Elective circumcision operation for male children can affect their psychological status.

We aimed to investigate the traumatic effect of the circumcision procedure and the predictive factors that could contribute to this effect.

One hundred and thirty-four children who admitted to urology and child surgery clinics to perform a circumcision procedure were included in the study. The whole group was divided into two groups including general anesthesia (GA) (n = 71) and local anesthesia (LA) (n = 63) groups. The procedure was performed under general and local anesthesia in the relevant groups. All of the participants filled the Child Depression invenTory (CDI), State (SA), and Trait (TA) Anxiety and Childhood Anxiety Sensitivity index (CASI) before the operation, and the Child Posttraumatic Stress Reaction index (CPSRI) 1 month after the operation.

CDI, CASI and TA scores of the children were similar in both groups, however, SA scores of the LA group were higher than GA group (P < 0.001), and CPSRI scores of the GA group were higher than LA group (P = 0.04). When the other parameters were controlled in regression analysis, only CDI scores predicted CPSRI scores in LA group (P = 0.02), and TA scores predicted CPSRI scores in the GA group (P = 0.03).

Children who witness the surgical procedure of the circumcision do not develop serious PTSD symptoms. In contrast, children who experience general anesthesia procedure during circumcision develop more serious PTSD symptoms than children operated with local anesthesia. Trait anxiety and depressive symptom severity may be important in developing PTSD symptoms after circumcision operation.

The authors have not supplied their declaration of competing interest.

About 20% of children suffer from an anxiety disorder and symptoms may persist in adulthood. About 13 in every 100 children from 9 to 17 years old experience anxiety disorders, girls seem more vulnerable than boys. Theoretical models of anxiety emphasize the effect of parenting on development and maintenance of child anxiety.

This research aims to study the nature of correlation between parenting styles and anxiety in children who attend Tirana Child & Adolescent Psychiatric Service.

One hundred and seventy-five children and 175 their parents filled Spence Children Anxiety Scale (SCAS) and Parenting Styles & Dimensions Questionnaire (PSDQ) was found a significant correlation between parenting styles and anxiety in children.

Parental overprotection produces vulnerable children who become adults ready to give up in front of life difficulties therefore; it is necessary parents’ awareness in practicing a balance in their parenting styles, in order to reduce children's anxiety.

The authors have not supplied their declaration of competing interest.

Attention deficit hyperactivity disorder (ADHD) is one of the most common mental disorders that manifest among children. Despite the fact that the teacher's role is essential in the assessment and management of pupils with ADHD and the recommendation of participation of teachers for the success and efficiency of diagnoses and treatment, the vast majority of teachers have neither understanding nor knowledge of ADHD.

The current study explores the kindergarten and elementary school teachers’ knowledge regarding early detection and management of ADHD.

Cross sectional survey using stratified random sampling technique was carried out in governmental and private elementary and kindergarten schools in four cities of Qassim region, Saudi Arabia.

The study included 1095 teachers, 711 (59.3%) did not get information about ADHD during undergraduate studies. Teachers’ overall ADHD knowledge mean was 21.7 + 5.5 out of 38 marks. Teachers with high qualification degree and kindergarten specialty scored 56.4% and 60.2%, respectively. Teachers who attended conferences related to ADHD scored 64.5%, while teachers who read about ADHD or have been ever asked to diagnose/teach an ADHD student had 59.4% and 62.1%, respectively. The sources for those who got their information through reading were statistically significant in overall knowledge, general knowledge and treatment dimensions. As scientific studies and books were the highest with percentage of 24.6% and 23.3%, respectively, 4% and 3.6%, respectively, 3% and 3%, respectively. The level of ADHD knowledge perception showed that 76% of teachers were knowledgeable in relation to overall ADHD perception.

Teachers who have higher qualifications or training in identifying ADHD children scored higher in our study.

The authors have not supplied their declaration of competing interest.

Attitudinal ambivalence is a mediator between attitudes and health behaviors. The present study contributes to our understanding of affective attitudes ambivalence.

We studied the ambivalence of affective attitudes towards health among adolescents.

We compared the affective attitudes ambivalence between younger (10–14 years) and older (15–16 years) adolescents.

Older (n = 51, Mage = 15.09 ± 0.30) and younger adolescents (n = 28, Mage = 12.96 ± 0.99) performed a modified Etkind Color Test. We calculated the associations between 13 factors related to health (e.g. sport, risky behavior) and positive emotions, as well as the associations between same factors and negative emotions. Thompson, Zanna and Griffin ambivalence index was a measure of attitudinal ambivalence.

Among younger adolescents all 13 correlations between negative and positive attitudes towards health related factors were significant and negative: −0.402 < r < −0.804 (which means the greater is the association between a word and positive emotions, the smaller is the association between the same word and negative emotions; and vice versa). Only 5 correlations were significant and negative among older adolescents (−0.209 < r < −0.463): environment, risky behaviors, family, sleep, my psychological well-being.

The difference in ambivalence indexes was significant in two groups of adolescents [F(14,64) = 5.97, P = −0.0001]. Younger adolescents had significantly lower ambivalence indexes in affective attitudes towards all 13 factors.

Older adolescents had more ambivalent affective attitudes towards health related factors compared to younger adolescents.

The authors have not supplied their declaration of competing interest.

Methylphenidate drugs is prescribed in attention deficit disorder and hyperactivity. Among its rare side effects, include alterations in the gynecological. We report a clinical case and review current evidence regarding the tolerability this drug in this area.

We performed a PubMed search of articles published in English of different types (case reports or case/controls studies). We collected the clinical practice guidelines conclusions regarding adverse drug reactions.

Our patient is a 14-year-old male diagnosed of ADHD treated with methylphenidate (0.8–1 mg\kg). He developed bilateral and asymmetric gynecomastia under this treatment plan so a referral was made to rule out other causes of this event. After performing several work up tests, it was concluded that this clinical presentation was caused by methylphenidate. Hence, we initiated crossed titration swapping this drug to atomoxetine. Four months later, he was mentally stable and he experimented a volumetric decrease as concerns his gynecomastia.

As regards methylphenidate, in 2009 a couple of cases in which alterations in the sexual sphere presented with the oros presentation were reported. There are series of reported pharmacological side effects (gynecomastia) and also denoted an improvement of the same months after drug discontinuation.

Gynecological clinic secondary to the use of psychotropic drugs in ADHD is uncommon. In line with our case, the current evidence suggests a drug suspension as adverse effects are usually reversible (although it may take several months to complete recovery). Further studies are needed to understand the mechanisms underlying these tolerability issues.

The authors have not supplied their declaration of competing interest.

The Phelan–McDermid syndrome is a chromosomal disorder consisting of a selection on chromosome 22q13.3 associated psychiatric and emotional level, behavioral and traits of autism spectrum disorders. During the neurodevelopmental such chromosomal deletion, which associated with haplo insufficiency Shank 3 causes alterations in the synaptogenesis altering the balance of activating and inhibitory transmission. Throughout the various studies, it is considered that this syndrome has a psychiatric disorder bipolar like.

Here, we present s 13-year-old female diagnosed with autism spectrum disorders in childhood and presented regression with catatonia features and behavioral disorders. Interestingly, she presented mutation/microdeletion of the SHANK3 gene, inducing a premature stop codon in exon 21. Different pharmacological treatments (antipsychotics at high doses and benzodiazepines) failed to improve clinical symptoms and lead to multiple adverse events. In contrast, lithium therapy reversed clinical regression, stabilized behavioral symptoms and allowed patients to recover their pre-catatonia level of functioning. After the first menstruation there was a cycling psychiatric worsening with a similar clinical pattern so risperidone as adjunctive therapy. As a result of this, this patient recovered clinical and socio-functional stability.

They are previous cases where there affective and behavioral improvement after use of mood stabilizer molecules such as valproate or lithium. There is also evidence of the benefit of risperidone low to have a beneficial effect on the balance of activatory and inhibitory transmission level doses of NMDA receptors.

The authors have not supplied their declaration of competing interest.

There has been no evidence so far about significant relationship between Gilles de la Tourette and psychosis. Perhaps a continuum psychosis perspective and the vulnerability model could improve the comprehension of our patients.

To describe a case in which motor and obsessive symptoms evolve to schizophreniform symptoms and important psychosocial deterioration.

Single case report and literature review.

A 20-year-old man, with clinical record of Gilles de la Tourette, and a psychosis episode 6 months before, is brought by his family with a syndrome consistent in motor retardation, whispered speech, poor visual contact, social withdrawal, hygiene neglect, abulia, apathy and blunted affect. In the one-year tracing conceptual disorganization and poor idea association are in the first place. Within child history, we found symptoms congruent with Gilles de la Tourette, obsessive symptoms and others that may be called mild psychotic symptoms (which did not fit in any diagnosis at that moment). We also found a pathological relationship between his parents and among him, as well as a poor economic and social condition.

According to the continuum perspective, psychotic symptoms could be found within the obsessive spectrum. Related to the vulnerability model, we found in our case external factors that affected the clinical evolution: family dynamics affected, communication deviation, social and economic impairment, social withdrawal and vital aim loss. These factors should be attended in first place, as they are not only related with the triggering of illness but they also are the main way to recovery.

The authors have not supplied their declaration of competing interest.

Benton Test of visual retention, methods of forward and reverse bills, Bourdon correction sample, Wechsler's subtests (subtest 11 – “Encryption”, subtest 12 – “Labyrinths” 1, 2, 3, 4, 5), Trail Creating a Test Part A.

All patients were divided into 3 groups. The first group (schizophrenia) and second group (other psychic disorders) showed the worst results than healthy subjects. Qualitative analysis of the “Benton Test” results showed similar variations of difficulty and types of errors in the subjects of the first and second groups – ignoring the number of the figure sides, as well as difficulties in the structuring element of the image corners. The “Methods of forward and reverse bills” demonstrated the fatigue and attention instability. “Bourdon test” showed a high level of the stability index (K = 0.09). Wechsler's subtest “Encryption B” obtained poor results, indicating a pathological decrease in visual-motor speed. During the subtest “Labyrinths 1, 2, 3, 4, 5” the subjects of first and second groups exceeded the allowable time limit, but the first group of schizophrenia patients allowed more blunders during pubertal study (ignored the walls of the maze, torn pencil despite the given instructions). The test groups 1 and 2 while passing “Trail Creating a Test Part A” have shown good results – job data did not cause difficulties and carried out in accordance with the specified instructions.

Neurocognitive disorders allow to confirm the presence of morphological and functional brain changes when endogenous mental illness occurs.

The authors have not supplied their declaration of competing interest.

Post-traumatic stress disorder (PTSD) symptomatology seems to depend of many variables like age, exposition to trauma, environment…

Compare, basing on gender, socio-demographic and symptomatology of patients with PTSD.

A retrospective and comparative study was conducted at the Child and Adolescent Psychiatry Department of Mongi Slim Hospital (Tunisia) from January 2013 until July 2016. We included all cases of patients followed for PTSD (DSM-5). They were divide into 2 groups according to the gender. Data was collected from patients’ records.

Our study featured 30 patients: 16 boys and 14 girls. The average age was similar for both teams (boys: 8.43 years; girls: 8.53 years). Boys had twice more personal history of somatic, psychiatric illness (70%), and low socioeconomic status (62.5%). The beginning of the facts were significantly later for the female group (P < 0.001). Females were more likely to be a witness, while males tented to be directly exposed to the trauma. Physical abuse was the major aggression for both groups.

Female gender was associated to parental trauma exposure (P = 0.023) and to an ongoing event (P = 0.004). Meanwhile, male gender was associated to a maternal history of psychiatric illness (P = 0.012), a single traumatic event (P = 0.010), and to a school located aggression (0.04). Girls have developed more hypervigilance, guilt symptoms and aggressive behaviors. Low self-worth, regression, specific phobia and suicidal ideations occurred more frequently among boys.

Health professionals must be aware of the youth PTSD warning signs in order to have the earlier right intervention.

The authors have not supplied their declaration of competing interest.

The aim was to determine the association between internet addition [IA] and fatigue, sleep disturbance, depression, and life style factors among school children.

A cross-sectional survey based on multistage stratified random sampling and 1188 students (73.3%) gave consent during October 2011 to December 2012. Data including socio-demographic details, lifestyle and dietary habits Internet Addiction Test (IAT), Fatigue Scale, Epworth Sleepiness Scale [ESS] and Beck Depression Inventory (BDI) test. Univariate and multiple logistic regression analysis were performed.

The overall prevalence of IA among school children was 19.8%. The proportion of IA was significantly more among males (56.4%) as compare to females (43.6%; P = 0.035), school performance (P < 0.001) and family income (P = 0.032). Those with IA had significantly less number of sleep hours (6.16 ± 0.80 vs. 6.58 ± 1.29; P < 0.001) as compared to normal. Those with IA had significantly high number of hours internet use (3.82 ± 1.64 vs. 3.03 ± 1.64; P < 0.001) as compared to normal. A significantly larger proportion of IA than normal subjects reported having headaches (P = 0.010), double vision (P = 0.037), eye hurt (P = 0.021), eye tired (P = 0.005), dizziness (34.4% vs. 27.3%; P = 0.002), fatigue, and hearing problem (P = 0.048). A significantly larger proportion of students with IA most frequently gratifying site (19.9% vs. 11.6%; P < 0.001), browsed games (38.6% vs. 29.9%; P = 0.010), chat sites (29.7% vs. 22%; P = 0.013), email (54.2% vs. 63.1%; P = 0.36), and research (61.0% vs. 69.2%; P = 0.017).

The current study confirmed the of evidence linking problematic internet use with negative fatigue, greater numbers of symptoms, anxiety, sleeping disturbances, depressive and lifestyle risk factors, among vulnerable young children.

The authors have not supplied their declaration of competing interest.

The authors have not supplied their declaration of competing interest.

Epidemiological studies indicate a high prevalence of self-injurious behavior in adolescents in the general population. So far, there are only very few studies on the course of self-injurious behavior in adolescents and young adults.

The aim of the present population-based study was the analysis of prospective predictors of onset, maintenance and cessation self-injurious behavior in adolescents.

A representative sample of the normal population of adolescents from Germany (initial sample: n = 1444; mean age = 14.7, SD = 0.80, 52% female adolescents) was studied over a two years period on 4 consecutive points of measurement in the context of the European school-based intervention study SEYLE.

There was a high remission rate (70.4%) of self-injurious behaviors at 24-month follow-up investigation. However, there was a substantial rate (29.6%) of adolescents who continued the self-injurious behavior, as well as a group of “new starters”. Self-injurious behavior during the baseline examination proved to be the strongest predictor of self-injurious behavior 2 years later. The extent of depressive symptoms and quality of peer relationships were significantly associated with maintaining self-injurious behavior two years later. Furthermore continued self-injurious behavior over the first 12-month was highly associated with suicide plans/suicide attempts at 24-month follow-up investigation.

While both, onset and maintenance of SIB are prospectively associated with an increased risk for suicidal behaviour in late adolescence, SIB cessation significantly reduces the risk for later suicidal behaviour.

The authors have not supplied their declaration of competing interest.

Opsoclonus myoclonus syndrome (OMS) in childhood still remains unexplored from the perspective of clinical psychology.

The research was aimed at defining types of psychological development in the group of children with OMS. The study included 18 children between ages 2 years 4 months and 9 years with OMS (8 boys, 10 girls).

The following methods were used: analysis of patient's development and medical record, psychological interview with parents, neurological state assessment and pathopsychological assessment.

Patients were divided into three groups according to cognitive development level:

– group with normal intelligence level (n = 4);

– group with developmental delay (n = 11);

– group with intellectual disability in different forms (n = 3).

Several children in group 1 (n = 3) and in group 2 (n = 4) expressed neurotic behavior with increased levels of anxiety and fear of trying unusual actions during psychological assessment. Children with delay in psychoverbal development (n = 7) and with developmental delay (n = 1) expressed psychopathy-like states with verbal aggression and had difficulties controlling their emotions. In some cases (n = 2), the psychological state of the patient was defined as borderline state with emotional instability, especially in mother–child interaction.

Psychological features of children with OMS indicate heterogeneity of their development types that implies different prognosis and developmental dynamics for each type. The results point out the necessity of detailed psychological examination aimed at correlation of psychological help to children with OMS and their families with their psychological state.

The authors have not supplied their declaration of competing interest.

Further research is still needed to demonstrate the benefits of animal-assisted therapy (AAT) for specific participant profiles, such as children with behavioural disorders.

We wanted to find out if AAT could be considered an efficient therapeutic strategy for the treatment of children with behavioural disorders.

We wanted to study the effects of a preestablished AAT program on the behaviour of children with emotional and behavioural issues in 6 different reception centres for children under government guardianship.

Forty-five children (12 to 17 years old) with emotional and behavioural issues participated in a 14-session AAT program. Behavioural measures were those routinely scored as part of therapy; an observational report of 3 different problematic behaviours (such as impulsivity, lack of social skills or lack of personal recognition) was made twice a week for each child (with a score of frequency and intensity). A pre- and post-treatment “global behaviour score” was calculated for each child, as an average value of the 3 problematic behaviours measured during the month pre-treatment and the month post-treatment.

The 45 participants attended, on average, 72.8% of AAT sessions. Independent behaviour scores differed between the pre- and post-intervention evaluations (n = 135 behaviours) (Wilcoxon test; P < 0.0001). Based on the global behaviour score for each child (n = 45), significant change was found between pre- and post-intervention evaluations (Wilcoxon test; P = 0.0011).

Our results suggest AAT could be a beneficial intervention for children with behavioural issues in terms of program adherence and behaviour improvement.

The authors have not supplied their declaration of competing interest.

The reported lifetime prevalence of depression in adolescents has increased drastically in recent decades. Depression in this population can be particularly damaging and can frequently have a long-lasting adverse impact. The common treatment approach includes psychological therapy and/or anti-depressant medication. However, the efficacy of these approaches, both singularly and combined, is far from conclusive. Recently, there have been an increased number of studies investigating the effect of exercise and physical activity on adolescent depression, however, despite this increased attention, there are no recent reviews and meta-analyses synthesising such studies.

The review examines the treatment effect of exercise on depression symptoms for adolescents aged 13–17 years of age.

A systematic search of seven electronic databases identified relevant randomised controlled trials. Screening, data extraction and trial methodological quality were undertaken by two independent researchers. Standardized mean differences were used for pooling post-intervention depressive symptom scores.

Eleven trials met the inclusion criteria, eight of which provided the necessary data for calculation of standardized effect size. Exercise showed a statistically significant moderate overall effect on depressive symptom reduction. Sensitivity analyses were also conducted and will be presented.

Exercise and physical activity appear to improve depression symptoms in adolescents, especially in clinical samples, suggesting that exercise may be a useful treatment strategy for adolescents with depression.

Despite the positive findings, large clinical trials that adequately minimise bias are required for firmer conclusions on the effectiveness of exercise as an antidepressant treatment.

The authors have not supplied their declaration of competing interest.

This paper illustrates the use of cohort data from a population to describe the early life prevalence and odds ratios (ORs) of the main classes of International Classification of Diseases (ICD) associated with any mental disorder arising at any time during the 16 year study period.

The main ICD disorder classes were examined in relation to psychiatric disorders over 16 years in a cohort under the age of two years between April 1st, 1993, and January 1st, 1995.

To demonstrate the utility of studying the complete profile of associated diagnoses over time in a population cohort.

The total number of individuals under the age of two years before 1995 (n = 17,603) were tallied within each main class of ICD disorder by year and expressed as ORs of those with and without any 16-year psychiatric disorder.

The greatest annual rates observed in the early years of life were for the following main ICD classes of disease: respiratory system, sense organs, symptoms signs ill-defined conditions, no diagnosis, injury poisoning, and skin subcutaneous tissue disorders. These disorders also had the highest ORs in early life given the presence of a mental disorder at any time during the study period.

Knowing the early life main class diagnoses associated with psychiatric disorders could guide both basic science research as well as early intervention social and health investment policies.

The authors have not supplied their declaration of competing interest.

Drawing can be a tool to complete the psychodiagnose process, especially in children with expression and verbal problems.

The autistic spectrum disorder (ASD) children have problems to describe their feelings and emotions, they can provide us many information drawing their own world.

The purpose of this study was to discover the psychopathology of children with ASD through their drawings.

A4-sized booklets were given for ASD children from 6 to 16 years to draw an imaginary family (L. Corman), a human figure (Buck) or a free drawing.

In most of the drawings of ASD children, we could find at least one of the three criteria of ASD: social deficits, communication difficulties and restricted interests.

A projective technique as drawing could help us to discover additional information about our patients, specially children and mainly the ones who had problems with the expression of feelings like ASD children.

The act of drawing can be used to understand children's struggles, their internal world. Moreover, it could also help the children gain insight and review progress through drawing records.

The authors have not supplied their declaration of competing interest.

The authors have not supplied their declaration of competing interest.

Compassion can be defined as an intentional sensitivity to the suffering, with a motivation and commitment to try to relieve it, which can have a positive impact on individuals’ emotional and psychological well-being. The relevance of compassion focused therapies is well established and this makes the development of reliable instruments for the assessment of the different facets of compassion targeting different age groups crucial for research and clinical practice. The Compassionate Attributes and Actions Scale (CAAS) aims to assess compassion on three directions: self-compassion, compassion for others or compassion received from others. Each of the scales assesses one's compassionate attributes and compassionate actions separately when dealing with difficult or painful situations.

This study aimed to adapt the CAAS for adolescents and to explore its factor structure and psychometric properties in a sample of Portuguese adolescents.

A total of 336 Portuguese adolescents with ages ranging from 12 to 19 years old participated in the study. Several exploratory factor analyses were conducted.

Exploratory factor analysis showed that, except for the attributes section of the self-compassion scale (that showed to be bi-factorial), all the other scales (and their sections) presented a single-factor structure. The three scales, and its sections, demonstrated a good reliability and excellent test-retest reliability and good convergent and discriminant validity.

Results were in line with the factor structure found in the adults’ version. The scales and its sections have shown good psychometric characteristics and constitute a useful instrument to assess and investigate the three directions of the compassion.

The authors have not supplied their declaration of competing interest.

Test anxiety represents a considerable personal burden due to its interfering nature and is associated with a range of deleterious life trajectories, encompassing school difficulties and health consequences. Although test anxiety seems to be highly prevalent and the pathological symptoms are similar to those of other childhood anxiety disorders, there are specificities that deserve a more in-depth approach. Given that adolescents seem to experience test anxiety in several school grades there is a need for a valid and reliable scale to measure test anxiety in school age students.

This study aims to adapt and analyse the psychometric properties of the Cognitive Test Anxiety Revised (CTAR25) for Portuguese adolescents. In addition, the convergent and divergent validities were examined with related constructs.

Participants were 279 adolescents, with ages between 12 and 19 years old, attending middle and high schools. Together with CTAR25, participants also filled out self-report questionnaires assessing tests anxiety (TAI), self-esteem (RSES), procrastination (QPE) and worry (PSWQ-C).

The scale showed good internal consistency, good test-retest reliability, and good validity. Factor analysis revealed the existence of two factors with good internal consistency.

Results showed that the Portuguese version of CTAR-25 is a valid and reliable self-report instrument for the assessment of test anxiety in adolescents, replicating the findings of the original version.

The authors have not supplied their declaration of competing interest.