longer corrected QT intervals than unmedicated controls when they rose rapidly from the supine position2024Ingår i: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Aim: Psychotropic medication can contribute to arrhythmia and identifying individuals at risk is crucial. This Swedish study compared the corrected QT (QTc) intervals of adolescents on psychotropic medication with unmedicated controls, when supine and after rising rapidly.

    Methods: The study was carried out at Östersund County Hospital in March 2022 and February to March 2023. It comprised 16 cases, aged 10–17 years and 28 controls. QTc intervals were measured with electrocardiography and calculated using Bazett's and Fridericia's formulas. Univariate and multiple linear regressions were used to assess differences in QTc intervals between the cases and controls and across sex, age and body mass index.

    Results: The mean QTc interval when supine, calculated with Bazett's formula, was longer for the adolescents on psychotropic medication than the controls (p = 0.046). The same was true for the mean QTc interval after rising rapidly from the supine position, calculated with both Bazett's formula (p = 0.009) and Fridericia's formula (p = 0.007). Mean QTc intervals varied by sex and age groups. Psychotropic medication prolonged QTc intervals, particularly in girls.

    Conclusion: Longer QTc intervals were found in adolescents on psychotropic medication, particularly after rising rapidly from the supine position.

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  • 3.
    Berglund, Staffan K.
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Pediatrik.
    Chmielewska, Anna
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Pediatrik.
    Starnberg, Josefine
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Pediatrik.
    Westrup, Björn
    Hägglöf, Bruno
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Barn- och ungdomspsykiatri.
    Norman, Mikael
    Domellöf, Magnus
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Pediatrik.
    Effects of iron supplementation of low-birth-weight infants on cognition and behavior at 7 years: a randomized controlled trial2018Ingår i: Pediatric Research, ISSN 0031-3998, E-ISSN 1530-0447, Vol. 83, s. 111-118Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background Low-birth-weight infants (LBW) are at an increased risk of iron deficiency that has been associated with impaired neurodevelopment. We hypothesized that iron supplementation of LBW infants improves cognitive scores and reduces behavioral problems until school age.

    Methods We randomized 285 marginally LBW (2,000-2,500 g) infants to receive 0, 1, or 2 mg/kg/day of iron supplements from 6 weeks to 6 months of age. At 7 years of age, 205 participants were assessed regarding cognition using Wechsler Intelligence Scale for Children (WISC-IV) and behavior using the parental questionnaires Child Behavior Checklist (CBCL) and Five to Fifteen (FTF).

    Results There were no significant differences between the intervention groups in WISC-IV or FTF. However, the CBCL scores for externalizing problems were significantly different, in favor of supplemented children (P=0.045). When combining the supplemented groups, they had significantly lower scores for externalizing behavior compared with placebo (median (interquartile range): 44 [34;51] vs. 48.5 [41;56] P=0.013), and their risk ratio (95% confidence interval) for a total behavioral score above the cutoff for clinical problems was 0.31 (0.09-1.0), P=0.054.

    Conclusion Lower scores of externalizing behavior in supplemented children support our previous findings at 3 years, and suggest that iron supplementation may have long-lasting effects on behavioral functions.

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  • 4.
    Berglund, Staffan
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Pediatrik.
    Westrup, Björn
    Division of Neonatology, Department of Women and Child Health, Karolinska Institute, Stockholm, Sweden.
    Hägglöf, Bruno
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Barn- och ungdomspsykiatri.
    Hernell, Olle
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Pediatrik.
    Domellöf, Magnus
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Pediatrik.
    Effects of iron supplementation of LBW infants on cognition and behavior at 3 years2013Ingår i: Pediatrics, ISSN 0031-4005, E-ISSN 1098-4275, Vol. 131, s. 47-55Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    OBJECTIVE: Low birth weight (LBW) infants are at increased risk of cognitive and behavioral problems and at risk for iron deficiency, which is associated with impaired neurodevelopment. We hypothesized that iron supplementation of LBW infants would improve cognitive scores and reduce behavioral problems. METHODS: In a randomized controlled trial, 285 marginally LBW (2000-2500 g) infants received 0, 1, or 2 mg/kg/day of iron supplements from 6 weeks to 6 months of age. At 3.5 years of age, these infants and 95 normal birth weight controls were assessed with a psychometric test (Wechsler Preschool and Primary Scale of Intelligence) and a questionnaire of behavioral problems (Child Behavior Checklist; CBCL). RESULTS: There were no significant differences in IQ between the LBW groups or LBW infants versus controls. Mean (SD) full-scale IQ was 105.2 (14.5), 104.2 (14.7), and 104.5 (12.7) in the placebo, 1 mg, and 2 mg groups, respectively (P = .924). However, for behavioral problems, there was a significant effect of intervention. The prevalence of children with CBCL scores above the US subclinical cutoff was 12.7%, 2.9%, and 2.7% in the placebo, 1-mg, and 2-mg groups, respectively (P = .027), compared with 3.2% in controls. Relative risk (95% confidence interval) for CBCL score above cutoff in placebo-treated children versus supplemented was 4.5 (1.4-14.2). CONCLUSIONS: Early iron supplementation of marginally LBW infants does not affect cognitive functions at 3.5 years of age but significantly reduces the prevalence of behavioral problems. The study suggests a causal relation between infant iron deficiency and later behavioral problems.

  • 5. Bielawska-Batorowicz, Eleonora
    et al.
    Siddiqui, Anver
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Barn- och ungdomspsykiatri. University of Växjö , Sweden .
    A study of prenatal attachment with Swedish and Polish expectant mothers2008Ingår i: Journal of Reproductive and Infant Psychology, ISSN 0264-6838, E-ISSN 1469-672X, Vol. 26, nr 4, s. 373-384Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    The main purpose of the study was to investigate maternal prenatal attachment in Sweden and Poland, to analyse its diverse aspects, links to age, parity, planning and complications of pregnancy. Women in the third trimester of gestation filled in the Prenatal Attachment Inventory (PAI) and provided some demographic and medical data. Factor analyses were performed on PAI items for both samples and scores for samples' factors were compared using ANCOVA and two-way ANOVA. Correlates of attachment were examined with Pearson r and multiple regression analysis. Five factors were extracted which explained 53.9% (Swedish data) and 51.9% (Polish data) of variance. Items with the highest loading were similar in both samples. Total PAI scores given by Polish women were higher. Polish mothers gave scores that indicated more intense interactions with unborn children, they also more often shared their opinions about the baby with others. Swedish mothers more often attributed traits and showed affection. Swedish and Polish mothers showed evidence of fantasising about their unborn babies to a similar degree. Total PAI scores and factor scores were similar in planned and unplanned pregnancies. Polish mothers had lower total scores in complicated pregnancies and Swedish mothers in uncomplicated pregnancies. When both samples were analysed together the best predictors of attachment intensity were age and nationality, but they explained only 5.2% of variance in total scores. Despite several differences the findings indicate similarities in the way relationships with an unborn child are conceptualised by Swedish and Polish mothers.

  • 6.
    Birkeland, Anna-Lena
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Pediatrik.
    Dahlgren, Lars
    Umeå universitet, Samhällsvetenskapliga fakulteten, Sociologiska institutionen.
    Hägglöf, Bruno
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Barn- och ungdomspsykiatri.
    Rydberg, Annika
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Pediatrik.
    Breaking bad news: an interview study of paediatric cardiologists2011Ingår i: Cardiology in the Young, ISSN 1047-9511, E-ISSN 1467-1107, Vol. 21, nr 3, s. 286-291Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Technical developments in paediatric cardiology over the last few decades have increased expectations on professionals, demanding of them more emotional competence and communicative ability. The aim of this study was to examine the approach of paediatric cardiologists in informing and communicating with the family of the patient.

    Method: A qualitative interview method was first tested in a pilot study with two paediatric cardiologists. There were nine subsequent semi-structured interviews that were carried out with paediatric cardiologists. A researcher performed all the interviews, which were taped, transcribed, decoded, and analysed.

    Results: Among paediatric cardiologists, how to break bad news to the family is an important concern, evident in findings regarding the significance of trust and confidence, the use of different emotional positions, and a common ambition to achieve skills to handle the situation. There is a need for reflection, education, and sharing of experiences. The cardiologists desire further development of teamwork and of skills in medical students and residents for delivering bad news.

    Conclusions: Doctors are expected to cope with the complexities of diagnoses and decisions, while simultaneously being sensitive to the feelings of the parents, aware of their own emotions, and able to keep it all under control in the context of breaking the bad news to the parents and keeping them informed. These conflicting demands create a need to expand the professional role of the doctor by including more training in emotional competence and communicative ability, beginning in medical school and continuing through consultancy.

  • 7.
    Birkeland, Anna-Lena
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Pediatrik.
    Hagglöf, Bruno
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Barn- och ungdomspsykiatri.
    Dahlgren, Lars
    Umeå universitet, Samhällsvetenskapliga fakulteten, Sociologiska institutionen.
    Rydberg, Annika
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Pediatrik.
    Interprofessional teamwork in Swedish pediatric cardiology: a national exploratory study2013Ingår i: Journal of Interprofessional Care, ISSN 1356-1820, E-ISSN 1469-9567, Vol. 27, nr 4, s. 320-325Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    This paper aims to describe the nature of pediatric cardiology teams (PCTs) based in Sweden through the use of a mixed methods approach. Questionnaires examining issues about the organization/ways of working, functions/tasks and attitudes were answered by 30 PCTs. Focus group interviews were conducted with six PCTs, selected purposefully by size and location, and information on experiences and attitudes on interprofessional teamwork was explored in depth. Results from the quantitative indicated that in 17 of the teams, where the nurse acted as the central coordinator, there was a positive attitude to the value of teamwork. In the interviews, different problems and needs of improvements were mentioned regarding structure, leadership, presence of physicians in the team as well as the team's mandate. All of the participants, however, agreed that interprofessional teams were required to manage the complexity of the children's care. In conclusion, this study suggests that PCTs need further support to develop structure, leadership and coordination of resources to function in a more effective manner. National plans or recommendations that mandate the organization and working methods of PCTs would be helpful for the ongoing development of PCTs in Sweden.

  • 8.
    Birkeland, Anna-Lena
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Pediatrik.
    Hällgren Graneheim, Ulla
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad.
    Rydberg, Annika
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Pediatrik.
    Hägglöf, Bruno
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Barn- och ungdomspsykiatri.
    Dahlgren, Lars
    Umeå universitet, Samhällsvetenskapliga fakulteten, Sociologiska institutionen.
    Facing bad news: a case study focusing on families having a child with congenital heart diseaseManuskript (preprint) (Övrigt vetenskapligt)
  • 9.
    Birkeland, Anna-Lena
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Pediatrik.
    Rydberg, Annika
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Pediatrik.
    Dahlgren, Lars
    Umeå universitet, Samhällsvetenskapliga fakulteten, Sociologiska institutionen.
    Hägglöf, Bruno
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Barn- och ungdomspsykiatri.
    Teamwork in Swedish paediatric cardiology: a national exploratory study examining function and dynamicsManuskript (preprint) (Övrigt vetenskapligt)
  • 10.
    Birkeland, Anna-Lena
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Pediatrik.
    Rydberg, Annika
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Pediatrik.
    Hägglöf, Bruno
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Barn- och ungdomspsykiatri.
    The complexity of the psychosocial situation in children and adolescents with heart disease2005Ingår i: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 94, nr 10, s. 1495-1501Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Aim: To describe the psychosocial situation of children/adolescents with heart disease and their families, an inventory method was worked out.

    Methods: Ninety-seven children/adolescents with congenital heart disease (CHD) were graded into three categories with respect to complexity of CHD. Group I included 42 patients with malformations requiring standardized operations. Group II included 20 patients with more complicated malformations, and group III included 35 patients with very complex malformations. The patients were compared with controls without heart disease, matched for age and gender. The psychosocial impact of CHD was measured by the inventory.

    Results: The most frequent problems in the patient group were healthcare and treatment-related needs (71/97) in the external sphere, family symptoms (68/97) in the interpersonal sphere, and somatic symptoms (19/97) in the personal sphere. Corresponding numbers in the controls were treatment-related needs (15/97), family (9/97) and somatic symptoms (25/97). Fifty per cent of the symptoms in the patient groups were mild, 30% moderate and 20% severe. The most severe symptoms were found in the interpersonal sphere, where family symptoms constituted the most severe variable. The frequency of severe problems in the personal sphere was 11% in the patients and 1% in the controls. This inventory method differentiates the grades of medical complexity both regarding number and severity of psychosocial symptoms. It indicates severe personal problems in the most complex group and shows that they have severe personal problems independent of family problems.

    Conclusion: This study elucidates the psychosocial complexity in children/adolescents with CHD, which has clinical implications in developing a psychosocial care programme.

  • 11.
    Björklund Olofsson, Lena
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Barn- och ungdomspsykiatri.
    Kidscreen: Självskattad livskvalitethos tolvåringar i fem svenska regioner2009Självständigt arbete på grundnivå (kandidatexamen), 10 poäng / 15 hpStudentuppsats (Examensarbete)
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  • 12.
    Blom, Eva Henje
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Barn- och ungdomspsykiatri. Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden; Department of Psychiatry, Division of Child and Adolescent Psychiatry, UCSF Weill Institute for Neurosciences, University of California San Francisco (UCSF), San Francisco, CA, USA.
    Tymofiyeva, Olga
    Chesney, Margaret A.
    Ho, Tiffany C.
    Moran, Patricia
    Connolly, Colm G.
    Duncan, Larissa G.
    Baldini, Lisa
    Weng, Helen Y.
    Acree, Michael
    Goldman, Veronica
    Hecht, Frederick M.
    Yang, Tony T.
    Feasibility and Preliminary Efficacy of a Novel RDoC-Based Treatment Program for Adolescent Depression: "Training for Awareness Resilience and Action" (TARA)-A Pilot Study2017Ingår i: Frontiers in Psychiatry, E-ISSN 1664-0640, Vol. 7, artikel-id 208Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: The novel group treatment program Training for Awareness, Resilience, and Action (TARA) was developed to target specific mechanisms based on neuroscience findings in adolescent depression and framed within the National Institute of Mental Health Research Domain Criteria. TARA contains training of autonomic and emotional self-regulation, interoceptive awareness, relational skills, and value-based committed action.

    Methods: We performed a single-arm trial to test the feasibility and preliminary efficacy of TARA in reducing depression and anxiety levels and assessed whether the specific targeted domains of function reflected the hypothesized symptom change. Twenty-six adolescents (14–18 years old, 7 males and 19 females) participated in the 12-week group program. Assessment was performed before (T0), immediately after (T1), and 3 months after the end of TARA (T2).

    Results: Significant improvement was seen in depression symptoms (Reynolds Adolescent Depression Scale Second Edition) between T0–T1 (t-value = −3.56, p = 0.002, CI = −6.64, −1.77) and T0–T2 (t-value = −4.17, p < 0.001, CI = −11.20, −3.75) and anxiety symptoms (Multidimensional Anxiety Scale for Children) between T0–T1 (t-value = −2.26, p = 0.033, CI = −4.61, −0.21) and T0–T2 (t-value = −3.06, p = 0.006, 95% confidence interval = −9.02, −1.73). Significant improvements in psychological flexibility, sleep, and mindfulness skills were also found between T0 and T2.

    Limitations: The sample size was small without a control condition. The pilot design did not allow for testing the hypothesized brain changes and effect of TARA on relevant systemic biomarkers.

    Conclusion: TARA is feasible in a sample of clinically depressed and/or anxious adolescents and preliminary efficacy was demonstrated by reduced depression and anxiety symptoms. The specific symptom and behavioral outcomes corresponded well with the hypothesized mechanisms of change.

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  • 13.
    Blomqvist, Ida
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Barn- och ungdomspsykiatri.
    Adolescent mental health: time trends and validity of self-report measures2021Doktorsavhandling, sammanläggning (Övrigt vetenskapligt)
    Abstract [en]

    Background: Studies of time trends of adolescent self-reported mental health suggest an increase of mental health symptoms globally. Unfortunately, several studies within the field have methodological problems, such as short time-period between measurements and different mental health measures over time. When estimating mental health through self-report measures, the measures need to be both valid and reliable. Reports from the Swedish National Board of Health and Welfare have shown that several self-report scales used in Child- and Adolescent Psychiatry lack validation in Swedish, and some are direct translations of adult self-report scales without proper age- adaption.

    Aims: This thesis aims to add to previous knowledge regarding time trends of self-reported mental health among Swedish youth and to validate internationally used reliable self-report measures for use in Sweden.

    Methods: In Study I, we investigated changes in self-reported mental health symptoms, both internalized and externalized, in two samples: The first sample in 1981 and the second in 2014, both samples including all grade 9 students of Luleå. The same composite self-report measures were used at both time points. In study II we translated and validated the Reynolds Adolescent Depression Scale second edition (RADS-2) with classical test theory. In study III, eight pediatric Patient-Reported Outcomes Measurement Information System (PROMIS®) item banks were translated to Swedish and culturally adapted using the Functional Assessment of Chronic Illness Therapy (FACIT) methodology. Study IV describes the item response theory (IRT) validation of two item banks, the PROMIS Pediatric Bank v2.0 – Anxiety and the PROMIS Pediatric Bank v2.0 - Depressive Symptoms, in a school- and Child- and Adolescent Psychiatry patient sample.

    Results: Study I: There has been an increase in internalizing symptoms, especially among girls. Externalizing symptoms have decreased, especially among boys, and in 2014 compared to 1981; there is no significant difference between girls and boys. Study 2: The factor structure of the Swedish version of RADS-2 was confirmed and measurement invariance for sex and age-group. Reliability was acceptable to excellent for all subscales and the RADS-2 total scale. Concurrent, convergent, and discriminant validity was acceptable. Study III: All of the eight pediatric PROMIS item banks had translation issues to resolve. However, the translated and adapted versions were linguistically acceptable. Study IV: After removing a few items, the pediatric PROMIS item banks of anxiety and depressive symptoms showed good IRT fit statistics and no differential item functioning. A computer adaptive test (CAT) simulation supports the idea of the item banks to be appropriate to use with CAT.

    Conclusion: This study supports the previous knowledge pointing to a rise in self-reported mental health, especially among girls. Valid and reliable diagnostic measures are needed in Child- and Adolescent Psychiatry. RADS-2 is an internationally established measure, and the Swedish version is now validated in a relatively large school sample. Item response theory has several advantages compared to classical test theory. We have translated eight PROMIS item banks to Swedish, and two of them, anxiety and depressive symptoms, have been validated with IRT in a school- and patient sample.

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  • 14.
    Blomqvist, Ida
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Barn- och ungdomspsykiatri.
    Chaplin, John Eric
    Henje, Eva
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Barn- och ungdomspsykiatri.
    Dennhag, Inga
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Barn- och ungdomspsykiatri.
    Item response theory validation of the Swedish pediatric PROMIS item banks of anxiety and depressive symptoms in clinical and community samplesManuskript (preprint) (Övrigt vetenskapligt)
  • 15.
    Blomqvist, Ida
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Barn- och ungdomspsykiatri.
    Chaplin, John Eric
    Department of Pediatrics, Institute of Clinical Sciences, University of Gothenburg, Gothenburg, Sweden.
    Nilsson, Evalill
    Department of Medicine and Optometry, Linnaeus University, Kalmar, Sweden.
    Henje Blom, Eva
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Barn- och ungdomspsykiatri.
    Dennhag, Inga
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Barn- och ungdomspsykiatri.
    Swedish translation and cross-cultural adaptation of eight pediatric item banks from the Patient-Reported Outcomes Measurement Information System (PROMIS)®2021Ingår i: Journal of Patient-Reported Outcomes, E-ISSN 2509-8020, Vol. 5, nr 1, artikel-id 80Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: This study is part of the Swedish initiative for the establishment of standardized, modern patient-reported measures for national use in Swedish healthcare. The goal was to translate and culturally adapt eight pediatric Patient-Reported Outcomes Measurement Information System (PROMIS®) item banks (anger, anxiety, depressive symptoms, family relationships, fatigue, pain interference, peer relationships and physical activity) into Swedish.

    Methods: Authorization to translate all currently available pediatric PROMIS item banks (autumn, 2016) into Swedish was obtained from the PROMIS Health Organization. The translation followed the Functional Assessment of Chronic Illness Therapy translation recommendations with one major modification, which was the use of a bilingual multi-professional review workshop. The following steps were applied: translation, reconciliation, a two-day multi professional reviewer workshop, back translation, and cognitive debriefing with eleven children (8–17 years) before final review. The bilingual multi-professional review workshop provided a simultaneous, in-depth assessment from different professionals. The group consisted of questionnaire design experts, researchers experienced in using patient-reported measures in healthcare, linguists, and pediatric healthcare professionals.

    Results: All item banks had translation issues that needed to be resolved. Twenty-four items (20.7%) needed resolution at the final review stage after cognitive debriefing. The issues with translations included 1. Lack of matching definitions with items across languages (6 items); 2. Problems related to language, vocabulary, and cultural differences (6 items); and 3. Difficulties in adaptation to age-appropriate language (12 items).

    Conclusions: The translated and adapted versions of the eight Swedish pediatric PROMIS item banks are linguistically acceptable. The next stage will be cross-cultural validation studies in Sweden. Despite the fact that there are cultural differences between Sweden and the United States, our translation processes have successfully managed to address all issues. Expert review groups from already-established networks and processes regarding pediatric healthcare throughout the country will facilitate the future implementation of pediatric PROMIS item banks in Sweden.

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  • 16.
    Blomqvist, Ida
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Barn- och ungdomspsykiatri.
    Ekbäck, Erik
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Barn- och ungdomspsykiatri.
    Dennhag, Inga
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Barn- och ungdomspsykiatri.
    Henje, Eva
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Barn- och ungdomspsykiatri.
    Validation of the Swedish version of the Reynolds Adolescent Depression Scale second edition (RADS-2) in a normative sample2021Ingår i: Nordic Journal of Psychiatry, ISSN 0803-9488, E-ISSN 1502-4725, Vol. 75, nr 4, s. 292-300Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Due to the sharp global increase in prevalence of adolescent major depressive disorder as defined by the Diagnostic and Statistical Manual of Mental Disorders, we need internationally validated tools for multi-dimensional assessment. Reynolds Adolescent Depression Scale second edition (RADS-2) measures dysphoric mood, anhedonia/negative affect, negative self-evaluation and somatic complaints and is widely used internationally, but not yet available in Swedish.

    Aim: The aim of this study is to test the psychometric characteristics of the Swedish version of RADS-2 in a normative sample.

    Material and method: Data was gathered from junior and high school students in Northern Sweden (N = 637). We performed: 1. Confirmatory factor analysis to examine the 4-factor structure proposed by Reynolds, 2. Measurement invariance analysis for sex (girls, boys) and age group (12-15 years, 16-20 years). 3. Reliability testing and 4. Tests for concurrent, discriminant and convergent validity using Beck's Youth Inventories of Emotional and Social Impairment Depression and Anger subscales, the Patient Reported Outcome Measurements Information System, Anxiety and Friends subscales and the World Health Organization Wellness Index.

    Results: The sample consisted of n = 637 students (n = 389 girls and n = 248 boys), mean age 15.73 (SD = 1.76); 12-20 years. The 4-factor structure was confirmed, as well as measurement invariance for sex and age group. Reliability was acceptable to excellent for all subscales and RADS-2 total scale. Concurrent, convergent and discriminant validity was good.

    Conclusion: The Swedish version of RADS-2 showed acceptable reliability and validity in a Swedish normative sample.

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  • 17.
    Blomqvist, Ida
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Barn- och ungdomspsykiatri.
    Henje Blom, Eva
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Barn- och ungdomspsykiatri.
    Hägglöf, Bruno
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Barn- och ungdomspsykiatri.
    Hammarström, Anne
    Increase of internalized mental health symptoms among adolescents during the last three decades2019Ingår i: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 29, nr 5, s. 925-931Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Previous studies suggest an overall increase of adolescent mental health symptoms globally since the 1980s until today, especially an increase of internalizing symptoms in girls. Due to methodological limitations of these studies, further studies are warranted to obtain a more solid knowledgebase.

    Methods: This study was cross-sectional and compared two separate but geographically identical groups of adolescents in a middle-sized industrial municipality in Northern Sweden at two time-points [(i) 1981, n = 1083, (505 girls, 577 boys), response rate 99.7%; (ii) 2014, n = 682, (338 girls, 344 boys), response rate 98.3%]. All students in their last year of compulsory school were included. The same self-report questionnaire, consisting of four sub-scales (functional somatic-, anxiety-, depressive symptoms and conduct problems), was used at both occasions. Data were analyzed with descriptive statistics, two-way ANOVA and general linear model.

    Results: Symptoms of anxiety and depression and functional somatic symptoms, increased among both boys and girls from 1981 until 2014 (P < 0.001 for all subscales), and the increase of these symptoms was higher in girls. Conduct problems were significantly higher in boys in 1981 and decreased over time so that in 2014 there was no longer a significant difference between boys and girls regarding conduct problems (P = 0.286).

    Conclusion: In this population-based study spanning over 30 years, both girls and boys showed increasing internalizing problems, while conduct problems decreased. To halt this trend, we need a deeper understanding of the impact of the major societal changes that have occurred during the last three decades.

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  • 18.
    Boström, Deborah
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Barn- och ungdomspsykiatri.
    Mom, why must ADHD exist?: Conceptions, experiences and concerns among children with ADHD and their parents2012Självständigt arbete på avancerad nivå (yrkesexamen), 20 poäng / 30 hpStudentuppsats (Examensarbete)
  • 19.
    Carballeira Suarez, Nivia
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Barn- och ungdomspsykiatri.
    Hägglöf, Bruno
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Barn- och ungdomspsykiatri.
    Nilsson, Karin
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Barn- och ungdomspsykiatri.
    Mitt barn svälter sig – hjälp!: Fallstudie med fokus på familjeterapi som behandling av ätstörning2012Ingår i: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 109, nr 42, s. 1889-1891Artikel i tidskrift (Övrigt vetenskapligt)
    Abstract [sv]

    Maudsley-modellen är en familjebaserad behandlingsmetod vid ätstörning.

    Behandlingen lägger tonvikt på ätande och viktuppgång med stöd av föräldrarna, förhandling om nya relationsmönster och hantering av vanliga tonårsfrågor för återgång till ett åldersadekvat liv.

    Denna studie summerar elva samtal med en familj, där samtalen enligt mätningar och observationer under behandlingsförloppet gav god effekt på såväl ätstörningsproblematiken som familjens kommunikation.

  • 20.
    Carlberg Rindestig, Frida
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Barn- och ungdomspsykiatri.
    Gillander Gådin, Katja
    Department of Health Sciences, Mid Sweden University, Sundsvall, Sweden.
    Dennhag, Inga
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Barn- och ungdomspsykiatri.
    Experiences of online sexual violence: interviews with Swedish teenage girls in psychiatric care2023Ingår i: Violence against Women, ISSN 1077-8012, E-ISSN 1552-8448Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Research about online sexual violence (OSV) is needed to be able to better meet the needs of girls in psychiatric care. The objectives of this study are to explore experiences of online sexual violence among young female psychiatric service users. Interviews with nine girls with psychiatric care needs were analyzed with thematic analysis. The findings are summarized in four themes which contribute to the notion that online sexual violence is only one, albeit important, part of a more complex picture of violence among young girls in psychiatric care. The girls’ narratives are shaped by, as well as reproducing gender norms.

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  • 21.
    Carlberg Rindestig, Frida
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Barn- och ungdomspsykiatri.
    Wiberg, Marie
    Umeå universitet, Samhällsvetenskapliga fakulteten, Handelshögskolan vid Umeå universitet, Statistik.
    Chaplin, John Eric
    Henje Blom, Eva
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Barn- och ungdomspsykiatri.
    Dennhag, Inga
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Barn- och ungdomspsykiatri.
    Psychometrics of three Swedish physical pediatric item banks from the Patient-Reported Outcomes Measurement Information System (PROMIS)®: pain interference, fatigue, and physical activity2021Ingår i: Journal of Patient-Reported Outcomes, ISSN 2509-8020, Vol. 5, nr 1, artikel-id 105Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: The Patient-Reported Outcomes Measurement Information System (PROMIS®) aims to provide self-reported item banks for several dimensions of physical, mental and social health. Here we investigate the psychometric properties of the Swedish pediatric versions of the Physical Health item banks for pain interference, fatigue and physical activity which can be used in school health care and other clinical pediatric settings. Physical health has been shown to be more important for teenagers’ well-being than ever because of the link to several somatic and mental conditions. The item banks are not yet available in Sweden.

    Methods: 12- to 19-year-old participants (n = 681) were recruited in public school settings, and at a child- and psychiatric outpatient clinic. Three one-factor models using CFA were performed to evaluate scale dimensionality. We analyzed monotonicity and local independence. The items were calibrated by fitting the graded response model. Differential Item analyses (DIF) for age, gender and language were calculated.

    Results: As part of the three one-factor models, we found support that each item bank measures a unidimensional construct. No monotonicity or local dependence were found. We found that 11 items had significant lack of fit in the item response theory (IRT) analyses. The result also showed DIF for age (seven items) and language (nine items). However, the differences on item fits and effect sizes of McFadden were negligible. After considering the analytic results, graphical illustration, item content and clinical relevance we decided to keep all items in the item banks.

    Conclusions: We translated and validated the U.S. PROMIS item banks pain interference, fatigue and physical activity into Swedish by applying CFA, IRT and DIF analyses. The results suggest adequacy of the translations in terms of their psychometrics. The questionnaires can be used in school health and other pediatric care. Future studies can be to use Computerized Adaptive Testing (CAT), which provide fewer but reliable items to the test person compared to classical testing.

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  • 22.
    Carlsson, Rasmus
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Barn- och ungdomspsykiatri.
    Prediktorer för utveckling av huvudvärk i samband med ADHDmedicinering2022Självständigt arbete på grundnivå (yrkesexamen), 20 poäng / 30 hpStudentuppsats (Examensarbete)
  • 23.
    Carnelius, Filippa
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Barn- och ungdomspsykiatri.
    Dennhag, Inga
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Barn- och ungdomspsykiatri.
    The association between gender, sexual harassment, and self-compassion on depressive symptoms in adolescents2023Ingår i: Nordic Journal of Psychiatry, ISSN 0803-9488, E-ISSN 1502-4725, Vol. 77, nr 3, s. 256-265Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Aim: The study aims to identify the prevalence of bullying and sexual harassment as well as possible risk and protective factors for depression among adolescents. We focus on the association of different types of sexual harassment, gender, bullying, and self-compassion to depression criteria according to DSM 4.

    Methods: This cross-sectional study included 318 adolescents aged 15–20 years, from Sweden. Participants answered the self-assessment scales Reynolds Adolescent Depression Scale, Second Edition, and Compassionate Engagement and Action Scales for Youth, as well as questions about sexual harassment and bullying. Regression analyses were conducted to examine the association between bullying, sexual harassment, self-compassion, and gender with depressive symptoms.

    Results: Few students had been subjected to bullying, whereas sexual harassment was more common. About 32.7% of students had been subjected to verbal harassment and girls were more frequently exposed. Both bullying and sexual harassment were associated with depressive symptoms, and gender patterns were observed. For boys, verbal harassment and bullying correlated with negative self-evaluation and somatic complaints. For girls, bullying correlated with all depressive symptoms. Higher levels of self-compassion were associated with less depression, and the correlation was especially strong among boys.

    Conclusion: Boys and girls express different types of depressive symptoms when subjected to bullying and sexual harassment. Not asking boys about negative self-evaluation or somatic complaints could lead to missing depression. However, for girls, all four symptoms are equally important to inquire about. Self-compassion is a possible protective factor against depression and future studies will show if teaching this to adolescents could lead to less depression.

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  • 24.
    Cederin, Hanna
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Barn- och ungdomspsykiatri.
    Lekterapi - Vad fungerar och för vem?: En översikt över forskningsstudier om psykoterapeutiska lekterapier med positiva effekter under 2000-talet.2011Självständigt arbete på grundnivå (kandidatexamen), 10 poäng / 15 hpStudentuppsats (Examensarbete)
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  • 25. Chaplin, John Eric
    et al.
    Kriström, Berit
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Pediatrik.
    Jonsson, Björn
    Hägglöf, Bruno
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Barn- och ungdomspsykiatri.
    Tuvemo, Torsten
    Aronson, A Stefan
    Dahlgren, Jovanna
    Albertsson-Wikland, Kerstin
    Improvements in behaviour and self-esteem following growth hormone treatment in short prepubertal children2011Ingår i: Hormone research in paediatrics, ISSN 1663-2826, Vol. 75, nr 4, s. 291-303Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background/Aims: To evaluate effects of growth hormone (GH) treatment on behaviour and psychosocial characteristics in short-stature children.

    Methods: 99 referred prepubertal non-familiar short-stature children (32 GH deficiency; 67 idiopathic short stature) aged 3-11 years, randomized to fixed or individual GH doses and their parents completed questionnaires (Child Behaviour Checklist, Birleson Depression Self-Report Scale, Abbreviated Parent-Teacher Questionnaire, I Think I Am, Well-Being Visual-Analogue Scales for Short-Stature Children) at baseline (BL) and after 3, 12, and 24 months.

    Results: At BL, children showed higher levels of internalizing behaviour (p < 0.001), lower levels of externalizing behaviour (p < 0.006) and self-esteem (p < 0.001) compared to reference values. During GH treatment, behavioural measures (p < 0.001) and depression (p < 0.01) changed towards the mean of the population within the first 3 months and remained improved to 24 months. Self-esteem improved at all time points (p < 0.001), and in all subgroups, as did well-being dimensions stability and mood (p < 0.05). Multiple regression analysis showed that greater improvements were related to lower BL value, height gain, higher maximal GH value, being older, and being male.

    Conclusion: On GH treatment, prepubertal short children significantly improved on behavioural, depression, and psychosocial evaluations over a 2-year period of GH treatment. Most change occurred within the first 3 months, which highlights this short period as important not only for growth and metabolic changes but also for behaviour and psychosocial improvements following GH treatment.

  • 26.
    Chotai, Jayanti
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Psykiatri.
    Jonasson, Mattias
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Psykiatri.
    Hägglöf, Bruno
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Barn- och ungdomspsykiatri.
    Adolfsson, Rolf
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Psykiatri.
    Adolescent attachment styles and their relation to the temperament and character traits of personality in a general population.2005Ingår i: Eur Psychiatry, ISSN 0924-9338, Vol. 20, nr 3, s. 251-9Artikel i tidskrift (Refereegranskat)
  • 27.
    Chotai, Jayanti
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Psykiatri.
    Jonasson, Mattias
    Hägglöf, Bruno
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Barn- och ungdomspsykiatri.
    Adolfsson, Rolf
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Psykiatri.
    The Temperament Scale of Novelty Seeking in adolescents shows an association with season of birth opposite to that in adults.2002Ingår i: Psychiatry Research, ISSN 0165-1781, E-ISSN 1872-7123, Vol. 111, nr 1, s. 45-54Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    We investigated the relationship between season of birth and the Junior Temperament and Character Inventory of Personality (Junior TCI, JTCI) in adolescents. The Temperament Scale of Novelty Seeking (NS) is significantly higher for females born during October-January as compared to females born otherwise. This association is opposite to that obtained earlier for adults. For both genders pooled, NS is significantly higher for those born during October-March compared to April-September. This association is also found when examining the data for those of age up to 18 years in a third independent study on the age range 11-81 years with the adult TCI. There is a greater tendency for exploration and risk-taking behavior as the child individuates from the family. Our study suggests that the effects of such environmental and developmental changes on personality are different in those born during October-March as compared to those born during April-September. The former show a higher rise in NS during adolescence and a steeper fall in NS during the years of adulthood, compared to the latter. Dopamine turnover is likely associated with NS, and the mutually inhibitory systems of dopamine and melatonin are the paracrine signals of day and night, respectively. Thus, the maternal entrainment of these systems during the prenatal period, or the postnatal environmental influence on these systems, may be different for those born during the short photoperiod of October-March as compared to those born during the long photoperiod part of the year.

  • 28.
    Dennhag, Inga
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Barn- och ungdomspsykiatri.
    Makt och psykoterapi2017Bok (Övrig (populärvetenskap, debatt, mm))
    Abstract [sv]

    Status och makt påverkar hur vi pratar och förhåller oss till varandra. Några kända makthierarkier handlar om kön, klass, etnicitet, ålder och funktionsnedsättning. Dessa utspelar sig i alla relationella sammanhang – även i psykoterapi.

    Relationen mellan klient och terapeut är inte jämlik. Terapeuten har mer makt utifrån sin utbildning och anställning, medan klienten ofta är i kris eller har svårigheter och är i behov av den hjälp som terapeuten kan erbjuda. Vilka former av makt kan gestalta sig i samtalet och hur kan makten påverka psykoterapin?

    Den här boken vill bidra till ökad förståelse för vad makt är, hur den yttrar sig i psykoterapi och hur makt kan utjämnas. Vinsterna med maktutjämning är många. Det kan stärka alliansen och samarbetet mellan klient och terapeut, göra terapeuten mer träffsäker i sina bedömningar, vara en hjälp i att anpassa behandlingsupplägget – och därmed bidra till färre avhopp och ett bättre utfall av terapin.

    Författaren undersöker och ger kunskap om jämställdhet, mångfald, fördomar och normer. Här finns också fördjupande kapitel om genus/kön, sexualitet, allians, språk och kommunikation, samt fallexempel med maktanalyser. De teoretiska verktyg som genomsyrar innehållet är kulturpsykologi, intersektionalitet och normkritik. Författaren visar också hur dessa perspektiv kan införlivas i en fallkonceptualisering i KBT med maktperspektiv. Till varje kapitel finns reflektionsfrågor och övningar som hjälper läsaren att öka sin medvetenhet om makt och att omsätta kunskapen i praktisk handling.

    Boken vänder sig till psykolog- och psykoterapistuderande samt till yrkesverksamma psykologer, psykoterapeuter, psykiatri- och vårdpersonal.

  • 29.
    Dennhag, Inga
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Barn- och ungdomspsykiatri.
    Henje, Eva
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Barn- och ungdomspsykiatri.
    Nilsson, Karin
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Barn- och ungdomspsykiatri.
    Parental caregiver burden and recovery of adolescent anorexia nervosa after multi-family therapy2021Ingår i: Eating Disorders, ISSN 1064-0266, E-ISSN 1532-530X, nr 5, s. 463-479Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    This study investigated whether parental caregiving burden changed during adjunct multi-family therapy of adolescent anorexia nervosa and eating disorders not otherwise specified (EDNOS) and whether caregiver burden at baseline and changes in caregiver burden during treatment were associated with treatment outcome.

    Twenty-four females, 13 to 16 years old, and their parents, participated in the study. Caregiver burden was measured with the Eating Disorders Symptom Impact Scale, by mothers (n = 23) and fathers (n = 22). Treatment outcome was measured by adolescent body mass index, level of global functioning and self-rated eating disorder symptoms by the Eating Disorders Examination Questionnaire 4.0.

    All patient outcomes improved and overall caregiver burden decreased significantly during treatment. When broken down in aspects of caregiver burden the decrease in parental perceived isolation, was found to be associated with improvement of BMI and Children's Global Assessment Scale. When analyzing fathers and mothers separately, we found that maternal feelings of guilt and paternal perceived burden of dysregulated behaviors at base-line were correlated to treatment outcome. Future studies are needed to clarify the role of caregiver burden as a potential mediator of treatment results.

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  • 30.
    Dennhag, Inga
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Barn- och ungdomspsykiatri.
    Steinvall, Anders
    Umeå universitet, Humanistiska fakulteten, Institutionen för språkstudier.
    Hakelind, Camilla
    Umeå universitet, Samhällsvetenskapliga fakulteten, Institutionen för psykologi.
    Deutschmann, Mats
    School of Humanities, Education and Social Sciences, Örebro University, Sweden.
    Exploring gender stereotypes about interpersonal behavior and personality factors using digital matched-guise techniques2019Ingår i: Social behavior and personality, ISSN 0301-2212, E-ISSN 1179-6391, Vol. 47, nr 8, artikel-id e8150Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    The current study explores gender stereotypes among Swedish university students (n=101) studying a course in psychology, using a matched-guise experimental design. The gender identity of a speaker in a dialogue, manifested by voice, was digitally manipulated to sound male or female. Responses to the recordings indicated that an actor with a male voice was rated significantly less conscientious, agreeable, extraverted, and open to experience than the same actor with a female voice. On social behavior, there was a tendency for the actor with a male voice to be rated as more hostile than the same actor with a female voice. The study suggests that stereotype effects rather than real behavioral differences may have an impact on perceived gender differences.

  • 31.
    Desta, Menelik
    Umeå universitet, Medicinsk fakultet, Klinisk vetenskap, Barn- och ungdomspsykiatri.
    Epidemiology of child psychiatric disorders in Addis Ababa, Ethiopia2008Doktorsavhandling, sammanläggning (Övrigt vetenskapligt)
    Abstract [en]

    Although mental disorders are common among children all over the world, information on the extent and types of child psychiatric disorders in Ethiopia is extremely limited. A study was conducted in an urban setting of Ethiopia to look at the prevalence of child psychiatric disorders and their correlates. A two-phase survey was performed. In the first phase, parents of 5000 children in Addis Ababa, the capital city of Ethiopia, were interviewed using the Reporting Questionnaire for Children (RQC). In the second phase, parents of all screen-positive children (n=864) and parents of 1537 screen-negative children were interviewed using the revised parent version of the Diagnostic Interview for Children and Adolescents (DICA-R), a semi-structured diagnostic instrument that is based on the third revised edition of the Diagnostic and Statistical Manual of the American Psychiatric Association (DSM-III-R). This thesis discusses the results of that study in comparison with other child mental health studies in Ethiopia and elsewhere.

    At the recommended cut-off score of 1, the sensitivity, specificity, predictive values and likelihood ratios of the RQC to DICA-R diagnoses were acceptable. The RQC had high accuracy with a misclassification rate of 17%.

    The weighted prevalence for any DSM-III-R diagnosis was 17%. The most prevalent condition was enuresis (12.1%) followed by simple phobia (5.5%). The prevalence rates of all other identified conditions were below 1%. Children's age, severe economic problems, and single parenthood were found to be risk factors for any DSM-III-R diagnosis in children. Male sex, younger age, and lower achieved educational grade of the child were all independently associated with childhood enuresis. The odds of having enuresis were significantly higher for children in families with extreme poverty and in children from single-parent homes. The risk of having enuresis was significantly higher in children who had anxiety disorders (AD) and disruptive behaviour disorders (DBD). Sex was significantly associated with disruptive behaviour disorders while grade level, age, family size, ethnicity, poverty, and single parenthood were not. Anxiety disorders were significantly associated with sex, ethnicity, and extreme poverty but not with the other socio-demographic variables. The absence of mood disorders and somatoform disorders, of which symptoms are often encountered in both children and adults at clinical settings and the low prevalence rates of most identified conditions, were probably related to the lack of awareness or alternative explanations at the community level regarding the understanding of behaviour changes. Campaigns of public mental health education with the aim of providing scientific information to society are highly recommended. While Ethiopia works towards mainstreaming mental health into its health care system, training health care workers in applying simple screening tools like the RQC is recommended.

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  • 32.
    Desta, Menelik
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Barn- och ungdomspsykiatri.
    Hägglöf, Bruno
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Barn- och ungdomspsykiatri.
    Kebede, Derege
    Alem, Atalay
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Psykiatri.
    Psychiatric disorders in urban children in Ethiopia: a population based cross sectional surveyManuskript (preprint) (Övrigt vetenskapligt)
  • 33.
    Desta, Menelik
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Barn- och ungdomspsykiatri.
    Hägglöf, Bruno
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Barn- och ungdomspsykiatri.
    Kebede, Derege
    Alem, Atalay
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Psykiatri.
    Socio-demographic and psychopathologic correlates of enuresis in urban Ethiopian children.2007Ingår i: Acta Paediatr, ISSN 0803-5253, Vol. 96, nr 4, s. 556-560Artikel i tidskrift (Refereegranskat)
  • 34.
    Desta, Menelik
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Barn- och ungdomspsykiatri.
    Hägglöf, Bruno
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Barn- och ungdomspsykiatri.
    Kebede, Derege
    Alem, Atalay
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Psykiatri.
    Stenlund, Hans
    Demographic and social factors associated with disruptive behaviour disorders and anxiety disorders in children in an urban community in EthiopiaManuskript (preprint) (Övrigt vetenskapligt)
  • 35.
    Desta, Menelik
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Barn- och ungdomspsykiatri.
    Hägglöf, Bruno
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Barn- och ungdomspsykiatri.
    Kebede, Derege
    Alem, Atalay
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Psykiatri.
    Stenlund, Hans
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin, Epidemiologi och global hälsa.
    The Reporting Questionnaire for Children (RQC) as a valid and simple child mental health screening instrument in EthiopiaManuskript (preprint) (Övrigt vetenskapligt)
  • 36.
    Doering, Sabrina
    et al.
    Centre for Ethics, Law and Mental Health, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Halldner, Linda
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Barn- och ungdomspsykiatri. Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
    Larsson, Henrik
    Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
    Gillberg, Christopher
    Gillberg Neuropsychiatry Centre, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Sweden.
    Kuja-Halkola, Ralf
    Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
    Lichtenstein, Paul
    Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
    Lundström, Sebastian
    Centre for Ethics, Law and Mental Health, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Gillberg Neuropsychiatry Centre, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Sweden.
    Childhood-onset versus adolescent-onset anxiety and depression: Epidemiological and neurodevelopmental aspects2022Ingår i: Psychiatry Research, ISSN 0165-1781, E-ISSN 1872-7123, Vol. 312, artikel-id 114556Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Anxiety and depression are common in youth and are frequently accompanied by attention-deficit/hyperactivity disorder (ADHD) and autism spectrum disorder (ASD). However, it is unclear how common ADHD, ASD, and other neurodevelopmental disorders (NDDs, i.e., ADHD, ASD, developmental coordination disorder, learning disorder, and tic disorders) are in children versus adolescents with anxiety and depression. We aimed to delineate whether different anxiety/depression age-of-onset groups show distinguishable NDD patterns. The study was based on 4492 twins born in Sweden between 1998 and 2003 from the nation-wide population-based Child and Adolescent Twin Study in Sweden. Prevalence and odds ratios were calculated using screening measures of anxiety and depression at ages 9 and 15, and NDDs at age 9. Individuals with childhood-onset anxiety/depression had a substantially higher NDD prevalence compared to individuals with adolescent-onset anxiety/depression. Highest prevalence was found for individuals with anxiety/depression both in childhood and adolescence. In this group, individuals also had substantially higher odds of having at least one NDD (14.7, 95% CI 6.3 – 34.0) compared to individuals without anxiety/depression. This emphasizes the need to further investigate the etiology of childhood and adolescent anxiety/depression, as they most likely represent different constructs depending on age-of-onset, lending support for possibly different treatment approaches.

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  • 37.
    Doering, Sabrina
    et al.
    Centre for Ethics, Law and Mental Health (CELAM), Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Larsson, Henrik
    Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
    Halldner, Linda
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Barn- och ungdomspsykiatri. Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
    Gillberg, Christopher
    Gillberg Neuropsychiatry Centre, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Kuja-Halkola, Ralf
    Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.
    Lundström, Sebastian
    Centre for Ethics, Law and Mental Health (CELAM), Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Gillberg Neuropsychiatry Centre, Institute of Neuroscience and Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
    Internalizing symptoms in adolescence are modestly affected by symptoms of anxiety, depression, and neurodevelopmental disorders in childhood2022Ingår i: BMC Psychiatry, E-ISSN 1471-244X, Vol. 22, nr 1, artikel-id 233Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Internalizing disorders, such as anxiety and depressive disorders, are common mental disorders in young people, but a detailed understanding of the symptom continuity from childhood to adolescence that additionally includes a variety of neurodevelopmental disorder (NDD) symptoms is lacking. We therefore aimed to assess the extent to which parent-reported anxiety, depression, and NDD symptoms in childhood predict parent-reported internalizing symptoms in adolescence.

    Methods: We used the nation-wide population-based Child and Adolescent Twin Study in Sweden, comprising 4492 twins born in Sweden between 1998 and 2003 that were assessed at age 9, and then again at age 15. Linear regression in a structural equation modelling framework was used to analyze the data.

    Results: Overall, our results indicate that 15.9% of the variance in internalizing symptoms at age 15 can be predicted by anxiety, depression, and NDD symptoms at age 9. Anxiety and NDD symptoms in childhood predicted the largest amount of internalizing symptoms in adolescence.

    Conclusions: Adolescent internalizing symptoms are modestly affected by childhood symptoms of anxiety, depression, and NDDs, suggesting that they may represent different constructs across age. Future studies should further empirically investigate differences in etiology and trajectories of childhood versus adolescent internalizing symptoms.

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  • 38. Durbeej, Natalie
    et al.
    Sörman, Karolina
    Norén Selinus, Eva
    Lundström, Sebastian
    Lichtenstein, Paul
    Hellner, Clara
    Halldner, Linda
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Barn- och ungdomspsykiatri. Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden; Child and Adolescent Psychiatry Research center, BUP Klinisk forskningsenhet, Stockholm, Sweden.
    Trends in childhood and adolescent internalizing symptoms: results from Swedish population based twin cohorts2019Ingår i: BMC Psychology, E-ISSN 2050-7283, Vol. 7, artikel-id 50Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: Previous research has noted trends of increasing internalizing problems (e.g., symptoms of depression and anxiety), particularly amongst adolescent girls. Cross-cohort comparisons using identical assessments of both anxiety and depression in youth are lacking, however.

    METHODS: In this large twin study, we examined trends in internalizing symptoms in samples of 9 year old children and 15 year old adolescents, gathered from successive birth cohorts from 1998 to 2008 (age 9) and 1994-2001 (age 15). Assessments at age 9 were parent-rated, and at age 15 self- and parent-rated. We examined (i) the relation between birth cohorts and internalizing symptoms using linear regressions, and (ii) whether percentages of participants exceeding scale cut-off scores changed over time, using Cochrane Armitage Trend Tests.

    RESULTS: Among 9 year old children, a significantly increasing percentage of participants (both boys and girls) had scores above cut-off on anxiety symptoms, but not on depressive symptoms. At age 15, a significantly increasing percentage of participants (both boys and girls) had scores above cut-off particularly on self-reported internalizing symptoms. On parent-reported internalizing symptoms, only girls demonstrated a corresponding trend.

    CONCLUSION: In line with previous studies, we found small changes over sequential birth cohorts in frequencies of depression and anxiety symptoms in children. Further, these changes were not exclusive to girls.

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  • 39.
    Egorova, Olga
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Pediatrik.
    Myte, Robin
    Umeå universitet, Medicinska fakulteten, Institutionen för strålningsvetenskaper, Onkologi.
    Schneede, Jørn
    Umeå universitet, Medicinska fakulteten, Institutionen för farmakologi och klinisk neurovetenskap.
    Hägglöf, Bruno
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Barn- och ungdomspsykiatri.
    Bölte, Sven
    Domellöf, Erik
    Umeå universitet, Samhällsvetenskapliga fakulteten, Institutionen för psykologi.
    Ivars A'roch, Barbro
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Barn- och ungdomspsykiatri.
    Elgh, Fredrik
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk mikrobiologi.
    Ueland, Per Magne
    Silfverdal, Sven-Arne
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Pediatrik.
    Maternal blood folate status during early pregnancy and occurrence of autism spectrum disorder in offspring: a study of 62 serum biomarkers2020Ingår i: Molecular Autism, ISSN 2040-2392, Vol. 11, artikel-id 7Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Autism spectrum disorder (ASD) evolves from an interplay between genetic and environmental factors during prenatal development. Since identifying maternal biomarkers associated with ASD risk in offspring during early pregnancy might result in new strategies for intervention, we investigated maternal metabolic biomarkers in relation to occurrence of ASD in offspring using both univariate logistic regression and multivariate network analysis.

    Methods: Serum samples from 100 women with an offspring diagnosed with ASD and 100 matched control women with typically developing offspring were collected at week 14 of pregnancy. Concentrations of 62 metabolic biomarkers were determined, including amino acids, vitamins (A, B, D, E, and K), and biomarkers related to folate (vitamin B9) metabolism, lifestyle factors, as well as C-reactive protein (CRP), the kynurenine-tryptophan ratio (KTR), and neopterin as markers of inflammation and immune activation.

    Results: We found weak evidence for a positive association between higher maternal serum concentrations of folate and increased occurrence of ASD (OR per 1 SD increase: 1.70, 95% CI 1.22–2.37, FDR adjusted P = 0.07). Multivariate network analysis confirmed expected internal biochemical relations between the biomarkers. Neither inflammation markers nor vitamin D3 levels, all hypothesized to be involved in ASD etiology, displayed associations with ASD occurrence in the offspring.

    Conclusions: Our findings suggest that high maternal serum folate status during early pregnancy may be associated with the occurrence of ASD in offspring. No inference about physiological mechanisms behind this observation can be made at the present time because blood folate levels may have complex relations with nutritional intake, the cellular folate status and status of other B-vitamins. Therefore, further investigations, which may clarify the potential role and mechanisms of maternal blood folate status in ASD risk and the interplay with other potential risk factors, in larger materials are warranted.

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  • 40.
    Ekbäck, Erik
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Barn- och ungdomspsykiatri.
    Depression in teenagers and young adults: foundational studies of the new treatment paradigm TARA: Training for Awareness, Resilience, and Action2024Doktorsavhandling, sammanläggning (Övrigt vetenskapligt)
    Abstract [en]

    Introduction: Depression in adolescents and young adults is an increasing global health concern and available treatments are not convincingly effective. It is therefore important to develop and test novel treatments to improve treatment outcomes. This dissertation lays the foundation for the evaluation of a Swedish version of the treatment program Training for Awareness, Resilience, and Action (TARA), and tests the psychometric properties of the primary outcome measure for that evaluation.

    Objectives: This dissertation aims to 1. Translate and pilot test TARA in Swedish medical students, 2. Evaluate the psychometric properties of the Swedish version of the Reynolds Adolescent Depression Scale second edition (RADS-2) in a clinical sample, 3. Perform a single arm multicenter clinical pilot study of the feasibility and safety of TARA and 4. Design a randomized controlled trial to test the clinical effectiveness of TARA.

    Methods: The TARA manual was translated into Swedish and 23 self-selected medical students, with or without mental disorders, received TARA. Self-rating as well as qualitative evaluation was performed. Patients (N = 536 individuals) with a variety of psychiatric diagnoses completed RADS-2 and other questionnaires for psychometric evaluation of RADS- 2. Thirty-five adolescents and young adults with depression received TARA either face-to-face or online, with data collection before, during, and after the treatment. The study design and statistical analysis plan for the randomized controlled trial was conceived and developed.

    Results: It was feasible and acceptable to give TARA to Swedish medical students and they described the program as an uncommon meeting ground for personal empowerment. Support was found for the four-factor structure of RADS-2, and the scale demonstrated good validity and acceptable to good reliability. The clinical pilot study further supported the feasibility and clinical safety of TARA, and preliminary signs of effectiveness were seen. A detailed description of the pragmatic, multicenter, randomized controlled superiority trial that will evaluate the clinical effectiveness of TARA compared to standard treatment for depression was outlined, peer reviewed, and published in a study protocol with a statistical analysis plan.

    Conclusions: The present results indicate that TARA is feasible and safe in Swedish clinical and non-clinical contexts. RADS-2 is a suitable outcome measure to use in routine clinical practice as well as in the present and future trials of depression. The initiated randomized controlled trial will be an important next step logically following the studies and results presented in this dissertation.

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  • 41.
    Ekbäck, Erik
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Barn- och ungdomspsykiatri.
    Blomqvist, Ida
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Barn- och ungdomspsykiatri.
    Dennhag, Inga
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Barn- och ungdomspsykiatri.
    Henje Blom, Eva
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Barn- och ungdomspsykiatri.
    Psychometric properties of the Swedish version of the Reynolds Adolescent Depression Scale second edition (RADS-2) in a clinical sample2023Ingår i: Nordic Journal of Psychiatry, ISSN 0803-9488, E-ISSN 1502-4725, Vol. 77, nr 4, s. 383-392Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Objective: Observed and predicted increases in the global burden of disease caused by major depressive disorder (MDD) highlight the need for psychometrically robust multi-dimensional measures to use for clinical and research purposes. Reynolds Adolescent Depression Scale second edition (RADS-2) is an internationally well-validated scale measuring different dimensions of adolescent depression. The Swedish version has previously only been evaluated in a normative sample.

    Methods: We collected data from patients in child and adolescent psychiatry and primary care and performed: (1) Confirmatory factor analysis (CFA) to evaluate the established four-factor structure, (2) Analyses of reliability and measurement invariance, (3) Analyses of convergent and discriminant validity using the Montgomery–Asberg Depression Rating Scale, the depression subscales of the Beck Youth Inventories and the Revised Child Anxiety and Depression Scale, as well as the Patient Reported Outcome Measurements Information System, peer-relationships and physical activity item banks.

    Results: Recruited participants (n = 536, 129 male and 407 female, mean age 16.45 years, SD = 2.47, range 12 − 22 years) had a variety of psychiatric diagnoses. We found support for the four-factor structure and acceptable to good reliability for the subscale and total scores. Convergent and discriminant validity were good. Measurement invariance was demonstrated for age, sex, and between the present sample and a previously published normative sample. The RADS-2-scores were significantly higher in the present sample than in the normative sample. In this clinical study, the Swedish RADS-2 demonstrated good validity and acceptable to good reliability. Our findings support the use of RADS-2 in Swedish clinical and research contexts.

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  • 42.
    Ekbäck, Erik
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Barn- och ungdomspsykiatri.
    Granåsen, Gabriel
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin.
    Svärling, Rachel
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Barn- och ungdomspsykiatri.
    Blomqvist, Ida
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Barn- och ungdomspsykiatri.
    Henje Blom, Eva
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Barn- och ungdomspsykiatri.
    Clinical Effectiveness of Training for Awareness Resilience and Action Online Compared to Standard Treatment for Adolescents and Young Adults With Depression: Study Protocol and Analysis Plan for a Pragmatic, Multi-Center Randomized Controlled Superiority Trial2021Ingår i: Frontiers in Psychiatry, E-ISSN 1664-0640, Vol. 12, artikel-id 674583Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Depression in adolescents and young adults is an increasing global health concern. Available treatments are not sufficiently effective and relapse rates remain high. The novel group-treatment program “Training for Awareness, Resilience and Action” (TARA) targets specific mechanisms based on neuroscientific findings in adolescent depression. TARA is framed within the National Institute of Mental Health's Research Domain Criteria and has documented feasibility and preliminary efficacy in the treatment of adolescent depression. Since neurodevelopment continues well into the mid-twenties, age-adapted treatments are warranted also for young adults. Patients 15–22 years old, with either major depressive disorder (MDD) or persistent depressive disorder (PDD) according to the DSM-IV/5 or a rating >40 on the clinician rating scale Children's Depression Rating Scale—Revised (CDRS-R), will be recruited from specialized Child and Adolescent Psychiatry and local Youth-Clinics and randomized to either TARA or standard treatment, including but not limited to antidepressant medication and/or psychotherapy. Outcome measures will be obtained before randomization (T0), after 3 months of treatment (T1) and at 6-months- (T2) and 24-months- (T3) follow-up. Additionally, dose-response measures will be obtained weekly in the TARA-arm and measures for mediation-analysis will be obtained halfway through treatment (T0.5). Primary outcome measure is Reynolds Adolescent Depression Scale (RADS-2) score at T1. Secondary outcome measures include RADS-2 score at T2, Multidimensional Anxiety Scale for Children at T1 and T2, and CDRS-R at T1. Additional outcome measures include self-report measures of depression-associated symptoms, systemic bio-indicators of depression from blood and hair, heartrate variability, brain magnetic resonance imaging, as well as three-axial accelerometry for sleep-objectivization. Qualitative data will be gathered to reach a more comprehensive understanding of the factors affecting adolescents and young adults with depression and the extent to which the different treatments address these factors. In summary, this article describes the design, methods and statistical analysis plan for pragmatically evaluating the clinical effectiveness of TARA. This will be the first RCT to examine the effects of TARA compared to standard treatment for adolescents and young adults with MDD or PDD. We argue that this study will extend the current knowledgebase regarding the treatment of depression.

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  • 43.
    Ekbäck, Erik
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Barn- och ungdomspsykiatri.
    Rådmark, Lina
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Barn- och ungdomspsykiatri.
    Granåsen, Gabriel
    Umeå universitet, Medicinska fakulteten, Institutionen för folkhälsa och klinisk medicin.
    Svärling, Rachel
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Barn- och ungdomspsykiatri.
    Sörlin, Matilda
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Barn- och ungdomspsykiatri.
    Schönbeck, Caspar
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Barn- och ungdomspsykiatri.
    Henje Blom, Eva
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Barn- och ungdomspsykiatri.
    Clinical effectiveness of training for awareness, resilience, and action for adolescents and young adults with depression: the pilot phase of a multicenter randomized controlled trial2023Ingår i: Frontiers in Psychiatry, E-ISSN 1664-0640, Vol. 14, artikel-id 1130035Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Depression is a top-ranking global health concern increasing in magnitude. Available treatments for adolescents and young adults are not convincingly effective and relapse rates remain high. Training for Awareness, Resilience and Action (TARA) is a group treatment program targeting specific pathophysiological mechanisms of depression in young people. TARA is feasible, acceptable, preliminarily efficacious in depressed American adolescents, and it affects postulated brain-circuitry.

    Methods: As an initial step of a multicenter randomized controlled trial (RCT) we performed a single-arm multicenter pilot-study on TARA. Thirty-five depressed individuals (15–21 years old, 28 females) received TARA for 12 weeks face-to-face or online. Data was collected before (T0), during, and after the intervention (T1). The trial was pre-registered at clinicaltrials.gov, NCT Registration: identifier [NCT04747340]. Feasibility outcomes included recruitment, attendance rates, and session ratings. Adverse events were recorded weekly and extracted from medical records at the end of the trial. Primary effectiveness outcome was self-rated depression severity on Reynolds Adolescent Depression scale 2nd ed. at T1. Secondary outcomes were Children’s Depression Rating Scale-revised (CDRS-R) and Multidimensional Anxiety Scale for Children (MASC) at T1.

    Results: TARA was feasible and safe in the present trial. No significant RADS-2-change was seen (adjusted mean difference –3.26, 95 % CI –8.35 to 1.83; p= 0.20), however a significant decrease in CDRS-R scores is reported (adjusted mean difference –9.99, 95% CI –14.76 to –5.22; p < 0.001). MASC-scores did not change significantly (adjusted mean difference 1.98, 95% CI –0.96 to 4.91; p=0.18). Additional feasibility aspects are presented and discussed.

    Discussion: Limitations include substantial loss-to-follow-up, no randomization to control, and that some participants received concomitant treatment(s). The Coronavirus pandemic complicated both implementation and interpretation of the trial. In conclusion TARA was feasible and safe in depressed adolescents and young adults. Preliminary signs of effectiveness were seen. The initiated RCT will be important and worthwhile to conduct, and several improvements to the design are suggested based on the present results.

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  • 44.
    Ekbäck, Erik
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Barn- och ungdomspsykiatri.
    Rådmark, Lina
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Barn- och ungdomspsykiatri.
    Molin, Jenny
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad. Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Psykiatri.
    Strömbäck, Maria
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering.
    Midgley, Nick
    Department of Clinical, Educational and Health Psychology, University College London, London, United Kingdom.
    Henje, Eva
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Barn- och ungdomspsykiatri.
    The Power Threat Meaning Framework: a qualitative study of depression in adolescents and young adults2024Ingår i: Frontiers in Psychiatry, E-ISSN 1664-0640, Vol. 15, artikel-id 1393066Artikel, forskningsöversikt (Refereegranskat)
    Abstract [en]

    Introduction: Depression constitutes one of our largest global health concerns and current treatment strategies lack convincing evidence of effectiveness in youth. We suggest that this is partly due to inherent limitations of the present diagnostic paradigm that may group fundamentally different conditions together without sufficient consideration of etiology, developmental aspects, or context. Alternatives that complement the diagnostic system are available yet understudied. The Power Threat and Meaning Framework (PTMF) is one option, developed for explanatory and practical purposes. While based on scientific evidence, empirical research on the framework itself is still lacking. This qualitative study was performed to explore the experiences of adolescents and young adults with depression from the perspective of the PTMF.

    Methods: We conducted semi-structured interviews with 11 Swedish individuals aged 15– 22 years, mainly female, currently enrolled in a clinical trial for major depressive disorder. Interviews were transcribed verbatim and analyzed with framework analysis informed by the PTMF.

    Results: A complex multitude of adversities preceding the onset of depression was described, with a rich variety of effects, interpretations, and reactions. In total, 17 themes were identified in the four dimensions of the PTMF, highlighting the explanatory power of the framework in this context. Not all participants were able to formulate coherent narratives.

    Discussion: The PTMF provides a framework for understanding the complexities, common themes, and lived experiences of young individuals with depression. This may be essential for the development of new interventions with increased precision and effectiveness in the young.

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  • 45.
    Ekbäck, Erik
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Barn- och ungdomspsykiatri.
    von Knorring, Johanna
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Professionell utveckling.
    Löfgren Burström, Anna
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Barn- och ungdomspsykiatri.
    Hunhammar, David
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Barn- och ungdomspsykiatri.
    Dennhag, Inga
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Barn- och ungdomspsykiatri.
    Molin, Jenny
    Umeå universitet, Medicinska fakulteten, Institutionen för omvårdnad. Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Psykiatri.
    Henje Blom, Eva
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Barn- och ungdomspsykiatri.
    Training for Awareness, Resilience and Action (TARA) for medical students: a single-arm mixed methods feasibility study to evaluate TARA as an indicated intervention to prevent mental disorders and stress-related symptoms2022Ingår i: BMC Medical Education, E-ISSN 1472-6920, Vol. 22, nr 1, artikel-id 132Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Background: Medical students have a higher risk for depression, anxiety, stress-related symptoms, burnout, and suicide, and more rarely seek professional help or treatment than the general population. Appeals are being made to address the mental health and resilience of physicians-to-be. The novel program Training for Awareness, Resilience, and Action (TARA) was originally developed to treat depressed adolescents, targeting specific neuroscientific findings in this population. TARA has shown feasibility and preliminary efficacy in clinically depressed adolescents and corresponding brain-changes in mixed community adolescent samples. The present study investigated the feasibility and acceptability of TARA as a potential indicated prevention program for symptoms of depression, anxiety, stress and burnout in Swedish medical students.

    Methods: We conducted a single-arm trial with 23 self-selected students in their early semesters of medical school (mean age 25.38 years, 5 males and 18 females), with or without mental disorders. All participants received TARA. Self-reported symptoms of depression, anxiety, perceived stress and psychological inflexibility were collected before (T0) and after the intervention (T1). Qualitative data on the participants’ experiences of TARA were collected in focus-group interviews conducted halfway through the program and upon completion of the program. Individual interviews were also conducted 2 years later. Qualitative content analysis was performed.

    Results: The mean attendance rate was 61.22% and the dropout rate was 17.40%. The Child Session Rating Scale administered after every session reflected an overall acceptable content, mean total score 34.99 out of 40.00. Trends towards improvement were seen across all outcome measures, including the Hospital Anxiety and Depression Scale Anxiety (t = 1.13, p = 0.29) and Depression (t = 1.71, p = 0.11) subscales, Perceived Stress Scale (t = 0.67, p = 0.51) and Avoidance and Fusion Questionnaire for youth (t = 1.64, p = 0.10). None of the participants deteriorated markedly during the intervention. Qualitative content analysis resulted in a main theme labeled: “An uncommon meeting-ground for personal empowerment”, with 4 themes; “Acknowledging unmet needs”, “Entering a free zone”, “Feeling connected to oneself and others” and “Expanding self-efficacy”.

    Conclusion: TARA is feasible and acceptable in a mixed sample of Swedish medical students. The students’ reports of entering an uncommon meeting-ground for personal empowerment supports effectiveness studies of TARA in this context.

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  • 46.
    Engman Bredvik, Sofie
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Barn- och ungdomspsykiatri.
    Carballeira Suarez, Nivia
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Barn- och ungdomspsykiatri. Umeå University Hospital.
    Levi, Richard
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering.
    Nilsson, Karin
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Barn- och ungdomspsykiatri. Umeå University Hospital.
    Multi-family therapy in anorexia nervosa: a qualitative study of parental experiences2016Ingår i: Innovations in family therapy for eating disorders: novel treatment developments, patient insights, and the role of carers / [ed] Stuart Murray; Leslie Anderson; Leigh Cohn, New York: Routledge, 2016, s. 236-248Kapitel i bok, del av antologi (Refereegranskat)
    Abstract [en]

    Anorexia nervosa (AN) is a serious eating disorder, often with psychiatric comorbidities. AN occurs in 1 percent of girls in the risk ages 13-18 years and in about 0.1 percent of boys in the same age group. It has a standardized mortality ratio of 5.86 (Arcelus, Mitchell, & Wales, 2014). In 10-20 percent of those affected, AN is refractory to treatment, thus leading to chronic suffering and psycho-social disturbances (Berkman, Lohr, & Bulik, 2007).

  • 47.
    Engman-Bredvik, Sofie
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Barn- och ungdomspsykiatri.
    Carballeira Suarez, Nivia
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Barn- och ungdomspsykiatri.
    Levi, Richard
    Umeå universitet, Medicinska fakulteten, Institutionen för samhällsmedicin och rehabilitering, Rehabiliteringsmedicin.
    Nilsson, Karin
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Barn- och ungdomspsykiatri.
    Multi-family therapy in anorexia nervosa: a qualitative study of parental experiences2016Ingår i: Eating Disorders, ISSN 1064-0266, E-ISSN 1532-530X, Vol. 24, nr 2, s. 186-197Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    This qualitative study from northern Sweden investigated experiences of multi-family therapy (MFT) in 12 parents of children with anorexia nervosa (AN). The main reported benefit was the opportunity to talk to others in a similar situation, thereby sharing experiences and struggles. MFT resulted in new perspectives and insights that improved family dynamics and enabled new constructive behaviors. In conclusion, MFT seems to be a useful therapeutic modality in the treatment of AN in a northern European setting.

  • 48. Eriksson, Charli
    et al.
    Kimber, Birgitta
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Barn- och ungdomspsykiatri.
    Skoog, Therése
    Design and implementation of RESCUR in Sweden for promoting resilience in children: a study protocol2018Ingår i: BMC Public Health, E-ISSN 1471-2458, Vol. 18, nr 1, s. 1-11, artikel-id 1250Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    BACKGROUND: This research program aims to investigate the implementation and effects of a theoretically promising prevention method. It is being developed in a European research collaboration within a Comenius project (2012-2015) between 6 European universities (in Malta, Italy, Greece, Croatia, Portugal and Sweden) with the purpose of enhancing European children's resilience.

    METHODS/DESIGN: RESCUR in Sweden consists in a RCT study of the Resilience Curriculum (RESCUR) that is taking place in Sweden 2017-2019. The study is being performed by Junis, IOGT-NTO's Junior Association, part of IOGT International, in conjunction with researchers at Göteborg, Umeå and Stockholm universities, and is being funded by the Public Health Agency of Sweden. Around 1000 children of the ages 7-12 will, through their schools and associations, or via groups in social services, be acquainted with the material. Children will learn and practice mindfulness, storytelling, group discussions and much more, all designed to strengthen protective factors and increase their resilience. The program also involves parents, who are taking part in the work to reinforce children's protective factors. Based on the work with groups of children, an effectiveness study including children aged 7-12 in school classes, with randomized and controlled pre- and post-measurements, self-rating questionnaires and group observations is being performed. The program will also be implemented in a non-governmental organization and in groups in social services. The study also investigates forms of implementation.

    DISCUSSION: The design of the study will enable the researchers to answer five research questions by using a mixed-methods approach. Implementation will be studied, which is a necessary prerequisite for an effect study. Moreover, the research procedure has been tailored to the target group, with age-appropriate measures as well as multiple informants, which will produce high-quality data for analysis. A special ethical challenge is the study of young children, and efforts to give children a voice have been included in the program. This project is regarded as having good potential to benefit children in general, and particularly children in vulnerable positions.

    TRIAL REGISTRATION: National Institute of Health, ClinicalTrials.gov identifier NCT03655418. Registered August 31, 2018.

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  • 49.
    Farooqi, Aijaz
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Barn- och ungdomspsykiatri. Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Pediatrik.
    School-age outcomes of children born at the limit of viability: a Swedish national prospective follow-up study at 10 to 12 years2007Doktorsavhandling, sammanläggning (Övrigt vetenskapligt)
    Abstract [en]

    Background/Aim: During the past two decades, major advances in maternal-fetal medicine, neonatology, and the development of regionalized perinatal care have resulted in dramatic increases in survival rates, by more than 60%, of extremely immature (EI) infants born at less than 26 completed weeks of gestation, creating a new infant population. Studies of school-age outcomes in children with an extremely low birth weight of < 1000 g, born in the1980s, indicated that these children had a substantially high prevalence of low-severity neuropsychological deficits, behavioral problems, and difficulties at school. Information on school-age outcomes of extremely preterm children born in the 1990s is sparse, and mainly restricted to the neurobehavioral and developmental outcome. The aim of this research was to investigate the comprehensive neurological, developmental, functional, and mental health status and health care needs of children born at 23-25 weeks of gestation in the 1990s, allowing a total view of the child in the context of the family, his peers, school, and the health care system. The ultimate aim was to obtain a clearer understanding of the functional capacities of these vulnerable children and the possibilities of ameliorative interventions, as a basis for planning and provision of services for this growing population.

    Methods: We studied 11-year-old children born from 1990 through 1992 before 26 completed weeks of gestation in all of Sweden. All had been evaluated at a corrected age of 36 months. Of 89 eligible children, 86 (97%) were studied at a mean age of 11 years. An equal number of children born at term served as controls. The following methods were used: 1) well validated, mailed questionnaires filled out by the parents, class teachers and the children themselves; 2) structured interviews were conducted with a parent or a primary caregiver; 3) review of pediatric case records and records from other specialist health care services; and 4) anthropometric measurements (length, weight, head circumference and body mass index) from birth to 11 years of age. The following domains were explored: current health status, growth attainment, mental health assessment, emotional well-being, adaptive functioning and social competencies, school performance, executive functions, and learning and language skills. Relations of socioeconomic background and of environmental and perinatal risk factors to the long-term outcome were evaluated.

    Results: EI children compared with the controls had significantly higher rates of specific diagnoses or disabilities including neurosensory impairment (15% vs 2%, respectively), asthma (20% vs 6%), poor motor skills (26% vs 3%), poor visual perception (21% vs 4%), poor learning skills (27% vs 3%),poor adaptive functioning (42% vs 9%), and poor academic performance (49% vs 7%). As a consequence of these disabilities, significantly more EI children than controls had chronic conditions, which included functional limitations (64% vs 11%), compensatory dependency needs (59% vs 25%), and services above those routinely required by children in general (67% vs 22%).

    Regarding growth attainment, EI children had significantly lower values for all three growth parameters (length, weight and head circumference) than the controls at 11 years. They showed a sharp decline in weight and height z scores up to 3 months’ corrected age, followed by good catch-up growth in both weight and height up to 11 years. EI children did not exhibit catch-up growth in head circumference after the first 6 months of life. Preterm birth and parental height were significant predictors of 11-year height, and group status (prematurity) correlated strongly with head circumference.

    Our results also suggest that the EI children had a significantly greater risk for poorer mental health and poorer emotional well-being than the control participants, including internalizing (anxiety/depression, withdrawn behavior and somatic complaints), and attention, social, and thought problems. No differences in externalizing problems were found between the EI cohort and controls. Multivariable analyses disclosed a number of significant predictors of behavioral adjustment: group status (EI vs control), family function, social risk, male gender, and presence of a chronic medical condition.

    Concerning school performance, more than half (59%) of our EI cohort were experiencing school difficulties and 15%, compared with 5% of the control children were attending special schools or having full-time special education. Despite fewer adaptive skills in the EI cohort these children were not different from the controls in respect to being happy and being positively adjusted in their day-to-day life.

    Compared with controls, EI children had a significantly increased risk for executive dysfunctions in most of the areas assessed (Attention control and Attention switching, Hypoactivity, Planning/organizing, and Working memory). EI children were also at increased risk for deficient skills in language tasks (comprehension, communication, and expression) and in the four standard measures of learning skills (reading/writing, math, general learning, and coping in learning). However, only a relatively small number of EI children exhibited severe impairments in executive or non-executive skills. Multivariate analyses revealed that prematurity, executive dysfunction and male gender were associated with poor learning skills.

    Conclusions and implications: Children born extremely immature have significantly greater health problems and special health care needs that require ongoing services through the school years. However, it is notable that very few children have severe impairments that curtail major activities of daily living. The overall results of this study are reassuring. Despite having an increased risk for mental health problems, executive dysfunctions and school difficulties, 85% of the EI children were in the mainstream schools and a majority were not having major adjustment difficulties. In terms of growth, most of our EI children showed good catch-up in late childhood and were within 2SD of their mean midparental height at 11 years of age.

    Although biological immaturity is associated with an increased risk for a substantial number of behavioral/emotional problems, improvement of the modifiable environmental factors will benefit the outcome in EI children. We also believe that knowledge of the course of development of psychopathological conditions from early childhood to adolescence and beyond is crucial for identifying the need for intervention and prevention strategies. Thus when there is evidence to suggest neuropsychological and behavioral or emotional problems, early identification and preventive measures might help families to manage these from an early stage. Our findings further suggest that current preterm follow-up programs might benefit from the addition of psychological and family services to traditional neurodevelopmental assessments, especially in the neonatal period and first years of life.

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  • 50.
    Farooqi, Aijaz
    et al.
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Pediatrik.
    Adamsson, Marie
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Pediatrik.
    Serenius, F.
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Pediatrik.
    Hägglöf, Bruno
    Umeå universitet, Medicinska fakulteten, Institutionen för klinisk vetenskap, Barn- och ungdomspsykiatri.
    Executive Functioning and Learning Skills of Adolescent Children Born at Fewer than 26 Weeks of Gestation2016Ingår i: PLOS ONE, E-ISSN 1932-6203, Vol. 11, nr 3, artikel-id e0151819Artikel i tidskrift (Refereegranskat)
    Abstract [en]

    Aims To assess the cognitive and behavioral aspects of executive functioning (EF) and learning skills in extremely preterm (EPT) children compared with term control children aged 10 to 15 years. Methods A total of 132 of 134 (98% of all eligible survivors) EPT children born at the 2 Swedish regional tertiary care centers from 1992 to 1998 (mean age = 12 years, mean birth weight = 718 g, and mean gestational age = 24.4 weeks) and 103 matched term controls were assessed. General intelligence was assessed using the Wechsler Intelligence Scale for Children (WISC-III-R), and cognitive aspects of EF were analyzed using EF-sensitive sub-scales of the WISC-III-R and Tower test of the Delis-Kaplan Executive Function Scale (D-KEFS). Behaviors related to EF and learning skills were assessed using the Five to Fifteen questionnaire, which is a validated parent and teacher instrument. Academic performance in school was assessed by teachers' responses on Achenbach's Teachers Report Form. Analyses performed included multivariate analyses of covariance (ANCOVA and MANCOVA) and logistic regression analyses. Results The EPT children displayed significant deficits in cognitive aspects of EF compared with the controls, exhibiting decreases on the order of 0.9 SD to 1.2 SD for tasks of verbal conceptual reasoning, verbal and non-verbal working memory, processing speed and planning ability (P < 0.001 for all). After excluding the children with major neurosensory impairment (NSI) or a Full Scale intelligence quotient (FSIQ) of < 70, significant differences were observed on all tests. Compared with controls, parents and teachers of EPT children reported significantly more EF-related behavioral problems. MANCOVA of teacher-reported learning skills in children with FSIQ > 70 and without major NSI revealed no interactions, but significant main effects were observed for the behavioral composite executive function score, group status (EPT vs control) and FSIQ, for which all effect sizes were medium to large. The corresponding findings of MANCOVA of the parent-reported learning skills were very similar. According to the teachers' ratings, the EPT children were less well adjusted to the school environment. Conclusion EPT children born in the 1990s who received active perinatal care are at an increased risk of executive dysfunction, even after excluding children with significant neurodevelopmental disabilities. Even mild to moderate executive dysfunctions has a significant impact on learning skills. These findings suggest the need for timely interventions that address specific cognitive vulnerabilities and executive dysfunctions.

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