| 21. |
- Carlsson, Torkel, et al.
(författare)
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Early environmental risk factors for neurodevelopmental disorders - a systematic review of twin and sibling studies
- 2021
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Ingår i: Development and psychopathology (Print). - : Cambridge University Press. - 0954-5794 .- 1469-2198. ; 33:4, s. 1448-1495
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Forskningsöversikt (refereegranskat)abstract
- While neurodevelopmental disorders (NDDs) are highly heritable, several environmental risk factors have also been suggested. However, the role of familial confounding is unclear. To shed more light on this, we reviewed the evidence from twin and sibling studies. A systematic review was performed on case control and cohort studies including a twin or sibling within-pair comparison of neurodevelopmental outcomes, with environmental exposures until the sixth birthday. From 7,315 screened abstracts, 140 eligible articles were identified. After adjustment for familial confounding advanced paternal age, low birth weight, birth defects, and perinatal hypoxia and respiratory stress were associated with autism spectrum disorder (ASD), and low birth weight, gestational age and family income were associated with attention-deficit/hyperactivity disorder (ADHD), categorically and dimensionally. Several previously suspected factors, including pregnancy-related factors, were deemed due to familial confounding. Most studies were conducted in North America and Scandinavia, pointing to a global research bias. Moreover, most studies focused on ASD and ADHD. This genetically informed review showed evidence for a range of environmental factors of potential casual significance in NDDs, but also points to a critical need of more genetically informed studies of good quality in the quest of the environmental causes of NDDs.
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| 22. |
- Choque Olsson, Nora, et al.
(författare)
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Social Skills Training for Children and Adolescents With Autism Spectrum Disorder : A Randomized Controlled Trial
- 2017
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Ingår i: Journal of the American Academy of Child and Adolescent Psychiatry. - : Elsevier BV. - 0890-8567 .- 1527-5418. ; 56:7, s. 585-592
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Tidskriftsartikel (refereegranskat)abstract
- OBJECTIVE: Social skills group training (SSGT) for children and adolescents with autism spectrum disorder (ASD) is widely applied, but effectiveness in real-world practice has not yet been properly evaluated. This study sought to bridge this gap.METHOD: This 12-week pragmatic randomized controlled trial of SSGT compared to standard care alone was conducted at 13 child and adolescent psychiatry outpatient units in Sweden. Twelve sessions of manualized SSGT ("KONTAKT") were delivered by regular clinical staff. Participants (N = 296; 88 females and 208 males) were children (n = 172) and adolescents (n = 124) aged 8 to 17 years with ASD without intellectual disability. The primary outcome was the Social Responsiveness Scale rating by parents and blinded teachers. Secondary outcomes included parent- and teacher-rated adaptive behaviors, trainer-rated global functioning and clinical severity, and self-reported child and caregiver stress. Assessments were made at baseline, posttreatment, and 3-month follow-up. Moderator analyses were conducted for age and gender.RESULTS: Significant treatment effects on the primary outcome were limited to parent ratings for the adolescent subgroup (posttreatment: -8.3; 95% CI = -14.2 to -1.9; p = .012, effect size [ES] = 0.32; follow-up: -8.6; 95% CI = -15.4 to -1.8; p = .015, ES = 0.33) and females (posttreatment: -8.9; 95% CI = -16.2 to -1.6; p = .019, ES = 0.40). Secondary outcomes indicated moderate effects on adaptive functioning and clinical severity.CONCLUSION: SSGT for children and adolescents with ASD in regular mental health services is feasible and safe. However, the modest and inconsistent effects underscore the importance of continued efforts to improve SSGT beyond current standards.CLINICAL TRIAL REGISTRATION INFORMATION: Social Skills Group Training ("KONTAKT") for Children and Adolescent With High-functioning Autism Spectrum Disorders; https://clinicaltrials.gov/; NCT01854346.
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| 23. |
- Copeland, William E., et al.
(författare)
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Associations of childhood and adolescent depression with adult psychiatric and functional outcomes
- 2021
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Ingår i: Journal of the American Academy of Child and Adolescent Psychiatry. - : Elsevier. - 0890-8567 .- 1527-5418. ; 60:5, s. 604-611
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Tidskriftsartikel (refereegranskat)abstract
- Objective: Depression is common, impairing, and the leading cause of disease burden in youths. This study aimed to identify the effects of childhood/adolescent depression on a broad range of longer-term outcomes.Method: The analysis is based on the prospective, representative Great Smoky Mountains Study of 1,420 participants. Participants were assessed with the structured Child and Adolescent Psychiatric Assessment interview up to 8 times in childhood (age 9 similar to 16 years; 6,674 observations; 1993-2000) for DSM-based depressive disorders, associated psychiatric comorbidities, and childhood adversities. Participants were followed up 4 times in adulthood (ages 19, 21, 25, and 30 years; 4,556 observations of 1,336 participants; 1999-2015) with the structured Young Adult Psychiatric Assessment Interview for psychiatric outcomes and functional outcomes.Results: In all, 7.7% of participants met criteria for a depressive disorder in childhood/adolescence. Any childhood/adolescent depression was associated with higher levels of adult anxiety and illicit drug disorders and also with worse health, criminal, and social functioning; these associations persisted when childhood psychiatric comorbidities and adversities were accounted for. No sex-specific patterns were identified. However, timing of depression mattered: individuals with adolescent-onset depression had worse outcomes than those with child-onset. Average depressive symptoms throughout childhood and adolescence were associated with more adverse outcomes. Finally, specialty mental health service use was protective against adult diagnostic outcomes.Conclusion: Early depression and especially persistent childhood/adolescent depressive symptoms have robust, lasting associations with adult functioning. Some of these effects may be attenuated by service use.
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| 24. |
- Hasslinger, John, et al.
(författare)
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Immediate and Sustained Effects of Neurofeedback and Working Memory Training on Cognitive Functions in Children and Adolescents with ADHD : A Multi-Arm Pragmatic Randomized Controlled Trial
- 2022
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Ingår i: Journal of Attention Disorders. - : Sage Publications. - 1087-0547 .- 1557-1246. ; 26:11, s. 1492-1506
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Tidskriftsartikel (refereegranskat)abstract
- Objective: To evaluate the effects of neurocognitive training methods on targeted cognitive functions in children and adolescent with ADHD.Method: A pragmatic four-arm randomized controlled trial compared two types of neurofeedback (Slow Cortical Potential and Live Z-score) and Working-memory training (WMT) with treatment as usual. N = 202 participants with ADHD aged 9 to 17 years were included. A battery of cognitive function tests was completed pretreatment, posttreatment, and after 6-months.Results: The effects of WMT on spatial and verbal working-memory were superior to neurofeedback and treatment as usual at posttreatment, but only partially sustained at follow-up. No other consistent effects were observed. We found no clear indications that effects were moderated by ADHD presentation, ongoing medication, age, or sex.Conclusion: The sustained effects of neurocognitive training on cognitive functioning in children and adolescents with ADHD may be limited. Future research should focus on more personalized forms of neurocognitive training.
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| 25. |
- Hasslinger, John, et al.
(författare)
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Slow Cortical Potential Versus Live Z-score Neurofeedback in Children and Adolescents with ADHD : A Multi-arm Pragmatic Randomized Controlled Trial with Active and Passive Comparators.
- 2022
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Ingår i: Research on child and adolescent psychopathology. - : Springer Nature. - 2730-7174 .- 2730-7166. ; 50, s. 447-462
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Tidskriftsartikel (refereegranskat)abstract
- Neurofeedback (NF) as a treatment for Attention Deficit Hyperactivity Disorder (ADHD) has been evaluated in several trials, but the specificity and generalizability of effects remain unclear. This four-arm randomized controlled trial evaluated the efficacy of Slow Cortical Potential (SCP; standard NF protocol) and Live Z-score (LZS; non-standard NF protocol) delivered in high-frequency format (five sessions per week during five weeks), compared to Working-memory training (WMT; active comparator) and Treatment-as-usual (TAU; passive comparator). N = 202 children/adolescents aged 9 to 17 years with ADHD participated. The primary outcome measure was multi-report (self-, teacher-, and parent-report) ADHD core symptoms on the Conners-3, assessed at baseline, posttreatment, and 6-months follow-up. Data were analyzed using a linear mixed model. Between-group differences were scarce and did not show a distinct pattern. Superiority of LZS over TAU at endpoint were observed for teacher-rated measures only, while significant differences between SCP and TAU were restricted to posttreatment measurements. Contrary to our expectations, LZS outperformed SCP at endpoint for teacher-rated hyperactivity (-5.37; 95% CI: -10.14 to -0.60; p = .028; d = -.36) and overall ADHD symptoms (-2.20; -4.18 to -0.22; p = .030; d = -.41). There was no indication that either form of NF was superior to WMT. No severe adverse events were reported during the trial, whereas transient stress-related problems were quite frequent. Overall, the results from this pragmatic trial do not provide convincing support for broad implementation of NF in child and adolescent psychiatric services. Future research should try to clarify for whom and under what circumstances NF might be a viable treatment option.
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| 26. |
- Jonsson, Ulf, 1974-
(författare)
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Adolescents with Depression Grown up : Education, Intimate Relationships, Mental Health, and Personality
- 2010
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Doktorsavhandling (övrigt vetenskapligt/konstnärligt)abstract
- Unipolar depression, estimated to be the leading contributor to burden of disease in middle- and high-income countries, often has an onset in adolescence. The disorder is associated with substantial role impairment and is highly recurrent. This raises questions about both subsequent mental health and social outcome. In order to shed light on this, a community sample of adolescents with depression and non-depressed peers was followed-up after 15 years. In 1991-93, first-year students in upper secondary school (age 16-17) in the town of Uppsala, Sweden, were screened for depression. Adolescents with positive screening and selected peers with negative screening (n=631 in total) were assessed regarding mental health, social situation, and personality. At around age 31, the participants were followed-up in both national registers (n=609) and personal interviews (n=409). Outcome regarding social factors, mental health, and personality was assessed. At follow-up, the former depressed adolescents had completed higher education to a lesser extent than the former non-depressed adolescents. The females with adolescent depression were also at increased risk of subsequent abortion, divorce, single parenthood, and partner violence. Characteristics associated with depression in adolescence (such as poor school performance and disruptive disorders) seemed to contribute to the poor outcome in the social domain. Regarding adult mental health, long-term depression in adolescence was associated with a particularly poor outcome. Compared to adolescents with shorter episodes of depression, those with long-term depression were more likely to report recurrent depression, suicidal ideation, and a range of other mental disorders in adulthood. Measures of personality traits related to neuroticism (a tendency towards negative emotionality) were elevated during ongoing depression and anxiety disorders, but were normalized with remission. However, repeated depressive episodes seemed to leave the individual more vulnerable to stress. It is now important to assess if early treatment can alter the poor outcome depicted in this thesis. Since social adversity, educational difficulties, and interpersonal problems accompany the depressive disorder from adolescence onward, it should also be investigated if interventions aimed at such contextual factors can prevent recurrence and improve quality of life.
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| 27. |
- Jonsson, Ulf, 1974-, et al.
(författare)
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Annual Research Review : Quality of life and childhood mental and behavioural disorders - a critical review of the research.
- 2017
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Ingår i: Journal of Child Psychology and Psychiatry. - : Wiley. - 0021-9630 .- 1469-7610. ; 58:4, s. 439-469
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Forskningsöversikt (refereegranskat)abstract
- BACKGROUND: An individual's subjective perception of well-being is increasingly recognized as an essential complement to clinical symptomatology and functional impairment in children's mental health. Measurement of quality of life (QoL) has the potential to give due weight to the child's perspective.SCOPE AND METHODOLOGY: Our aim was to critically review the current evidence on how childhood mental disorders affect QoL. First, the major challenges in this research field are outlined. Then we present a systematic review of QoL in children and adolescents aged 0-18 years formally diagnosed with a mental and behavioural disorder, as compared to healthy or typically developing children or children with other health conditions. Finally, we discuss limitations of the current evidence base and future directions based on the results of the systematic review and other relevant literature.FINDINGS AND CONCLUSIONS: The systematic review identified 41 eligible studies. All were published after the year 2000 and 21 originated in Europe. The majority examined QoL in neurodevelopmental disorders, including attention-deficit hyperactivity disorder (k = 17), autism spectrum disorder (k = 6), motor disorders (k = 5) and intellectual disability (k = 4). Despite substantial heterogeneity, studies demonstrate that self-reported global QoL is significantly reduced compared to typical/healthy controls across several disorders and QoL dimensions. Parents' ratings were on average substantially lower, casting doubt on the validity of proxy-report. Studies for large diagnostic groups such as depressive disorders, anxiety disorders, (early onset) schizophrenia and eating disorders are largely lacking. We conclude that representative, well-characterized normative and clinical samples as well as longitudinal and qualitative designs are needed to further clarify the construct of QoL, to derive measures of high ecological validity, and to examine how QoL fluctuates over time and is attributable to specific conditions or contextual factors.
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| 28. |
- Jonsson, Ulf, 1974-, et al.
(författare)
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Can findings from randomized controlled trials of social skills training in autism spectrum disorder be generalized? : The neglected dimension of external validity.
- 2016
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Ingår i: Autism. - : SAGE Publications. - 1362-3613 .- 1461-7005. ; 20:3, s. 295-305
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Tidskriftsartikel (refereegranskat)abstract
- Systematic reviews have traditionally focused on internal validity, while external validity often has been overlooked. In this study, we systematically reviewed determinants of external validity in the accumulated randomized controlled trials of social skills group interventions for children and adolescents with autism spectrum disorder. We extracted data clustered into six overarching themes: source population, included population, context, treatment provider, treatment intervention, and outcome. A total of 15 eligible randomized controlled trials were identified. The eligible population was typically limited to high-functioning school-aged children with autism spectrum disorder, and the included population was predominantly male and Caucasian. Scant information about the recruitment of participants was provided, and details about treatment providers and settings were sparse. It was not evident from the trials to what extent acquired social skills were enacted in everyday life and maintained over time. We conclude that the generalizability of the accumulated evidence is unclear and that the determinants of external validity are often inadequately reported. At this point, more effectiveness-oriented randomized controlled trials of equally high internal and external validity are needed. More attention to the determinants of external validity is warranted when this new generation of randomized controlled trials are planned and reported. We provide a tentative checklist for this purpose.
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| 29. |
- Jonsson, Ulf, 1974-, et al.
(författare)
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Diagnosis-specific disability pension predicts suicidal behaviour and mortality in young adults : a nationwide prospective cohort study
- 2013
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Ingår i: BMJ Open. - : BMJ. - 2044-6055. ; 3:2
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Tidskriftsartikel (refereegranskat)abstract
- Objectives: Increasing rates of disability pension (DP), particularly owing to mental diagnoses, have been observed among young adults in Organisation for Economic Co-operation and Development (OECD) countries. There is a lack of knowledge about the health prognosis in this group. The aim of this study was to investigate whether DP in young adulthood owing to specific mental diagnoses or somatic diagnoses predicts suicidal behaviour and all-cause mortality.Design: A nationwide prospective cohort study.Setting: A register study of all young adults who in 2005 were 19-23 years old and lived in Sweden. Registers held by the National Board of Health and Welfare, Statistics Sweden and the National Social Insurance Agency were used.Participants: 525 276 young adults. Those who in 2005 had DP with mental diagnoses (n=8070) or somatic diagnoses (n=3975) were compared to all the other young adults in the same age group (n=513 231).Outcome measures: HRs for suicide attempt, suicide and all-cause mortality in 2006-2010 were calculated by Cox proportionate hazard regression models, adjusted for sex, country of birth, parental education and parental and previous own suicidal behaviour.Results: The adjusted HR for suicide attempt was 3.32 (95% CI 2.98 to 3.69) among those on DP with mental diagnoses and 1.78 (95% CI 1.41 to 2.26) among those on DP with somatic diagnoses. For the specific mental diagnoses, the unadjusted HRs ranged between 2.42 (mental retardation) and 22.94 (personality disorders), while the adjusted HRs ranged between 2.03 (mental retardation) and 6.00 (bipolar disorder). There was an increased risk of mortality for young adults on DP in general, but only those with mental DP diagnoses had a significantly elevated HR of completed suicide with an adjusted HR of 3.92 (95% CI 2.83 to 5.43).Conclusions: Young adults on DP are at increased risk of suicidal behaviour and preterm death, which emphasises the need for improved treatment and follow-up.
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| 30. |
- Jonsson, Ulf, 1974-, et al.
(författare)
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Internet-delivered psychological treatment as an add-on to treatment as usual for common mental disorders : A systematic review with meta-analysis of randomized trials
- 2023
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Ingår i: Journal of Affective Disorders. - : Elsevier. - 0165-0327 .- 1573-2517. ; 322, s. 221-234
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Forskningsöversikt (refereegranskat)abstract
- BACKGROUND: Psychological treatments for common mental disorders are increasingly being delivered remotely via the internet. Evidence suggests that internet-delivered cognitive behavioural therapy (iCBT) is superior to waitlist. However, the benefits are unclear of using this treatment modality as an add-on to treatment as usual (TAU) in regular healthcare.METHODS: The literature was systematically searched up to August 2021 for randomized trials of internet-delivered psychological treatments using TAU as the comparator. Eligible participants were diagnosed with depressive, anxiety, obsessive-compulsive, or trauma- and stress-related disorders. Outcomes of interest were symptoms, functioning, quality of life, healthcare utilization, and negative effects. Results were synthesized using random-effects meta-analyses. Quality of evidence was assessed using GRADE.RESULTS: The included studies evaluated iCBT for adults with depression (k = 9), depressive or anxiety disorders (k = 4), and post-traumatic stress disorder (k = 2) and were conducted in primary care or similar settings. For depression, low-certainty evidence suggested beneficial short-term effects on symptoms (g = -0.23; 95 % CI: = -0.37, -0.09), response rate (OR = 2.46; 1.31, 4.64), and remission (OR = 1.70; 1.19, 2.42;). The certainty of evidence was very low for long-term effects, other outcomes, and other disorders.LIMITATIONS: TAU varied across studies and was often insufficiently described.CONCLUSIONS: iCBT as a complement to usual care for adult with depression may result in a small incremental effect, which potentially could be clinically important. Studies are lacking for several common disorders and for children, adolescents, and the elderly. More robust studies of long-term effects are also needed, to better inform clinical decision-making.
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