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  • 1.
    Allansson, Elin
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Health Sciences.
    Gustafsson, Per E
    Linköping University, Department of Clinical and Experimental Medicine, Child and Adolescent Psychiatry. Linköping University, Faculty of Health Sciences.
    Gustafsson, Per
    Linköping University, Department of Clinical and Experimental Medicine, Child and Adolescent Psychiatry. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Local Health Care Services in Central Östergötland, Department of Child and Adolescent Psychiatry in Linköping.
    Nelson, Nina
    Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Center of Paediatrics and Gynaecology and Obstetrics, Department of Paediatrics in Linköping.
    Overweight and obese children have lower cortisol levels than normal weight children2014In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 103, no 3, p. 295-299Article in journal (Refereed)
    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.

  • 2.
    Annerbäck, Eva-Maria
    et al.
    Linköping University, Department of Molecular and Clinical Medicine, Child and Adolescent Psychiatry. Linköping University, Faculty of Health Sciences.
    Lindell, Charlotta
    Linköping University, Department of Molecular and Clinical Medicine, Child and Adolescent Psychiatry. Linköping University, Faculty of Health Sciences.
    Svedin, Carl Göran
    Linköping University, Department of Molecular and Clinical Medicine, Child and Adolescent Psychiatry. Linköping University, Faculty of Health Sciences.
    Gustafsson, Per
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Molecular and Clinical Medicine, Child and Adolescent Psychiatry. Östergötlands Läns Landsting, Local Health Care Services in Central Östergötland, Department of Child and Adolescent Psychiatry.
    Severe child abuse: A study of cases reported to the police2007In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 96, no 12, p. 1760-1764Article in journal (Refereed)
    Abstract [en]

    Aim: To investigate the characteristics of severe abuse of children and possible differences in comparison with less severe abuse. Method: Cases of abuse reported to the police within a single police district (n = 142) in Sweden were studied. The severe cases were compared to all the remaining cases. Results: Severe abuse constituted 14% of the total cases and was reported by agencies to a greater degree than minor cases. The suspected perpetrators were socially disadvantaged people in both groups. Half of the most serious cases led to conviction in the courts, compared to 8% in the reference group. The children who had been subjected to abuse were often already known to social services and reports of child abuse had frequently been made. Conclusion: In comparison between cases of severe and minor child abuse reported to the police, the results did not show any crucial differences except the pattern of reporting and a higher occurrence of prosecution/conviction in the severe cases. This finding places a responsibility on agencies outside of the justice system to consider all cases of reported abuse as serious warning signals and to make independent evaluations to identify risks and the possible need for child protection. © 2007 The Author(s).

  • 3.
    Annerbäck, Eva-Maria
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Child and Adolescent Psychiatry. Linköping University, Faculty of Health Sciences.
    Sahlqvist, L.
    Research and Development Centre, Sörmlands County Council, S-631 88 Eskilstuna, Sweden.
    Svedin, Carl Göran
    Linköping University, Department of Clinical and Experimental Medicine, Child and Adolescent Psychiatry. Linköping University, Faculty of Health Sciences.
    Wingren, Gun
    Linköping University, Department of Clinical and Experimental Medicine, Work and Environmental Science. Linköping University, Faculty of Health Sciences.
    Gustafsson, Per
    Linköping University, Department of Clinical and Experimental Medicine, Child and Adolescent Psychiatry. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Local Health Care Services in Central Östergötland, Department of Child and Adolescent Psychiatry.
    Child Physical Abuse and concurrence of other types of Child Abuse: associations with health and risk behaviors2012In: International Journal of Child Abuse & Neglect, ISSN 0145-2134, E-ISSN 1873-7757, Vol. 36, no 7-8, p. 585-595Article in journal (Refereed)
    Abstract [en]

    Objective: To examine the associations between child physical abuse and health problems/risk-taking behaviors among teen-agers. Further to evaluate concurrence of other types of abuse and how these alone and in addition to child physical abuse were associated with bad health status and risk-taking behaviors.

    Methods: A population-based survey was carried out in 2008 among all the pupils in two different grades (15 respectively 17 years old) in Södermanland County, Sweden (N=7 262). The response rate was 81.8 %. The pupils were asked among other things about their exposure to child physical abuse, exposure to parental intimate violence, bullying and exposure to being forced to engage in sexual acts. Adjusted analyses were conducted to estimate associations between exposure and illhealth/risk-taking behaviors.

    Results: Child physical abuse was associated with poor health and risk-taking behaviors with adjusted Odds Ratios (OR) ranging from 1.6 to 6.2. The associations were stronger when the pupils reported repeated abuse with OR ranging from 2.0 to 13.2. Also experiencing parental intimate partner violence, bullying and being forced to engage in sexual acts was associated with poor health and risk-taking behaviors with the same graded relationship to repeated abuse. Finally there was a cumulative effect of multiple abuse in the form of being exposed to child physical abuse plus other types of abuse and the associations increase with the number of concurrent abuse.

    Conclusions: This study provides strong indications that child abuse is a serious public health problem based on the clear links seen between abuse and poor health and behavioral problems. Consistent with other studies showing a graded relationship between experiences of abuse and poor health/risk-taking behaviors our study shows poorer outcomes for repeated and multiple abuse. Thus, our study calls for improvement of methods of comprehensive assessments, interventions and treatment in all settings where professionals meet young people.

  • 4.
    Annerbäck, Eva-Maria
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Child and Adolescent Psychiatry. Linköping University, Faculty of Health Sciences.
    Svedin, Carl Göran
    Linköping University, Department of Clinical and Experimental Medicine, Child and Adolescent Psychiatry. Linköping University, Faculty of Health Sciences.
    Gustafsson, Per
    Linköping University, Department of Clinical and Experimental Medicine, Child and Adolescent Psychiatry. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Local Health Care Services in Central Östergötland, Department of Child and Adolescent Psychiatry.
    Characteristic Features of Severe Child Physical Abuse-A Multi-informant Approach2010In: Journal of family Violence, ISSN 0885-7482, E-ISSN 1573-2851, Vol. 25, no 2, p. 165-172Article in journal (Refereed)
    Abstract [en]

    Minor child physical abuse has decreased in Sweden since 1979, when a law banning corporal punishment of children was passed, but more serious forms have not decreased. The aim of this study was to examine risk and background factors in cases of severe child abuse reported to the police. Files from different agencies (e.g., Social services, Adult and Child psychiatry and Pediatric clinic) for 20 children and 34 caretakers were studied. An accumulation of risk factors was found. It is concluded that when the following four factors are present, there is a risk for severe child abuse: 1) a person with a tendency to use violence in conflict situations; 2) a strong level of stress on the perpetrator and the family; 3) an insufficient social network that does not manage to protect the child; 4) a child that does not manage to protect him or herself. Thus, multiple sources of information must be used when investigating child abuse.

  • 5.
    Annerbäck, Eva-Maria
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Child and Adolescent Psychiatry . Linköping University, Faculty of Health Sciences.
    Wingren, Gun
    Linköping University, Department of Clinical and Experimental Medicine, Occupational and Environmental Medicine . Linköping University, Faculty of Health Sciences.
    Göran Svedin, Carl
    Linköping University, Department of Clinical and Experimental Medicine, Child and Adolescent Psychiatry . Linköping University, Faculty of Health Sciences.
    Gustafsson, Per
    Linköping University, Department of Clinical and Experimental Medicine, Child and Adolescent Psychiatry . Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Local Health Care Services in Central Östergötland, Department of Child and Adolescent Psychiatry.
    Prevalence and characteristics of child physical abuse in Sweden - findings from a population-based youth survey2010In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 99, no 8, p. 1229-1236Article in journal (Refereed)
    Abstract [en]

    Aim: To examine prevalence rates of child physical abuse perpetrated by a parent/caretaker, abuse characteristics and the extent of disclosures. Methods: A population-based survey was carried out in 2008 amongst all the pupils in three different grades (n = 8494) in schools in Sodermanland County, Sweden. The pupils were asked about their exposure to violence and their experiences of parental intimate-partner violence. Data were analysed with bi- and multivariate models and a comparison between means of accumulating risk factors between three groups were performed. Results: A total of 15.2% of the children reported that they had been hit. There were strong associations between abuse and risk factors and there was a dose-response relationship between risks and reported abuse. It was shown that children who reported parental intimate-partner violence were at a considerably higher risk for abuse than other children and that only 7% of the children exposed to violence had disclosed this to authorities. Conclusion: Even though child abuse in Sweden has decreased markedly during the last 40 years, violence against children is still a considerable problem. It is a challenge to develop methods of assessment and interventions that will ensure that the violence and its underlying causes are directly addressed.

  • 6.
    Back, Christina
    et al.
    Linköping University, Department of Clinical and Experimental Medicine. Linköping University, Faculty of Health Sciences.
    Gustafsson, Per A.
    Linköping University, Department of Clinical and Experimental Medicine, Child and Adolescent Psychiatry. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Local Health Care Services in Central Östergötland, Department of Child and Adolescent Psychiatry.
    Berterö, Carina
    Linköping University, Department of Medical and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
    How do children overcome difficulties talking about sexual abuseManuscript (preprint) (Other academic)
    Abstract [en]

    Aim of this study was to identify and describe the obstacles that can prevent children from talking about sexual abuse in a police interview. Data consisted of 28 investigative interviews with children and 12 police interrogations with non-offending parents. The children in these situations were between 8 and 15 years of age when they were interviewed. Data interpretation and analysis were based on content analysis. The following categories were identified: not being believed/telling the truth, need of support and dependence on adults, guilt and shame, fear, and spatial- and time-oriented.

  • 7.
    Back, Christina
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Local Health Care Services in Central Östergötland, Department of Child and Adolescent Psychiatry in Linköping.
    Gustafsson, Per A.
    Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Local Health Care Services in Central Östergötland, Department of Child and Adolescent Psychiatry in Linköping.
    Berterö, Carina
    Linköping University, Department of Medical and Health Sciences, Division of Nursing Science. Linköping University, Faculty of Health Sciences.
    Parental opinions of their child's experience in the legal process: an interpretative analysis2014In: Journal of Child Sexual Abuse, ISSN 1053-8712, E-ISSN 1547-0679, Vol. 23, no 3, p. 290-303Article in journal (Refereed)
    Abstract [en]

    The aim of this study is to demonstrate how parents of children who are victims of sexual assault experience the legal process from the children’s and parents’ perspective. Nine parents, identified in the records of three public prosecution offices in three cities in Sweden, were interviewed. The parents described feelings of shame and guilt over what their children had experienced. They felt stigmatized and had difficulty fulfilling their parental role, perceived a lack of information and support from the professionals involved, and experienced a sense of withdrawal from their role as parents, though they felt the professionals who worked with their children were helpful and influential.

  • 8.
    Back, Christina
    et al.
    Linköping University, Department of Clinical and Experimental Medicine. Linköping University, Faculty of Health Sciences.
    Gustafsson, Per A.
    Linköping University, Department of Clinical and Experimental Medicine, Child and Adolescent Psychiatry. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Local Health Care Services in Central Östergötland, Department of Child and Adolescent Psychiatry in Linköping.
    Berterö, Carina
    Linköping University, Department of Medical and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
    Parents’ opinions – view of their child´s experiences in the legal process: An interpretative analysis of parents’ opinionsManuscript (preprint) (Other academic)
    Abstract [en]

    The aim of this study was to demonstrate how parents of children, who are victims of sexual assault, experience the legal process, seen from the child’s, as well as the parents’ perspective. Nine parents identified in the records of three public prosecution offices in three cities in Sweden, were interviewed. The parents described feelings of shame and guilt over what their children had experienced. They felt stigmatized and had difficulty fulfilling their parental role; perceived a lack of information and support from the professionals involved; experienced a sense of withdrawal from their role as parents, even though they felt the professionals who worked with their children were helpful and influential.

  • 9.
    Back, Christina
    et al.
    Linköping University, Department of Clinical and Experimental Medicine. Linköping University, Faculty of Health Sciences.
    Gustafsson, Per A.
    Linköping University, Department of Clinical and Experimental Medicine, Child and Adolescent Psychiatry. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Local Health Care Services in Central Östergötland, Department of Child and Adolescent Psychiatry.
    Berterö, Carina
    Linköping University, Department of Medical and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
    Sexually Abused Children – Prosecutors' Experiences of their Participation in the Legal Process in Sweden2013In: Psychiatry, Psychology and Law, ISSN 1321-8719, E-ISSN 1934-1687, Vol. 20, no 2, p. 273-283Article in journal (Refereed)
    Abstract [en]

    The purpose of the present study was to interview prosecutors, based on their experiences working with children who have been sexually abused. The informants were seven prosecutors identified from the records of three public prosecution offices in three cities in Sweden. The informants' experiences were elicited via individual in-depth semi-structured interviews. The interviews were carried out and analysed using interpretative phenomenological analysis (IPA). Three themes emerged: (1) difficulties with evidence of criminal conduct, (2) children's special needs, and (3) children's dependence on adults. Informants' descriptions of how they perceived the children in the legal process were associated with their experience of the difficulty of finding proof of the crime. Informants were found to experience difficulties when they encounter children in the legal process. As prosecutors they often face difficulties proving that the child has been exposed to crime.

  • 10.
    Back, Kristina
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Child and Adolescent Psychiatry. Linköping University, Faculty of Health Sciences.
    Gustafsson, Per A
    Linköping University, Department of Clinical and Experimental Medicine, Child and Adolescent Psychiatry. Linköping University, Faculty of Health Sciences.
    Larsson, IngBeth
    Linköping University, The Tema Institute, The Department of Gender Studies. Linköping University, Faculty of Arts and Sciences.
    Berterö, Carina
    Linköping University, Department of Medical and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
    Managing the legal proceedings: An interpretative phenomenological analysis of sexually abused children's experience with the legal process2011In: International Journal of Child Abuse & Neglect, ISSN 0145-2134, E-ISSN 1873-7757, Vol. 35, no 1, p. 50-57Article in journal (Refereed)
    Abstract [en]

    OBJECTIVE: The aim of this study was to describe how sexually abused children experience the legal process, a process that includes being questioned by the police during the preliminary investigation and by lawyers and the prosecutor in the courtroom, and meeting other professionals from various agencies.

    METHOD: Face-to-face in-depth interviews were conducted with 10 children-9 girls and 1 boy between 9 and 15 years old-who had experienced child sexual abuse (CSA). The interviews were semi structured and carried out and analyzed by interpretative phenomenological analysis (IPA). The aim of IPA is to explore the participants' views of the world and to adopt as far as possible an "insider perspective." IPA draws on a tradition of phenomenology and symbolic interactionism in attempting to understand how people make sense of their experiences.

    RESULTS: Five major themes emerged through the analysis: not being believed, making CSA visible, need for support, sanctions for offenders, and lack of respect for the child's integrity. Almost all the children had a feeling of not being believed. They described feelings ranging from anxiety to dread and even terror when they had to describe the CSA they had experienced. Even though the importance of support for such children is already well understood, the children stated that the support they were given was not sufficient. The children said that they wanted support from a single professional who was well informed about both the legal process and CSA. When the children were asked to reflect on sanctions against the abusers, they said that it was important that the perpetrator got treatment/therapy but they also said that imprisonment was desirable. Financial compensation was not as important to them; the damage had been done and money could not compensate for that damage. The children also said that both the lawyers and the media had treated them with disrespect.

    CONCLUSIONS: It is valuable for children who have been exposed to CSA to learn that they can take part in the legal process as equal partners with the other participants, and it is evident that the quality of psychological care and support needs to be improved. The children want to be participants in the legal process rather than passive objects of that process.

  • 11.
    Bergström, Malin
    et al.
    Stockholm University, Sweden.
    Fransson, Emma
    Stockholm University, Sweden.
    Modin, Bitte
    Stockholm University, Sweden.
    Berlin, Marie
    National Board Health and Welf, Sweden; Stockholm University, Sweden.
    Gustafsson, Per A.
    Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Local Health Care Services in Central Östergötland, Department of Child and Adolescent Psychiatry in Linköping.
    Hjern, Anders
    Stockholm University, Sweden; Karolinska Institute, Sweden.
    Fifty moves a year: is there an association between joint physical custody and psychosomatic problems in children?2015In: Journal of Epidemiology and Community Health, ISSN 0143-005X, E-ISSN 1470-2738, Vol. 69, no 8, p. 769-774Article in journal (Refereed)
    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.

  • 12.
    Bergström, Malin
    et al.
    Stockholm University, Sweden.
    Modin, Bitte
    Stockholm University, Sweden.
    Fransson, Emma
    Stockholm University, Sweden.
    Rajmil, Luis
    Catalan Agency Health Informat Assessment and Qual, Spain.
    Berlin, Marie
    National Board Health and Welf, Sweden.
    Gustafsson, Per
    Linköping University, Department of Clinical and Experimental Medicine, Child and Adolescent Psychiatry. Linköping University, Faculty of Health Sciences. Region Östergötland, Local Health Care Services in Central Östergötland, Department of Child and Adolescent Psychiatry in Linköping.
    Hjern, Anders
    Stockholm University, Sweden.
    Living in two homes-a Swedish national survey of wellbeing in 12 and 15 year olds with joint physical custody2013In: BMC Public Health, ISSN 1471-2458, E-ISSN 1471-2458, Vol. 13Article in journal (Refereed)
    Abstract [en]

    Background

    The practice of joint physical custody, where children spend equal time in each parent’s home after they separate, is increasing in many countries. It is particularly common in Sweden, where this custody arrangement applies to 30 per cent of children with separated parents. The aim of this study was to examine children’s health-related quality of life after parental separation, by comparing children living with both parents in nuclear families to those living in joint physical custody and other forms of domestic arrangements.

    Methods

    Data from a national Swedish classroom study of 164,580 children aged 12 and 15-years-old were analysed by two-level linear regression modelling. Z-scores were used to equalise scales for ten dimensions of wellbeing from the KIDSCREEN-52 and the KIDSCREEN-10 Index and analysed for children in joint physical custody in comparison with children living in nuclear families and mostly or only with one parent.

    Results

    Living in a nuclear family was positively associated with almost all aspects of wellbeing in comparison to children with separated parents. Children in joint physical custody experienced more positive outcomes, in terms of subjective wellbeing, family life and peer relations, than children living mostly or only with one parent. For the 12-year-olds, beta coefficients for moods and emotions ranged from −0.20 to −0.33 and peer relations from −0.11 to −0.20 for children in joint physical custody and living mostly or only with one parent. The corresponding estimates for the 15-year-olds varied from −0.08 to −0.28 and from −0.03 to −0.13 on these subscales. The 15-year-olds in joint physical custody were more likely than the 12-year-olds to report similar wellbeing levels on most outcomes to the children in nuclear families.

    Conclusions

    Children who spent equal time living with both parents after a separation reported better wellbeing than children in predominantly single parent care. This was particularly true for the 15-year-olds, while the reported wellbeing of 12-years-olds was less satisfactory. There is a need for further studies that can account for the pre and post separation context of individual families and the wellbeing of younger age groups in joint physical custody.

  • 13.
    Birberg Thornberg, Ulrika
    et al.
    Linköping University, Department of Behavioural Sciences and Learning. Linköping University, Faculty of Arts and Sciences.
    Gustafsson, Per A.
    Linköping University, Department of Clinical and Experimental Medicine, Child and Adolescent Psychiatry. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Local Health Care Services in Central Östergötland, Department of Child and Adolescent Psychiatry.
    Silfverdal, Sven-Arne
    Division of Paediatrics, Department of Clinical Sciences, Umeå University.
    Duchén, Karel
    Linköping University, Department of Clinical and Experimental Medicine, Pediatrics. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre of Paediatrics and Gynecology and Obstetrics, Department of Paediatrics in Linköping.
    A Placebo controlled, randomized study of PUFA (Poly Unsaturated Fatty Acids) as treatment for neurodevelopmental problems in 7-year-old children and cognitive performance in relation to an age-matched control groupManuscript (preprint) (Other academic)
    Abstract [en]

    OBJECTIVE: The goal of the present randomized placebo controlled double-blind study was to investigate the potential effect of PUFA supplementation on cognitive and behavioural performance in children with neurodevelopmental problems at 7 years of age (n = 28) and to compare findings with an age matched healthy control group (n = 20).

    METHODS: Children were screened with parent and teacher rating scales (Conner’s and SNAP-IV), and were included if they showed a range of neurodevelopmental problems that reached ADHD criteria. The group with neurodevelopmental difficulties was randomized to treatment with an EPA rich formula (n = 13) or to placebo (n = 15). Cognitive performance was determined at baseline and after 15 weeks of supplementation with a cognitive test battery including executive function and theory of mind tasks.

    RESULTS: Children with neurodevelopmental problems differed from the control group regarding working memory, inhibition and language ability, but not on an advanced theory of mind task. Regarding the treatment with EPA supplement there were no significant advantages in the active treatment group compared to placebo in any of the cognitive measures or in parents or teacher rating scales.

    CONCLUSION: The significant differences in cognitive performance and rating scales between the group with neurodevelopmental problems and the healthy control group at baseline indicate problems at a clinical level and suitability for treatment. However we found no significant effects of PUFA supplementation. The study is small and limited by a number of drop-outs.

  • 14.
    Birberg Thornberg, Ulrika
    et al.
    Linköping University, Department of Behavioural Sciences. Linköping University, Faculty of Arts and Sciences.
    Karlsson, Thomas
    Linköping University, Department of Behavioural Sciences and Learning. Linköping University, Faculty of Arts and Sciences.
    Gustafsson, Per
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Clinical and Experimental Medicine, Child and Adolescent Psychiatry. Östergötlands Läns Landsting, Local Health Care Services in Central Östergötland, Department of Child and Adolescent Psychiatry.
    Duchén, Karel
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Clinical and Experimental Medicine, Pediatrics. Östergötlands Läns Landsting, Centre of Paediatrics and Gynecology and Obstetrics, Department of Paediatrics in Linköping.
    Nutrition and theory of mind: The role of polyunsaturated fatty acids (PUFA) in the development of theory of mind2006In: Prostaglandins, Leukotrienes and Essential Fatty Acids, ISSN 0952-3278, E-ISSN 1532-2823, Vol. 75, no 1, p. 33-41Article in journal (Refereed)
    Abstract [en]

    Breast-milk provides nutrients required for the development of the brain. n-6 and n-3 long-chain polyunsaturated fatty acids (LCPUFAs) have been suggested to be particularly involved. In this study levels of fatty acids in breast-milk were examined in relation to theory of mind (ToM) (n=13) and WISC-III (n=22) in six-year-old children. ToM tasks comprised four illustrated stories with questions about emotional (sad) events. Single polyunsaturated fatty acids (PUFA) were estimated as well as ratios between different fatty acids in order to describe putative associations between PUFA and psychological measures. Results show correlations between both ToM and WISC-III with single n-6 PUFA and the ratios DHA/AA and DHA/DPA. The correlations remained when socio-demographic factors were statistically controlled for. The positive findings related to the n-6 and n-3 LCPUFAs corroborate previous findings related to child cognitive development. © 2006 Elsevier Ltd. All rights reserved.

  • 15. Broberg, AG
    et al.
    Ekeroth, K
    Gustafsson, Per
    Linköping University, Faculty of Health Sciences. Linköping University, Department of health and environment. Östergötlands Läns Landsting, CPS - Centrum för psykiatri och samhällsmedicin, BUP - Barn- och ungdomspsykiatri.
    Hansson, K
    Hägglöf, B
    Ivarsson, T
    Larsson, B
    Self-reported competencies and problems among Swedish adolescents: A normative study of the YSR2001In: European Child and Adolescent Psychiatry, ISSN 1018-8827, E-ISSN 1435-165X, Vol. 10, no 3, p. 186-193Article in journal (Refereed)
    Abstract [en]

    The aim of the study was to provide a standardisation of self-reported competencies and emotional/behavioural problems among Swedish adolescents, using the Youth Self-Report (YSR). The YSR was completed by 2522 adolescents aged 13-18 years, recruited from secondary and upper secondary schools in different regions in Sweden. The results showed that effects of gender and age were small but significant with girls scoring higher than boys on most problem scales, and 15- to 16-year-olds scoring higher than younger and older adolescents on the problem scales. Small effects were also found for residence as well as for parental SES. The correlations between internalising and externalising problems were 0.51 for boys and 0.49 for girls, whereas the correlation between competence and problem scores was low. We conclude that the individual variation in YSR-scores is much greater than can be attributed to factors such as gender, age, SES, or residential area. Consequently, the YSR has the potential to serve as an instrument for assessing individual adolescents' self-reported competencies and problems in Sweden. Given the almost orthogonal relation between self-reported competencies and problems, the competence scale is surprisingly little used in psychopathology research.

  • 16.
    Chermá, Maria D.
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Drug Research. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center for Diagnostics, Department of Clinical Pharmacology. Department of Forensic Genetics and Forensic Toxicology, National Board of Forensic Medicine, Linköping, Sweden.
    Josefsson, Martin
    Linköping University, Department of Physics, Chemistry and Biology, Chemistry. Linköping University, Faculty of Science & Engineering. Department of Forensic Genetics and Forensic Toxicology, National Board of Forensic Medicine, Linköping, Sweden.
    Rydberg, Irene
    Linköping University, Department of Medical and Health Sciences, Division of Drug Research. Linköping University, Faculty of Medicine and Health Sciences.
    Woxler, Per
    Region Östergötland, Local Health Care Services in Central Östergötland, Department of Dependency in Linköping.
    Trygg, Tomas
    Region Östergötland, Local Health Care Services in Central Östergötland, Department of Dependency in Linköping.
    Hollertz, Olle
    Department of General Psychiatry, Västervik Hospital, Västervik, Sweden.
    Gustafsson, Per A.
    Linköping University, Department of Clinical and Experimental Medicine, Center for Social and Affective Neuroscience. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Local Health Care Services in Central Östergötland, Department of Child and Adolescent Psychiatry in Linköping.
    Methylphenidate for Treating ADHD: A Naturalistic Clinical Study of Methylphenidate Blood Concentrations in Children and Adults With Optimized Dosage.2017In: European journal of drug metabolism and pharmacokinetics, ISSN 0378-7966, E-ISSN 2107-0180, Vol. 42, no 2, p. 295-307Article in journal (Refereed)
    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.

  • 17.
    Cocozza, Madeleine
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Child and Adolescent Psychiatry. Linköping University, Faculty of Health Sciences.
    Gustafsson, Per
    Linköping University, Department of Clinical and Experimental Medicine, Child and Adolescent Psychiatry. Linköping University, Faculty of Health Sciences.
    Sydsjö, Gunilla
    Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Center of Paediatrics and Gynaecology and Obstetrics, Department of Gynaecology and Obstetrics in Linköping.
    Child Protection in a Family Service Organisation in Sweden- What is the outcome for maltreated children?2010In: Children and youth services review, ISSN 0190-7409, E-ISSN 1873-7765, Vol. 32, no 7, p. 922-928Article in journal (Refereed)
    Abstract [en]

    This study was conducted to increase the knowledge of what characterises the child-protection process in family-service organisations. A total of 1570 (regarding 1051 children) reports made to Social Services in one municipality during 1 year were followed to a final decision. A five-year follow-up study was conducted. There were 651 (41%) of the reports that were not investigated, 84% of the reports filed were judged not to demonstrate child maltreatment. The most usual cluster consisted of children that had committed a crime/offence when they were between 13 and 18 years old (314/1051–30%). The social worker reported 38% of the reports that regarded sexual or physical abuse to the police. Comparing the filtering pattern with the results from a study conducted in England, the family-service organisation does not seem to lead to the provision of services for a greater percentage of children than does a distinctive child-protection system. In the five-year follow-up period there were 61% of the children that were or had been targeted for an intervention or an investigation. This study raises questions about child protection in Sweden and emphasises the need for the system to be studied further.

  • 18.
    Cocozza, Madeleine
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Child and Adolescent Psychiatry . Linköping University, Faculty of Health Sciences.
    Gustafsson, Per
    Linköping University, Department of Clinical and Experimental Medicine, Child and Adolescent Psychiatry . Linköping University, Faculty of Health Sciences.
    Sydsjö, Gunilla
    Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology . Linköping University, Faculty of Health Sciences.
    Child Protection in Sweden: Are routine assesments reliable?2006In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 95, no 11, p. 1474-1480Article in journal (Refereed)
    Abstract [en]

    Aim: To study the validity of the decision not to investigate mandatory reports of suspected child maltreatment.

    Methods: Written files of 220 reports indicating possible child maltreatment were analysed and re-evaluated. As a measure of the justification for the decisions, a 5-y follow-up study was done.

    Results: We determined that 76% of the reports still indicated child maltreatment after the initial assessment was done. In the follow-up study, 45% of the children had been investigated. The social worker used the family as the only source of information in 74% of the cases, in 6% someone outside the family was contacted, and in 11% no further information in addition to the report was collected. In 9%, data on information sources were missing.

    Conclusion: The findings are rather discouraging, as they challenge the belief that a report is a means of ensuring that maltreatment does not continue. The study shows that, depending upon the way in which the initial assessments are made, maltreated children may run a risk of not being identified, even though the maltreatment has been reported. This suggests that there may be a need for national guidelines concerning the reporting of maltreatment.

  • 19.
    Cocozza, Madeleine
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Child and Adolescent Psychiatry . Linköping University, Faculty of Health Sciences.
    Gustafsson, Per
    Linköping University, Department of Clinical and Experimental Medicine, Child and Adolescent Psychiatry . Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Local Health Care Services in Central Östergötland, Department of Child and Adolescent Psychiatry.
    Sydsjö, Gunilla
    Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology . Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre of Paediatrics and Gynecology and Obstetrics, Department of Gynecology and Obstetrics in Linköping.
    Who suspects and report child maltreatment to Social Services in Sweden?: Is there a reliable mandatory reporting process?2007In: European Journal of Social Work, ISSN 1369-1457, E-ISSN 1468-2664, Vol. 10, no 2, p. 209-223Article in journal (Refereed)
    Abstract [en]

    This article deals with the mandatory report process in Sweden. The components that are analysed are who makes the reports, what is reported and the outcome for the reports. Data were collected in a Swedish county in the year 2000 by means of locating every report made to the Social Services during one year (1998). The net sample consisted of 1,570 reports regarding 1,051 children. A follow-up study was carried out in 2003 of all the children for whom a report in 1998 did not lead to an investigation being initiated. We found in these study indicators that the process might not be secure. The professionals reported 1% of the children in the municipality; 22% of the reports from professionals were not investigated. The five-year follow-up study shows that 53% of the children that these reports concerned had been the subject of an investigation. This could be an indicator that children continue to be maltreated after being reported since the assessments are not accurate. In this study, 67% of 'crime reports' were 'not indicating' child maltreatment. There should be a questioning of 'crime reports' automatically entering the mandated report process as, if registered nationally, this could lead to a deflation of mandatory reports. Administration needs to change introducing a national form for filing reports.

  • 20.
    Comasco, Erika
    et al.
    Uppsala University, Sweden.
    Gustafsson, Per
    Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Local Health Care Services in Central Östergötland, Department of Child and Adolescent Psychiatry in Linköping.
    Sydsjö, Gunilla
    Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center of Paediatrics and Gynaecology and Obstetrics, Department of Gynaecology and Obstetrics in Linköping.
    Agnafors, Sara
    Linköping University, Department of Clinical and Experimental Medicine, Division of Neuro and Inflammation Science. Linköping University, Faculty of Medicine and Health Sciences.
    Aho, Nikolas
    Linköping University, Department of Clinical and Experimental Medicine, Division of Neuro and Inflammation Science. Linköping University, Faculty of Medicine and Health Sciences.
    Svedin, Carl Göran
    Linköping University, Department of Clinical and Experimental Medicine, Division of Neuro and Inflammation Science. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Local Health Care Services in Central Östergötland, Department of Child and Adolescent Psychiatry in Linköping.
    Psychiatric symptoms in adolescents: FKBP5 genotype-early life adversity interaction effects2015In: European Child and Adolescent Psychiatry, ISSN 1018-8827, E-ISSN 1435-165X, Vol. 24, no 12, p. 1473-1483Article in journal (Refereed)
    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.

  • 21.
    D Cherma, Maria
    et al.
    Linköping University, Department of Medicine and Health Sciences, Clinical Pharmacology. Linköping University, Faculty of Health Sciences.
    Ahlner, Johan
    Linköping University, Department of Medicine and Health Sciences, Clinical Pharmacology. Linköping University, Faculty of Health Sciences.
    Bengtsson, Finn
    Linköping University, Department of Medicine and Health Sciences, Clinical Pharmacology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre for Laboratory Medicine, Department of Clinical Pharmacology.
    Gustafsson, Per
    Linköping University, Department of Clinical and Experimental Medicine, Child and Adolescent Psychiatry. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Local Health Care Services in Central Östergötland, Department of Child and Adolescent Psychiatry.
    Antidepressant Drugs in Children and Adolescents Analytical and Demographic Data in a Naturalistic, Clinical Study2011In: JOURNAL OF CLINICAL PSYCHOPHARMACOLOGY, ISSN 0271-0749, Vol. 31, no 1, p. 98-102Article in journal (Refereed)
    Abstract [en]

    Pharmacokinetics of antidepressant drugs (ATDs), in terms of steady-state and trough values, in patients from Child and Adolescent Psychiatry centers in the midsouth-eastern part of Sweden, were evaluated, and the use of ATDs in this population were described. Patients to be prescribed an ATD were studied between 2002 and 2004. Two hundred eleven children, 64% girls and 36% boys (ages 8-20 years) were evaluated. The primary indication for the antidepressant treatment was depression in 69% of subjects. The median body mass index was 20.2 kg/m(2) (range, 12.4-38.6 kg/m(2)). Suspected adverse drug reactions were spontaneously reported in 31% (no serious). Monotherapy was indicated in 49% of request forms. The most common drug combination with the ATD was oral contraceptives. The concentrations of drugs in the patient evaluated population to referenced data for adults from the dose administered were as expected in 63%, higher than expected in 26% and lower than expected in 11%. The most prescribed ATD was sertraline (SERT). Dose-concentration relationships for SERT and metabolite desmethylsertraline (DSERT) were seen, r(s) = 0.48 and r(s) = 0.5, respectively. No relationship was found between dose and ratio DSERT/SERT. The median daily dose was 50 mg (range, 12.5-150 mg), SERT concentration 16 ng/mL (range, 3-88 ng/mL), and DSERT 33 ng/mL (range, 0-253 ng/mL). CYP2D6*4 was the most common poor metabolizer allele. Therapeutic drug monitoring may provide support to prescribing physicians to individual dose optimizing and to assess drug compliance, above all when ATDs are not well studied in pediatric patients before approval for general prescription.

  • 22. Ekman, JT
    et al.
    Gustafsson, Per
    Linköping University, Faculty of Health Sciences. Linköping University, Department of health and environment. Östergötlands Läns Landsting, CPS - Centrum för psykiatri och samhällsmedicin, BUP - Barn- och ungdomspsykiatri.
    Stimulants in AD/HD, a controversial treatment only in Sweden?2000In: European Child and Adolescent Psychiatry, ISSN 1018-8827, E-ISSN 1435-165X, Vol. 9, no 4, p. 312-313Article in journal (Refereed)
  • 23.
    Emilsson, Maria
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Center for Social and Affective Neuroscience. Linköping University, Faculty of Medicine and Health Sciences. Department of Health Science, Section of Nursing Graduate Level, University West, Trollhättan, Sweden.
    Gustafsson, Per A
    Linköping University, Department of Clinical and Experimental Medicine, Center for Social and Affective Neuroscience. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Local Health Care Services in Central Östergötland, Department of Child and Adolescent Psychiatry in Linköping.
    Öhnström, Gisela
    Linköping University, Department of Clinical and Experimental Medicine, Center for Social and Affective Neuroscience. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Local Health Care Services in Central Östergötland, Department of Child and Adolescent Psychiatry in Linköping.
    Marteinsdottir, Ina
    Linköping University, Department of Clinical and Experimental Medicine, Center for Social and Affective Neuroscience. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Local Health Care Services in Central Östergötland, Department of Psychiatry.
    Beliefs regarding medication and side effects influence treatment adherence in adolescents with attention deficit hyperactivity disorder2017In: European Child and Adolescent Psychiatry, ISSN 1018-8827, E-ISSN 1435-165X, Vol. 26, no 5, p. 559-571Article in journal (Refereed)
    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.

  • 24.
    Gustafsson, Per
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Molecular and Clinical Medicine, Child and Adolescent Psychiatry. Östergötlands Läns Landsting, Local Health Care Services in Central Östergötland, Department of Child and Adolescent Psychiatry.
    Don't blame it on the parents - Make them your allies: A family/systems approach to paediatric illness2005In: Clinical Child Psychology and Psychiatry, ISSN 1359-1045, E-ISSN 1461-7021, Vol. 10, no 1, p. 23-31Article in journal (Refereed)
    Abstract [en]

    A family/systems approach allows us to see the individual in context. The family and the informal social network constitute the most important environment for a child. A basic assumption is that changes in family interaction patterns will have an impact on somatic as well as psychiatric symptoms in the child. In modern paediatric practice parents are routinely instructed to give their sick child the prescribed treatment and to implement preventive measures, they are recruited as part of the medical team. A family/systems approach helps families to identify their strengths and needs. The approach described here with a session transcript illustrates how understanding the ways in which family relatioinships interact with the course of illness and treatment can influence quality of life.

  • 25.
    Gustafsson, Per
    Linköping University, Faculty of Health Sciences. Linköping University, Department of health and environment. Östergötlands Läns Landsting, CPS - Centrum för psykiatri och samhällsmedicin, BUP - Barn- och ungdomspsykiatri.
    Familjen den viktigaste resursen inom familjeterapi. Felfinneri och skuldbeläggning av anhöriga bör motverkas.2000In: Läkartidningen, ISSN 0023-7205, E-ISSN 1652-7518, Vol. 97, p. 804-806Article in journal (Other (popular science, discussion, etc.))
  • 26.
    Gustafsson, Per
    Linköping University, Faculty of Health Sciences. Linköping University, Department of health and environment. Östergötlands Läns Landsting, CPS - Centrum för psykiatri och samhällsmedicin, BUP - Barn- och ungdomspsykiatri.
    Family interaction and supportive social network as salutogenic factors in childhood atopic disease.2000In: Journal of Psychosomatic Research, ISSN 0022-3999, E-ISSN 1879-1360, Vol. 48, p. 239-240Article in journal (Refereed)
  • 27.
    Gustafsson, Per
    Linköping University, Department of Molecular and Clinical Medicine, Pediatrics. Linköping University, Department of Medical and Health Sciences, Clinical Physiology. Linköping University, Faculty of Health Sciences.
    Oesophageal function, acid reflux and bronchopulmonary disease: A study on children and adolescents with asthma or cystic fibrosis1991Doctoral thesis, comprehensive summary (Other academic)
    Abstract [en]

    This thesis comprises a literature review of gastro-ocsophageal reflux (GOR) and six studies which aim to determine the prevalence of oesophageal dysfunction (OD) and pathological GOR and their significance concerning the bronchopulmonary disease in children and adolescents with bronchial asthma or cystic fibrosis (CF). Oesophageal function was assessed by manomctry combined with oesophageal provocation tests. 24-hour two-level oesophageal pH monitoring was used to quantify GOR, to study the temporal relationship between acid reflux and asthma symptoms, and to assess the propensity to aspirate. Symptoms of OD and asthma were evaluated by interview and by the use of questionnaires. Severity of bronchopulmonary disease in the CF patients was assessed by radiography and spirometry. A double-blind placebo-controlled trial of ranitidine 150/300 mg per day over four weeks was performed in the asthma group to see if a reduction in acid reflux improved asthma. The relative significance of reflux symptoms and atopic allergy, regarding lung function and bronchial histamine reactivity in asthma, was evaluated. Pathological GOR and OD were significantly more common in asthma and CF patients than in controls. Episodes of acid reflux seemed to provoke asthma symptoms in a few patients. Ranitidine produced a significant but modest reduction in nocturnal/morning asthma symptoms in patients with pathological GOR, when compared to those with normal GOR. Asthma patients with reflux symptoms more frequently experienced asthma attacks initiated by non-specifictrigger factors than patients without such symptoms. The presence of atopic allergy was related to impaired lung function and increased bronchial hyperreactivity. Severity of OD and bronchopulmonarydisease correlated well in CF patients.

    OD or pathological GOR are found in the majority of children and adolescents with asthma or CF. In CF subjects OD and GOR may be parts of a vicious circle including malnutrition and progressive lung damage. In asthma acid reflux is, on the whole, a mild trigger or a modulatory factor, and appears to influence the airways via oesophago-bronchial reflexes rather than by aspiration. Atopic allergy is still more important than GOR in childhood asthma.

  • 28.
    Gustafsson, Per
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Child and Adolescent Psychiatry. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Local Health Care Services in Central Östergötland, Department of Child and Adolescent Psychiatry.
    Birberg Thornberg, Ulrika
    Linköping University, Department of Behavioural Sciences and Learning. Linköping University, Faculty of Arts and Sciences.
    Duchén, Karel
    Linköping University, Department of Clinical and Experimental Medicine, Pediatrics. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre of Paediatrics and Gynecology and Obstetrics, Department of Paediatrics in Linköping.
    Landgren, Magnus
    Department of Pediatrics, Mariestad, Sweden .
    Malmberg, Kerstin
    Karolinska Institutet, Stockholm.
    Pelling, Henrik
    Uppsala University.
    Strandvik, Birgitta
    Gothenburg University, Sweden.
    Karlsson, Thomas
    Linköping University, Department of Behavioural Sciences and Learning. Linköping University, Faculty of Arts and Sciences.
    EPA supplementation improves teacher-rated behaviour and oppositional symptoms in children with ADHD2010In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 99, no 10, p. 1540-1549Article in journal (Refereed)
    Abstract [en]

    Aim: Measure efficacy of eicosapentaenoic acid (EPA) in children with attention deficit hyperactivity disorder (ADHD). Methods: Randomized controlled trial (RCT) of 0.5 g EPA or placebo (15 weeks) in 92 children (7-12 years) with ADHD. Efficacy measure was Conners Parent/Teacher Rating Scales (CPRS/CTRS). Fatty acids were analysed in serum phospholipids and red blood cell membranes (RBC) at baseline and endpoint with gas chromatography. Results: EPA improved CTRS inattention/cognitive subscale (p = 0.04), but not Conners total score. In oppositional children (n = 48), CTRS total score improved andgt;= 25% in 48% of the children receiving EPA vs. 9% for placebo [effect size (ES) 0.63, p = 0.01]. In less hyperactive/impulsive children (n = 44), andgt;= 25% improvement was seen in 36% vs. 18% (ES 0.41, n.s.), and with both these types of symptoms 8/13 with EPA vs. 1/9 for placebo improved andgt;= 25% (p = 0.03). Children responding to treatment had lower EPA concentrations (p = 0.02), higher AA/EPA (p = 0.005) and higher AA/DHA ratios (p = 0.03) in serum at baseline. Similarly, AA/EPA (p = 0.01), AA/DHA (p = 0.038) and total omega-6/omega-3 ratios (p = 0.028) were higher in RBC, probably because of higher AA (p = 0.011). Conclusion: Two ADHD subgroups (oppositional and less hyperactive/impulsive children) improved after 15-week EPA treatment. Increasing EPA and decreasing omega-6 fatty acid concentrations in phospholipids were related to clinical improvement.

  • 29.
    Gustafsson, Per
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Molecular and Clinical Medicine, Child and Adolescent Psychiatry. Östergötlands Läns Landsting, Local Health Care Services in Central Östergötland, Department of Child and Adolescent Psychiatry.
    Duchén, Karel
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Molecular and Clinical Medicine, Pediatrics. Östergötlands Läns Landsting, Centre of Paediatrics and Gynecology and Obstetrics, Department of Paediatrics in Linköping.
    Birberg, Ulrika
    Linköping University, Department of Behavioural Sciences. Linköping University, Faculty of Arts and Sciences.
    Karlsson, Thomas
    Linköping University, Department of Behavioural Sciences. Linköping University, Faculty of Arts and Sciences.
    Breastfeeding, very long polyunsaturated fatty acids (PUFA) and IQ at 6 1/2 years of age2004In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 93, no 10, p. 1280-1287Article in journal (Refereed)
    Abstract [en]

    Aim: Breastfeeding seems to be favorable for cognitive development. Could levels of polyunsaturated fatty acids (PUFA) explain this? Methods: Pregnant mothers were recruited consecutively at maternity care centres. PUFA were analysed in colostrum and breast milk at 1 and 3 mo. The product-precursor ratios of n-6+n-3 PUFA were examined as measures of activity in respective steps in the fatty acid metabolic chain. Also, the quotient between DHA and AA was analysed. The children were tested with the full WISC-III at 6.5 y. Results: First, the influence of length of breastfeeding was analysed by multiple regression together with relevant cofactors (except for PUFA). In the best models, 46% of the variation in total IQ was explained. Length of breastfeeding contributed significantly to total IQ (beta = 0.228, p = 0.021), verbal IQ (beta = 0.204, p = 0.040) and performance IQ (beta = 0.210, p = 0.056). There were no significant single correlations between PUFA and measures of cognitive development. However, in multiple regression analysis of colostrum, significant beta-coefficients were found for steps 4+5 in the fatty acid metabolic chain (beta = 0.559, p = 0.002). If length of breastfeeding and gestation week were added to steps 4+5, this three-factor model could explain 67% of the variation of total IQ. Introducing length of breastfeeding and gestation week together with the quotient DHA/AA (beta = 0.510, p < 0.001) yielded a three-factor model, which explained 76% of the variation in total IQ. Conclusion: Our findings could be interpreted as supporting the importance of high levels of PUFA for cognitive development. However, the sample is small and the results must be interpreted with caution.

  • 30.
    Gustafsson, Per E
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Child and Adolescent Psychiatry . Linköping University, Faculty of Health Sciences.
    Gustafsson, Per A
    Linköping University, Department of Clinical and Experimental Medicine, Child and Adolescent Psychiatry . Linköping University, Faculty of Health Sciences.
    Nelson, Nina
    Linköping University, Department of Clinical and Experimental Medicine, Pediatrics . Linköping University, Faculty of Health Sciences.
    Cortisol levels and psychosocial factors in preadolescent children2006In: Stress and Health, ISSN 1532-3005, E-ISSN 1532-2998, Vol. 22, no 1, p. 3-9Article in journal (Refereed)
    Abstract [en]

    Regarding the relationship between psychosocial factors and health, one model of explanation states that psychosocial stress constitutes a principal mediator connecting psychosocial factors to health outcome, affecting the body through psychobiological mechanisms. This relationship has scarcely been studied in children. In the present study the relation between diurnal cortisol secretion and psychosocial factors [socio-economic status (SES), immigrant status and impact of psychiatric symptoms] was investigated in a normal population of 6-12 year old children (n = 273). Salivary cortisol levels were measured in the early morning, late morning and in the evening during three consecutive days. Parents answered demographic questionnaires and teachers answered psychiatric questionnaires concerning the children. Children exposed to one or more of the factors of psychosocial load (n = 117) had significantly higher morning (p < 0.001) and evening (p = 0.029) cortisol levels as well as total daily cortisol secretion [measured by the area under the curve (AUC), p = 0.003] compared to the group of children with none of the factors (n = 156). Different psychosocial stressors seemed to influence different parts of the diurnal cortisol curve. In conclusion, this study indicates that even children exposed to a moderate degree of psychosocial load differ in their cortisol levels compared to non-exposed children.

  • 31.
    Gustafsson, Per E
    et al.
    Dept. of Public Health and Clinical Medicine, Family Medicine, Umeå University.
    Anckarsäter, Henrik
    Dept. of Neuroscience and Physiology, Forensic Psychiatry, Gothenburg University.
    Lichtenstein, Paul
    Dept. of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm.
    Nelson, Nina
    Linköping University, Department of Clinical and Experimental Medicine, Pediatrics. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre of Paediatrics and Gynecology and Obstetrics, Department of Paediatrics in Linköping.
    Gustafsson, Per A
    Linköping University, Department of Clinical and Experimental Medicine, Child and Adolescent Psychiatry. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Local Health Care Services in Central Östergötland, Department of Child and Adolescent Psychiatry.
    Does quantity have a quality all its own?: Cumulative adversity and up- and down-regulation of circadian salivary cortisol levels in healthy children2010In: Psychoneuroendocrinology, ISSN 0306-4530, E-ISSN 1873-3360, Vol. 35, no 9, p. 1410-1415Article in journal (Refereed)
    Abstract [en]

    Findings have been divergent regarding the direction of basal cortisol dysregulations resulting from stressor exposure, and seem to differ between young people and adults. Accumulated stress exposure has been suggested to be a risk factor for the development of hypocortisolism. This cross-sectional study aims to examine the impact of cumulative adversity, i.e., the number of adversities, on diurnal salivary cortisol levels, including the cortisol awakening response (CAR), in children without psychiatric disorder. The sample consisted of 130 children (mean age 12.8 years), representing one in each twin pair included in the population-based Child and Adolescent Twin Study in Sweden (CATSS). Information about socioeconomic disadvantage, negative life events and potentially traumatic life events were collected by telephone interview and questionnaires, with parents as informants. Salivary cortisol sampling was performed in the home during two school days: at awakening, +30 min post-awakening, and at bedtime. Results showed that the number of adversities was related to the CAR, diurnal decline and +30 min post-awakening cortisol levels. Children with a moderate amount of cumulative adversity displayed high cortisol measures, while those with a high amount (3 or more) of adversities instead showed levels similar to the non-exposed group, yielding an inverse U-pattern of the association between cortisol and adversity. These results indicate that the accumulation of adversity might be an explanation of patterns of basal cortisol up-regulation in children and that those most severely exposed can exhibit an early stage of down-regulation, an issue which should be further examined in longitudinal studies.

  • 32.
    Gustafsson, Per E.
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Child and Adolescent Psychiatry. Linköping University, Faculty of Health Sciences.
    Gustafsson, Per A.
    Linköping University, Department of Clinical and Experimental Medicine, Child and Adolescent Psychiatry. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Local Health Care Services in Central Östergötland, Department of Child and Adolescent Psychiatry in Linköping.
    Ivarsson, Tord
    Department of Child and Adolescent Psychiatry, Göteborg University, Göteborg, Sweden; The Regional Center for Child and Adolescent Psychiatry (R. BUP), Oslo, Norway.
    Nelson, Nina
    Linköping University, Department of Clinical and Experimental Medicine, Pediatrics. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Center of Paediatrics and Gynaecology and Obstetrics, Department of Paediatrics in Linköping.
    Diurnal Cortisol Levels and Cortisol Response in Youths with Obsessive-Compulsive Disorder2008In: Neuropsychobiology, ISSN 0302-282X, E-ISSN 1423-0224, Vol. 57, no 1-2, p. 14-21Article in journal (Refereed)
    Abstract [en]

    Background/Aims: Recent results indicate a role of the hypothalamic-pituitary-adrenal (HPA) axis in the pathophysiology of obsessive-compulsive disorder (OCD). Although childhood onset is common, the HPA axis has scarcely been studied in young OCD subjects. Therefore, the present study aimed at examining basal and response levels of salivary cortisol in a sample of young OCD subjects.

    Methods: Twenty-three children and adolescents with DSM-IV OCD were compared to a reference group of school children (n = 240-336). The basal cortisol rhythm was measured through saliva samples 3 times/day. The cortisol response to a psychological stressor (exposure therapy in the OCD group and a fire alarm in the reference group) was also examined.

    Results: Compared to the reference group, OCD subjects displayed higher early-morning cortisol values (p = 0.005) with no difference between the late-morning and evening values. The cortisol levels in the OCD group diminished in response to the psychological stressor, compared to a positive response in the reference group (p < 0.001). No relation was found between cortisol and clinical parameters.

    Conclusion: These results support the idea that HPA hyperactivity, commonly found in adult OCD patients, is also present at an earlier stage of development, with specificity for the early-morning peak.

  • 33.
    Gustafsson, Per E.
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Child and Adolescent Psychiatry . Linköping University, Faculty of Health Sciences.
    Larsson, Ingbeth
    Linköping University, Department of Clinical and Experimental Medicine. Linköping University, Faculty of Health Sciences.
    Nelson, Nina
    Linköping University, Department of Clinical and Experimental Medicine, Pediatrics . Linköping University, Faculty of Health Sciences.
    Gustafsson, Per A
    Linköping University, Department of Clinical and Experimental Medicine, Child and Adolescent Psychiatry . Linköping University, Faculty of Health Sciences.
    Sociocultural Disadvantage, Traumatic Life Events, and Psychiatric Symptoms in Preadolescent Children2009In: American Journal of Orthopsychiatry, ISSN 0002-9432, E-ISSN 1939-0025, Vol. 79, no 3, p. 387-397Article in journal (Refereed)
    Abstract [en]

    Previous research has demonstrated impact of psychosocial adversity on the mental health of children. This cross-sectional study examined the differential relationships between life-time exposure to interpersonal and non-interpersonal traumatic life events as well as sociocultural factors (family social class and immigrant family), and the level of externalizing versus internalizing symptoms. Participants included 258 children aged 6 to 12 years from two Swedish elementary schools. Information was obtained from their parents by means of questionnaires (a demographic form including information about parental occupation and country of origin, the Strengths and Difficulties Questionnaire and the Life Incidence of Traumatic Events checklist). While controlling for gender, age and the other symptom dimension, the sociocultural factors were associated to internalizing but not to externalizing symptoms. In contrast, traumatic life events and especially interpersonal traumas related to externalizing symptoms but not to internalizing symptoms. These findings provide some support for specificity of psychosocial adversities and for the importance of interpersonal traumas, in the impact on child mental health.

     

  • 34.
    Gustafsson, Per E.
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Child and Adolescent Psychiatry. Linköping University, Faculty of Health Sciences.
    Nelson, Nina
    Linköping University, Department of Clinical and Experimental Medicine, Pediatrics. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Center of Paediatrics and Gynaecology and Obstetrics, Department of Paediatrics in Linköping.
    Gustafsson, Per A
    Linköping University, Department of Clinical and Experimental Medicine, Child and Adolescent Psychiatry. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Local Health Care Services in Central Östergötland, Department of Child and Adolescent Psychiatry in Linköping.
    Diurnal cortisol levels, psychiatric symptoms and sense of coherence in abused adolescents2010In: Nordic Journal of Psychiatry, ISSN 0803-9488, E-ISSN 1502-4725, Vol. 64, no 1, p. 27-31Article in journal (Refereed)
    Abstract [en]

    Background. The role of the HPA axis in psychiatric disorders following trauma is poorly studied and most studies have been done on adults. Aims. To investigate the association of mental well-being and diurnal cortisol in abused adolescents. Methods. The present crosssectional study examined diurnal salivary cortisol (measured three times a day during three days) in relation to psychiatric symptoms (Trauma Symptoms Checklist for Children) and the salutogenic construct “Sense of coherence”, in fifteen adolescents exposed to childhood abuse. Results. Significant positive correlations were found between symptoms and sense of coherence versus early and late morning cortisol concentrations. The correlations were most consistent for internalizing and externalizing symptoms, and somewhat less for post-traumatic symptoms and sense of coherence. In contrast, evening cortisol did not correlate with any of the psychological measures. Conclusion. These results extend previous research findings by pointing towards a relation between symptoms and higher morning cortisol and accentuated diurnal cortisol variation in abused adolescent as opposed to lower basal cortisol and a flattening of the cortisol rhythm repeatedly observed in traumatized adults.

  • 35.
    Gustafsson, Per E
    et al.
    Folkhälsa och Klinisk Medicin/Socialmedicin, Umeå University.
    Szczepanski, Anders
    Linköping University, Department of Behavioural Sciences and Learning. Linköping University, Department of Culture and Communication, Arts, Crafts and Design. Linköping University, Faculty of Arts and Sciences.
    Nelson, Nina
    Linköping University, Department of Clinical and Experimental Medicine, Pediatrics. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Center of Paediatrics and Gynaecology and Obstetrics, Department of Paediatrics in Linköping.
    Gustafsson, Per A
    Linköping University, Department of Clinical and Experimental Medicine, Child and Adolescent Psychiatry. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Local Health Care Services in Central Östergötland, Department of Child and Adolescent Psychiatry in Linköping.
    Effects of an outdoor education intervention on the mental health of schoolchildren2012In: Journal of Adventure Education and Outdoor Learning, ISSN 1472-9679, E-ISSN 1754-0402, Vol. 12, no 1, p. 63-79Article in journal (Refereed)
    Abstract [en]

    This study aimed at examining the effects of an outdoor educational intervention on the mental health of schoolchildren. Two elementary schools participated (N = 230); one experimental school where the intervention was implemented, and the other a reference school. Demographic questions and the Strengths and Difficulties Questionnaire were completed by the parents. An outdoor educational intervention was implemented at the experimental school, and the data collection was repeated after one year. The results point towards a small but non-significant improvement in mental health at the experimental school while adjusting for demographics. However, this effect was significantly moderated by gender: boys generally fared better than girls at the intervention school, relative to the reference school. The results indicate that it may be important to address gender issues when educational programmes are implemented in schools.

  • 36.
    Gustafsson, Per
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Child and Adolescent Psychiatry. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Local Health Care Services in Central Östergötland, Department of Child and Adolescent Psychiatry.
    Gustafsson, Per E
    Umeå University.
    Anckarsater, Henrik
    Gothenburg University.
    Lichtenstein, Paul
    Karolinska Institute.
    Ljung, Therese
    Karolinska Institute.
    Nelson, Nina
    Linköping University, Department of Clinical and Experimental Medicine, Pediatrics. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Centre of Paediatrics and Gynecology and Obstetrics, Department of Paediatrics in Linköping.
    Larsson, Henrik
    Karolinska Institute.
    Heritability of Cortisol Regulation in Children2011In: Twin Research and Human Genetics, ISSN 1832-4274, E-ISSN 1839-2628, Vol. 14, no 6, p. 553-561Article in journal (Refereed)
    Abstract [en]

    Background: The normal development of cortisol regulation during childhood is thought to be influenced by a complex interplay between environmental and genetic factors. Method: The aim of this study was to estimate genetic and environmental influences on basal cortisol levels in a sample of 151 twin pairs aged 9-16 years. Salivary cortisol was collected on two consecutive days when the children attended school immediately after awakening, 30 min post-awakening and at bedtime. Results: Heritability was highest (60%) for cortisol levels about 30 min after awakening. For samples taken immediately at awakening heritability was less pronounced (28%) and in the evening low (8%). Conclusion: The limited genetic influence on evening levels, moderate on cortisol at awakening and high on awakening response, might imply two genetic regulation patterns, one specifically for awakening response and one for the circadian rhythm proper. These findings could explain divergent results in previous studies and highlight the importance of taking the circadian rhythm into account in studies of cortisol levels in children.

  • 37.
    Gustafsson, Per
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Molecular and Clinical Medicine, Child and Adolescent Psychiatry. Östergötlands Läns Landsting, CPS - Centrum för psykiatri och samhällsmedicin, BUP - Barn- och ungdomspsykiatri.
    Kjellman, N-IM
    Björkstén, B
    Family interaction and a supportive social network as salutogenic factors in childhood atopic illness2002In: Pediatric Allergy and Immunology, ISSN 0905-6157, E-ISSN 1399-3038, Vol. 13, no 1, p. 51-57Article in journal (Refereed)
    Abstract [en]

    The role of psycho-social factors in the development of allergy was studied prospectively in 82 infants with a family history of atopy. The family participated in a standardized family test when the children were 18 months old. The ability to adjust to demands of the situation ('adaptability'), and the balance between emotional closeness and distance ('cohesion'), were assessed from videotapes by independent raters. Families rated as functional in both of these aspects were classified as 'functional', otherwise as 'dysfunctional'. The social network, life events, atopic symptoms (based on postal inquiries regarding symptoms answered by the parents, and on physical examinations), psychiatric symptoms, and socio-economic circumstances of the families were evaluated when the children were 18 months and 3 years of age. The children were classified as atopic (asthmatic symptoms or eczema) or as non-atopic. All but two children with atopic disease at 3 years of age had atopic disease before 18 months of age, while 32 of 60 children with atopic disease at 18 months of age had no problems by 3 years of age. An unbalanced family interplay at 18 months was associated with a relative risk (RR) of 1.99 for continuing atopic illness at 3 years of age (1.18

  • 38.
    Hjern, Anders
    et al.
    Stockholm University, Sweden .
    Rajmil, Luis
    Catalan Agency Health Informat Assessment and Qual, Spain .
    Bergstrom, Malin
    Stockholm University, Sweden .
    Berlin, Marie
    National Board Health and Welf, Sweden .
    Gustafsson, Per A.
    Linköping University, Department of Clinical and Experimental Medicine, Division of Neuro and Inflammation Science. Linköping University, Faculty of Medicine and Health Sciences. Linköping University, Center for Social and Affective Neuroscience (CSAN).
    Modin, Bitte
    Stockholm University, Sweden .
    Migrant density and well-being-A national school survey of 15-year-olds in Sweden2013In: European Journal of Public Health, ISSN 1101-1262, E-ISSN 1464-360X, Vol. 23, no 5, p. 823-828Article in journal (Refereed)
    Abstract [en]

    Background: The aim of this study was to investigate the impact of migrant density in school on the well-being of pupils with a migrant origin in first as well as second generation. Methods: Cross-sectional analysis of data from a national classroom survey of 15-year-old Swedish schoolchildren. The study population included 76 229 pupils (86.5% participation) with complete data set from 1352 schools. Six dimensions of well-being from the KIDSCREEN were analysed in two-level linear regression models to assess the influence of migrant origin at individual level and percentage of students with a migrant origin at school level, as well as interaction terms between them. Z-scores were used to equalize scales. Results: A high density (andgt; 50%) of pupils with a migrant origin in first or second generation was associated with positive well-being on all six scales for foreign-born pupils originating in Africa or Asia compared with schools with low (andlt; 10%) migrant density. The effect sizes were 0.56 for boys and 0.29 for girls on the comprehensive KIDSCREEN 10-index (P andlt; 0.001) and 0.61 and 0.34, respectively, for psychological well-being (P andlt; 0.001). Of the boys and girls born in Africa or Asia, 31.6% and 34.6%, respectively, reported being bullied during the past week in schools with low (andlt; 10%) migrant density. Conclusions: Pupils born in Africa or Asia are at high risk for being bullied and having impaired well-being in schools with few other migrant children. School interventions to improve peer relations and prevent bullying are needed to promote well-being in non-European migrant children.

  • 39.
    Jarkman Björn, Gunilla
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Child and Adolescent Psychiatry. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Local Health Care Services in Central Östergötland, Department of Child and Adolescent Psychiatry in Linköping.
    Bodén, Christina
    Linköping University, Department of Clinical and Experimental Medicine, Child and Adolescent Psychiatry. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Local Health Care Services in Central Östergötland, Department of Child and Adolescent Psychiatry in Linköping.
    Sydsjö, Gunilla
    Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Center of Paediatrics and Gynaecology and Obstetrics, Department of Gynaecology and Obstetrics in Linköping.
    Gustafsson, Per A.
    Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Local Health Care Services in Central Östergötland, Department of Child and Adolescent Psychiatry in Linköping.
    Brief Family Therapy for Refugee Children2013In: The Family Journal, ISSN 1066-4807, E-ISSN 1552-3950, Vol. 21, no 3, p. 272-278Article in journal (Refereed)
    Abstract [en]

    The aim of this study was to compare refugee children’s psychological well-being before and after brief family therapy. Families from Bosnia-Herzegovina with one child aged 5–12 years received three family therapy sessions. Psychological assessments using the Erica play-diagnostic method and parental interviews were made before and after the intervention. The main finding was that more children built normal sandboxes (showing no pathological findings)after the intervention than before, indicating that the rather short intervention had a positive effect on the children’s psychological well-being. To conclude, it might be valuable to offer refugee families a few family therapy sessions even if the children do not have psychiatric symptoms with the aim of helping them adapt to a new system of society.

  • 40.
    Jarkman Björn, Gunilla
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Child and Adolescent Psychiatry. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Local Health Care Services in Central Östergötland, Department of Child and Adolescent Psychiatry in Linköping.
    Gustafsson, Per A.
    Linköping University, Department of Clinical and Experimental Medicine, Child and Adolescent Psychiatry. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Local Health Care Services in Central Östergötland, Department of Child and Adolescent Psychiatry in Linköping.
    Sydsjö, Gunilla
    Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Center of Paediatrics and Gynaecology and Obstetrics, Department of Gynaecology and Obstetrics in Linköping.
    Berterö, Carina
    Linköping University, Department of Medical and Health Sciences, Nursing Science. Linköping University, Faculty of Health Sciences.
    Family therapy sessions with regugee families: a qualitative study2013In: Conflict and Health, ISSN 1752-1505, E-ISSN 1752-1505, Vol. 7, article id 7Article in journal (Refereed)
    Abstract [en]

    Background

    Due to the armed conflicts in the Balkans in the 1990s many families escaped to other countries. The main goal of this study was to explore in more detail the complexity of various family members’ experiences and perceptions from their life before the war, during the war and the escape, and during their new life in Sweden. There is insufficient knowledge of refugee families’ perceptions, experiences and needs, and especially of the complexity of family perspectives and family systems. This study focused on three families from Bosnia and Herzegovina who came to Sweden and were granted permanent residence permits. The families had at least one child between 5 and 12 years old.

    Method

    Family therapy sessions were videotaped and verbatim transcriptions were made. Nine family therapy sessions were analysed using a qualitative method with directed content analysis.

    Results

    Three main categories and ten subcategories were found - 1. Everyday life at home, with two subcategories: The family, Work and School/preschool; 2. The influence of war on everyday life, with three subcategories: The war, The escape, Reflections; 3. The new life, with five subcategories: Employment, Health, Relatives and friends, Limited future, Transition to the new life.

    Conclusions

    Health care and social welfare professionals need to find out what kind of lives refugee families have lived before coming to a new country, in order to determine individual needs of support. In this study the families had lived ordinary lives in their country of origin, and after experiencing a war situation they escaped to a new country and started a new life. They had thoughts of a limited future but also hopes of getting jobs and taking care of themselves and their families. When analysing each person’s point of view one must seek an all-embracing picture of a family and its complexity to tie together the family narrative. To offer refugee families meetings with family-oriented professionals to provide the opportunity to create a family narrative is recommended for the health and social welfare sector. Using this knowledge by emphasizing the salutogenic perspectives facilitates support to refugee families and individuals. This kind of support can help refugee families to adapt to a new system of society and recapture a sense of coherence, including all three components that lead to coherence: comprehensibility, manageability and meaningfulness. More studies are needed to further investigate the thoughts, experiences and needs of various refugee families and how refugee receiving societies can give the most effective support.

  • 41.
    Jarkman-Björn, Gunilla
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Child and Adolescent Psychiatry. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Local Health Care Services in Central Östergötland, Department of Child and Adolescent Psychiatry in Linköping.
    Bodén, Christina
    Linköping University, Department of Clinical and Experimental Medicine. Linköping University, Faculty of Health Sciences.
    Sydsjö, Gunilla
    Linköping University, Department of Clinical and Experimental Medicine, Obstetrics and gynecology. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Center of Paediatrics and Gynaecology and Obstetrics, Department of Gynaecology and Obstetrics in Linköping.
    Gustafsson, Per A
    Linköping University, Department of Clinical and Experimental Medicine, Child and Adolescent Psychiatry. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Local Health Care Services in Central Östergötland, Department of Child and Adolescent Psychiatry in Linköping.
    Psychological evaluation of refugee children: contrasting results from play diagnosis and parental interviews2011In: Clinical Child Psychology and Psychiatry, ISSN 1359-1045, E-ISSN 1461-7021, Vol. 16, no 4, p. 517-34Article in journal (Refereed)
    Abstract [en]

    Many refugee families from Bosnia and Herzegovina arrived in Sweden during the Balkan conflict in the 1990s. We studied 14 of these families to compare psychological evaluation of the children using two different methods. We first carried out a semi-structured interview of a parent or parents in each family. The symptoms of each of the children, who ranged in age from 5 to 12 years, were evaluated based on these interview results. Then a second method, the Erica play-diagnosis method, was used to study the inner thoughts and feelings of the children. Results from the Erica play-diagnosis method were compared with results from Erica play- diagnosis from a normal group. According to results from the parental interviews all but one child in this study had a low level of psychological symptoms. In contrast, results from Erica play-diagnosis of these children showed that there were higher frequencies of not-normal play in these children compared with those in the normal group, which is an indication of deficiencies in the psychological well-being of these children. The results emphasise the importance of getting diagnostic information from the child in order to understand each child's psychological condition.

  • 42. Klingberg, Torkel
    et al.
    Fernell, Elisabeth
    Olesen, Pernille
    Johnson, Mats
    Gustafsson, Per
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Molecular and Clinical Medicine, Child and Adolescent Psychiatry. Östergötlands Läns Landsting, Local Health Care Services in Central Östergötland, Department of Child and Adolescent Psychiatry.
    Dahlström, Kerstin
    Gillberg, Christopher
    Forssberg, Hans
    Westerberg, Helena
    Computerized training of working memory in children with ADHD - A randomized, controlled trial2005In: Journal of the American Academy of Child and Adolescent Psychiatry, ISSN 0890-8567, E-ISSN 1527-5418, Vol. 44, no 2, p. 177-186Article in journal (Refereed)
    Abstract [en]

    Objective: Deficits in executive functioning, including working memory (WM) deficits, have been suggested to be important in attention-deficit/ hyperactivity disorder (ADHD). During 2002 to 2003, the authors conducted a multicenter, randomized, controlled, double-blind trial to investigate the effect of improving WM by computerized, systematic practice of WM tasks. Method: Included in the trial were 53 children with ADHD (9 girls, 15 of 53 inattentive subtype), aged 7 to 12 years, without stimulant medication. The compliance criterion (>20 days of training) was met by 44 subjects, 42 of whom were also evaluated at follow-up 3 months later. Participants were randomly assigned to use either the treatment computer program for training WM or a comparison program. The main outcome measure was the span-board task, a visuospatial WM task that was not part of the training program. Results: For the span-board task, there was a significant treatment effect both post-intervention and at follow-up. In addition, there were significant effects for secondary outcome tasks measuring verbal WM, response inhibition, and complex reasoning. Parent ratings showed significant reduction in symptoms of inattention and hyperactivity/impulsivity, both post-intervention and at follow-up. Conclusions: This study shows that WM can be improved by training in children with ADHD. This training also improved response inhibition and reasoning and resulted in a reduction of the parent-rated inattentive symptoms of ADHD.

  • 43.
    Mörelius, Evalotte
    et al.
    Linköping University, Department of Social and Welfare Studies, Division of Health, Activity and Care. Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Center of Paediatrics and Gynaecology and Obstetrics, Department of Paediatrics in Linköping.
    Gustafsson, Per A.
    Linköping University, Department of Clinical and Experimental Medicine, Child and Adolescent Psychiatry. Linköping University, Faculty of Health Sciences. Region Östergötland, Local Health Care Services in Central Östergötland, Department of Child and Adolescent Psychiatry in Linköping.
    Ekberg, Kerstin
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Health Sciences.
    Nelson, Nina
    Östergötlands Läns Landsting, Center of Paediatrics and Gynaecology and Obstetrics, Department of Paediatrics in Norrköping. Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Health Sciences.
    Neonatal Intensive Care and Child Psychiatry Inpatient Care: Do Different Working Conditions Influence Stress Levels?2013In: Nursing Research and Practice, ISSN 2090-1429, E-ISSN 2090-1437, Vol. 2013Article in journal (Refereed)
    Abstract [en]

    Introduction. Nurses often experience work-related stress. High stress can negatively affect job satisfaction and lead to emotional exhaustion with risk of burnout.

    Aim. To analyse possible differences in biological stress markers, psychosocial working conditions,health, and well-being between nurses working in two different departments.

    Methods. Stress was evaluated in nurses working in a neonatal intensive care unit (NICU) (𝑛 = 33) and nursesworking in a child and adolescent psychiatry inpatient ward (CAP) (𝑛 = 14) using salivary cortisol and HbA1c. Salivary cortisol was measured three times a day on two consecutive days during two one-week periods, seven weeks apart (= 12 samples/person). Psychosocial working conditions, health, and well-being were measured once.

    Results. NICU nurses had better social support and more self-determination. CAP nurses had a lower salivary cortisol quotient,poorer general health, and higher client-related burnout scores.

    Conclusion.When comparing these nurses with existing normdata for Sweden, as a group their scores reflect less work-related stress than Swedes overall. However, the comparison between NICU and CAP nurses indicates a less healthy work situation for CAP nurses.

    Relevance to Clinical Practice. Healthcare managers need to acknowledge the less healthy work situation CAP nurses experience in order to provide optimal support and promote good health.

  • 44.
    Mörelius, Evalotte
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Pediatrics . Linköping University, Faculty of Health Sciences.
    Nelson, Nina
    Linköping University, Department of Clinical and Experimental Medicine, Pediatrics . Linköping University, Faculty of Health Sciences.
    Gustafsson, Per A
    Linköping University, Department of Clinical and Experimental Medicine, Child and Adolescent Psychiatry . Linköping University, Faculty of Health Sciences.
    Salivary cortisol response in mother-infant dyads at psychosocial high-risk2006In: Child Care Health and Development, ISSN 0305-1862, E-ISSN 1365-2214, Vol. 33, no 2, p. 128-136Article in journal (Refereed)
    Abstract [en]

    Objectives The aim of the present study was to investigate the adrenocortical response to diaper change in mother–infant dyads with psychosocial risk factors.

    Material and methods Twenty-two mother–infant pairs with well-defined psychosocial problems were included. The mother–infant pairs were treated for 6 weeks in a daycare programme to improve attachment. Salivary cortisol was measured before and after a diaper change during the first and last weeks of enrolment in the programme. Mothers' sensitivity towards their infants' signals was measured using a scale from 1 (highly insensitive) to 9 (highly sensitive) according to Ainsworth.

    Results Median salivary cortisol increased in 15 out of 22 infants after the first diaper change. The increase was most pronounced in the group of infants below 3 months of age (n = 15) where median salivary cortisol increased 170% after the first diaper change (P < 0.05) and decreased 19% after the last diaper change (not significant). Out of these 15 infants, 11 showed an increase in salivary cortisol in response to the first diaper change while four out of 15 did so in response to the last diaper change (P < 0.05). The salivary cortisol response did not change over time in infants aged 3 months or above. A mother's sensitivity to her child increased significantly (P < 0.001) from the first to the last week. In mothers, median salivary cortisol decreased 38% after the first diaper change (P < 0.05) and 57% after the last diaper change (P = 0.001).

    Discussion A diaper change is normally not perceived as stressful. The stress response caused by a diaper change may illustrate an insufficiency in the mother–infant relationship before treatment. Professional support improved the mothers' sensitivity and stabilized the stress response to diaper change in the youngest infants.

  • 45.
    Proczkowska-Björklund, Marie
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Child and Adolescent Psychiatry. Linköping University, Faculty of Health Sciences.
    Gustafsson, Per A.
    Linköping University, Department of Clinical and Experimental Medicine, Child and Adolescent Psychiatry. Linköping University, Faculty of Health Sciences.
    Svedin, Carl Göran
    Linköping University, Department of Clinical and Experimental Medicine, Child and Adolescent Psychiatry. Linköping University, Faculty of Health Sciences.
    Children's play after anaesthesia and surgery: background factors and associations to behaviour during anaesthetic induction2010In: Journal of Child Health Care, ISSN 1367-4935, E-ISSN 1741-2889, Vol. 14, no 2, p. 170-178Article in journal (Refereed)
    Abstract [en]

    Children can experience anaesthetic induction as fearful and frightening and this can lead to postoperative behaviour changes and symptoms of high anxiety. A fearful experience can also lead to avoidant reactions due to raised negative emotions in situations similar to that, which evoked the fear. To analyse children’s reactions after anaesthesia to anaesthetic play equipment, 49 children (three—six years old) were video-filmed during play with anaesthetic equipment 14 days after anaesthesia and surgery. The risk that the child avoided playing with anaesthetic equipment was increased if the child took the premedication unwillingly and if the child was younger. The risk for not telling about the experience was increased if the child took the premedication unwillingly and if the child showed signs of shyness. The risk for telling mostly unspecific memories increased if the child was younger and if the child showed signs of shyness. Avoidant reactions could bee seen in 50 percent of the children. It is important to be aware of the characteristics of a vulnerable child (age, shyness) and to meet the child without raising negative emotions in any part of the anaesthetic process, in order to avoid negative reactions in future encounters.

  • 46.
    Proczkowska-Björklund, Marie
    et al.
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Clinical and Experimental Medicine, Child and Adolescent Psychiatry.
    Runeson, I.
    Department of Health and Behaviour Sciences, University of Kalmar, Kalmar, Sweden.
    Gustafsson, Per A.
    Linköping University, Department of Clinical and Experimental Medicine, Child and Adolescent Psychiatry. Linköping University, Faculty of Health Sciences.
    Svedin, Carl Göran
    Linköping University, Faculty of Health Sciences. Linköping University, Department of Clinical and Experimental Medicine, Child and Adolescent Psychiatry.
    Decision making about pre-medication to children.2008In: Child Care Health and Development, ISSN 0305-1862, E-ISSN 1365-2214, Vol. 34, no 6, p. 713-720Article in journal (Refereed)
    Abstract [en]

    Background: Inviting the child to participate in medical decisions regarding common medical procedures might influence the child's behaviour during the procedures. We wanted to study nurse decision-making communication regarding pre-medication before ear, nose and throat (ENT) surgery.

    Method: In total, 102 children (3-6 years) signed for ENT surgery were video-filmed during the pre-medication process. The nurse decision-making communication was identified, transcribed and grouped in six main categories dependent on the level of participation (self-determination, compromise, negotiation, questioning, information, lack of communication). Associations between child factors (age, gender, verbal communication and non-verbal communication) and different nurse decision-making communication were studied. Associations between the decision-making communication and verbal hesitation and/or the child's compliance in taking pre-medication were also studied.

    Results: Totally, information was the most frequently used category of decision making communication followed by negotiation and questioning. To the children showing signs of shyness, the nurse used more negotiation, questions and self-determination communication and less information. The nurse used more compromise, negotiation and gave less information to children with less compliance. No specific type of nurse decision-making communication was associated with verbal hesitation. The most important predictors for verbal hesitation were none or hesitant eye contact with nurse (OR = 4.5) and placement nearby or in parent's lap (OR = 4.7). Predictors for less compliance in taking pre-medication were verbal hesitation from the child (OR = 22.7) and children who did not give any verbal answer to nurse initial questions (OR = 5.5).

    Conclusion: Decision-making communication could not predict the child's compliance during pre-medication. Although negotiation, questioning and self-determination communication were associated with more unwillingness to take pre-medication. More knowledge is needed about communication to children in medical settings and how it influences the child's behaviours.

  • 47.
    Proczkowska-Björklund, Marie
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Child and Adolescent Psychiatry . Linköping University, Faculty of Health Sciences.
    Runeson, Ingrid
    Department of Health and Behaviour Sciences, University of Kalmar, Kalmar, Sweden.
    Gustafsson, Per A
    Linköping University, Department of Clinical and Experimental Medicine, Child and Adolescent Psychiatry . Linköping University, Faculty of Health Sciences.
    Svedin, Carl Göran
    Linköping University, Department of Clinical and Experimental Medicine, Child and Adolescent Psychiatry . Linköping University, Faculty of Health Sciences.
    Communication and child behaviour associated with unwillingness to take premedication.2008In: Acta Paediatrica, ISSN 0803-5253, E-ISSN 1651-2227, Vol. 97, no 9, p. 1238-1242Article in journal (Refereed)
    Abstract [en]

    Aim: To see how dominance in adult communication and child behaviour during premedication affects the child's unwillingness to take premedication.

    Method: Ninety-five children scheduled for ENT surgery were video-filmed during premedication. All communication was translated verbatim and the communication was grouped according to; if the parent or nurse directed their communication towards the child or not, or; if they talked about nonprocedural matters or procedural matters.

    Results: Unwillingness to take premedication was associated with more parent communication and less anaesthetic nurse communication compared to willingness to take premedication. There was a heighten risk that the child took their premedication unwillingly if their parent talked more directly to the child (OR = 4.9, p < or = 0.01), the child gave hesitant eye contact with the anaesthetic nurse (OR = 4.5, p < or = 0.05), the child had experienced an earlier traumatic medical procedure (OR = 4.1. p < or = 0.001) or if the child placed her/himself nearby their parent (OR = 4.0, p < or = 0.001).

    Conclusion: Together with behaviour that could be signs of shyness and earlier medical traumatic experience, parents that are actively communicating with their child before premedication may heighten the risk that the child will take the premedication unwillingly.

  • 48.
    Sikirica, Vanja
    et al.
    Shire, Wayne, PA, USA.
    Gustafsson, Per A.
    Linköping University, Department of Clinical and Experimental Medicine, Center for Social and Affective Neuroscience. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Local Health Care Services in Central Östergötland, Department of Child and Adolescent Psychiatry in Linköping.
    Makin, Charles
    IMS Health, San Francisco, CA, USA.
    Treatment Patterns among Children and Adolescents with Attention-Deficit/Hyperactivity Disorder with or without Psychiatric or Neurologic Comorbidities in Sweden: A Retrospective Cohort Study2017In: Neurology and therapy, ISSN 2193-6536, Vol. 6, no 1, p. 115-130Article in journal (Refereed)
    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.

  • 49.
    Svanborg, Paer
    et al.
    Eli Lilly Sweden AB.
    Thernlund, Gunilla
    Lund University.
    Gustafsson, Per
    Linköping University, Department of Clinical and Experimental Medicine, Child and Adolescent Psychiatry . Linköping University, Faculty of Health Sciences. Östergötlands Läns Landsting, Local Health Care Services in Central Östergötland, Department of Child and Adolescent Psychiatry.
    Hagglof, Bruno
    Umeå University.
    Poole, Lynne
    Eli Lilly & Co.
    Kadesjoe, Bjoern
    University of Gothenburg.
    Efficacy and safety of atomoxetine as add-on to psychoeducation in the treatment of attention deficit/hyperactivity disorder A randomized, double-blind, placebo-controlled study in stimulant-naive Swedish children and adolescents2009In: EUROPEAN CHILD and ADOLESCENT PSYCHIATRY, ISSN 1018-8827, Vol. 18, no 4, p. 240-249Article in journal (Refereed)
    Abstract [en]

    Objective The primary objective of this study was to assess the impact of atomoxetine in combination with psychoeducation, compared with placebo and psychoeducation, on health-related quality of life (HRQL) in Swedish stimulant-naive pediatric patients with attention deficit/hyperactivity disorder (ADHD). HRQL results will be presented elsewhere. Here, psychoeducation as well as efficacy and safety of the treatment are described. Patients and methods A total of 99 pediatric ADHD patients were randomized to a 10-week double-blind treatment with atomoxetine (49 patients) or placebo (50 patients). Parents of all patients received four sessions of psychoeducation. Atomoxetine was dosed up to approximately 1.2 mg/kg day (<= 70 kg) or 80 mg/day (>70 kg). Improvement of ADHD symptoms was evaluated using the ADHD rating scale (ADHD-RS) and clinical global impression (CGI) rating scales. Safety was assessed based on adverse events (AEs). Results The study population was predominantly male (80.8%) and diagnosed with the combined ADHD subtype (77.8%). The least square mean (lsmean) change from baseline to endpoint in total ADHD-RS score was -19.0 for atomoxetine patients and -6.3 for placebo patients, resulting in an effect size (ES) of 1.3 at endpoint. Treatment response (reduction in ADHD-RS score of >= 25 or >= 40%) was achieved in 71.4 or 63.3% of atomoxetine patients and 28.6 or 14.3% of placebo patients. The lsmean change from baseline to endpoint in CGI-Severity group compared with -0.3 in the placebo group. The difference between treatments in CGI-Improvement at endpoint was -1.4 in favor of atomoxetine. No serious AEs occurred. The safety profile of atomoxetine was in line with the current label. Conclusions Atomoxetine combined with psychoeducation was superior to placebo and psychoeducation in ADHD core symptoms improvement. The large ES might be a result of including stimulant-naive patients only, but also may indicate a positive interaction between atomoxetine treatment and psychoeducation, possibly by increased compliance.

  • 50.
    Svanborg, Par
    et al.
    Eli Lilly Sweden AB.
    Thernlund, Gunilla
    Lund University.
    Gustafsson, Per
    Linköping University, Department of Clinical and Experimental Medicine, Child and Adolescent Psychiatry . Linköping University, Faculty of Health Sciences.
    Hagglof, Bruno
    Umeå University.
    Schacht, Alexander
    Lilly Deutschland GmbH.
    Kadesjo, Bjorn
    University of Gothenburg.
    Atomoxetine improves patient and family coping in attention deficit/hyperactivity disorder: a randomized, double-blind, placebo-controlled study in Swedish children and adolescents2009In: EUROPEAN CHILD and ADOLESCENT PSYCHIATRY, ISSN 1018-8827, Vol. 18, no 12, p. 725-735Article in journal (Refereed)
    Abstract [en]

    This 10-week study assessed the efficacy of atomoxetine in combination with psychoeducation compared to placebo and psychoeducation in the improvement of Quality of Life in Swedish stimulant-naive children and adolescents with attention deficit/hyperactivity disorder. A total of 99 patients were treated with atomoxetine (49 patients) or placebo (50 patients) for 10 weeks and assessed regarding broader areas of functioning using the Quality of Life measures Child Health and Illness Profile-Child Edition (CHIP-CE), Family Strain Index [FSI; equivalent to the Family Burden of Illness Module used in the study], Appraisal of Stress in Child-Rearing (ASCR), Five to fifteen (FTF), "I think I am" ("Jag tycker jag ar"), and Childrens Depression Rating Scale-Revised (CDRS-R) before and after the active treatment phase. Simultaneously, the patients parents participated in a 4-session psychoeducation program. A statistically significant difference in favor of atomoxetine was seen in the improvement from baseline to study endpoint for the CHIP-CE domains "Achievement" and "Risk avoidance", for the FSI total score, for the ASCR section (I) domain "Child as a burden", for all FTF domains except for "Language and Speech", and for the CDRS-R total score. No difference between treatment groups was observed in the patient-assessed evaluation of self-esteem using the "I think I am" scale. Atomoxetine combined with psychoeducation had a positive effect on various everyday coping abilities of the patients as well as their families during 10 weeks of treatment, whereas the patients self-image and the parents image of the climate in the family were not significantly improved.

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