The aim of the study was to identify risk factors for significant changes in emotional and behavioural problem load in a community-based cohort of Danish children aged 9-16 years, the risk factors being seven parental and two child-related adverse life events.
Data on emotional and behavioural problems was obtained from parents filling in the Child Behavior Checklist (CBCL) when the child was 8-9 and again when 15 years old. Data on risk factors was drawn from Danish registers. Analysis used was logistic regression for crude and adjusted change.
Parental divorce significantly raised the odds ratio of an increase in emotional and behavioural problems; furthermore, the risk of deterioration in problem behaviour rose significantly with increasing number of adverse life events. By dividing the children into four groups based on the pathway in problem load (increasers, decreasers, high persisters and low persisters), we found that children with a consistently high level of behavioural problems also had the highest number of adverse life events compared with any other group.
Family break-up was found to be a significant risk factor. This supports findings in previous studies. The fact that no other risk factor proved to be of significance might be due to lack of power in the study. Children experiencing high levels of adverse life events are at high risk of chronic problem behaviour. Thus these risk factors should be assessed in daily clinical practice.
Spinal cord lesions affect colorectal motility, anorectal sensation and anal sphincter function. The aim of this study was to describe bowel habits in children with Myelomeningocele (MMC). Questionnaires describing age, gender, neurological deficit, bowel function and the Child Behaviour Checklist were send to all Danish children with MMC aged 2-18 years. Among 208 patients, 125 (60%; 63 girls) responded. Defecation was described as abnormal in 85 (68%). Digital stimulation or evacuation were used by 25 (20%), suppositories by 13 (10%) and enemas 35 by (28%). Time spent at each defecation was > 30 minutes in 29 (24%). Among children aged four years or more (n = 100), daily faecal incontinence was reported by 14 (14%) and weekly incontinence by another 14 (14%). Bowel dysfunction had some or major impact on social activities or quality of life in 48 (40%). Time spent on defecation increased and the impact on quality of life became more severe with advancing age. Information about bowel management had been given to 56% of parents and 9% of children. In conclusion colorectal problems are common in children with MMC and their impact of quality of life becomes more severe as the children grow older. There is an unfullfilled need for information about bowel management.
BACKGROUND: Psychometric instruments are used increasingly within research and clinical settings, and therefore standardization has become an important prerequisite, even for investigating very young children. Currently, there are no standardized psychometric instruments available for assessment of preschool children in Denmark. AIMS: The aim was to achieve Danish national norm scores for the Child Behavior Checklist for Ages 1(1/2)-5 (CBCL/1(1/2)-5) and the Caregiver Report Form (C-TRF). METHODS: The study was based on an age- and gender-stratified cohort sample of 1750 children aged 1(1/2)-5 years born at Aarhus University Hospital, Denmark. The CBCL/1(1/2)-5 and C-TRF were mailed to parents, who were asked to pass on the C-TRF to the preschool caregiver. The national standard register data gave access to information on socio-economic status, family type, ethnicity and parental educational level for analysis of participation and representation. RESULTS: A total number of 850 (49%) families replied, and 624 caregivers replied. The mean Total Problem Score (TPS) with 95% confidence interval was 17.3 (16.3-18.3) for parents' reports. Age-and gender-specific scale score findings for Danish preschoolers and schoolchildren were comparable. No differences were found in the mean TPS within subgroups related to parental socio-demographic features. CONCLUSION: On the basis of a large sample, Danish national norm scores and profiles of the ASEBA Preschool Forms were established; the scores of descendents must, however, be assessed with some caution. With this reservation, the CBCL/1(1/2)-5 and C-TRF forms are now available in Danish and can be recommended for use in clinical and research settings.
Genetic epidemiological studies of Autism Spectrum Disorders (ASDs) based on twin pairs ascertained from the population and thoroughly assessed to obtain a high degree of diagnostic validity are few. All twin pairs aged 3-14 years in the nationwide Danish Twin Registry were approached. A three-step procedure was used. Five items from the "Child Behaviour Checklist" (CBCL) were used in the first screening phase, while screening in the second phase included the "Social and Communication Questionnaire" and the "Autism Spectrum Screening Questionnaire". The final clinical assessment was based on "gold standard" diagnostic research procedures including diagnostic interview, observation and cognitive examination. Classification was based on DSM-IV-TR criteria. The initial sample included 7,296 same-sexed twin pairs and, after two phases of screening and clinical assessment, the final calculations were based on 36 pairs. The probandwise concordance rate for ASD was 95.2% in monozygotic (MZ) twins (n=13 pairs) and 4.3% in dizygotic (DZ) twins (n=23 pairs). The high MZ and low DZ concordance rate support a genetic aetiology to ASDs.
Eating disorders (EDs) are psychiatric disorders associated with high morbidity and mortality. It is well established that patients with anorexia nervosa (AN) have an increased risk of premature death, whereas mortality data are lacking for the other EDs. This study aimed to establish mortality rates in a sample of ED patients (n=998) with a mean follow-up of 12 years. This was compared to previous data from the same catchment area before a multidisciplinary centre was established. The standardized mortality ratio (SMR) was calculated. To compare the two cohorts, adjusted crude ratios were calculated with the confounding variables: body mass index (BMI), age at referral and diagnosis. In the latest cohort the SMR for AN was 2.89 vs 11.16 in the time before our specialization. SMR for bulimia nervosa (BN) and for eating disorder not otherwise specified (EDNOS) in the latest cohort were 2.37 and 1.14 respectively. When comparing two retrospective cohorts it is not possible to draw a definite conclusion, however the present study supports that integrating a somatic unit in a multidisciplinary centre may have a favourable influence on mortality in AN.
INTRODUCTION: Assessment of the effectiveness of clinical practice requires appropriate outcome measures.Health of the Nation Outcome Scales for Children and Adolescents (HoNOSCA) is a recently developed measure of outcome for use in child and adolescent mental health services (CAMHS). The aims of the present study were to evaluate sensitivity to change, face validity and clinical feasibility of HoNOSCA in a Danish field trial. METHOD: A prospective design in which HoNOSCA, Global Assessment of Psychosocial Disability (GAPD) and a clinician rated global outcome measure were completed at 15 field sites. 173 patients were rated both at initial assessment and at follow-up after three months. RESULTS: HoNOSCA demonstrated satisfactory face validity. There was a strong correlation between HoNOSCA scores and GAPD scores ( r = 0.6, P
To estimate the Danish epidemiological long-term incidence rates for suicide attempts in the general population of children and adolescents, and to analyze the impact from single and multiple risk factors on the risk of suicide attempts.
We used longitudinal register data from a total cohort of all individuals born between 1983 and 1989 and living in Denmark to calculate incidence rates. From the cohort, we identified all who have attempted suicide, and matched 50 controls to each case. A nested case-control design was used to estimate the impact from risk factors on the risk for index suicide attempts. We established a link to the biological parents and identified risk factors for two generations. Risk factors were analyzed in a conditional logistic regression model.
We identified 3718 suicide attempters and 185,900 controls (189,618 individuals, aged 10-21 years). We found increasing incidence rates during the period 1994-2005, and higher incidence rates for girls and the oldest adolescents. Mental illness was the strongest independent risk factor (IRR = 4.77, CI = (4.35-5.23), p
In child mental health services, the Child Behaviour Checklist (CBCL) and related materials are internationally renowned psychometric questionnaires for assessment of children aged 6-16 years. The CBCL consists of three versions for different informants: the CBCL for parents, the Teacher's Report Form (TRF) and the Youth Self-Report (YSR) for 11-16-year-old children.
The CBCL was standardized in Denmark in 1996, but a need for renewed standardization has emerged because of an update in 2001 and possible cultural changes. We also wanted to increase the response rate and the validity of the national norms.
A total of 949 children from demographically representative schools and their parents were invited to participate. Response rates were high: CBCL 84% (n = 793), TRF 99% (n = 938) and YSR 89% (n = 434). The mean total problem scores, externalizing and internalizing scores, and diagnose-specific sub-scores are presented. Compared with the 1996 standardization, parents rate their children significantly lower in problem score, and the same pattern is found in teachers' ratings. The young, however, rate themselves higher than previously. Some differences in single-item prevalence have occurred. This may indicate a change in the perception of the problems rather than a shift in psychopathology.
New norm scores and cut-off scores have been generated, and the questionnaires are now available for on-line completion.
The effect of parental brain injury on children has been relatively little investigated. This study examines post-traumatic stress symptoms (PSS) and psychological functioning in children with a parent with an acquired brain injury.
The participants were 35 patients with acquired brain injury, their spouses and children aged 7-14 years recruited from out-patient brain injury rehabilitation units across Denmark. Children self-reported psychological functioning using the Becks Youth Inventory (BYI) and Child Impact of Events revised (CRIES) measuring PSS symptoms. Emotional and behavioural problems among the children were also identified by the parents using the Achenbach's Child Behaviour Checklist (CBCL). A matched control group, consisting of 20 children of parents suffering from diabetes, was recruited from the National Danish Diabetes Register.