The aim of this study was to examine whether the presence of risk alleles of the norepinephrine transporter gene (SLC6A2) polymorphisms is associated with differences in regional cerebral blood flow (rCBF) measured by 99mTc-HMPAO single photon emission computerized tomography in a Korean sample of ADHD.

The present study included 24 children with ADHD (9.5±2.4 years), consisting of 20 boys and 4 girls, aged 6-16 years. We investigated the G1287A and -3081(A/T) polymorphisms of the SLC6A2. The rCBF was compared between the ADHD subjects with and without risk alleles at the G1287A polymorphism and at the -3081(A/T) polymorphism. Image analyses were performed with voxelwise t-statistics using SPM2.

1. 1) The ADHD subjects with the A allele (risk allele) at the G1287A polymorphism showed reduced perfusion in the left middle frontal gyrus, left inferior parietal lobule, precuneus, right superior frontal gyrus, and right superior parietal lobule as compared with ADHD subjects without the A allele (p< 0.001).

2. 2) The ADHD subjects with the A allele at the G1287A polymorphism showed increased perfusion in the right middle frontal gyrus, right middle temporal gyrus, right superior temporal gyrus, right fusiform gyrus, right precentral gyrus, and right anterior lobe of cerebellum as compared with ADHD subjects without the A allele (p< 0.001).

3. 3) No significant perfusion differences were found between ADHD subjects with and without the T allele (risk allele) at the -3081(A/T) polymorphism.

Our findings suggest that the SLC6A2 G1287A polymorphism might exert differential effects on rCBF in children with ADHD.

Intellectual disability (ID) is defined as significantly subaverage intellectual functioning with deficits in adaptive behavior. For ∼40% of individuals, cause for disability remains unknown and these are categorized as idiopathic ID (IID). Various behavioral problems co-occur with ID and thus serotonergic neurotransmission, known to control emotion, mood and drive, has received immense attention. Synaptic serotonin (5-HT) level is primarily maintained by metabolizing enzyme MAOA and serotonin transporter (SLC6A4) which helps in reuptake of the neurotransmitter. Since functional genetic polymorphisms have a potency to affect activities of these proteins, in the present investigation polymorphisms in these genes (MAOA-u VNTR, rs6323, 5-HTTLPR and STIN2) have been analyzed in IID individuals associated with various behavioral problems.

Families (N=189) with IID probands were recruited following DSM-IV. After obtaining informed written consent for participation, peripheral blood was collected for isolation of genomic DNA used for PCR-based genotyping of target sites followed by family-based statistical analyses of data.

Significant association of MAOA rs6323 “T” allele with female IID (P=0.016) and a trend towards association with female IID patients exhibiting behavioral problems (P=0.046) was noticed. Non significant over transmission of the 5-HTTLPR “L” allele was also observed in female IID probands with behavioral problems (P=0.076). Synergistic epistatic interaction, with a sex-bias, was noticed between MAOA and 5-HTT (P< 0.05).

From the data obtained it could be summarized that serotonergic system may have some role in the etiology of behavioral problems of female IID individuals.

Travellers have historically suffered from discrimination in Ireland and their children have been marginalised as a result.

Review relevant online and hardcopy literature pertaining to special needs of Traveller Children and Adolescents

1. 1/ Assess/evaluate impact of socio-cultural context and environment upon treatment for psychiatric problems of Traveller children/adolescents in Ireland.

2. 2/ Assess/evaluate coverage of mainstream knowledge and understanding of Traveller family and community culture; categorisation of traveller children/adolescents affected by cultural/social misunderstandings; communication issues due to cultural differences with settled community; impact of sense of exclusion and/or discrimination upon traveller children/adolescents; role of ‘racism’ in tendency to believe traveller children/adolescents have mental problems more quickly than those from settled community; apprehension of involvement in treatment process; different expectations of traveller families from mainstream specialists with respect to treatment process and objectives.

Rigorous review of relevant and applicable hardcopy/internet literature in English since 2000 with particular emphasis on traveller children/adolescents in Ireland.

Problems associated with traveller children/adolescents generally multi-dimensional and require additional assistance through family and community oriented mental health services that respect and understand cultural values and way of life of the traveller population. Furthermore, awareness of discrimination and exclusion that has been and is suffered by the travelling population is essential in responding to psychiatric needs of traveller children/adolescents.

History of discrimination and exclusion together with lack of cultural understanding and empathy have often hampered effective treatment of traveller children/adolescents in Ireland. Need for greater involvement of travelling communities in psychiatric treatment process.

To determine the metacognitive deficits and behavioural and emotional regulation deficits among a group of children undergoing treatment for ADHD and to compare these with the hyperactivity/inattentive and behavioural assessments which contributed to the diagnosis.

Children and adolescents referred for ADHD assessment to a community Child & Adolescent Mental Health Service were assessed using clinical assessment, SNAP-IV, FTF and BRIEF rating scales. Comorbidities were assessed using clinical assessment and screened using the FTF. Clinical assessment included interview of parents, relatives and relevant school supervisors. The BRIEF scale was used to advise on specific executive function difficulties.

A total of 25 children and adolescents had complete assessments as part of routine clinical practice. There were particular groups which demonstrated elevated behavioural regulation difficulties; in the group with higher metacognition scores, groups were identified that had higher initiation and working memory deficits, higher planning and organisational deficits, or a mixture of all 5 items being elevated.

It is advantageous to complete an executive function assessment as part of ADHD assessment in clinical practice as it allows more detailed management advice to be given to teachers and support/special needs teachers and parents. It may also demonstrate successful patient-specific indicators of treatment response and outcome measures among those children who have high ADHD-related executive function deficits but whose core ADHD Hyperactive/Impulsive symptoms remain highly rated.

Childhood ADHD typically presents with comorbidites. Assessment tools for developmental screening vary greatly in length and complexitity, and parental preference has an impact on the usefulness of clinical tools in routine practice.

To determine among a group of children which ones may benefit from occupational therapy, speech and language therapy and educational progress re-assessment as part of routine clinical assessment for ADHD with the intention to improve service delivery.

Children were referred on a routine basis to a community clinic for ADHD assessment. SNAP-IV, FTF and BRIEF rating scales were administered. The FTF was used as a parent-rated screen for general development; it is a 200-item questionairre and includes sections on motor skills, speech and language skills and variety of other areas.

A review of freely available developmental questionaires was conducted. The FTF was introduced on a trial basis as a balance between the typical shorter scale of the SDQ and longer time needed for the DAWBA.

The parents of 25 children completed the FTF as part of routine clinical assessment for ADHD. Along with identifying groups of children who could benefit from further allied-healthcare assessment, the majority of parents had no difficulty with the length, although minority did report difficulty with understanding the language. Diagnoses were confirmed using SNAP-IV and clinical interview and assessment. Executive function scores were compared to FTF executive function screening scores.

Routine screening of developmental comorbidities may help with the development of patient -related outcome measures.

To examine the reasons for non attendance at clinic appointments, and to identify any ways in which these rates might be reduced.

We examined the records of those patients who, having consented to a referral to a child and adolescent psychiatry service, then either failed to attend any appointments, or who ceased to attend after having attended one or more appointments, but without being discharged, over an 18-month period. The parents of these children were contacted by telephone and a semi-structured interview was conducted to ascertain the reason in each case for defaulting on the appointment.

The reasons given by the parents of the patients for missing appointments included their opinion that the referral was unnecessary (31.8%), resolution of the problem which led to the referral (22.7%), the child refusing to attend (22.7%) and problems with clinicians (9%). In the majority of cases where the parent did not consider the referral necessary, the referral had been made by the child's school (71%), with the parent reporting that they had felt pressurised into consenting to the referral.

The high levels of non-attendance at clinics have serious implications, especially if it means that those in need of services are not accessing them. The factors which we have identified in this study are chiefly patient rather than service factors, which are likely to be related to socio-economic factors.

To evaluate relationships between alexithymia, somatic complaints and depressive symptoms in a non-clinical sample of school-aged Italian adolescents.

A mixed male-female sample of 168 school-aged adolescents with a mean age of 15.8 years was investigated with self-reported rating scales. Scales were: Toronto Alexithymia Scale (TAS-20), Beck Depression Inventory (BDI), Symptom Checklist 90 - Somatization Subscale (SCL-90-SOM), State-Trait Anxiety Inventory (STAI), Rosemberg Self Esteem Scale (RSES). Subjects were evaluated at three times: at the beginning (T0), at the middle (T1) and at the end (T2) of the scholastic year.

30 subjects (17.9%) were categorized as alexithymics and, overall, showed greater psychological distress than non-alexithymics. Alexithymia levels remained stable during the time as well as the number of alexithymics. Alexithymics were more suitable to develop more severe depressive symptoms. Results of a linear regression supported the notion that depressive symptoms at endpoint were significantly associated with female sex, DIF subscale of TAS-20 and higher SCL-90-SOM scores.

Alexithymia, depressive symptoms and somatic complaints appeared to be highly correlated in adolescence.

To assess subjective and objective sleep disturbances in an egyptan sample of children who have ADHD.

25 medication-free children with a clinical diagnosis of ADHD (21 boys and 4 girls; age range 5-12 years) recruited from outpatient psychiatry clinics- Tanta University Hospital, Egypt, were compared with 20 healthy matched controls.

All 25 children with ADHD and controls underwent a semi-structured psychiatric interview (Kiddie-SADS) and a behavior assessment by Conners Teacher Rating Scale (CTRS), Conners Parents Rating Scale (CPRS), and Swanson, Nolan and Pelham Rating Scale (SNAP-IV). The demographic, clinical and psychiatric information of all children was collected from the histories reported by the parents. All patients and control were administered a sleep questionnaire before undergoing nocturnal video-polysmography.

Parents reported a wide range of frequently occurring sleep disturbances in their children. Objective sleep measures revealed increase of rapid eye movement (REM) sleep latency and a decrease of REM sleep percentage, and decreased duration of sleep in children diagnosed with ADHD (p < 0.01). No significant correlations between objective sleep measures and clinical symptoms were found.

ADHD is associated with specific sleep alterations. The results stress the need for clinicians to routinely screen for the presence of sleep disorders, and found to future evidence-based guidelines on the management of sleep disturbances in children with ADHD.

The main purposes of this work are: recognition of presence of anxiety disorders in children and adolescents referred to our unit; comparison with other disorders; their type and spread; age of symptoms beginning; age of referrals, eventual differences in gender; source of referral and the scale of drop-out.

Data are collected from 1110 our referred cases; evaluated and treated in our service 2001-2009 year. We use the retrospective method to review our work. Data processing is done with Excel program.

From our 1110 referred cases assessed and treated in our unit we found 224 cases with one anxiety disorder. Anxiety disorders occupied the first place with 20, 18% of all cases; 51, 33% are males and 48, 61% females. In 85 from 224 cases accounted starting time of symptoms and find age 12, 25 year.In the sample of 224 cases with anxiety disorders the most prevalent is ASD with 33%, GAD 18%, Panic disorder 11%, etc. In 39% of cases the source of referral are family doctors/GP. The percentage of drop-out is 63%, where approximately 42, 25% terminated assessment or treatment after the first session. In 31, 69% of cases we use one medicament.

Anxiety disorders are among the most presented disorders in our unit. More diagnosed cases are males than females. Age group 0-6 year remains after age groups 7-12 and 13-18 years. Acute stress disorders dominated Generalized Anxiety Disorder and Panic Disorder.

Several clinical and neuroimaging studies suggest developmental lag in children with ADHD, which normalizes in late adolescence. However, studies using dimensional behavioral and neuropsychological assessment point to the persistent nature of deficits.

Two hundred five children with diagnosis of ADHD (187 boys, 18 girls; age 10.9±2.7) and 155 healthy controls (80 boys, 75 girls; age 10.3±2.3) were recruited. Both (unmedicated for 48 hours) patients and healthy controls were assessed with Continous Performance Test (CPT).

Patients with ADHD made more errors and less hits than healthy control children, respectively (19.9±17.4 vs. 16.0±16.2; p=0.02) and (38.0±8.6 vs. 41.4±6.2; p< 0.001). In early school age (7-9 years) children with ADHD performed worse than healthy children in terms of reaction time, number of errors and number of hits, respectively (864.9±111.0 vs. 799.9±116.2; p< 0.001), (32.7±20.2 vs. 23.4±19.6; p< 0.001), (33.1±9.0 vs. 39.0±6.1; p< 0.001). In older school age (10-12 years) and in adolescence (13-17 years) significant differences were observed only in number of hits, respectively (40.3±7.5 vs. 43.0±6.0; p=0.002) and (41.3±6.7 vs. 44.9±2.0; p=0.03).

Young children with ADHD may show more pervasive cognitive deficits, than older children and adolescents. More specific neuropsychological dysfunction may be a trait of ADHD patients, irrespectively of age. These results may suggest existence of several attentional systems, which mature in different developmental periods.

Polymorphisms in dopamine transporter gene (DAT1) has been associated with ADHD in previous studies. Some data point also to the role of DAT1 gene in cognitive functions, such as attention, affecting ADHD phenotype.

Two hundred five children with diagnosis of ADHD (187 boys, 18 girls; age 10.9±2.7) and 155 healthy controls (80 boys, 75 girls; age 10.3±2.3) were recruited. DAT rs463379 SNP intron polymorphism was genotyped. Both (unmedicated for 48 hours) patients and healthy controls were assessed with modified Stroop Interference Test (SIT).

: Due to low number of patients with CC genotype, in analysis we combined CC and GC genotypes. In patients GG compared to CC + GC genotype was associated with lower number of errors in part A ST (2.5±3.3 vs. 4.1±4.7; p=0.01). In part B of SIT, controls and patients with GG performed better (made less errors) than individuals with GC and GG genotypes; respectively (0.4±0.7 vs. 0.5±0.9 vs. 1.3±1.0; p=0.02); (1.0±1.4 vs. 2.0±3.3; p=0.03). Part C of SIT was performed better (less errors and shorter time) in patients with GG genotype vs. patients with other genotypes, respectively (139.9±48.0 vs. 166.2±67.6; p=0.009); (6.8±5.6 vs. 10.1±8.5; p=0.009).

We observed association between polymorphism in intron of DAT1 gene and performance in SIT. GG genotype of rs463379 SNP may be related to better cognitive functioning (better inhibition) in patients with ADHD. This may suggest the role of inhibition as intermediate variable between genotype and clinical picture of ADHD.

The transition from a child and adolescent to an adult mental health service is necessary for young people whose mental health problems are likely to be both severe and enduring.

Adolescents between the ages of 10 and 20 make up 13-15% of the total population of the UK and they form a significant social group with major health needs.

The issue of concern is that some young people fail to make the transition, usually for reasons of service design, configuration and ethos.

The Trust transition protocol was developed to ensure that young people with continuing mental health problems, are effectively supported during the transition from child and adolescent mental health services (CAMHS) to adult mental health services(AMH) or other adult services.

To determine the compliance with trust guidelines in transfer of care from CAMHS to Adult mental health.

Consider practical and administrative issues that come up when implementing the current protocol.

Review of case notes of clients transferred to AMH between March 08 - July 09.

12 cases identified

All transfer had detailed written referral letter.In three-quarters of cases a care coordinator in AMH was allocated within 2-3 weeks of the referral, following which a formal transfer meeting took place in 75% of cases and during the transfer any crisis was managed by the CAMHS team.

GP & CMHT received a detailed discharge letter in majority of cases.However only 1/2 of cases had a planning meeting, and attendance at meetings was incomplete.

The issue of school attendance is currently the focus of intense activity in Schools & Local Educational Authorities in England. The latest figures from the Department for Schools, Children and Families shows the overall absenteeism as 6.26%, in England. It is thought approximately 1 to 5 percent of all school-aged children have school refusal (Fremont, 2003) and is one of the reason of School non attendance.

To investigate if the current practice regarding the assessment and management of school refusal is compliant with the local CAMHS School refusal protocol.

20 case notes of clients diagnosed with anxiety based school refusal were reviewed against standards

Majority (80%) of the patients attended their first CAMHS Clinic during which evaluations of Child (100%), family (100%) & school factors (70%) contributing to School refusal was carried out. We found anxiety disorders (83%) & depression (66%) as the main contributing child factors. We also found that nearly half of the children had parental mental illness as a signification contributory factor.

Following the initial assessment, school reports including attendance were requested in 84% of the cases. Unfortunately 33% of the patients who attended the 1st clinic did not attend further appointments. All the patients (67%) were offered gradual return to school, attendance at pupil referral unit and home tuition.25% were offered family therapy and 16% of the patients have their parents referred to the adult mental health unit. Individual works including behavioural and cognitive approach was undertaken in 42% of the cases.

The objective of this presentation is to present the experience from the first year of operation of the Specialized Outpatient Unit for Internet and PC Addiction created in the Department of Child and Adolescent Psychiatry of the Hippokration General Hospital of Thessaloniki, Greece.

We present data from the first 40 adolescents who attended our service. Demographics and PC / Internet usage statistics are presented along with final diagnosis and treatment where it was deemed appropriate, both for Internet addiction disorder but also any co-morbid psychiatric disorder. We describe the diagnostic tests that are employed and their appropriateness for this goal and the therapeutic methods including psychotherapy (a sixteen session CBT protocol) and pharmacotherapy. Recommendations for effectively setting up similar services are given.

All cases involved teenage boys (mean age 15 yrs) who abused the Internet primarily to play on-line games. In all cases it was the parents who initiated contact with our Unit. In 75% of the cases the primary concern was addiction to the Internet per se while in 25% of the cases it was the drop in school achievement that prompted the parents to seek a possible explanation in excessive Internet use.

During the first year of operations the Unit has treated with success a variety of cases of Internet addiction disorder and made an effort to alert the public to the new phenomenon. A need for similar services is becoming evident throughout Europe as they have already proliferated in Asia.

To determine the differential impact of gender and age on pathological internet use (PIU) in the island of Kos, birthplace of Hippokrates and cradle of Medicine.

We surveyed the entire teen population (aged 14-19) of the island of Kos for symptoms of Internet addiction using Young's brief diagnostic questionnaire (YDQ) and an expanded demographics questionnaire. The sample consisted of 1221 adolescents, 587 male and 634 females, with a similar age distribution among the sexes.

One-hundred fourteen teens (11,3% of Internet users) were classified as possibly addicted to the Internet. Results indicate that gender plays a more significant role than age in Internet abuse; there is a distinct pattern among the sexes with the girls scoring lower scores in the YDQ in all ages (chi square=22.758, p< .001) with a marked difference in the 17-19 age range. Although the symptoms of PIU in girls subside in that age range, boys’ symptoms increase dramatically. Furthermore boys in that age range with higher YDQ scores report a subjective feeling of happiness, showing that PIU can be ego-syntonic. Usage patterns of those Internet users reporting heavier use are analyzed and presented graphically.

The discontents of modern civilization have spread to the furthermost corner of Europe, an island isolated from the continent during winter time. Results indicate that gender tends to heavily mitigate the effect of age on Internet abuse, with females being only transiently affected as their scores tend to fall dramatically with the onset of adult life.

To investigate the effect of perinatal depression on birth weight, head circumference, length and infant behaviour in a group of Pakistani women living in the Greater Manchester area of the United Kingdom.

Using a prospective cohort design British Pakistani women were screened using the Edinburgh Postnatal Depression Scale (n=714), the Life events and Difficulty Schedule was used to measure social stress and the Schedule for Clinical Assessment in Neuropsychiatry interview to confirm the diagnosis of depression. Details of birth weight and height were taken from hospital records. Physical and cognitive development of the infants using the Bayleys Scale of Infant Development (BSID-111) was assessed at 6 months postnatal.

There was no significant difference in birth weight (p=0.0948) and head circumference (p=0.75) at baseline or at 6 months between the two groups. The length of the infants of depressed mothers at 6 months was significantly less (p=0.02) than the infants of non depressed mothers. There was also a significant difference between the two groups in adaptive behaviour in leisure (p=0.043) and health & safety (p=0.049).

Infants of depressed British Pakistani mothers are not more likely to weigh less at birth or 6 months when compared to infants of non depressed mothers. However they are more likely to be shorter at 6 months and score lower on the BSID on leisure and health & safety areas of adaptive behaviour.

It is well known that between two thirds and three fourths of children with autism also have intellectual disability. Some of these children were not diagnosed as to have autism due to diagnostic overshadowing between autism and severe forms of intellectual disability.

The objective of this research was to determine the capability of autism index (AI) to correctly identify individuals who have been already diagnosed as having autism.

The sample consisted of 64 participants with moderate, severe and profound intellectual disabilities who have been previously determined to meet DSM-IV-TR criteria for autism spectrum disorder. Autism index was derived by Gilliam Autism Rating Scale (GARS-2).

It was revealed that AI was very high in 39 (60.9%) participants meaning that they were very likely to have autism according to GARS-2. In addition, probability of autism in 18 (28.1%) participants was labeled as “possibly”. AI failed to detect 7 children with autism spectrum disorders.

Sensitivity of AI is quite acceptable (88.9%) providing all children with scores higher than 69 (possibly and very likely as having autism) are considered to have autism spectrum disorder.

Obsessive compulsive disorder is a separate diagnostic entity, but it occurs in a number of other psychopathological entities.

We will present 22-years old adolescent. Early psychomotoric development was ordinary. Because of father's insisting, and against his own will, the patient has intensively played tennis since the age of six until his seventeenth. He was achieving good results but the father was constantly objecting that he is not showing enough fight spirit. When he was seventeen, after verbal conflict with father, he broke his racket and he stopped playing tennis.His father continued to play tennis and “everything is infected with earth from tennis court”. He hasn’t achieved emotional relationship, social contacts with peers are insufficient. At the age of twenty he has looked for psychiatric help, in order to get acknowledgment that he needs “peace for study” which he couldn’t get from his parents because he has constantly needed to clean.

Of this case report is to show obsessive compulsive actions as a defense from psychotic decompensation.

Psychiatric interview, mental status examination, psychological testing, EEG.

In the April, 2008 he has been hospitalized because his mental condition was worse due to suicidality. In clinical picture compulsions were dominant (throughout the nights he was cleaning the house, he has given away all the cloths in orange color, he has even “get rid of” his hamster because it was orange). He was tense, elevated mood, outdistanced and erotized.

Obsessive compulsive actions helped our patient to delay psychotic decompensation.