Publications by authors named "Beate Oerbeck"

37 Publications

"Less stress": a pilot study on a cognitive behavioral treatment program for anxiety in children with autism spectrum disorders.

Scand J Child Adolesc Psychiatr Psychol 2021 25;9:30-40. Epub 2021 Apr 25.

Stavanger University Hospital, Division of Psychiatry, Stavanger, Norway.

Background: Comorbid anxiety disorders are prevalent in children with autism spectrum disorders (ASD), but only a minority receives adequate treatment for anxiety. Cognitive behavioral therapy (CBT) has been shown to be effective in treating anxiety disorders. The objectives of the present pilot study were to test the feasibility of the CBT program "Less stress" for comorbid anxiety disorders in children with ASD and explore whether an improvement in diagnostic outcomes for anxiety disorders and symptoms of anxiety was found after treatment.

Methods: Participants were ten children diagnosed with ASD and anxiety disorders (eight boys, mean age = 9.5 years, range 8 - 12 years). The "Less Stress" program includes three months of weekly treatment sessions followed by three monthly booster sessions. Five therapists participated. A standardized semi-structured diagnostic interview with the mothers was used to assess comorbid disorders. Child anxiety symptoms were measured with the Revised Child Anxiety and Depression Scale (RCADS).

Results: The therapists found the manual easy to use but adaptations were necessary, particularly shorter sessions due to frequent (n = 7) comorbid Attention-Deficit/Hyperactivity Disorder. The participants found the program useful and the parents noted that they had learned methods they could continue using after the end of the program.Eight of ten children completed the treatment. Seven of the eight completers benefited from the program. Five of those seven children were free from all anxiety disorders, while two had fewer anxiety disorders. On a group level, a significant mean reduction of anxiety symptoms (RCADS) was found after treatment.

Conclusion: The therapists found the "Less stress" program to be a feasible intervention in a sample of children with ASD and comorbid anxiety. The significant reduction of anxiety after treatment is promising, but a replication in a larger and more rigorous study is needed to investigate the effectiveness of the intervention.
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http://dx.doi.org/10.21307/sjcapp-2021-005DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC8077410PMC
April 2021

Youth with hearing loss: Emotional and behavioral problems and quality of life.

Int J Pediatr Otorhinolaryngol 2021 Jun 19;145:110718. Epub 2021 Apr 19.

Oslo University Hospital, Division of Mental Health and Addiction, Department of Research and Innovation, Norway; University of Oslo, Institute of Clinical Medicine, Norway.

Objectives: To compare parent- and self-reported emotional and behavioral problems and quality of life (QoL) among youth with hearing loss (HL) to norms, and to investigate possible associations between emotional and behavioral problems and QoL among youth with HL.

Methods: We used the Strengths and Difficulties questionnaire (SDQ) and the Inventory of Life Quality in Children and Adolescents (ILC) to measure emotional and behavioral problems and QoL in youth with HL (n = 317, ages 6-18), where 78% had bilateral HL, 22% unilateral HL, 16% had cochlear implants, and 59% conventional hearing aids.

Results: The youth with HL had significantly more parent-reported (but not self-reported) emotional and behavioral problems and poorer parent- and self-reported QoL than hearing youth. SDQ and ILC total scores were significantly correlated (-0.47 to -0.63). Conclusion Emotional and behavioral problems and poor QoL appear closely related in youth with HL, suggesting that attending to these problems may improve QoL.
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http://dx.doi.org/10.1016/j.ijporl.2021.110718DOI Listing
June 2021

Predictive validity of attention-deficit/hyperactivity disorder from ages 3 to 5 Years.

Eur Child Adolesc Psychiatry 2021 Mar 7. Epub 2021 Mar 7.

Division of Mental Health and Addiction, Oslo University Hospital, Pb. 4959 Nydalen, 0424, Oslo, Norway.

We investigated to what extent parent-rated attention-deficit/hyperactivity disorder (ADHD) and impairment at age 3 years predicted elevated ADHD symptoms at age 5 years, and whether teacher-rated ADHD symptoms improved these predictions. This study is part of the longitudinal, population-based Norwegian Mother, Father and Child Cohort Study. Parents of 3-year-old children (n = 1195) were interviewed about ADHD and impairment, and teachers rated child ADHD symptoms by the Strengths and Difficulties Questionnaire or the Early Childhood Inventory-4. At 5 years of age, the children (n = 957) were classified as ADHD-positive or -negative using Conners' Parent Rating Scale. Relying solely on parent-rated ADHD or impairment at age 3 years did moderately well in identifying children with persistent elevation of ADHD symptoms, but gave many false positives (positive predictive values (PPVs): .40-.57). A small group of children (n = 20, 13 boys) scored above cut-off on both parent-rated ADHD and impairment, and teacher-rated ADHD symptoms, although adding teacher-rated ADHD symptoms slightly weakened the predictive power for girls. For this small group, PPVs were .76 for boys and .64 for girls. Limiting follow-up to these few children will miss many children at risk for ADHD. Therefore, we recommend close monitoring also of children with parent-reported ADHD symptoms and/or impairment to avoid delay in providing interventions. Clinicians should also be aware that teachers may miss ADHD symptoms in preschool girls.
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http://dx.doi.org/10.1007/s00787-021-01750-5DOI Listing
March 2021

The Use of Antidepressants, Antipsychotics, and Stimulants in Youth Residential Care.

J Child Adolesc Psychopharmacol 2021 Feb 25. Epub 2021 Feb 25.

Norwegian National Advisory Unit on Concurrent Substance Abuse and Mental Health Disorders, Innlandet Hospital Trust, Hamar, Norway.

To assess the use of three commonly prescribed psychotropic medications in youth placed in residential care (RC). Participants were youth aged 0-20 years placed in RC institutions at least once during 2016. Data on filled prescriptions were taken from the Norwegian Prescription Database to compare the use of antidepressants, antipsychotics, and stimulants in RC with the age- and gender-adjusted general child population (GenPop) and how this co-varied with reasons for RC placement, age, and gender. One thousand eight hundred fifty-six children and adolescents were identified in RC, with mean age 14 (range 0-20 years), 46% girls, 81% ≥ 13 years. Among those, 423 or 23% used any of the 3 psychotropics, which was significantly more than the 3.7% in GenPop. The prevalence ratios RC/GenPop were 6.6 for antidepressants, 17.9 for antipsychotics, and 4.4 for stimulants. The median number of days per year for the dispensed defined daily doses varied from 8.3 to 244.0 for the different antipsychotics, indicating short time use for most of the people. Polypharmacy was not frequent in RC, as only 26% used ≥2 classes of medication, but still significantly more frequent than the 10% in GenPop. Youth placed in RC for serious behavior problems had significantly higher use of stimulants than those with other placement reasons. Psychotropics were not used below age 6 years, and although the use of antidepressants and antipsychotics overall increased with age, stimulants were mostly used by 6-16-year olds. The girl/boy ratio for any psychotropic medication use in RC was 1.4 (95% confidence interval [95% CI]: 1.1-1.6), significantly higher than the corresponding ratio in GenPop: 1.0 (95% CI: 0.9-1.0). The present findings do not necessarily suggest an overtreatment with medication in RC. However, the frequent short-term use of antipsychotics, presumably for non-psychotic symptoms, is a concern, as it may reflect that the youth are not provided with the recommended first-line psychological treatments.
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http://dx.doi.org/10.1089/cap.2020.0123DOI Listing
February 2021

Child and Parental Characteristics of Medication Use for Attention-Deficit/Hyperactivity Disorder.

J Child Adolesc Psychopharmacol 2020 09 14;30(7):456-464. Epub 2020 Jul 14.

Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway.

To investigate child and parental characteristics of medication use for attention-deficit/hyperactivity disorder (ADHD). Participants were part of the prospective population-based Norwegian Mother, Father and Child Cohort study (MoBa) ( = 114,500 children, 95,000 mothers, and 75,000 fathers). This cohort was linked to the Norwegian Prescription Database (NorPD) and the Norwegian Patient Registry (NPR) to compare child and parental characteristics in children medicated and not medicated for ADHD during years 2008-2013. One thousand seven hundred and sixty-four children (74% boys) with ADHD (International Classification of Diseases [ICD-10]: F90 and F98.8) were identified. One thousand three hundred and sixty-two (77%) used medication. Boys and girls did not differ in the use of ADHD medication (both 77%). Mean age at first prescription was 9 years in both boys and girls, and age at ADHD diagnosis was 8 years in medicated and unmedicated children. Significantly more hyperkinetic conduct disorders (F90.1), and significantly fewer with attention-deficit disorder (F98.8) were found among the medicated children compared to the unmedicated children. The medicated children also had a significantly lower global functioning (Child Global Assessment Scale). Child disruptive symptoms reported in the MoBa child age 3 year questionnaire were significantly higher in children who used medication compared to the nonusers ( = 2.2,  = 0.03), and group differences in ADHD symptoms at age 3 years were close to significant ( = 1.8,  = 0.07). Other preschool child and parental characteristics were not significantly different in the two groups. In this large birth cohort study, where a great majority of children with ADHD used medication, only child characteristics were significantly associated with the use of medication. We could not replicate previous findings suggesting that "environmental factors," such as parental education and psychopathology, drive medication use. The small differences between medicated and unmedicated children in this cohort study, where a majority used medication, might be due to strong established clinical practices where medication is offered as a treatment option, particularly for hyperkinetic conduct disorder in an egalitarian high-income society.
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http://dx.doi.org/10.1089/cap.2019.0019DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7475088PMC
September 2020

The Selective Mutism Questionnaire: Data from typically developing children and children with selective mutism.

Clin Child Psychol Psychiatry 2020 Oct 13;25(4):754-765. Epub 2020 Apr 13.

Regional Centre for Child and Adolescent Mental Health, Eastern and Southern Norway, Norway.

The core symptom of the anxiety disorder selective mutism (SM) is absence of speech in specific situations, such as at school. The most commonly used standardized instruments to assess speaking behavior are the parent-rated Selective Mutism Questionnaire (SMQ) and the teacher-rated School Speech Questionnaire (SSQ), scored from 0 to 3, indicating that speaking behavior never, seldom, often, and always occur. They were developed to assess severity of mutism and potential effects of treatment. However, prospective data on speaking behavior in typically developing children (TDs) are missing in the literature. The main aim of this study was to present data from TDs over time with previously reported data from children treated for SM, as a comparison. Participants were 64 children aged 3-9 years, 32 TDs who were a matched control group to 32 children with SM. At baseline, the mean SMQ and SSQ scores were ⩾2.5 in TDs and 0.5 in children with SM. The TDs did not show significant changes over time, while significantly increased speech was found in children with SM after treatment. Thus, our findings support the use of the SMQ/SSQ to assess baseline SM severity and to evaluate potential treatment effects in future studies.
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http://dx.doi.org/10.1177/1359104520914695DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7528533PMC
October 2020

The Use of Sleep Medication in Youth Residential Care.

J Child Adolesc Psychopharmacol 2020 06 23;30(5):335-341. Epub 2020 Jan 23.

Norwegian National Advisory Unit on Concurrent Substance Abuse and Mental Health Disorders, Innlandet Hospital Trust, Hamar, Norway.

To investigate the use of sleep medication and concomitant psychotropic medication in children and adolescents placed under residential care (RC). Participants were youth 0-20 years of age placed in RC institutions at least once during 2016. Data on filled prescriptions were taken from the Norwegian Prescription Database to compare the use of sleep medication in RC with the general child population (GenPop) and how it covaried with gender, age, reasons for RC placement, and concomitant use of other psychotropic medications (antidepressants, anxiolytics, antipsychotics, and psychostimulants). A total of 2171 youths were identified in RC at mean age 14 years (82% ≥ 13 years). Seventeen percent (371/2171) used sleep medications (melatonin 11%, alimemazine 7%, and benzodiazepines/z-hypnotics 2%) significantly more than the 2.3% who used in GenPop. The girl/boy ratio for medication use in RC was 1.8 (95% confidence interval [CI] = 1.5-2.2), not significantly different from the corresponding ratio in GenPop (1.4; 95% CI = 1.3-1.5). The use of sleep medication increased with age. When comparing reasons for placement in RC, medication use was particularly low among unaccompanied minor asylum seekers (2%). About half of the youths used concomitant psychotropic medication, with clear gender differences; girls used about twice as much antidepressants, anxiolytics, and antipsychotics, whereas boys used 1.3 times more psychostimulants. Youths in RC used more sleep medication and concomitant psychotropic medication than the GenPop, most likely reflecting the increased psychosocial strain and mental disorders reported in this population. Further studies of prevalence, assessment, and treatment of sleep problems in RC populations are warranted.
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http://dx.doi.org/10.1089/cap.2019.0172DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7310223PMC
June 2020

Screening with an ADHD-specific rating scale in preschoolers: A cross-cultural comparison of the Early Childhood Inventory-4.

Psychol Assess 2019 Aug 8;31(8):985-994. Epub 2019 Apr 8.

Division of Mental Health and Addiction.

The Early Childhood Inventory-4 (ECI-4) Hyperactivity-Impulsivity (HI) and Inattention (IA) subscales are screeners for attention-deficit/hyperactivity disorder (ADHD). There have been few studies of the screening properties of these subscales, particularly outside the United States. We investigated the classification accuracy of the parent and teacher versions of the HI and IA subscales and the cross-cultural validity of the cutoff values based on norms from a United States sample. The present study was part of the Norwegian Mother and Child Cohort Study. Parents and teachers rated boys (n = 332) and girls (n = 319) with the ECI-4 (mean Age 3.5 years). Interviewers who were blind to the ratings used the Preschool Age Psychiatric Assessment Interview to assign ADHD diagnoses. The ECI-4 HI and IA subscales showed acceptable accuracy in identifying ADHD in boys and girls (areas under the curve ranged from .67 to .85). In a multivariate regression analysis, the parent and teacher HI subscale scores significantly contributed to ADHD identification, but not the IA subscale scores. To achieve the necessary sensitivity to detect children with ADHD, lower cutoff levels than those specified by the United States ECI-4 norms were needed. For screening purposes, the parent and teacher ECI-4 showed acceptable accuracy in identifying preschoolers at risk for ADHD, and it may be sufficient to use the HI subscale scores. The suggested cutoff values provided by the United States ECI-4 norms had limited cross-cultural validity. (PsycINFO Database Record (c) 2019 APA, all rights reserved).
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http://dx.doi.org/10.1037/pas0000722DOI Listing
August 2019

The predictive validity of the Strengths and Difficulties Questionnaire for child attention-deficit/hyperactivity disorder.

Eur Child Adolesc Psychiatry 2019 May 15;28(5):625-633. Epub 2018 Sep 15.

Department of Public Health, Aarhus University, Aarhus, Denmark.

We need accurate screening measures for attention-deficit/hyperactivity disorder (ADHD) to ensure that children with the disorder are referred for assessment without raising concern for children with normal behaviour. The Strengths and Difficulties Questionnaire (SDQ) provides hyperactivity-inattention (HI), conduct, emotional and peer problem subscales and impact scores that may be used for screening. The aim of the study was to investigate the predictive validity of the Danish version of the parent SDQ HI subscale at the child age of 7 years for subsequent clinically diagnosed ADHD (age 8-15 years). Participants were part of the Danish National Birth Cohort (N = 51,096), and children with ADHD were identified through the Danish National Health registries (n = 943). Receiver operating characteristic analysis showed that the screening accuracy for the HI scores was good (area under the curve = .84). With Cox multivariate regression analysis, we found that SDQ HI subscale scores ≥ 7 with impact gave a nearly 14-fold [hazard ratio (HR) = 13.59] increased risk for ADHD, while conduct and emotional problems indicated low risk (HRs of 1.62 and 1.67, respectively). For the HI subscale to be a sensitive measure for ADHD, a low cutoff (4) was needed, but gave many false screening positives (PPV = .02). Although the diagnostic accuracy of the parent version of the SDQ HI subscale for predicting ADHD was good, our results question the feasibility of screening the general child population for ADHD with only the parent SDQ HI subscale.
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http://dx.doi.org/10.1007/s00787-018-1226-9DOI Listing
May 2019

Dr. Øvergaard et al. Reply.

J Am Acad Child Adolesc Psychiatry 2018 09;57(9):701-702

Oslo University Hospital, Norway.

We appreciate that Rimvall et al. read our latest article with interest. Early and accurate screening of attention-deficit/hyperactivity disorder (ADHD) is important for the remediation of the disorder. Clinicians' lack of time has been identified as a barrier to screening for behavioral disorders. A short screener such as the Strengths and Difficulties Questionnaire (SDQ) hyperactivity-inattention (HI) subscale holds the potential to improve detection of ADHD in preschoolers. Rimvall et al. make the point that diagnosing children with ADHD requires a broader assessment that includes information from parents, teachers, and the child. We agree, except to say that 3-year-old children are too young to provide information.
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http://dx.doi.org/10.1016/j.jaac.2018.05.021DOI Listing
September 2018

Updated developmental norms for fine motor functions as measured by finger tapping speed and the Grooved Pegboard Test.

Dev Neuropsychol 2018 29;43(7):551-565. Epub 2018 Aug 29.

c Department of Research , Vestfold Hospital Trust , Tønsberg , Norway.

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http://dx.doi.org/10.1080/87565641.2018.1495724DOI Listing
August 2018

Attention-Deficit/Hyperactivity Disorder in Preschoolers: The Accuracy of a Short Screener.

J Am Acad Child Adolesc Psychiatry 2018 06 7;57(6):428-435. Epub 2018 Apr 7.

Oslo University Hospital, Norway.

Objective: Although early and accurate screening is required for the remediation of attention-deficit/hyperactivity disorder (ADHD), possible gender differences have not been extensively studied. We examined the classification accuracy of the parent and preschool teacher version of the Strengths and Difficulties Questionnaire (SDQ) hyperactivity-inattention (HI) subscale in girls and boys.

Method: The study was part of the Norwegian Mother and Child Cohort Study (MoBa). Parents and preschool teachers rated a total of 238 girls and 276 boys (mean age 3.5 years) with the SDQ HI subscale. Blinded to the parent and teacher ratings, interviewers classified the children by ADHD diagnoses with the Preschool Age Psychiatric Assessment Interview.

Results: Areas under the curves for the parent HI subscale scores were good for both girls and boys (0.87 and 0.80, respectively). Preschool teacher classifications were fair (0.76) for girls and poor (0.62) for boys, a significant difference (p = .017). The subscale accurately identified children without ADHD at low parent scores (≤4), and fairly accurately identified ADHD at high scores (≥9), with maximum probabilities of finding true cases of 0.75 in girls and 0.55 in boys. Intermediate scores gave the best balance between sensitivity and specificity with low probabilities of correctly identifying children with ADHD.

Conclusion: The parental SDQ HI subscale was useful for screening for ADHD in preschool girls and boys. For preschool teachers, the subscale was useful for screening girls.
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http://dx.doi.org/10.1016/j.jaac.2018.03.008DOI Listing
June 2018

Neurodevelopmental disorders: prevalence and comorbidity in children referred to mental health services.

Nord J Psychiatry 2018 May 28;72(4):285-291. Epub 2018 Feb 28.

g Center for Child and Adolescent Mental Health , Eastern and Southern Norway , Oslo , Norway.

Background: Accurate prevalence rates of the neurodevelopmental disorders (ND) and comorbid conditions in child and adolescent mental health services (CAMHS) are essential for treatment planning and organization of health care. However, valid and reliable prevalence estimates from Nordic CAMHS populations are scarce, and the published findings vary.

Aims: To report prevalence rates of ND (attention-deficit hyperactivity disorder: ADHD, tic disorder: TD or autism spectrum disorder: ASD) and comorbid disorders by a validated diagnostic instrument in children referred to CAMHS outpatient clinics.

Methods: Parents of 407 consecutively referred children aged 7-13 years were interviewed with the semistructured interview schedule for affective disorders and schizophrenia, present and lifetime version (Kiddie-SADS-PL) at time of admittance.

Results: One or more ND was diagnosed in 226 children (55.5%; 69.9% boys): ADHD (44.5%; 68.5% boys); TD (17.7%; 77.8% boys) and ASD (6.1%; 76% boys). Among children with ND 70 (31.0%) had only one ND with no comorbid disorder, 49 (21.7%) had more than one ND (homotypic comorbidity) and 131 (58%) had a non-ND psychiatric disorder (heterotypic comorbidity). Anxiety disorders were the most frequently occurring heterotypic comorbidity in all three ND. Comorbid depressive disorder was associated with older age, and comorbid anxiety disorder with female gender.

Conclusion: In children referred to CAMHS, ND constitute the most frequently occurring group of disorders, with high rates of both homotypic and heterotypic comorbidity. This needs to be taken into consideration in health service planning and treatment delivery.
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http://dx.doi.org/10.1080/08039488.2018.1444087DOI Listing
May 2018

Treatment of selective mutism: a 5-year follow-up study.

Eur Child Adolesc Psychiatry 2018 Aug 22;27(8):997-1009. Epub 2018 Jan 22.

Centre for Child and Adolescent Mental Health, Eastern and Southern Norway, Oslo, Norway.

Selective mutism (SM) has been defined as an anxiety disorder in the diagnostic and statistical manual of mental disorders (DSM-5). Cognitive behavioral therapy (CBT) is the recommended approach for SM, but prospective long-term outcome studies are lacking. Reports from the children themselves, and the use of more global quality of life measures, are also missing in the literature. We have developed a school-based CBT intervention previously found to increase speech in a pilot efficacy study and a randomized controlled treatment study. Continued progress was found in our 1-year follow-up studies, where older age and more severe SM had a significant negative effect upon outcome. In the present study, we provide 5-year outcome data for 30 of these 32 children with SM who completed the same CBT for mean 21 weeks (sd 5, range 8-24) at mean age 6 years (10 boys). Mean age at the 5-year follow-up was 11 years (range 8-14). Outcome measures were diagnostic status, the teacher- and parent-rated selective mutism questionnaires, and child rated quality of life and speaking behavior. At the 5-year follow-up, 21 children were in full remission, five were in partial remission and four fulfilled diagnostic criteria for SM. Seven children (23%) fulfilled criteria for social phobia, and separation anxiety disorder, specific phobia and/or enuresis nocturna were found in a total of five children (17%). Older age and severity at baseline and familial SM were significant negative predictors of outcome. Treatment gains were maintained on the teacher- and parent questionnaires. The children rated their overall quality of life as good. Although most of them talked outside of home, 50% still experienced it as somewhat challenging. These results point to the long-term effectiveness of CBT for SM, but also highlight the need to develop more effective interventions for the subset of children with persistent symptoms.Clinical trials registration NCT01002196.
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http://dx.doi.org/10.1007/s00787-018-1110-7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6060963PMC
August 2018

Early Predictors of ADHD: Evidence from a Prospective Birth Cohort.

J Atten Disord 2020 10 9;24(12):1685-1692. Epub 2017 Mar 9.

Oslo University Hospital, Norway.

To identify preschool predictors of registered ADHD diagnoses and compare two ADHD rating scales, Child Behavior Checklist (CBCL) and Conners' Parent Rating Scale (CPRS-R:S). The Norwegian Mother and Child Cohort study (MoBa) is a prospective population-based cohort study. The sample were singletons whose mothers responded to MoBa questionnaires at child age 3 years ( = 57,986) and 5 years ( = 32,377). ADHD diagnoses were obtained from the Norwegian Patient Register. Predictors were child gender, development and symptoms, and maternal ADHD symptoms. We used Cox proportional hazard regression analyses. In all final models, ADHD symptoms at age 3 and 5 years predicted later ADHD: Age 3, CBCL: hazard ratio (HR) = 3.23 (CI [2.59, 4.02]); age 5, CBCL: HR = 10.30 (CI [7.44, 14.26]); and age 5 CPRS-R:S: HR = 5.92 (CI [4.95, 7.07]). The findings underline the importance of taking early parent-reported symptoms seriously. Both rating scales were useful for predicting ADHD.
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http://dx.doi.org/10.1177/1087054717696765DOI Listing
October 2020

ADHD, comorbid disorders and psychosocial functioning: How representative is a child cohort study? Findings from a national patient registry.

BMC Psychiatry 2017 01 17;17(1):23. Epub 2017 Jan 17.

Division of Mental Health and Addiction, Oslo University Hospital, Pb. 4959 Nydalen, 0424, Oslo, Norway.

Background: Cohort studies often report findings on children with Attention Deficit Hyperactivity Disorder (ADHD) but may be biased by self-selection. The representativeness of cohort studies needs to be investigated to determine whether their findings can be generalised to the general child population. The aim of the present study was to examine the representativeness of child ADHD in the Norwegian Mother and Child Cohort Study (MoBa).

Methods: The study population was children born between January 1, 2000 and December 31, 2008 registered with hyperkinetic disorders (hereafter ADHD) in the Norwegian Patient Registry during the years 2008-2013, and two groups of children with ADHD were identified in: 1. MoBa and 2. The general child population. We used the multiaxial International Classification of Diseases (ICD-10) and compared the proportions of comorbid disorders (axes I-III), abnormal psychosocial situations (axis V) and child global functioning (axis VI) between these two groups. We also compared the relative differences in the multiaxial classifications for boys and girls and for children with/without axis I comorbidity, respectively in these two groups of children with ADHD.

Results: A total of 11 119 children were registered with ADHD, with significantly fewer in MoBa (1.45%) than the general child population (2.11%), p < 0.0001. The proportions of comorbid axis I, II, and III disorders were low, with no significant group differences. Compared with the general child population with ADHD, children with ADHD in MoBa were registered with fewer abnormal psychosocial situations (axis V: t = 7.63, p < .0001; d = -.18) and better child global functioning (axis VI: t = 7.93, p < 0.0001; d = .17). When analysing relative differences in the two groups, essentially the same patterns were found for boys and girls and for children with/without axis I comorbidity.

Conclusions: Self-selection was found to affect the proportions of ADHD, psychosocial adversity and child global functioning in the cohort. However, the differences from the general population were small. This indicates that studies on ADHD and multiaxial classifications in MoBa, as well as other cohort studies with similar self-selection biases, may have reasonable generalisability to the general child population.
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http://dx.doi.org/10.1186/s12888-017-1204-7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5240379PMC
January 2017

Convergent and divergent validity of K-SADS-PL anxiety and attention deficit hyperactivity disorder diagnoses in a clinical sample of school-aged children.

Nord J Psychiatry 2016 Jul 2;70(5):358-64. Epub 2016 Feb 2.

a Center for Child and Adolescent Mental Health , Oslo , Norway ;

Background The Schedule for Affective Disorders and Schizophrenia for School Age Children, Present and Lifetime Version (K-SADS-PL) is a commonly used diagnostic interview both in research and clinical settings, yet published data on the psychometric properties of the interview generated diagnoses are scarce. Aims To examine the convergent and divergent validity of the Norwegian version of the K-SADS-PL current diagnoses of anxiety disorders and attention deficit hyperactivity disorder (ADHD). Method Participants were 105 children aged 7-13 years referred for treatment at child mental health clinics and 36 controls. Diagnostic status was determined based on K-SADS-PL interviews with the mothers. Child and mother reported child symptoms of anxiety on the Multidimensional Anxiety Scale for Children and teachers reported anxiety symptoms on the Teacher Report Form. Mother and teacher reported on symptoms of ADHD on the Disruptive Behavior Rating Scale. Results Rating scale data from multiple informants in a clinical sample and healthy controls supported the convergent and divergent validity of K-SADS-PL anxiety diagnoses combined, and, specifically, the diagnoses of separation anxiety disorder, social phobia, and specific phobia. Support was also observed for convergent and divergent validity of ADHD diagnoses, including the predominately inattentive subtype. Conclusion The K-SADS-PL generates valid diagnoses of anxiety disorders and ADHD.
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http://dx.doi.org/10.3109/08039488.2015.1125944DOI Listing
July 2016

Adult ADHD Symptoms and Satisfaction With Life: Does Age and Sex Matter?

J Atten Disord 2019 01 17;23(1):3-11. Epub 2015 Nov 17.

1 Oslo University Hospital, Norway.

Objective: To investigate adult ADHD symptoms and satisfaction with life, with a focus on age and sex differences.

Method: This study is based on parents in the Norwegian Mother and Child Cohort Study (MoBa). The Adult Self-Report Scale (ASRS-6) and Satisfaction With Life Scale (SWLS) scores were analyzed from 33,210 men and 41,983 women from young to middle adulthood.

Results: Mean ASRS total score was significantly higher in men, where 5.1% scored above cutoff, compared with 2.9% in women. Factor loadings supported the two ASRS subscales: Inattention (Inatt) and Hyperactivity-Impulsivity (HyImp) in both sexes. A significant decline with age was found on HyImp, whereas Inatt scores were reasonably stable in men and u-curved in women. High ASRS scores were associated with lower SWLS, but poor satisfaction with life was found only in high-scoring women.

Conclusion: Our findings suggest caution to age and sex when using the ASRS-6.
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http://dx.doi.org/10.1177/1087054715612257DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6291909PMC
January 2019

The use of medication in selective mutism: a systematic review.

Eur Child Adolesc Psychiatry 2016 Jun 9;25(6):571-8. Epub 2015 Nov 9.

Division of Mental Health and Addiction, Oslo University Hospital, Oslo, Norway.

Despite limited evidence, selective serotonin reuptake inhibitors (SSRIs) and monoamine oxidase inhibitors (MAOIs) are used to reduce symptoms of selective mutism (SM) in children unresponsive to psychosocial interventions. We review existing evidence for the efficacy of these medications, limitations of the literature, and resulting treatment considerations. Bibliographic searches were conducted in Medline, Embase, PsycInfo, Web of Science and Cochrane up to June 2015. Two reviewers independently sought studies of children with SM as primary psychiatric diagnosis, which reported response to medication treatment. Abstracts were limited to those reporting original data. Two reviewers independently assessed the ten papers reporting on >2 subjects regarding study design, key results, and limitations. Heterogeneity of designs mandated a descriptive summary. Symptomatic improvement was found for 66/79 children treated with SSRIs and 4/4 children treated with phenelzine. Only 3/10 studies had unmedicated comparison groups and only two were double-blinded. This review may be affected by publication bias, missed studies, and variability of outcome measures in included studies. Although there is some evidence for symptomatic improvement in SM with medication, especially SSRIs, it is limited by small numbers, lack of comparative trials, lack of consistent measures, and lack of consistent reporting on tolerability. The clinician must weigh this paucity of evidence against the highly debilitating nature of SM, and its adverse effects on the development of those children whose progress with psychosocial interventions is limited or very slow. Studies of optimal dosage and timing of medications in relation to psychosocial treatments are also needed.
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http://dx.doi.org/10.1007/s00787-015-0794-1DOI Listing
June 2016

Non-obsessive-compulsive anxiety disorders in child and adolescent mental health services--Are they underdiagnosed, and how accurate is referral information?

Nord J Psychiatry 2016 16;70(2):133-9. Epub 2015 Jul 16.

d Hanne Kristensen, Center for Child and Adolescent Mental Health, Eastern and Southern Norway , Oslo , Norway.

Background: Previous studies have reported low prevalence of non-obsessive-compulsive (OCD) anxiety disorders in child and adolescent mental health services (CAMHSs), suggesting that these disorders may go unrecognized. Possible reasons may be lack of routinely used standardized diagnostic instruments, and/or an under-reporting of anxiety symptoms in the referral information.

Aims: To examine the frequency of non-OCD anxiety disorders in referred children based on a standardized diagnostic interview, to compare the results with data from the Norwegian Patient Register (NPR), and to explore the correspondence between anxiety as a referral symptom and anxiety as a diagnosis, and the influence of heterotypic co-morbidity on this correspondence.

Methods: Parents of 407 consecutive referrals to CAMHS aged 7-13 years were interviewed with the semi-structured diagnostic interview Kiddie-SADS-PL at the time of admittance. Referral symptoms were collected from national referral forms.

Results: A total of 133 referred children (32.7%) met the criteria for a non-OCD anxiety disorder compared with about 5% in the NPR. Half of those who met diagnostic criteria for an anxiety disorder did not have anxiety as a referral symptom. Co-morbid ADHD or disruptive disorder was significantly associated with a lower probability of having anxiety as a referral symptom.

Conclusions: The use of a standardized diagnostic interview in consecutively referred children yielded significantly higher rates of anxiety disorders than the NPR prevalence rates. Co-morbid ADHD or disruptive disorder may contribute to the underdiagnosing of anxiety disorders. Diagnostic instruments covering the whole range of child psychiatric symptoms should be implemented routinely in CAMHS.
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http://dx.doi.org/10.3109/08039488.2015.1061053DOI Listing
July 2016

Emotional Lability in Preschoolers With Symptoms of ADHD.

J Atten Disord 2018 06 24;22(8):787-795. Epub 2015 Mar 24.

1 Oslo University Hospital, Norway.

Objective: The aim of this study was to examine occurrence of emotional lability (EL) in preschoolers with ADHD symptoms versus controls.

Method: The study was part of the Norwegian Mother and Child Cohort Study (MoBa) at the Norwegian Institute of Public Health. In the present study, 495 preschoolers were clinically examined. Symptoms of ADHD, anxiety, and oppositional defiant disorder (ODD) were measured with the Preschool Age Psychiatric Assessment Interview. An EL measure was obtained from the Emotional Control subscale of the Behavior Rating Inventory of Executive Function-Preschool Version (BRIEF-P), which parents and teachers completed.

Results: EL was significantly more frequent in the ADHD group compared with controls (25% vs. 7%, p < .001). By parent report, EL correlated significantly with ADHD-, anxiety-, and ODD symptoms. By teacher report, EL was significantly correlated only with hyperactivity-impulsivity.

Conclusion: EL appears identifiable in young preschoolers and was particularly associated with ODD in children with ADHD symptoms.
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http://dx.doi.org/10.1177/1087054715576342DOI Listing
June 2018

Factor structure of the Behavior Rating Inventory of Executive Functions (BRIEF-P) at age three years.

Child Neuropsychol 2016 9;22(4):472-92. Epub 2015 Jan 9.

d Division of Mental Health , Norwegian Institute of Public Health , Oslo , Norway.

The preschool period is an important developmental period for the emergence of cognitive self-regulatory skills or executive functions (EF). To date, evidence regarding the structure of EF in preschool children has supported both unitary and multicomponent models. The aim of the present study was to test the factor structure of early EF as measured by the Behavior Rating Inventory of Executive Function-Preschool version (BRIEF-P). BRIEF-P consists of five subscales and three broader indexes, hypothesized to tap into different subcomponents of EF. Parent ratings of EF from a nonreferred sample of children recruited from the Norwegian Mother and Child Cohort Study (N = 1134; age range 37-47 months) were subjected to confirmatory factor analyses (CFA). Three theoretically derived models were assessed; the second-order three-factor model originally proposed by the BRIEF-P authors, a "true" first-order one-factor model and a second-order one-factor model. CFA fit statistics supported the original three-factor solution. However, the difference in fit was marginal between this model and the second-order one-factor model. A follow-up exploratory factor analysis (EFA) supported the existence of several factors underlying EF in early preschool years, with a considerable overlap with the five BRIEF-P subscales. Our results suggest that some differentiation in EF has taken place at age 3 years, which is reflected in behavior ratings. The internal consistency of the BRIEF-P five clinical subscales is supported. Subscale interrelations may, however, differ at this age from those observed in the preschool group as a whole.
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http://dx.doi.org/10.1080/09297049.2014.992401DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4743590PMC
July 2016

Selective mutism: follow-up study 1 year after end of treatment.

Eur Child Adolesc Psychiatry 2015 Jul 30;24(7):757-66. Epub 2014 Sep 30.

Department of Mental Health and Addiction, Oslo University Hospital, Po box 4959, Nydalen, 0424, Oslo, Norway,

Cognitive behavioral therapy (CBT) is generally considered the recommended approach for selective mutism (SM). Prospective follow-up studies of treated SM and predictors of outcome are scarce. We have developed a CBT home and school-based intervention for children with SM previously found to increase speech in a pilot efficacy study and in a randomized controlled treatment study. In the present report we provide outcome data 1 year after having completed the 6-month course of CBT for 24 children with SM, aged 3-9 years (mean age 6.5 years, 16 girls). Primary outcome measures were the teacher rated School Speech Questionnaire (SSQ) and diagnostic status. At follow-up, no significant decline was found on the SSQ scores. Age and severity of SM had a significant effect upon outcome, as measured by the SSQ. Eight children still fulfilled diagnostic criteria for SM, four were in remission, and 12 children were without diagnosis. Younger children improved more, as 78% of the children aged 3-5 years did not have SM, compared with 33% of children aged 6-9 years. Treatment gain was upheld at follow-up. Greater improvement in the younger children highlights the importance of an early intervention.
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http://dx.doi.org/10.1007/s00787-014-0620-1DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4490179PMC
July 2015

A randomized controlled trial of a home and school-based intervention for selective mutism - defocused communication and behavioural techniques.

Child Adolesc Ment Health 2014 Sep 26;19(3):192-198. Epub 2013 Oct 26.

Centre for Child and Adolescent Mental Health, Eastern and Southern Norway, PO box 4623 Nydalen, Oslo, N-0405, Norway.

Background: Randomized controlled psychosocial treatment studies on selective mutism (SM) are lacking.

Method: Overall, 24 children with SM, aged 3-9 years, were randomized to 3 months treatment (n = 12) or wait list (n = 12). Primary outcome measure was the School Speech Questionnaire.

Results: A significant time by group interaction was found (p = .029) with significantly increased speech in the treatment group (p = .004) and no change in wait list controls (p = .936). A time by age interaction favoured younger children (p = .029). Clinical trail registration: Norwegian Research CouncilNCT01002196.

Conclusions: The treatment significantly improved speech. Greater improvement in the younger age group highlights the importance of an early intervention.
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http://dx.doi.org/10.1111/camh.12045DOI Listing
September 2014

Continuity in features of anxiety and attention deficit/hyperactivity disorder in young preschool children.

Eur Child Adolesc Psychiatry 2014 Sep 1;23(9):743-52. Epub 2014 Apr 1.

Division of Mental Health and Addiction, Oslo University Hospital, Pb. 4959 Nydalen, 0424, Oslo, Norway,

Anxiety disorders and attention deficit/hyperactivity disorder (ADHD) develop before school age, but little is known about early developmental pathways. Here we test two hypotheses: first, that early signs of anxiety and ADHD at 18 months predict symptoms of anxiety and ADHD at age 3½ years; second, that emotional dysregulation at 18 months predicts the outcome of co-occurring anxiety and ADHD at age 3½ years. The study was part of the prospective Norwegian Mother and Child Cohort Study (MoBa) at the Norwegian Institute of Public Health. The 628 participants were clinically assessed at 3½ years. Questionnaire data collected at 18 months were categorized into early behavioural scales of anxiety, ADHD, and emotional dysregulation. We investigated continuity in features of anxiety and ADHD from 18 months to 3½ years of age through logistic regression analyses. Anxiety symptoms at 3½ years were predicted by early signs of anxiety (Odds ratio (OR) = 1.41, CI = 1.15-1.73) and emotional dysregulation (OR = 1.33, CI = 1.15-1.54). ADHD symptoms at 3½ years were predicted by early signs of ADHD (OR = 1.51, CI = 1.30-1.76) and emotional dysregulation (OR = 1.31, CI = 1.13-1.51). Co-occurring anxiety and ADHD symptoms at 3½ years were predicted by early signs of anxiety (OR = 1.43, CI = 1.13-1.84), ADHD (OR = 1.30, CI = 1.11-1.54), and emotional dysregulation (OR = 1.34, CI = 1.13-1.58). We conclude that there were modest continuities in features of anxiety and ADHD through early preschool years, while emotional dysregulation at age 18 months was associated with symptoms of anxiety, ADHD, and co-occurring anxiety and ADHD at age 3½ years.
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http://dx.doi.org/10.1007/s00787-014-0538-7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4152619PMC
September 2014

Somatic symptoms in children with anxiety disorders: an exploratory cross-sectional study of the relationship between subjective and objective measures.

Eur Child Adolesc Psychiatry 2014 Sep 5;23(9):795-803. Epub 2014 Jan 5.

Centre for Child and Adolescent Mental Health, Eastern and Southern Norway, Nydalen, PO Box 4623, 0405, Oslo, Norway,

Symptoms of childhood anxiety disorders include activation of bodily stress systems to fear stimuli, indicating alterations of the autonomic nervous system (ANS). Self-reported somatic symptoms are frequently reported, while studies including objective measures of ANS are scarce and show inconsistent results. Even less studied is the relationship between subjective and objective measures of somatic symptoms in anxious children. Increased knowledge of this relationship may have relevance for treatment programmes for anxiety disorders. This cross-sectional study examined subjective and objective measures of ANS responsiveness in a clinical sample of children with anxiety disorders (7-13 years; n = 23) and in healthy controls (HC; n = 22) with equal distributions of gender and age. The subjective measure used was the Multidimensional Anxiety Scale for Children, which includes a subscale on somatic symptoms. The objective measures consisted of an orthostatic challenge (head-up tilt test), and an isometric muscular exercise (handgrip) while the participants were attached to the Task Force Monitor, a combined hardware and software device used for continuous, non-invasive recording of cardiovascular variables. The anxiety disorder group reported significantly more somatic symptoms than HCs (both by mother and child reports). In contrast, no relevant differences in cardiovascular variables were demonstrated between the anxiety group and HCs. Finally, there were no significant correlations between subjective and objective measures in either group. Because of the small sample size, the findings must be interpreted carefully, but the results do not support previous reports of functional alterations of the ANS in anxious children.
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http://dx.doi.org/10.1007/s00787-013-0512-9DOI Listing
September 2014

Associations between sleep problems and attentional and behavioral functioning in children with anxiety disorders and ADHD.

Behav Sleep Med 2014 5;12(1):53-68. Epub 2013 Mar 5.

a Research Department , Center for Child and Adolescent Mental Health, Eastern and Southern Norway.

This study examined associations between sleep problems and attentional and behavioral functioning in 137 children aged 7 to 13 years with anxiety disorders (n = 39), attention deficit hyperactivity disorder (ADHD; n = 38), combined anxiety disorder and ADHD (n = 25), and 35 controls. Diagnoses were made using the semistructured diagnostic interview Schedule for Affective Disorders and Schizophrenia for School-age Children-Present and Lifetime Version. Sleep problems were assessed using the Children's Sleep Habits Questionnaire, attention was measured by the Attention Network Test, and behavioral problems were measured by teacher ratings on the Achenbach System of Empirically Based Assessment, Teacher Report Form. Sleep problems were associated with reduced efficiency of the alerting attention system for all children and with increased internalizing problems in children with anxiety disorders.
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http://dx.doi.org/10.1080/15402002.2013.764525DOI Listing
February 2014

Persistence of sleep problems in children with anxiety and attention deficit hyperactivity disorders.

Child Psychiatry Hum Dev 2013 Apr;44(2):290-304

Centre for Child and Adolescent Mental Health, Eastern and Southern Norway, P.O. Box 4623, Nydalen, 0405, Oslo, Norway.

This study examines the persistence of sleep problems over 18 months in 76 referred children with anxiety disorders and/or attention deficit hyperactivity disorders (ADHD) and 31 nonreferred controls, and explores predictors of sleep problems at follow-up (T2) in the referred children. Diagnoses were assessed at initial assessment (T1) using the semi-structured interview Kaufman Schedule for Affective Disorders and Schizophrenia. Sleep problems were assessed using the Children's Sleep Habit Questionnaire at T1 and at T2. Persistence rate of total sleep problems in the clinical range was 72.4 % in referred children, and did not differ significantly between children with a T1 diagnosis of anxiety disorder (76.0 %), ADHD (70.6 %), anxiety disorder and ADHD (68.8 %) or nonreferred controls (50.0 %) The total sleep problems score at T1 significantly predicted the total sleep problems score at T2, whereas age, sex, parent education level and total number of life events did not.
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http://dx.doi.org/10.1007/s10578-012-0325-yDOI Listing
April 2013

Motor impairment in children with anxiety disorders.

Psychiatry Res 2012 Jun 3;198(1):135-9. Epub 2012 Mar 3.

Centre for Child and Adolescent Mental Health, Eastern and Southern Norway, Oslo, Norway.

This study examined the frequency and degree of motor impairment in referred children with anxiety disorders (AnxDs), compared with children with attention deficit/hyperactivity disorder (ADHD), children with comorbid AnxDs and ADHD, and nonreferred controls. All participants (n=141; 90 males, 51 females; mean age: 10 years, 1 month; range: 7-13 years) had an IQ greater than 70. Diagnoses of mental disorders were established using the Schedule for Affective Disorders and Schizophrenia for School-Aged Children (Kiddie-SADS). Motor ability was assessed using the Movement Assessment Battery for Children (M-ABC). We found that children with AnxDs exhibited significantly higher total impairment scores on the M-ABC than controls, but were not significantly different from children with ADHD or children with comorbid AnxDs and ADHD. All clinical groups exhibited similar profiles of motor impairment. A total of 19 (46%) children with AnxDs scored below the 5th percentile on the M-ABC, indicating that motor function is impaired in many children with AnxDs to a degree that probably interferes with their activities of daily living. These results support the notion that assessment of motor function is important in understanding the daily challenges of children with AnxDs.
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http://dx.doi.org/10.1016/j.psychres.2011.12.008DOI Listing
June 2012

Selective mutism: a home-and kindergarten-based intervention for children 3-5 years: a pilot study.

Clin Child Psychol Psychiatry 2012 Jul 18;17(3):370-83. Epub 2011 Aug 18.

Centre for Child and Adolescent Mental Health, Eastern & Southern Norway.

The aim was to examine the outcome of a multimodal treatment for selective mutism (SM). Seven children, aged three-five years, who were referred for SM were included. The treatment started at home and was continued at kindergarten for a maximum of six months, with predefined treatment goals in terms of speaking levels, from I ("Speaks to the therapist in a separate room with a parent present") through to VI ("Speaks in all kindergarten settings without the therapist present"). The outcome measures were the teacher-reported School Speech Questionnaire (SSQ) and the treatment goal obtained (I-VI) six months after the onset of treatment, and the SSQ and Clinical Global Impression Scale (CGI) at one-year follow-up. Six children spoke in all kindergarten settings (VI) after a mean of 14 weeks treatment. One child, with more extensive neuro-developmental delay, spoke in some settings only (V). The mean SSQ score was 0.59 (SD = 0.51) at baseline compared with 2.68 (SD = 0.35) at the six-month evaluation and 2.26 (SD = 0.93) at one-year follow-up. The mean CGI score at baseline was 4.43 (SD = 0.79) compared with 1.14 (SD = 0.38) at follow-up. Home- and kindergarten-based treatment appears to be promising.
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http://dx.doi.org/10.1177/1359104511415174DOI Listing
July 2012