How should we classify complex neurodevelopmental disorders?

<abstract>
<title style='display:none'>Abstract</title>
<sec id="j_sjcapp-2022-0009_s_004"><title style='display:none'>Background</title>
Increase of serum prolactin is a common adverse effect to antipsychotic medication, potentially leading to galactorrhea, menstrual cycle disturbances or sexual adverse effects. Lurasidone is commonly associated with a low risk of prolactin change.</sec>
<sec id="j_sjcapp-2022-0009_s_005"><title style='display:none'>Objective</title>
To describe a case of severe hyperprolactinemia in a 16-year old female with schizophrenia.</sec>
<sec id="j_sjcapp-2022-0009_s_006"><title style='display:none'>Method</title>
Case report.</sec>
<sec id="j_sjcapp-2022-0009_s_007"><title style='display:none'>Results</title>
We saw a severe and sustained prolactin increase during treatment with lurasidone.</sec>
<sec id="j_sjcapp-2022-0009_s_008"><title style='display:none'>Conclusions</title>
Although lurasidone is usually considered not to increase prolactin, some patients may experience this adverse effect. As related subjective consequences may be falsely attributed to the disease or as direct effects of the antipsycotic agent, serum prolactin measurements should be made prior to and during antipsychotic treatment regardless of medication choice.</sec></abstract>

Severe hyperprolactinemia during lurasidone treatment in a 16-year old girl with schizophrenia – a case report

<abstract><title style='display:none'>Abstract</title><sec id="j_sjcapp-2017-007_s_001"><title style='display:none'>Background</title>The Dimensional Assessment of Personality Pathology – Short Form for Adolescents (DAPP-SF-A) is an age-adapted version of the DAPP Basic Questionnaire (DAPP-BQ). The psychometric properties of this questionnaire were established by Tromp and Koot. However, norming data are currently available exclusively for Dutch adolescents.</sec><sec id="j_sjcapp-2017-007_s_002"><title style='display:none'>Objective</title>The main aim of this study was to provide community-based norming data for the DAPP-SF-A in Flemish adolescents and separately for boys and girls. The second aim was to compare the Flemish norms with the Dutch norms.</sec><sec id="j_sjcapp-2017-007_s_003"><title style='display:none'>Method</title>The sample consisted of 425 adolescents (52% girls), aged 16 to 21 years (mean, 18.6; SD, 1.16), from the general Flemish population. In 2012, all respondents completed the DAPP-SF-A and the Youth Self-Report as a part of the longitudinal Flemish Study on Parenting, Personality, and Development.</sec><sec id="j_sjcapp-2017-007_s_004"><title style='display:none'>Results:</title>Internal consistency reliabilities of the lower-order dimensions were acceptable to good (<italic>a</italic> ranged from 0.71 to 0.87, median=0.85, mean item-rest correlations ranged from 0.44 to 0.67). The lower-order dimensions showed distinctive mean patterns for boys and girls, with higher scores for girls on Affective Instability and Insecure Attachment [effect sizes (<italic>d</italic>) were both −0.35] and higher scores for boys on all lower-order dimensions of Dissocial Behavior, Inhibitedness, and three lower-order dimensions of Emotional Dysregulation (<italic>d</italic> ranged from 0.21 to 0.79). The comparison of the Flemish scores with the Dutch scores showed substantial inter-cultural differences (<italic>d</italic> ranged from 0.13 to −1.78).</sec><sec id="j_sjcapp-2017-007_s_005"><title style='display:none'>Conclusions</title>The DAPP-SF-A shows satisfactory reliability in a Flemish community-based sample of adolescents. Furthermore, given the differences between boys and girls, the use of gender-based norms seems appropriate. Finally, substantial differences with the Dutch general population norms warrant the use of separate norms in Flemish adolescents.</sec></abstract>

The Dimensional Assessment of Personality Pathology – Short Form for Adolescents (DAPP-SF-A): normative data for Flemish adolescents aged 16 to 21 years

<abstract><title style='display:none'>Abstract</title><sec id="j_sjcapp-2015-016_s_001"><title style='display:none'>Background:</title>Autism spectrum disorder (ASD) is currently not curable, but it may be malleable to varying degrees in response to different interventions to improve outcomes.</sec><sec id="j_sjcapp-2015-016_s_002"><title style='display:none'>Objective:</title>We conducted a systematic review of interventions aimed at ameliorating social communication impairments in patients with ASD. This study was registered in the International Prospective Register of Systematic Reviews (no. CRD42013003780).</sec><sec id="j_sjcapp-2015-016_s_003"><title style='display:none'>Methods:</title>We focused on the ASD interventions that are frequently applied in Swedish clincial practice to address ASD. To ensure stakeholder involvement, we also conducted two surveys with three major Swedish ASD interest organizations to assess perceived research priorities for ASD treatment. With the use of this rationale for selection, Early Intensive Behavioral Intervention [EIBI], Treatment and Education of Autistic and Related Communication Handicapped Children [TEACCH], social skills training groups, and interventions that involved significant others were reviewed. A bibliographic search was conducted via five databases: Medline, PubMed, PsycInfo, CINAHL, and ERIC. Identified articles were screened for relevance by two independent reviewers, who also assessed the risk of bias in randomized controlled trials using systematic checklists.</sec><sec id="j_sjcapp-2015-016_s_004"><title style='display:none'>Results:</title>A total of 7264 citations were identified as being published before February 2013, and 109 studies (18 of EIBI, 18 of social skills training, 4 of TEACCH, and 69 of interventions involving significant others) were included in the analysis. The included studies provided some support for the positive effects of each of the interventions; this is especially true if the most recently published research (March 2013 through August 2015) is considered, and a crude updated search for relevant randomized controlled trials was performed. The interventions that involve the significant others of individuals with ASD form a heterogenous area of treatment strategies that require subcategorization for future review.</sec><sec id="j_sjcapp-2015-016_s_005"><title style='display:none'>Conclusions:</title>These findings provide preliminary support for treatments that are commonly used in clinical practice for the treatment of ASD in Sweden. However, larger and more rigorously designed and controlled studies are still needed before definitive conclusions regarding their effects can be made.</sec></abstract>

A Systematic Review of Social Communication and Interaction Interventions for Patients with Autism Spectrum Disorder

<abstract><title style='display:none'>Abstract</title>Personality disorders can be seen as patterns of maladaptive personality traits that have their onset during childhood or adolescence and that have an impact on the individual throughout the life span. Identity disturbance is seen as the central construct for detecting severe personality pathology—and, most notably, borderline personality disorder—in adults and adolescents. Therefore, in the revision of the <italic toggle="yes">Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition</italic>, the construct of “identity” has been integrated as a core diagnostic criterion for personality disorders.One of the most central tasks of normal adolescent development is the consolidation of identity. Crises in the development of identity usually resolve into a normal and consolidated identity with flexible and adaptive functioning. By contrast, identity diffusion is viewed as a lack of integration of the concept of the self and significant others; it is also seen as the basis for subsequent personality pathology, including that of borderline personality disorder, which leads to a broad spectrum of maladaptive and dysfunctional behaviors.To measure identity pathology and its improvement with treatment, we developed a self-report questionnaire entitled Assessment of Identity Development in Adolescence to establish a reliable, valid, and time-efficient inventory to represent a dimensional concept of healthy and impaired personality development. The reliability of this self-report questionnaire is excellent, and the total score differentiated significantly between controls and patients with personality disorders. Adolescent Identity Treatment is a treatment model that focuses on identity pathology as the core characteristic of personality disorders. This model integrates specific techniques for the treatment of adolescent personality pathology on the background of object-relation theories and modified elements of Transference-Focused Psychotherapy. Moreover, psychoeducation, behavior-oriented home plans, and family work support the therapeutic process of the adolescent.</abstract>

schlueter-mueller@praxis-schlueter-mueller.de

Assessment and Treatment of Identity Pathology During Adolescence

A conceptual framework for understanding characteristics of self-awareness associated with autism spectrum disorder

<abstract>
<title style='display:none'>Abstract</title>
<sec><title style='display:none'>Background</title>
The experience of several adverse childhood experiences (ACEs) has been shown to be associated with Post-Traumatic Stress Disorder (PTSD) and Disturbances in Self-Organization (DSO) symptoms among adolescents. Defense mechanisms and coping styles are psychological processes involved in the association of ACEs with PTSD and DSO symptoms. However, there is a lack of research on the joint association of these variables among Faroese adolescents.
</sec>
<sec><title style='display:none'>Aim</title>
The aim of this study was to analyze the effect of exposure to ACEs on PTSD and DSO symptoms trough the indirect effect of defense mechanisms and coping styles in a sample of Faroese adolescents.
</sec>
<sec><title style='display:none'>Method</title>
Six hundred and eighty-seven Faroese adolescents were recruited from 19 schools. Participants responded to validated self-report questionnaires. A multiple step mediation and a serial mediation methodology were conducted through structural equation modeling.
</sec>
<sec><title style='display:none'>Results</title>
Exposure to ACEs was linked to PTSD and DSO symptoms through the indirect effect of immature defense mechanisms, emotional coping, and detachment coping. Exposure to ACEs was linked to PTSD symptoms through rational coping.
</sec>
<sec><title style='display:none'>Conclusions</title>
The results suggest a mutual relationship between defense mechanisms and coping styles in coping with multiple adversity among adolescents.
</sec>
</abstract>

Coping Styles and Defense Mechanisms Mediate Associations Between Exposure to Adverse Childhood Experiences and CPTSD Symptoms in Faroese Adolescents

<abstract>
<title style='display:none'>Abstract</title>
<sec><title style='display:none'>Background</title>
The covid-19 pandemic has influenced children and parents worldwide. The pandemic has also been suggested to especially affect and exacerbate health anxiety (HA) symptoms in children and adolescents. However, there is limited understanding of the potential mechanisms challenges of families where parents themselves experience mental health issues such as high degree of HA symptoms.
</sec>
<sec><title style='display:none'>Objective</title>
The aim of this study was to explore parental experiences of pandemic life in families with continuously high levels of HA symptoms during the covid-19 pandemic.
</sec>
<sec><title style='display:none'>Method</title>
Six parents, identified with high levels of HA symptoms, participated in qualitative individual semi-structured interviews. Interviews were analysed according to Interpretative Phenomenological Analysis principles.
</sec>
<sec><title style='display:none'>Results</title>
Three main themes emerged. Theme 1) “Anxious children in a pandemic world” explores how pandemic – independent child factors including anxious temperament may have influenced the child pandemic experience. Theme 2) “Parental influences on child anxiety” describes parental reflections on their possible influence on child anxious thoughts. Theme 3) “Living with pandemic guidelines and restrictions” demonstrates the varying parental experiences of interventions and how these may affect HA thoughts.
</sec>
<sec><title style='display:none'>Conclusion</title>
Parents who themselves experience HA symptoms see their children, who also experience HA symptoms, to be particularly susceptible and vulnerable to both content and rhetoric of pandemic information. These children may however, experience school lockdown to be anxiety relieving. Parents who themselves have illness-related fears may not see themselves as perpetuating for their child's anxious thoughts.
</sec>
</abstract>

Pandemic life in families with health anxiety symptoms, parental perspectives

<abstract>
<title style='display:none'>Abstract</title>
<sec><title style='display:none'>Objective</title>
Replicated evidence shows a weak or non-significant correlation between different methods of evaluating executive functions (EF). The current study investigates the association between rating scales and cognitive tests of EF in a sample of children with ADHD and executive dysfunction.
</sec>
<sec><title style='display:none'>Method</title>
The sample included 139 children (aged 6–13) diagnosed with ADHD and executive dysfunctions. The children completed subtests of the Cambridge Neuropsychological Test Automated Battery (CANTAB). Parents completed the Behavior Rating Inventory of Executive Function (BRIEF) and the Children’s Organizational Skills Scale (COSS).
</sec>
<sec><title style='display:none'>Analysis</title>
Pairwise Spearman correlations were calculated between the composite and separate subscales of cognitive tests and rating scales. In secondary analyses, pairwise Spearman correlations were conducted between all composite scales and subscales, stratified by child sex and child ADHD subtype.
</sec>
<sec><title style='display:none'>Results</title>
The correlation analyses between composite scores yielded no significant correlations. The results when comparing CANTAB TO and BRIEF GE are r=−.095, p=.289, and r=.042, p=.643 when comparing CANTAB TO and COSS TO. The analyses between all composite scales and subscales found one significant negative correlation (r=−.25, p&lt;.01). There are significant cross-method differences when stratified by the ADHD-Inattentive subtype, showing significant negative correlations (moderate) between CANTAB and BRIEF composite (r=−.355, p=.014) and subscales.
</sec>
<sec><title style='display:none'>Discussion</title>
It is possible that the different methods measure different underlying constructs of EF. It may be relevant to consider the effects of responder bias and differences in ecological validity in both measurement methods.
</sec>
<sec><title style='display:none'>Conclusion</title>
The results found no significant correlations. The expectation in research and clinical settings should not be to find the same results when comparing data from cognitive tests and rating scales. Future research might explore novel approaches to EF testing with a higher level of ecological validity, and designing EF rating scales that capture EF behaviors more so than EF cognition.
</sec>
</abstract>

Executive functioning in children with ADHD Investigating the cross-method correlations between performance tests and rating scales

<abstract>
<title style='display:none'>Abstract</title>
<sec><title style='display:none'>Background</title>
Parents of children with neurodevelopmental conditions (NDC) are at risk of experiencing elevated levels of parental stress. Access to robust instruments to assess parental stress is important in both clinical and research contexts. Objective: We aimed to evaluate the psychometric properties of a Swedish version of the Parental Stress Scale (PSS), completed by parents of 3- to 17-year-old children, with and without NDCs.
</sec>
<sec><title style='display:none'>Method</title>
Main analyses were conducted on data from three independent samples: a community sample (<italic>n</italic>=1018), a treatment-seeking sample of parents of children with various disabilities (<italic>n</italic>=653), and a sample of parents of children with Attention-Deficit/Hyperactivity Disorder (ADHD) who themselves reported varying ADHD symptom severities (<italic>n</italic>=562). Additional analyses were enabled by the use of data from a complementary test-retest sample (<italic>n</italic>=337).
</sec>
<sec><title style='display:none'>Results</title>
The internal consistency of the PSS was good (Cronbach’s alpha, <italic>α</italic>=.87) and its test-retest reliability moderate (ICC=.66). The scale correlated in the expected direction with related constructs (<italic>r=</italic>.50–.56 in the community sample). An exploratory factor analysis found its internal structure to reflect two aspects of parental stress: Lack of Parental Rewards and Role Satisfaction (factor 1, <italic>α</italic>=.90) and Parental Stressors and Distress (factor 2, <italic>α</italic>=.85). The treatment-seeking parents of children with disabilities reported higher parental stress than community reference parents (<italic>p</italic>&lt;.001; Cohen’s <italic>d</italic>=1.17). Moreover, we found that parents with high ADHD symptom severity reported higher parental stress than parents with low ADHD symptom severity (<italic>p</italic>&lt;.001; <italic>d</italic>=0.39).
</sec>
<sec><title style='display:none'>Conclusion</title>
In summary, we found evidence in support of the reliability and validity of the PSS, which overall was judged to be useful as a measure of parental stress in a Swedish context. In addition, our results underline the importance of considering parental stress and related needs in assessments and intervention planning involving families of children with NDCs.
</sec>
</abstract>

Psychometric Properties of the Parental Stress Scale in Swedish Parents of Children with and without Neurodevelopmental Conditions

Eleven years with Scandinavian Journal of Child and Adolescent Psychiatry and Psychology

<abstract>
<title style='display:none'>Abstract</title>
<sec>
<title style='display:none'>Background</title>
Prolonged stress is a risk factor for developing mental illness and stress-related diseases. As there has been an increase in self-reported psychological symptoms and diagnosis of mental illness among Scandinavian adolescents, more knowledge of stress prevalence in this age group is needed.
</sec>
<sec>
<title style='display:none'>Aim</title>
This literature review will investigate a possible increase in stress prevalence among Scandinavian adolescents, aged 13-18, between the years 2000 and 2019.
</sec>
<sec>
<title style='display:none'>Methods</title>
A systematic literature search was conducted in the PubMed and PsycInfo databases. In addition, a grey literature search was conducted to find relevant surveys and reports. Altogether, nine papers and nine surveys, and reports containing relevant data were identified, assessed for risk of bias, and included in the analysis.
</sec>
<sec>
<title style='display:none'>Results</title>
The results show higher stress scores among the older participants in the age group 13-18 years and a gender difference, where girls score higher than boys. The literature neither supports nor rejects the hypothesis that stress levels have increased among adolescents in Scandinavia, from year 2000 to 2019. Only two of the included studies used a validated stress questionnaire and there was a substantial risk of non-response bias. Therefore, the existing literature is considered insufficient to determine if there has been an increase in stress over time. A majority of the papers, surveys, and reports had moderate risk of bias.
</sec>
<sec>
<title style='display:none'>Conclusions</title>
Further research using validated stress questionnaires in representative populations is needed to investigate changes in stress prevalence among Scandinavian adolescents. Also, the age and gender difference in stress prevalence among 13-18-year-olds may be of relevance for planning preventive interventions to reduce stress.
</sec>
</abstract>

Did Stress Prevalence Among Adolescents in Scandinavia Change from 2000 to 2019? A literature review

<abstract><title style='display:none'>Abstract</title><sec id="j_sjcapp-2014-011_s_001"><title style='display:none'>Background:</title>Adults with autism spectrum disorders (ASDs) and with intelligence quotients in the normal range are disproportionately affected by unemployment.</sec><sec id="j_sjcapp-2014-011_s_002"><title style='display:none'>Objective:</title>We sought to assess special interests that could bear potential for employment as well as factors deemed relevant for work performance in adults with ASD.</sec><sec id="j_sjcapp-2014-011_s_003"><title style='display:none'>Method:</title>A newly compiled self-report online questionnaire was administered to high-functioning adults with ASD to assess special interests as well as factors that both interfere with and facilitate work performance.</sec><sec id="j_sjcapp-2014-011_s_004"><title style='display:none'>Results:</title>Participants reported that they spent an average of 26 hours per week on their special interests, and their average level of proficiency was rated as very good. Although special interests were reported to be in the social sciences and the creative fields as often as they were in the natural sciences and technology/engineering, the most common approach taken within those fields was systemizing rather than a creative or knowledge-acquiring pursuit. Social interaction problems with coworkers and superiors as well as sensory issues were most often rated as interfering with work performance. In addition, mental underload was rated as an important factor that interfered with work performance, whereas excessive demands were not. Among the factors most often reported to facilitate work performance were employers’ and colleagues’ awareness of the individual’s ASD diagnosis.</sec><sec id="j_sjcapp-2014-011_s_005"><title style='display:none'>Conclusion:</title>Our data suggest that special interests among individuals with ASD may bear important potential for employment. Given the focus on systemizing in this population, recent efforts to create job opportunities in the information technology sector specifically for high-functioning individuals with ASD are a promising start. However, these efforts should be expanded into other fields.</sec></abstract>

Toward the Successful Employment of Adults with Autism: A First Analysis of Special Interests and Factors Deemed Important for Vocational Performance

<abstract><title style='display:none'>Abstract</title>In this article, the authors provide a narrative review of the mounting evidence base on personality disorder in childhood and adolescence. Topics covered include diagnostic validity, prevalence, developmental issues, comorbidity, risk and protective factors, and treatment. Novel indicated prevention and early intervention programs for borderline personality disorder in adolescence are given special priority. To conclude, directions for future research are provided.</abstract>

Personality Disorder in Childhood and Adolescence comes of Age: a Review of the Current Evidence and Prospects for Future Research

<abstract><title style='display:none'>Abstract</title>Background: Stressor experience is an important topic of research concerning adolescent health and ill-health. For this, valid and reliable measures of adolescent stress are needed. The Adolescent Stress Questionnaire 2 was developed to tap into stressor domains specific for adolescence. Psychometric evaluations in Australian and European samples have indicated adequate psychometric properties. However, the ASQ-2 is quite extensive, which may render its use in large cohort studies, where several aspects of adolescent health are investigated, inconvenient and problematic.Objective: To evaluate the psychometric properties of a short version of the ASQ-2 (ASQ-S) in terms of construct validity and factorial invariance across gender.Method: The ASQ-2 was translated into Swedish and items were retained from nine of the ten scales based on factor loadings. One scale (stress of emerging adult responsibilities) was removed entirely due to low internal consistency and variance explained. The remaining 27 items were piloted and then included in an ongoing 5-year longitudinal study involving the participation of all students in the 7th and 8th grade in public schools from three Swedish municipalities (N = 2768, 47.5 % girls, mean age 13.64 years). For this study data from the first and second wave was used.Results: A nine factor Confirmatory Factor Analysis (CFA) showed a good fit to the data and invariance across sexes was supported. The nine scales correlated positively with depressive symptoms, anxiety and worry and negatively with self-esteem. Girls reported higher stress levels than boys in eight of the nine scales. Stressors related to peer pressure predicted reported levels of anxiety and worry one year later, whereas stressors related to romantic relationships predicted depressive symptoms.Conclusions: Overall this study suggests that the ASQ-S could be a valid measure of adolescent stressor experience and psychometrically equivalent to the full ASQ-2.</abstract>

Development of a Shortened Version of the Adolescent Stress Questionnaire (ASQ-S): construct validity and sex invariance in a large sample of Swedish adolescents

<abstract><title style='display:none'>Abstract</title><sec id="j_sjcapp-2014-010_s_001"><title style='display:none'>Background:</title>Autism spectrum disorder (ASD) is diagnosed more often in males than females, with the male-to-female gender ratio reported to be around 4.3:1 to 5:1. It is possible that the underrecognition of ASD in females partially contributes to this uneven ratio. Recent attention has been placed on understanding the processes that give rise to this gender difference in ASD prevalence. Socialization may contribute to the unique presentation of ASD in females, which may underlie this condition’s subsequent underidentification in this group.</sec><sec id="j_sjcapp-2014-010_s_002"><title style='display:none'>Objective:</title>The purpose of this case series is to demonstrate how symptoms of ASD may uniquely manifest in females without co-occurring intellectual impairment.</sec><sec id="j_sjcapp-2014-010_s_003"><title style='display:none'>Method:</title>An examination of three case examples of young women diagnosed with ASD will illustrate the processes that contribute to the atypical manifestation and underidentification of ASD in females.</sec><sec id="j_sjcapp-2014-010_s_004"><title style='display:none'>Results:</title>Across cases, the females in this study demonstrated shared symptom presentations within three domains: 1) unique core symptom manifestation (insistence on sameness, lack of social engagement, and social processing difficulties); 2) heightened psychiatric comorbidities with internalizing disorders (anxiety, depression, and borderline personality traits); and 3) emotional dysregulation. These three domains reflect specific processes that may help to explain the underidentification of ASD in females via diagnostic overshadowing.</sec><sec id="j_sjcapp-2014-010_s_005"><title style='display:none'>Conclusions:</title>Consideration of atypical symptom presentations, heightened comorbidities, and emotion regulation difficulties may help with the understanding of why ASD symptoms in females are commonly underidentified or identified later than they are in males. Social difficulties in combination with internalizing psychiatric disorders and emotional dysregulation may lead to the development of a specific symptom presentation in females that obscures the detection of ASD symptoms. Suggestions for clinical practice are made to promote the accurate identification of ASD and to inform case formulation and treatment planning.</sec></abstract>

Underidentification of Autism Spectrum Disorder in Females: A Case Series Illustrating the Unique Presentation of this Disorder in Young Women

<abstract><title style='display:none'>Abstract</title><sec id="j_sjcapp-2017-003_s_001"><title style='display:none'>Background</title>Mental health problems in adolescents have become a major public health challenge in many western countries. Many adolescents participate in noncompetitive or competitive sports for leisure. The aim of this study was to examine the association between participation in noncompetitive or competitive sports and mental health problems among Norwegian adolescents.</sec><sec id="j_sjcapp-2017-003_s_002"><title style='display:none'>Method</title>Data from a cross-sectional survey conducted among Norwegian junior high (N=9414) and high school students (N=10,571) aged 13 to 22 years were examined. The Strengths and Difficulties Questionnaire (SDQ) was used for measuring mental health problems, in the form of total symptom scores and impact on daily life. Participation in sports was categorized as follows: 1) not participating; 2) participating in noncompetitive sports; and 3) participating in competitive sports. Sports were divided into individual and team sports. Weekly exercise, healthy diet, and number of friends were investigated as mediating factors, and age, gender, and perceived economic status were controlled for in the analysis.</sec><sec id="j_sjcapp-2017-003_s_003"><title style='display:none'>Results</title>Adolescents participating in either noncompetitive or competitive sports had fewer total symptoms and less impact of problems on their daily life compared with those not participating in sports. In particular, participation in team sports as opposed to participation in individual sports seemed to be associated with fewer mental health problems. Weekly exercise, healthy diet, and number of friends were found to be partially mediating factors, explaining some, but not all, of the association between participation in either sports group. Participation in competitive sports, especially, was associated with fewer mental health problems.</sec><sec id="j_sjcapp-2017-003_s_004"><title style='display:none'>Conclusions</title>Participation in sports, either noncompetitive or competitive, is associated with fewer mental health problems in adolescents. This negative association is strongest for those participating in competitive sports. Further research is needed to explore the mechanisms underlying this relationship.</sec></abstract>

Association Between Participating in Noncompetitive or Competitive Sports and Mental Health among Adolescents – a Norwegian Population-based Cross-sectional Study

<abstract><title style='display:none'>Abstract</title>Background: The results of several international studies indicate a high prevalence of language and communication impairments among children who are referred to child psychiatric services. However, these impairments are likely to remain undetected unless language and communication impairments are evaluated during the psychiatric assessment.Aims: The aim of the present study is to investigate the specific association between general and specific mental health problems, as expressed by the problem scales of Child Behavior Checklist (CBCL) and Teachers Report Form (TRF), and pragmatic skills and pragmatic language impairments (PLI) as defined the Pragmatic Composite of the Child Communication Checklist (CCC-PC).Methods: Children aged from 8 to 13 years (n = 73) were recruited in sequence following referral to a child and adolescent psychiatry (CAMHS) outpatient clinic within 12 months. Children with possible or established autism or intellectual disability were excluded. Standardized instruments measuring language, communication and mental health symptoms were distributed to parents and teachers, an intelligence test administered for clinical purposes, and demographic information was included.Results: The parent reports showed PLI among 38% of the children and revealed strong associations with the CBCL scales for emotional problems, thought problems and, especially, social and withdrawal symptoms, which mean more associations to internalized and non-externalized problems. PC-scores were at similar levels and PLI was reported by teachers at similar rates (compared to parent reports) with moderate agreement. Teacher PC-scores showed associations to only one TRF-scale, social problems. The CCC-PC subscale with the strongest associations to mental health symptoms was «Use of Context» («Social Relationships» do not contribute to the CCC-PC scores).Conclusion: There was a general increase in PC-scores and increased prevalence of PLI in this clinical sample. PC-scores correlated with symptom scores for internalizing and non-externalizing problems scales. The strongest common factors appear to be related to the social aspects of mental health. Pragmatic skills should be considered as a protective factor for mental health rather than investigating pragmatic impairment as a risk or vulnerability factor.</abstract>

Pragmatic language impairment general and specific associations to mental health symptom dimensions in a child psychiatric sample

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