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Gustafsson, Per A
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Publications (10 of 55) Show all publications
Wennberg, B., Janeslätt, G., Kjellberg, A. & Gustafsson, P. A. (2018). Effectiveness of time-related interventions in children with ADHD aged 9-15 years: a randomized contolled study. European Child and Adolescent Psychiatry, 27(3), 329-342
Open this publication in new window or tab >>Effectiveness of time-related interventions in children with ADHD aged 9-15 years: a randomized contolled study
2018 (English)In: European Child and Adolescent Psychiatry, ISSN 1018-8827, E-ISSN 1435-165X, Vol. 27, no 3, p. 329-342Article in journal (Refereed) Published
Abstract [en]

Specific problems with time and timing that affect daily routines, homework, school work, and social relations have been recognized in children with ADHD. The primary treatments for children with ADHD do not specifically focus on time-related difficulties. The aim of this randomized controlled study (RCT) was to investigate how multimodal interventions, consisting of training in time-processing ability (TPA) and compensation with time-assistive devices (TAD), affect TPA and daily time management (DTM) in children with ADHD and time difficulties, compared with only educational intervention. Thirty-eight children on stable medication for ADHD in the 9–15-year age range were randomly allocated to an intervention or a control group. The children’s TPA was measured with a structured assessment (KaTid), and the children’s DTM was rated by a parent questionnaire (Time-Parent scale) and by children’s self-reporting (Time-Self-rating). The intervention consisted of time-skill training and compensation with TAD. Data were analysed for differences in TPA and in DTM between the control and intervention groups in the 24-week follow-up. Children in the intervention group increased their TPA significantly (p = 0.019) more compared to the control group. The largest increase was in orientation to time. In addition, the parents in the intervention group rated their children’s DTM as significantly (p = 0.01) improved compared with the parents in the control group. According to the children, their DTM was not significantly changed. In conclusion, a multimodal intervention consisting of time-skill training and TAD improved TPA and DTM in children with ADHD aged 9–15 years.

Place, publisher, year, edition, pages
Springer, 2018
Keywords
Children, ADHD, Time perception, Time-assistive devices, Intervention
National Category
Occupational Therapy
Identifiers
urn:nbn:se:liu:diva-142298 (URN)10.1007/s00787-017-1052-5 (DOI)000427592600009 ()2-s2.0-85030099032 (Scopus ID)
Note

Funding agencies: Stiftelsen Sunnerdahls Handikappfond; Medical Research Council of Southeast Sweden Stiftelsen Probilia [FORSS-305331, FORSS-565411]; Habilitering Halsa, SLSO; Riksforbundet for Rorelsehindrade Barn och Ungdomar (RBU); Vardalstiftelsen Ideprovningsprojekt 

Available from: 2017-10-25 Created: 2017-10-25 Last updated: 2018-04-12Bibliographically approved
Gustafsson, B. M., Danielsson, H., Granlund, M., Gustafsson, P. A. & Proczkowska, M. (2018). Hyperactivity precedes conduct problems in preschool children: a longitudinal study.. BJPsych Open, 4(4), 186-191
Open this publication in new window or tab >>Hyperactivity precedes conduct problems in preschool children: a longitudinal study.
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2018 (English)In: BJPsych Open, E-ISSN 2056-4724, Vol. 4, no 4, p. 186-191Article in journal (Refereed) Published
Abstract [en]

Background: Externalising problems are among the most common symptoms of mental health problems in preschool children.

Aims: To investigate the development of externalising problems in preschool children over time, and the way in which conduct problems are linked to hyperactivity problems.

Method: In this longitudinal study, 195 preschool children were included. Latent growth modelling of conduct problems was carried out, with gender and hyperactivity at year 1 as time-invariant predictors.

Results: Hyperactivity was a significant predictor for the intercept and slope of conduct problems. Children with more hyperactivity at year 1 had more conduct problems and a slower reduction in conduct problems. Gender was a significant predictor for the slope of conduct problems.

Conclusions: Children with more initial hyperactivity have less of a reduction in conduct problems over time. It is important to consider the role of hyperactivity in studies of the development of conduct problems.

Declaration of interest: None.

National Category
Pediatrics Psychology (excluding Applied Psychology)
Identifiers
urn:nbn:se:liu:diva-153582 (URN)10.1192/bjo.2018.20 (DOI)29989010 (PubMedID)
Available from: 2018-12-20 Created: 2018-12-20 Last updated: 2018-12-20
Emilsson, M., Gustafsson, P. A., Öhnström, G. & Marteinsdottir, I. (2017). Beliefs regarding medication and side effects influence treatment adherence in adolescents with attention deficit hyperactivity disorder. European Child and Adolescent Psychiatry, 26(5), 559-571
Open this publication in new window or tab >>Beliefs regarding medication and side effects influence treatment adherence in adolescents with attention deficit hyperactivity disorder
2017 (English)In: European Child and Adolescent Psychiatry, ISSN 1018-8827, E-ISSN 1435-165X, Vol. 26, no 5, p. 559-571Article in journal (Refereed) Published
Abstract [en]

Adherence to attention deficit hyperactivity disorder (ADHD) treatment is important because, when untreated, it may have serious consequences with lifelong effects. In the case of adolescents on long-term medicine prescription, more knowledge is needed regarding adherence and factors influencing adherence, which was the purpose of this study. Adolescents (n = 101) on ADHD medication ≥6 months were administrated questionnaires at a monitoring appointment: Medication Adherence Report Scale (MARS), beliefs about medicines (BMQ) and the Brief Illness Perception Questionnaire (B-IPQ). Adherence was high, the mean value was 88% of the maximum MARS score, and correlated positively with the “BMQ-necessity-concerns differential” but negatively with “BMQ-concerns” and “BMQ-side effects”. Adolescents with more belief in the necessity of the medication, less concerns and less experience of side effects tended to be more adherent to medication prescription (“intentional non-adherence”), while “unintentional non-adherence” (forgetfulness) was associated with how much they perceived that their ADHD affected their lives. In a multiple regression model, the variance of MARS total (R2 = 0.21) and “intentional non-adherence” (R2 = 0.24) was explained by the “BMQ-necessity–concern differential” and “BMQ-experienced side effects”. The variance of “unintentional non-adherence” (R2 = 0.12) was explained by the “BMQ-necessity–concern differential” and “B-IPQ-consequences of ADHD”. In conclusion, adolescents on long-term medication reported good adherence, mainly influenced by more beliefs in the necessity versus concerns of the medications, less experienced side effects and more perceived consequences of ADHD. BMQ could be useful to identify risks of low adherence, which should be counteracted by partially gender-specific interventions.

Place, publisher, year, edition, pages
Springer, 2017
Keywords
Electron beam melting, IN718, microstructure, texture, hardness
National Category
Psychiatry
Identifiers
urn:nbn:se:liu:diva-132825 (URN)10.1007/s00787-016-0919-1 (DOI)000399701900007 ()27848023 (PubMedID)
Note

Funding agencies: Medical Research Council of Southeast Sweden [FORSS-466211]; "Child and Youth Studies" at the University West

Available from: 2016-11-30 Created: 2016-11-30 Last updated: 2018-04-18Bibliographically approved
Chermá, M. D., Josefsson, M., Rydberg, I., Woxler, P., Trygg, T., Hollertz, O. & Gustafsson, P. A. (2017). Methylphenidate for Treating ADHD: A Naturalistic Clinical Study of Methylphenidate Blood Concentrations in Children and Adults With Optimized Dosage.. European journal of drug metabolism and pharmacokinetics, 42(2), 295-307
Open this publication in new window or tab >>Methylphenidate for Treating ADHD: A Naturalistic Clinical Study of Methylphenidate Blood Concentrations in Children and Adults With Optimized Dosage.
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2017 (English)In: European journal of drug metabolism and pharmacokinetics, ISSN 0378-7966, E-ISSN 2107-0180, Vol. 42, no 2, p. 295-307Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: Methylphenidate (MPH), along with behavioral and psychosocial interventions, is the first-line medication to treat attention-deficit hyperactivity disorder (ADHD) in Sweden. The dose of MPH for good symptom control differs between patients. However, studies of MPH concentration measurement in ADHD treatment are limited.

OBJECTIVE: To describe blood and oral fluid (OF) concentrations of MPH after administration of medication in patients with well-adjusted MPH treatment for ADHD, and to identify the most suitable matrix for accurate MPH concentration during treatment.

METHODS: Patients were recruited from Child and Adolescent Psychiatry (CAP), General Psychiatry (GP), and the Department of Dependency (DD). Blood and OF samples were collected in the morning before MPH administration as well as 1 and 6 h after administration of the prescribed morning dose of MPH.

RESULTS: Fifty-nine patients aged between 9 and 69 years, 76 % males. The daily dose of MPH varied from 18 to 180 mg, but the median daily dose per body weight was similar, approximately 1.0 mg/kg body weight. The median MPH concentration in blood 1 and 6 h after the morning dose was 5.4 and 9.3 ng/mL, respectively. Highly variable OF-to-blood ratios for MPH were found at all time points for all three groups.

CONCLUSIONS: Weight is a reliable clinical parameter for optimal dose titration. Otherwise, MPH blood concentration might be used for individual dose optimization and for monitoring of the prescribed dose. Relying only on the outcome in OF cannot be recommended for evaluation of accurate MPH concentrations for treatment monitoring.

National Category
Health Sciences
Identifiers
urn:nbn:se:liu:diva-134701 (URN)10.1007/s13318-016-0346-1 (DOI)000405400500013 ()27220743 (PubMedID)
Note

Funding agencies: Swedish Medical Research Council [2009-4740]; Medical Research Council of Southeast Sweden [FORSS-12147, FORSS-155281]

Available from: 2017-02-23 Created: 2017-02-23 Last updated: 2018-04-19
Sikirica, V., Gustafsson, P. A. & Makin, C. (2017). Treatment Patterns among Children and Adolescents with Attention-Deficit/Hyperactivity Disorder with or without Psychiatric or Neurologic Comorbidities in Sweden: A Retrospective Cohort Study. Neurology and therapy, 6(1), 115-130
Open this publication in new window or tab >>Treatment Patterns among Children and Adolescents with Attention-Deficit/Hyperactivity Disorder with or without Psychiatric or Neurologic Comorbidities in Sweden: A Retrospective Cohort Study
2017 (English)In: Neurology and therapy, ISSN 2193-6536, Vol. 6, no 1, p. 115-130Article in journal (Refereed) Published
Abstract [en]

Attention-deficit/hyperactivity disorder (ADHD) is a common psychiatric disorder in children/adolescents and occurs frequently with psychiatric/neurologic comorbidities. The objective of this study was to assess the impact of psychiatric/neurologic comorbidities on pharmacotherapy patterns among patients with ADHD in Sweden.

Place, publisher, year, edition, pages
Springer, 2017
Keywords
ADHD; Adolescent; Attention-deficit/hyperactivity disorder; Child; Comorbidities; Pharmacotherapy; Retrospective cohort analysis; Sweden
National Category
Psychiatry
Identifiers
urn:nbn:se:liu:diva-146059 (URN)10.1007/s40120-017-0066-8 (DOI)28455812 (PubMedID)
Available from: 2018-03-28 Created: 2018-03-28 Last updated: 2018-05-02
van Vliet, J. S., Gustafsson, P. & Nelson Follin, N. (2016). Feeling ‘too fat’ rather than being ‘too fat’ increases unhealthy eating habits among adolescents – even in boys. Food & Nutrition Research, 60, Article ID 29530.
Open this publication in new window or tab >>Feeling ‘too fat’ rather than being ‘too fat’ increases unhealthy eating habits among adolescents – even in boys
2016 (English)In: Food & Nutrition Research, ISSN 1654-6628, E-ISSN 1654-661X, Vol. 60, article id 29530Article in journal (Refereed) Published
Abstract [en]

Background: Adolescence is a period of gender-specific physical changes, during which eating habits develop. To better understand what factors determine unhealthy eating habits such as dieting to lose weight, skipping meals and consumption of unhealthy foods, we studied how physical measurements and body perception relate to eating habits in boys and girls, before and during adolescence.

Methods: For this cross-sectional study, we obtained data from both written questionnaires and physical measurements of height, weight and waist circumference (WC).

Results: Dieting to lose weight and skipping breakfast were more common among adolescents than among younger boys and girls (p<0.05). The strongest risk factor for dieting in both boys and girls was perception of overweight, which persisted after adjusting for age and for being overweight (p<0.01). Another independent risk factor for dieting behaviour was overweight, as defined by body mass index (BMI) among boys (p<0.01) and WC among girls (p<0.05). In both boys and girls, skipping breakfast was associated with both a more negative body perception and higher BMI (p<0.05). Skipping breakfast was also associated with age- and gender-specific unhealthy eating habits such as skipping other meals, lower consumption of fruits and vegetables, and higher consumption of sweets and sugary drinks (p<0.05).

Conclusion: Body perception among adolescents is an important factor relating to unhealthy eating habits, not only in girls, but even in boys. Focus on body perception and eating breakfast daily is crucial for the development of healthy food consumption behaviours during adolescence and tracking into adulthood.

Place, publisher, year, edition, pages
Co-Action Publishing, 2016
Keywords
Body image, overweight, adolescent behaviour, food habits, prevention
National Category
Clinical Medicine
Identifiers
urn:nbn:se:liu:diva-123852 (URN)10.3402/fnr.v60.29530 (DOI)000370126700001 ()
Note

On the day of the defence date the status of this article was Manuscript.

Funding agencies:  Erik Johan Ljungberg Educational Fund; County Council of Ostergotland; Medical Research Council of south-east Sweden [FORSS-233111]

Available from: 2016-01-11 Created: 2016-01-11 Last updated: 2017-12-01Bibliographically approved
Bergström, M., Fransson, E., Modin, B., Berlin, M., Gustafsson, P. A. & Hjern, A. (2015). Fifty moves a year: is there an association between joint physical custody and psychosomatic problems in children?. Journal of Epidemiology and Community Health, 69(8), 769-774
Open this publication in new window or tab >>Fifty moves a year: is there an association between joint physical custody and psychosomatic problems in children?
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2015 (English)In: Journal of Epidemiology and Community Health, ISSN 0143-005X, E-ISSN 1470-2738, Vol. 69, no 8, p. 769-774Article in journal (Refereed) Published
Abstract [en]

Background In many Western countries, an increasing number of children with separated parents have joint physical custody, that is, live equally much in their parents respective homes. In Sweden, joint physical custody is particularly common and concerns between 30% and 40% of the children with separated parents. It has been hypothesised that the frequent moves and lack of stability in parenting may be stressful for these children. Methods We used data from a national classroom survey of all sixth and ninth grade students in Sweden (N=147839) to investigate the association between childrens psychosomatic problems and living arrangements. Children in joint physical custody were compared with those living only or mostly with one parent and in nuclear families. We conducted sex-specific linear regression analyses for z-transformed sum scores of psychosomatic problems and adjusted for age, country of origin as well as childrens satisfaction with material resources and relationships to parents. Clustering by school was accounted for by using a two-level random intercept model. Results Children in joint physical custody suffered from less psychosomatic problems than those living mostly or only with one parent but reported more symptoms than those in nuclear families. Satisfaction with their material resources and parent-child relationships was associated with childrens psychosomatic health but could not explain the differences between children in the different living arrangements. Conclusions Children with non-cohabitant parents experience more psychosomatic problems than those in nuclear families. Those in joint physical custody do however report better psychosomatic health than children living mostly or only with one parent. Longitudinal studies with information on family factors before and after the separation are needed to inform policy of childrens postseparation living arrangements.

Place, publisher, year, edition, pages
BMJ Publishing Group, 2015
National Category
Social Work
Identifiers
urn:nbn:se:liu:diva-120335 (URN)10.1136/jech-2014-205058 (DOI)000357720500009 ()25922471 (PubMedID)
Note

Funding Agencies|Lansforsakringsbolagens Forskningsfond

Available from: 2015-07-31 Created: 2015-07-31 Last updated: 2017-12-04
Comasco, E., Gustafsson, P., Sydsjö, G., Agnafors, S., Aho, N. & Svedin, C. G. (2015). Psychiatric symptoms in adolescents: FKBP5 genotype-early life adversity interaction effects. European Child and Adolescent Psychiatry, 24(12), 1473-1483
Open this publication in new window or tab >>Psychiatric symptoms in adolescents: FKBP5 genotype-early life adversity interaction effects
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2015 (English)In: European Child and Adolescent Psychiatry, ISSN 1018-8827, E-ISSN 1435-165X, Vol. 24, no 12, p. 1473-1483Article in journal (Refereed) Published
Abstract [en]

Psychiatric disorders are multi-factorial and their symptoms overlap. Constitutional and environmental factors influence each other, and this contributes to risk and resilience in mental ill-health. We investigated functional genetic variation of stress responsiveness, assessed as FKBP5 genotype, in relation to early life adversity and mental health in two samples of adolescents. One population-based sample of 909 12-year-old adolescents was assessed using the Life Incidence of Traumatic Events scale and the Strengths and Difficulties Questionnaire. One sample of 398 17-year-old adolescents, enriched for poly-victimized individuals (USSS), was assessed using the Juvenile Victimization Questionnaire and the Trauma Symptom Checklist for Children (TSCC). The FKBP5 rs1360780 and rs3800373 polymorphisms were genotyped using a fluorescence-based competitive allele-specific PCR. Most prominently among poly-victimized older male adolescents, the least common alleles of the polymorphisms, in interaction with adverse life events, were associated with psychiatric symptoms, after controlling for ethno-socio-economic factors. The interaction effect between rs3800373 and adverse life events on the TSCC sub-scales-anxiety, depression, anger, and dissociation-and with the rs1360780 on dissociation in the USSS cohort remained significant after Bonferroni correction. This pattern of association is in line with the findings of clinical and neuroimaging studies, and implies interactive effects of FKBP5 polymorphisms and early life environment on several psychiatric symptoms. These correlates add up to provide constructs that are relevant to several psychiatric symptoms, and to identify early predictors of mental ill-health.

Place, publisher, year, edition, pages
Springer, 2015
Keywords
Adolescents; FKBP5; Gene; Mental health; Stress
National Category
Clinical Medicine
Identifiers
urn:nbn:se:liu:diva-123510 (URN)10.1007/s00787-015-0768-3 (DOI)000365191700005 ()26424511 (PubMedID)
Note

Funding Agencies|Swedish Crime Victim Compensation and Support Authority [09042/2008]; Swedish Council for Working Life and Social Research; Swedish Council for Working Life and Social Research [2011-0627]; Uppsala University

Available from: 2015-12-22 Created: 2015-12-21 Last updated: 2018-02-21Bibliographically approved
van Vliet, J. S., Gustafsson, P., Duchén, K. & Nelson Follin, N. (2015). Social inequality and age-specific gender differences in overweight and perception of overweight among Swedish children and adolescents: a cross-sectional study. BMC Public Health, 15(628)
Open this publication in new window or tab >>Social inequality and age-specific gender differences in overweight and perception of overweight among Swedish children and adolescents: a cross-sectional study
2015 (English)In: BMC Public Health, ISSN 1471-2458, E-ISSN 1471-2458, Vol. 15, no 628Article in journal (Refereed) Published
Abstract [en]

Background: Overweight among children and adolescents related to social inequality, as well as age and gender differences, may contribute to poor self-image, thereby raising important public health concerns. This study explores social inequality in relation to overweight and perception of overweight among 263 boys and girls, age 7 to 17, in Vaxjo, Sweden. Methods: Data were obtained through a questionnaire and from physical measurements of height, weight and waist circumference [WC]. To assess social, age and gender differences in relation to overweight, the independent sample t- and chi-square tests were used, while logistic regression modeling was used to study determinants for perception of overweight. Results: Social inequality and gender differences as they relate to high ISO-BMI [Body Mass Index for children] and WC were associated with low maternal socioeconomic status [SES] among boys less than 13 years [mean age = 10.4; n = 65] and with low paternal education level among boys = 13 years [mean age = 15.0; n = 39] [p less than 0.05]. One suggested explanation for this finding is maternal impact on boys during childhood and the influence of the father as a role model for adolescent boys. The only association found among girls was between high ISO-BMI in girls = 13 years [mean age = 15.0; n = 74] and low paternal occupational status. Concerning perception of overweight, age and gender differences were found, but social inequality was not the case. Among boys and girls less than 13 years, perception of overweight increased only when overweight was actually present according to BMI or WC [p less than 0.01]. Girls = 13 years [mean age = 15.0] were more likely to unrealistically perceive themselves as overweight or "too fat," despite factual measurements to the contrary, than boys [p less than 0.05] and girls less than 13 years [mean age = 10.4; n = 83] [p less than 0.001]. Conclusions: The association between social inequality and overweight in adolescence in this study is age-and gender-specific. Gender differences, especially in perception of overweight, tend to increase with age, indicating that adolescence is a crucial period. When planning interventions to prevent overweight and obesity among children and adolescents, parental SES as well as age and gender-specific differences in social norms and perception of body weight status should be taken into account.

Place, publisher, year, edition, pages
BioMed Central, 2015
Keywords
Social inequality; Overweight; Obesity; Perception of overweight; Childhood; Adolescence
National Category
Clinical Medicine
Identifiers
urn:nbn:se:liu:diva-120339 (URN)10.1186/s12889-015-1985-x (DOI)000357559600001 ()26156095 (PubMedID)
Note

Funding Agencies|Erik Johan Ljungberg Educational Fund; County Council of Ostergotland; Medical Research Council of Southeast Sweden [FORSS-233111]

Available from: 2015-07-31 Created: 2015-07-31 Last updated: 2017-12-04
Allansson, E., Gustafsson, P. E., Gustafsson, P. & Nelson, N. (2014). Overweight and obese children have lower cortisol levels than normal weight children. Acta Paediatrica, 103(3), 295-299
Open this publication in new window or tab >>Overweight and obese children have lower cortisol levels than normal weight children
2014 (English)In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 103, no 3, p. 295-299Article in journal (Refereed) Published
Abstract [en]

AimThe stress hormone cortisol is vital to survival, and a disturbed circadian rhythm can be deleterious to health. However, little is known about cortisol levels in healthy children. The aim of this study was to examine cortisol levels in relation to body mass index (BMI), age and sex. MethodsSalivary samples were collected in early morning, late morning and evening, on four consecutive days, from 342 children aged 6-12years using Salivette((R)) tubes. Samples were analysed using a commercial enzyme immunoassay (EIA). School nurses measured the childrens height and weight, and these measurements were used to calculate their BMI. ResultsThe children displayed a circadian rhythm in cortisol secretion, with morning zeniths and evening nadirs. Average cortisol levels in early morning, late morning and evening were significantly lower in overweight and obese children than in their normal weight counterparts. Cortisol levels did not vary significantly with age or sex. ConclusionOur findings may suggest cortisol suppression in overweight and obese children. We found no evidence that sex or age influences cortisol levels. These findings highlight the need for further research on the relationship between stress and obesity in children.

Place, publisher, year, edition, pages
Wiley, 2014
Keywords
Body mass index; child; circadian rhythm; cortisol; obesity
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:liu:diva-105742 (URN)10.1111/apa.12499 (DOI)000331270000024 ()
Available from: 2014-04-07 Created: 2014-04-04 Last updated: 2017-12-05
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