Gender dysphoria (GD) in children and adolescents is a condition that is characterized by an incongruence between the assigned and experienced gender. Despite the diversity in clinical presentation, ...literature demonstrates that GD might lead to poor mental health and high rates of co-occurring psychopathology. Due to the overlap of physical aspects as well as psychological needs in these children, a multidisciplinary approach is highly desirable. The aim of this narrative review is to give an overview of recent literature on several topics relevant in this domain. Guidelines on psychological counseling and hormonal treatment are given and challenging topics subject to controversy are explained. Furthermore, attention is drawn to the risks and protective factors in psychological functioning, including the growing evidence of a frequent co-occurrence with Autism Spectrum Disorder. Finally the psycho-sexual development in these children, the impact on fertility and fertility preservation are discussed.
Research on gender variant children and adolescents has stirred debate on the increased amount of referrals, the sex ratio in referrals, the impact of trans care on their psychological well-being, ...and the amount of children/adolescents who stop treatment. This retrospective study includes the number of referrals, first contacts at the outpatient clinic and the amount of drop-outs between January 1
2007 to December 31
2016 from the sole Belgian Pediatric Gender clinic. Emotional and behavioral problems, measured by the Child Behavioral Checklist (CBCL) and the Youth Self-Report (YSR), were screened. The adolescents who ceased the counseling, were contacted for follow-up. We included 235 adolescents, referred to the clinic, and 177 (of 235) who had a first physical appointment with a psychologist. Almost one in four (24.5%) on the YSR and more than half (54.8%) on the CBCL fall within the clinical range on the total problem score. On the YSR, 40.4% reported having suicide thoughts and 32.1% reported self-harm behavior and/or at least one suicide attempt, all in the last six months. Five adolescents committed suicide. According to parents, more difficulties with peers predicts more emotional and behavioral problems (F(5, 36) = 3.539, p = 0.011). In this study group, 29 adolescents ceased the counseling, whereof 7 could be traced back in the adult gender clinic after 2016. Results are indicative of the need for mental support for trans youth and their families and moreover, highlight the need for longitudinal follow-up studies.
Abstract
Background
Over the last decades, adolescents’ sleep has deteriorated, suggesting the need for effective healthy sleep interventions. To develop such interventions, it is important to first ...gather insight into the possible factors related to sleep. Moreover, previous research has indicated that chances of intervention effectivity could be increased by actively involving adolescents when developing such interventions. This study examined psychosocial factors related to sleep in adolescents and investigated adolescents’ willingness to participate in the development of a healthy sleep intervention.
Methods
Nine focus group interviews were conducted with seventy-two adolescents (63.9% girls, 14.8 (± 1.0) years) using a standardized interview guide. Interviews were audio-recorded and thematic content analysis was performed using Nvivo 11.
Results
Adolescents showed limited knowledge concerning sleep guidelines, sleep hygiene and the long-term consequences of sleep deficiency, but they demonstrated adequate knowledge of the short-term consequences. Positive attitudes towards sleep were outweighed by positive attitudes towards other behaviors such as screen time. In addition, adolescents reported leisure activities, the use of smartphones and television, high amounts of schoolwork, early school start time and excessive worrying as barriers for healthy sleep. Perceived behavioral control towards changing sleep was reported to be low and norms about sufficient sleep among peers were perceived as negative. Although some adolescents indicated that parental rules provoke feelings of frustration, others indicated these have a positive influence on their sleep. Finally, adolescents emphasized that it would be important to allow students to participate in the development process of healthy sleep interventions at school, although adult supervision would be necessary.
Conclusion
Future interventions promoting healthy sleep in adolescents could focus on enhancing knowledge of sleep guidelines, sleep hygiene and the consequences of sleep deficiency, and on enhancing perceived behavioral control towards changing sleep. Interventions could also focus on prioritizing positive sleep attitudes over positive attitudes towards screen time, finding solutions for barriers towards healthy sleep and creating a positive perceived norm regarding healthy sleep. Involving adolescents in intervention development could lead to intervention components that match their specific needs and are more attractive for them.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
This study examines the mediating role of sleep duration and sleep onset difficulties in the association of school pressure, physical activity, and screen time with psychological symptoms in early ...adolescents. Data were retrieved from 49,403 children (13.7 ± 1.6 years old, 48.1% boys) from 12 countries participating in the World Health Organization (WHO) "Health Behaviour in School-aged Children" 2013/2014 study. A validated self-report questionnaire assessed psychological symptoms (feeling low, irritability or bad temper, feeling nervous), school pressure, physical activity (number of days/week 60 min moderate-to-vigorous), screen time, sleep duration on week- and weekend days, and perceived difficulties in getting asleep. Multilevel mediation analyses were conducted. School pressure and screen time were positively associated with psychological symptoms, whereas physical activity was negatively associated. With the exception of sleep duration in the association between physical activity and psychological symptoms, all associations were significantly mediated by sleep duration on week- and weekend days and sleep onset difficulties. Percentages mediated ranged from 0.66% to 34.13%. This study partly explains how school pressure, physical activity, and screen time are related to adolescents' psychological symptoms. Future interventions improving adolescents' mental well-being could target schoolwork, physical activity, and screen time, as these behaviours are directly and indirectly (through sleep) related to psychological symptoms.
Adolescents' sleep deteriorated over the last decades, urging the need to develop effective interventions. Using participatory action research (PAR) is a promising and unique approach to target ...adolescents' sleep. This study aims to describe the process and results of combining PAR and intervention mapping (IM) to guide future researchers on developing and planning of the implementation and evaluation of interventions promoting healthy sleep in adolescents.
In each of three intervention schools (two with general and technical education and one with technical and vocational education), an action team including adolescents (age 13- 15 years, n=max. 12) and a researcher was composed to develop and plan the intervention. During weekly sessions (n=ranging from 23 to 34 per school), the action team went through the six steps of IM. A short PAR was performed with parents (n=7) to develop parental intervention components.
Combining PAR and IM resulted in interventions focusing on the importance of healthy sleep, regular sleep patterns and associated behaviors: screen behaviors, physical activity, dietary behavior and relaxation. Several differences in the participatory process (i.e. more guidance needed during brainstorms in the vocational/technical school) and developed intervention (i.e. less intrusive intervention components in the vocational/technical school) were observed between schools.
Combining PAR with IM resulted in more extensive interventions than other existing school-based sleep interventions. Future studies should investigate whether a participatory developed sleep intervention could be transferred to another setting using a shorter participatory process.
Enuresis, particularly in children during sleep, can be a debilitating condition, affecting the quality of life of the child and his or her family. The pathophysiology of nocturnal enuresis, though ...not clear, revolves around the inter-related mechanisms of overactive bladder, excessive nocturnal urine production, and sleep fragmentation. The first mechanism is more related to isolated nocturnal voiding, whereas the latter two are more related to nocturnal enuresis, in which circadian variations in arginine vasopressin hormone play a key role. A successful treatment would depend upon appropriately addressing the key factors precipitating nocturnal enuresis, necessitating an accurate diagnosis. Thus, advancements in diagnostic tools and treatment options play a key role in achieving overall success. This review summarizes recent advances in understanding the pathophysiology of nocturnal enuresis, diagnostic tools, and treatment options which can be explored in the future.
Purpose The relation between sleep and nocturnal enuresis has been an area of discussion for many years. Children with enuresis are generally believed to have sleep that is too deep with decreased ...arousability. We investigated sleep characteristics in children with refractory nocturnal enuresis. Materials and Methods Nine girls and 20 boys between 5 and 19 years old (mean ± SD age 12.1 ± 2.7) diagnosed with desmopressin dependent (14) and/or resistant (15) nocturnal enuresis and nocturnal polyuria underwent a standardized investigation protocol, including 1 night of polysomnography. Two age groups of 4 boys and 2 girls 5 to 9 years old, and 16 boys and 7 girls 10 to 19 years old were compared to previously defined controls, including 5 boys and 2 girls 5 to 9 years old and 7 boys and 2 girls 10 to 19 years old. Five to 9 and 10 to 19-year-old controls had a mean of 4.2 ± 1.5 and 3.3 ± 0.6 periodic limb movements per hour of sleep, respectively. The total number of arousal-awakenings during sleep was 21.6 ± 8.1 at ages 5 to 9 years and 21.7 ± 12.8 at ages 10 to 19. Results All except 1 patient had greater than 5 periodic limb movements per sleep hour. The younger and older age groups had a mean of 18.6 ± 5.7 and 18 ± 7.8 periodic limb movements per sleep hour, respectively. Total arousal-awakenings were also increased at 86.7 ± 58.1 and 73.8 ± 34.8, respectively. Statistical differences were calculated with the Mann-Whitney U test in controls vs the study population for periodic limb movements and in the 2 age groups for arousal-awakening (p = 0.003 and <0.001, respectively). Conclusions Preliminary data indicate a high incidence of periodic limb movements in sleep at night in children with refractory nocturnal enuresis and increased cortical arousability, leading to awakening.
Background
Marfan syndrome (MFS) is an inherited connective tissue disorder characterized by ectopia lentis, aortic root dilation and dissection and specific skeletal features. Obstructive sleep ...apnea (OSA) in MFS has been described earlier but the prevalence and its relation with the cardiovascular risk is still controversial. This study aimed to further investigate these aspects.
Methods
In this prospective longitudinal study, we performed an attended polysomnography in 40 MFS patients (60% women, 37 ± 12.8 years) and evaluated several cardiovascular parameters through echocardiography, resting electrocardiogram, 24 hr‐Holter monitoring and serum NT‐ProBNP measurements.
Results
We found that OSA was present in 42.5% of the patients and that higher body mass index was the most important factor associated with the presence of OSA. We observed that overweight was present in 27.5% of the patients in the whole cohort and in 55.6% if >40 years. Furthermore, when evaluating the impact of OSA on the cardiovascular system, we observed that patients with OSA tended to have higher systolic blood pressure, larger distal aortic diameters and a higher prevalence of ventricular arrhythmia. These differences were, however, not significant after adjusting for confounders.
Conclusions
Our study shows a high prevalence of OSA and a high prevalence of overweight in MFS patients. We found some trends between OSA and cardiovascular features but we could not establish a solid association. Our study, however might be underpowered, and a multicenter collaborative study could be very useful to answer some important open questions.
Obstructive sleep apnea (OSA) is present in 42.5% of Marfan syndrome (MFS) patients. Higher body mass index is an important factor contributing to OSA in MFS. Patients with OSA tend to have higher systolic blood pressure, larger distal aortic diameters, and a higher prevalence of ventricular arrhythmia
Abstract
Objective
The COVID-19 pandemic and associated quarantine measures highly impacted parental psychological well-being. Parents of children with chronic diseases might be specifically ...vulnerable as they already face multiple challenges to provide adequate care for their child. The research questions of the current study were twofold: (a) to examine whether parents of children with a chronic disease experienced more anxiety and depression compared to parents of healthy children and (b) to examine a series of risk factors for worsened well-being (i.e., depression, anxiety, and sleep problems), such as sociodemographic variables, COVID-19-specific variables (i.e., financial worries, living space, and perceived quality of health care), and parental psychological experiences (i.e., parental burn-out and less positive parenting experiences).
Methods
Parents of children with a chronic disease (i.e., the clinical sample; N = 599 and 507 for Research Questions 1 and 2, respectively) and parents of healthy children (i.e., the reference sample: N = 417) filled out an online survey.
Results
Findings demonstrated that the parents in the clinical sample reported higher levels of anxiety than parents in the reference sample. Analyses within the clinical sample indicated that COVID-19-specific stressors and parental psychological experiences were associated with higher levels of anxiety, depression, and sleep problems. Mediation analyses furthermore indicated that the association of COVID-19-specific stressors with all outcome measures was mediated by parental burn-out.
Conclusions
Parents of children with a chronic disease constitute a vulnerable group for worse well-being during the current pandemic. Findings suggest interventions directly targeting parental burn-out are warranted.
Opinion statement
This review describes the diagnosis and management of cataplexy: attacks of bilateral loss of muscle tone, triggered by emotions and with preserved consciousness. Although cataplexy ...is rare, its recognition is important as in most cases, it leads to a diagnosis of narcolepsy, a disorder that still takes a median of 9 years to be diagnosed. The expression of cataplexy varies widely, from partial episodes affecting only the neck muscles to generalized attacks leading to falls. Moreover, childhood cataplexy differs from the presentation in adults, with a prominent facial involvement, already evident without clear emotional triggers (‘cataplectic facies’) and ‘active’ motor phenomena especially of the tongue and perioral muscles. Next to narcolepsy, cataplexy can sometimes be caused by other diseases, such as Niemann-Pick type C, Prader Willi Syndrome, or lesions in the hypothalamic or pontomedullary region. Cataplexy mimics include syncope, epilepsy, hyperekplexia, drop attacks and pseudocataplexy. They can be differentiated from cataplexy using thorough history taking, supplemented with (home)video recordings whenever possible. Childhood narcolepsy, with its profound facial hypotonia, can be confused with neuromuscular disorders, and the active motor phenomenona resemble those found in childhood movement disorders such as Sydenham’s chorea. Currently, the diagnosis of cataplexy is made almost solely on clinical grounds, based on history taking and (home) videos. Cataplexy shows remarkable differences in childhood compared to adults, with profound facial hypotonia and complex active motor phenomena. Over time, these severe symptoms evolve to the milder adult phenotype, and this pattern is crucial to recognize when assessing the outcome of uncontrolled case series with potential treatments such as immunomodulation. Symptomatic treatment is possible with antidepressants and sodium oxybate. Importantly, management also needs to involve sleep hygiene advice, safety measures whenever applicable and guidance with regard to the social sequelae of cataplexy.
PDF
