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  • 51.
    Nilsson, Doris
    et al.
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences. Region Östergötland, Local Health Care Services in Central Östergötland, Department of Child and Adolescent Psychiatry in Linköping.
    Lejoonclou, Annika
    Region Östergötland.
    Holmqvist, Rolf
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences.
    Psychoform and somatoform dissociation amongindividuals with eating disorders2019In: Nordic Journal of Psychiatry, ISSN 0803-9488, E-ISSN 1502-4725, p. 1-8Article in journal (Refereed)
    Abstract [en]

    Objective: This study analyzed the prevalence of psychoform and somatoform dissociation among individuals with the whole spectrum of eating disorder diagnoses and compared it with ratings from a non-clinical group. The relationship between dissociation and severity of eating disturbance was examined as well as differences between the eating disorder diagnosis groups in extent of dissociation. The validity of a new structural dissociation interview suitable for eating disorder patients was analyzed.

    Method: Sixty individuals with eating disorder completed three self-report questionnaires: Dissociation Questionnaire Sweden, Somatoform Dissociation Questionnaire and Eating Disorder Examination Questionnaire. The ratings were compared with the scores in a female non-clinical group (N = 245). Twenty patients with eating disorder diagnoses were interviewed with the Interview for Dissociative Disorders and Trauma Related Symptoms. The validity of the interview was tested by comparing the ratings on the interview subscales with the scores on the Dissociation questionnaires and the Somatoform Dissociation Questionnaire.

    Results: Participants with eating disorders reported a higher extent of both psychoform and somatoform dissociation compared with the non-clinical individuals. Analyses also showed a correlation between degree of dissociation and severity of eating disorder symptoms. No differences in dissociation were found between the ED subgroups. Participants reporting more dissociation got higher ratings on the interview, indicating convergent validity.

    Discussion: Eating disorders seem to be associated with presence and severity of dissociative symptoms. The extent of dissociation needs to be assessed for these individuals as treatment may benefit from a focus on such symptoms in order to increase its effect.

  • 52.
    Nilsson, Doris
    et al.
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences. Region Östergötland, Local Health Care Services in Central Östergötland, Department of Child and Adolescent Psychiatry in Linköping.
    Nordås, Elvira
    Linköping University, Department of Behavioural Sciences and Learning. Linköping University, Faculty of Arts and Sciences.
    Priebe, Gisela
    Linköping University, Department of Clinical and Experimental Medicine, Barnafrid. Linköping University, Faculty of Medicine and Health Sciences. Department of Psychology, Lund University, Lund, Sweden.
    Svedin, Carl Göran
    Linköping University, Department of Clinical and Experimental Medicine, Barnafrid. 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.
    Child physical abuse: High school students’ mental health and parental relations depending on who perpetrated the abuse2017In: International Journal of Child Abuse & Neglect, ISSN 0145-2134, E-ISSN 1873-7757, Vol. 70, p. 28-38Article in journal (Refereed)
    Abstract [en]

    The aim of this study was to contribute to the research of child physical abuse (CPA) by examining if there were any differences in high school students’ mental health (in this study symptoms of depression and anxiety, self-esteem and sense of coherence) and/or, in how they perceive their parents, depending on whether or not they had been subjected to CPA during childhood. In addition, if high school students reported different mental health and/or, relationships with their parents, depending on if their mother, father or both parents were the perpetrators of CPA.

    A representative national sample of high school students (N = 3288, data collected 2009) participated in the study. Participants completed the following: questions about CPA and alleged perpetrators, the Hopkins Symptom Checklist, Rosenberg Self-Esteem Scale, the Sense of Coherence Scale and Parental Bonding Instrument.

    The results showed students who reported experiences of CPA were more likely to report symptoms of mental illness and negative perceptions of their parents’ parenting. However, there were no mental health differences depending on whether their mother, father or both parents were the perpetrators of CPA. Still, there were differences in perceived parenting indicating that mothers’ parenting was perceived as more negative when mothers only or both parents were perpetrators of the abuse than when only fathers were perpetrators.

  • 53.
    Nilsson, Doris
    et al.
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences. Region Östergötland, Local Health Care Services in Central Östergötland, Department of Child and Adolescent Psychiatry in Linköping.
    Svedin, Carl Göran
    Linköping University, Department of Clinical and Experimental Medicine, Barnafrid. 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.
    Kunskapsöversikt om stöd och behandling för barn som utsatts för sexuella övergrepp och fysisk misshandel2017Report (Other academic)
    Abstract [sv]

    Denna översikt är inte vad man brukar kalla en systematisk litteraturöversikt utan en översikt i huvudsak baserad på tidigare kunskapsöversikter och metaanalyser. Det innebar att enstaka artiklar och studier kan ha förbisetts beroende på de sökord som har använts i de olika översiktsartiklarna och metaanalyserna. Vi har dock så långt det är möjligt letat i andra sammanställningar och organisationers hemsidor för att minimera risken för att viktiga instrument och evidensbaserade interventioner missats.

    Det som framkommit i denna kunskapsöversikt är att när något barn eller ungdom varit utsatt för ett trauma så är det viktigt att det tidigt finns ett gott omhändertagande för att lindra och om möjligt förhindra en negativ utveckling av den psykiska hälsan som följd av att ha varit utsatt för ett potentiellt trauma. I vissa fall och kanske framförallt när det gäller potentiella trauman som inte innehåller våld eller sexuella övergrepp kan det kanske räcka med en kortare men evidensbaserad tidig intervention. Forskning visar att det för ungefär hälften av de traumatiserade barnen sker en spontanläkning de första tre månaderna av posttraumatisk stress, för att sedan plana ut, men att det efter 6 månader inte längre är troligt att symtomen försvinner utan intervention (Hiller et al., 2016).

    Genom screening och annan bedömning bör man kunna avgöra om barnet eller ungdomen behöver någon ytterligare behandling, förslagsvis då en av de evidensbaserade behandlingar som finns, och vid mer komplex traumatisering en behandling anpassad för detta ändamål.

    Det är dock viktigt att betona att en del barn och ungdomar kan behöva behandling omedelbart, till exempel när allvarliga symtom utvecklas snabbt. Observera också att tidsintervallet inom 4 veckor avser tid efter traumahändelsen, inte tid efter avslöjande eller anmälan. Våld och sexuella övergrepp består inte sällan av många händelser över tid. Utsatta barn berättar ofta att de utsatts en lång tid efteråt. Vid avslöjandet kan de redan ha utvecklat symtom som kräver behandling direkt.

    För att kunna ge rätt insats/behandling, både tidigt och senare, efter ett eller flera potentiella trauman, är det viktigt med validerade mätinstrument för screening av traumaerfarenheter och symtom, men även för bedömning av mer allvarlig problematik/diagnoser. Detta är något som framkommit mycket tydligt under arbetet med denna kunskapsöversikt. Då det många gånger är psykologiska begrepp och symtom som inte så lätt låter sig identifieras, operationaliserar man det man vill mäta med frågor som besvaras av den som berörs. Man försöker identifiera hur en person mår, vilka symtom den har etc. genom ett frågeformulär som används regelbundet bland t.ex. barn och ungdomar. Efter att ha studerat formulärets kvaliteter (att det mäter vad det utger sig för att mäta och att det är stabilt över tid) har man utvecklat ett standardiserat instrument för att mäta ett visst symtom. Det är i detta sammanhang också viktigt att påpeka att de mätinstrument man använder även är undersökta i det land de används.

    Sammanfattning av Bedömningsinstrument

    I denna översikt finns såväl skattnings- och bedömningsinstrument som mäter förekomsten av trauma som instrument som mäter symtom och beteendeproblem som kan förknippas med traumatiska händelser. Instrumenten kan vara i form av intervjuer, mer eller mindre kliniska/diagnostiska eller utformade som självsvarsformulär.

    Barn och unga är givetvis en viktig källa då det gäller information omkring deras egna erfarenheter och posttraumatiska reaktioner och de rapporterar sina erfarenheter (Bernstein et al., 1997) och sina symtom tillförlitligt (Hamby, Finkelhor, Ormod & Turner, 2005). Dessutom rapporterar de mer symtom än vad andra gör å deras vägnar (Nader, 2008). Då det gäller överensstämmelsen mellan hur olika informanter rapporterar barns erfarenhet av potentiellt traumatiska händelser så har den visat sig inte vara särskilt god (Tingskull, Svedin, Agnafors, deKeyser, Sydsjö & Nilsson, 2013) varför vi med ledning av ovanstående rekommenderar att använda självsvarsformulär för de barn och ungdomar som själva kan hantera dessa.

    När det gäller att screena för erfarenheter av potentiellt traumatiska händelser traumaformulär så kan man välja att använda kortare formulär som på så sätt tidsmässigt är lättare att administrera (LITE, LYLES) eller längre och mer omfattande formulär som JVQ som ger en mer allsidig bild av barnets utsatthet. För mindre barn finns då föräldraversioner av såväl LITE som LYLES.

    Symtomformulär finns med olika inriktning och i huvudsak ser vi översatta formulär som mäter akut stress, symtom relaterade till traumaupplevelser, som posttraumatiskt stressyndrom samt formulär som mäter dissociativa symtom. Här finns flera att välja på men det som är mest allsidigt och mest använt i Sverige är TSCC och TSCYC vars nackdelar är att de inte är fria att användas utan kostnad och behörighet. För akut stress finns ASC-kids. Beträffande dissociation så finns flera formulär att välja på men tre som är relativt lättadministrerade är Dis-Q-Sweden (självsvar), CDC (föräldrasvar) samt SDQ-20 vid misstanke om somatoform dissociation.

    Vid behov av vidare diagnostik finns en rad kliniska standardiserade intervjuer men där kanske K-SADS-PL eller M.I.N.I. KID är de mest använda i klinisk praxis med barn och ungdomar.

    För forskning så är det också angeläget att använda internationellt erkända formulär om man vill jämföra traumaförekomst eller symtom efter potentiellt traumatiska upplevelser med undersökningar från andra länder.

    För framtiden ser vi behov av att fler instrument översätts till andra språk då Sverige idag är ett multikulturellt samhälle med stort inflöde av unga människor med annan språklig bakgrund, traumatiska erfarenheter samt traumarelaterade symtom. Det finns också behov av att översätta eller utveckla ett kortare kombinerat instrument för screening av såväl traumahistoria som symtom.

    Sammanfattning av tidig intervention

    Att tidigt kunna ge stöd och hjälp vid upplevda potentiella trauman såväl naturkatastrofer, trafikolyckor som vid våld och sexuella övergrepp måste anses som viktigt.

    Att kunna identifiera barn som riskerar att utveckla posttraumatisk stress kan spela en viktig roll när det gäller att minska risken för att utveckla kvarstående svårigheter efter potentiellt traumatiska händelser. Detta är något som framkommer i alla dessa studier. Ingen studie rapporterar skadlig inverkan vid de tidiga interventionerna. Således hittar man positiva tendenser även om inte man inte alltid får signifikanta symtomreduktioner när det gäller posttraumatisk stress. De flesta av studierna har interventioner som bara är en gång, vissa 1–2 och ibland endast en information via webben och en broschyr. Den intervention som framstår som den mest välgjorda studien var metoden Child and Family Traumatic Stress Intervention (CFTSI) (metoden beskrivs i kapitlet om tidig intervention) som visade på bäst resultat med signifikant symtomreduktion på flera utfallsmått och även posttraumatisk stress efter 4 sessioner. Denna metod har även i en icke randomiserad studie (n=114, 5-8 sessioner) vid för- och eftermätning visat på signifikanta resultat och metoden är också bedömd av CEBC som ha ett lovande vetenskapligt stöd (nivå 3).

    Det som i denna kunskapsöversikt samstämmigt framkommit i alla studierna är att screena för risk samt ge psykoedukation om trauma och hur man kan reagera efter en traumatisk händelse samt information om vad som kommer att ske.

    De svagheter vi kan se är att i stort sett inga interventioner vänder sig till barn under 6–7 års ålder samt att de flesta interventioner vänder sig till barn som varit utsatt för kroppsligt trauma såsom bilolyckor. Få vänder sig till barn som upplevt interpersonella trauman.

    För framtiden ser vi ett behov av att i Sverige utvärdera och implementera såväl CFTSI som den modell ”Efter barnförhöret” som utvecklats av Elfström, Landberg och Olofsson (2017).

    Sammanfattning av Behandling

    Det framkommer tydligt från studierna i denna kunskapsöversikt att psykologiska behandlingar för barn och ungdom som exponerats för potentiella trauman hjälper. De hjälper för barn och ungdomar som varit utsatt för våld och eller sexuella övergrepp. Det finns också flera studier som visar att det är viktigt att också välja behandling utefter barnets erfarenheter, behov och förutsättningar såsom ålder, typ av övergrepp/trauma, vad man söker för och vilket problem man tycker att man har. De komponenter som förkommer i alla de behandlingar som visar på stark evidens är: Psykoedukation om trauma och prevalens, och vad trauma kan få för inverkan (impact) och om behandlingen; träning i känsloregleringsstrategier (t.ex. avslappning, identifikation av känslor, kognitiv koping, imaginär exponering, in vivo exponering, kognitivt processande och problemlösning).

    Av den ovanstående genomgången blir det tydligt att det också finns mer evidens för vissa behandlingar än andra ibland beroende på att det finns fler studier av en viss sorts behandling och färre eller mycket små av en annan typ.

    Det finns i dagsläget ett mycket starkt stöd för TF-KBT baserat på minst 17 randomiserade studier som styrker TF-KBT:s effektivitet. Behandlingen har kortfattat beskrivits i detta dokument. Dock ska man beakta att TF-KBT vänder sig till barn som fyllt 6 år och som har ett bättre utvecklat språk och har större kognitiva förmågor än yngre barn. När det gäller yngre barn (under 6 år) så bör leken få en större plats. Child and Parent Psychotherapy (CPP) är en behandling som visat sig vara troligen effektiv. Även denna behandling är kortfattat beskriven i detta dokument och rekommenderas till mindre barn som bevittnat våld. Även EMDR kan ges till mycket små barn Kognitiv integrerad behandling vid Barnmisshandel (KIBB) är ytterligare en behandling för barn 6 år och äldre och där det beslutats att barnet ska fortsättta leva med den som utövat våldet. KIBB har de ingredienser som de väletablerade behandlingarna har men har fortfarande för få och för små studier.

    Således är det TF-KBT som kan sägas vara den behandling som bör rekommenderas i första hand när det gäller sexuella övergrepp. Vid fysisk misshandel rekommenderas KIBB om barnet ska fortsätta leva med den som utsatt barnet, i annat fall TF-KBT. För yngre barn rekommenderas CPP och EMDR.

    För ungdomar som uppvisar mer komplex traumatisering rekommenderas IITCT som innehåller alla plus fler ingredienser som de väletablerade behandlingarna gör.

    Det är viktigt att se var i vårdkedjan de olika behandlingarna kommer in alltifrån exponering av ett potentiellt trauma, screening/risk, bedömning, behandling som sätts in efter ca 4 veckor eller om det behövs mer komplexbehandling. För de svenska Barnahusen syns det som en viktig uppgift att till alla barn erbjuda screening av trauma och symtom samt tidig intervention. Även bedömning för fortsatt terapi är en viktig uppgift samt tillförsäkra och ha rutiner för att de barn som bedöms ha ett behov av fortsatt behandling också erhåller detta allt i enlighet med FN’s konvention om barns rättigheter.

    Det visar sig således att vi idag har en god kunskap om vad som är effektivt när det gäller arbete med barn och trauma men inför framtiden ser vi ett behov av att denna kunskap implementeras samt att barn oavsett var man bor i Sverige får ett likartat bemötande baserad på forskning (evidens) och beprövad erfarenhet (framtida evidens).

    Vi har i denna genomgång inte hittat terapiformer som anpassats eller utvecklats för barn med olika typer av funktionsnedsättningar.

  • 54.
    Nilsson, Doris
    et al.
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences. Region Östergötland, Local Health Care Services in Central Östergötland, Department of Child and Adolescent Psychiatry in Linköping.
    Ängarne-Lindberg, Teresia
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences.
    Children who lose a parent suddenly: what kind of assistance do they feel provides relief?: a content analysis study of children and their parents2016In: Child Care in Practice, ISSN 1357-5279, E-ISSN 1476-489X, Vol. 22, no 2, p. 197-209Article in journal (Refereed)
    Abstract [en]

    There are few studies that have investigated children and adolescents’ own perceptions of early intervention following the death of a parent, and even fewer that focus on children and adolescents who have lost a parent suddenly. The aim of this study was to use interviews to identify what children and the surviving parent perceived to be helpful or unhelpful in terms of the interventions they received when a parent died suddenly. The children and young people in the study had received help from a team whose work involves early intervention for children and adolescents affected by the sudden death of a parent. Fourteen adolescents and 15 parents were interviewed for this purpose. The interview material was analysed using qualitative content analysis. The results identified one theme (perception of support), two categories (feeling confident and secure; and receiving help to bring about order), and six subcategories (a feeling of being noticed and attended to; a feeling that they knew what they were doing; a feeling of being able to hand over; a feeling of being in a free zone; a feeling of recovery and inner order; and a feeling of clarity and structure).

  • 55.
    Perini, Irene
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Center for Social and Affective Neuroscience. Linköping University, Faculty of Medicine and Health Sciences.
    Gustafsson, Per
    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.
    Hamilton, Paul
    Linköping University, Department of Clinical and Experimental Medicine, Center for Social and Affective Neuroscience. Linköping University, Faculty of Medicine and Health Sciences.
    Kämpe, Robin
    Linköping University, Department of Clinical and Experimental Medicine, Center for Social and Affective Neuroscience. Linköping University, Faculty of Medicine and Health Sciences.
    Zetterqvist, Maria
    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.
    Heilig, Markus
    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.
    The salience of self, not social pain, is encoded by dorsal anterior cingulate and insula2018In: Scientific Reports, ISSN 2045-2322, E-ISSN 2045-2322, Vol. 8, article id 6165Article in journal (Refereed)
    Abstract [en]

    The human neural correlates of social rejection have attracted significant research interest, but remain subject to vigorous debate. Specifically, it has been proposed that a matrix of brain regions overlapping with the classical pain matrix, and including the dorsal anterior cingulate cortex (dACC) and the anterior insular cortex (AI) is critical for processing of social rejection. The present study expands on this conceptualization, by showing that these areas are involved in processing of self-relevant social evaluation, irrespective of valence. Forty healthy adolescents (N = 20 females) were tested in a magnetic resonance imaging (MRI) scanner. We used a novel paradigm that balanced participants experience of rejection and acceptance. In addition, the paradigm also controlled for whether the social judgment was towards the participants or towards other fictitious players. By creating a "self" and "other" distinction, we show that right AI and dACC are involved in processing the salience of being judged by others, irrespective of the quality of this judgment. This finding supports the idea that these regions are not specific to social rejection or even to pain or metaphorically painful experiences, but activate to self-relevant, highly salient information.

  • 56.
    Quayle, Ethel
    et al.
    Univ Edinburgh, Scotland.
    Jonsson, Linda
    Linköping University, Department of Clinical and Experimental Medicine, Barnafrid. 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.
    Cooper, Karen
    Univ Edinburgh, Scotland.
    Traynor, James
    NCA CEOP Command, England.
    Svedin, Carl Göran
    Linköping University, Department of Clinical and Experimental Medicine, Barnafrid. 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.
    Children in Identified Sexual Images - Who Are they? Self- and Non-Self-Taken Images in the International Child Sexual Exploitation Image Database 2006-20152018In: Child Abuse Review, ISSN 0952-9136, E-ISSN 1099-0852, Vol. 27, no 3, p. 223-238Article in journal (Refereed)
    Abstract [en]

    Child sexual abuse and exploitation material has drawn concern and legislative attention since the turn of the century, and the work to identify children in the images has been a prioritised task through international cooperation. The International Child Sexual Exploitation Image Database (ICSE DB) includes more than 8000 identified victims from nearly 50 countries. The database contains considerable important information about child abuse image crimes. The general aim of this study was to quantify the characteristics of children in identified illegal images from the UK ICSE DB (n = 687) with the subsidiary aim to describe differences between cases of self-taken images and those whose images had been taken by others. The analysis showed an increase in identified victims during the study years 2006-2015. Almost two-thirds were female, the majority were white and 44.3 per cent of images were self-taken (34.4% taken in a coercive and 9.9% in a non-coercive relationship). Since 2010, the number of self-taken images each year has exceeded more than 40 per cent of the total number of images in the database. Although self-taken images may be perceived as less worrisome, two-thirds were classified as coercive. This is an important argument in favour of continuing to investigate these cases under victim identification programmes. The general aim of this study was to quantify the characteristics of children in identified illegal images from the UK ICSE DB Key Practitioner Messages The ICSE DB includes more than 8000 identified victims and contains important information about child abuse image crimes. A majority of the identified victims were female and white children. Almost half of all images were self-taken and had been taken in a coercive relationship. Parents and practitioners need to recognise that even if a child sends sexual images these should be considered worrisome and therefore investigated further.

  • 57.
    Rajan, Gita
    et al.
    Karolinska Institute, Sweden; Stockholm County Council, Sweden.
    Ljunggren, Gunnar
    Stockholm County Council, Sweden; Karolinska Institute, Sweden.
    Wandell, Per
    Karolinska Institute, Sweden; Stockholm County Council, Sweden.
    Wahlstrom, Lars
    Karolinska Institute, Sweden.
    Svedin, Carl Göran
    Linköping University, Department of Clinical and Experimental Medicine, Barnafrid. 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.
    Carlsson, Axel C.
    Karolinska Institute, Sweden; Uppsala University, Sweden.
    Diagnoses of sexual abuse and their common registered comorbidities in the total population of Stockholm2017In: Journal of Epidemiology and Community Health, ISSN 0143-005X, E-ISSN 1470-2738, Vol. 71, no 6, p. 592-598Article in journal (Refereed)
    Abstract [en]

    Background Prior research based on self-reports has proven sexual abuse to be a risk factor for pain and psychiatric disorders. However, less is known about how this is reflected within the healthcare system. The aim of this study was to study the 2-year prevalence of diagnosis of sexual abuse and concomitant conditions. Methods Using data from VAL, the study population included all living persons in Stockholm County, Sweden, between 1 January 2008 and 31 December 2014 (N=2 549 496). Diagnoses of sexual abuse were identified during 2013-2014, with information on the concomitant conditions somatic pain, depression, anxiety, psychotic disorders and bipolar disorders, stress disorders and alcohol and substance abuse. All diagnoses were prospectively registered. Age and neighbourhood socioeconomic status-adjusted ORs with 95% CIs for individuals with a diagnosis of sexual abuse, using individuals without sexual abuse as referents, were calculated. Results Girls at the ages 13-17 years had the highest 2-year prevalence (0.69%) of sexual abuse followed by girls 5-12 years (0.11%), and girls 0-4 years (0.04%). For women 45 years and older the 2-year prevalence rates were substantially lower (0.008-0.004%). The highest 2-year prevalence of sexual abuse in men was seen in boys 5-12 (0.03%) years. The total 2-year prevalence of diagnoses of sexual abuse among the population in the material was 0.04%. The highest ORs of comorbidities for girls (ages 017 years) with sexual abuse versus those without sexual abuse were: Stress disorder; 15.7 (13.1 to 18.9), drug abuse; 10.0 (7.7 to 13.0), and alcohol abuse; 9.7(7.8 to 12.0). For boys (ages 0-17 years), the highest ORs of comorbidities were: Stress disorder 12.4 (6.0 to 25.7), anxiety disorders; 5.5 (2.6 to 11.5), and alcohol abuse; 3.9 (1.4 to 11.3). The highest ORs of comorbidities for women (18-) with sexual abuse versus those without sexual abuse were: alcohol abuse; 19.3 (12.6 to 29.6), drug abuse; 16.7 (10.7 to 26.1) and psychotic disorders; 15.3 (8.0 to 29.4). For men (18-) the highest ORs of comorbidities were: alcohol abuse; 25.8 (15.2 to 43.9), anxiety disorders; 14.3 (8.5 to 24.2) stress disorder; 12.9 (7.5 to 22.1) and drug abuse; 12.9 (6.9 to 24.1). Conclusions Diagnoses of drug and alcohol abuse, psychotic, bipolar, stress anxiety disorders, depression and somatic pain are more common among individuals with a diagnosis of sexual abuse than among individuals without a diagnosis of sexual abuse.

  • 58.
    Schneider, Gary
    et al.
    Evidera, MA USA; ICON, MA USA.
    Banaschewski, Tobias
    Heidelberg Univ, Germany.
    Feldman, Brian L.
    Naval Med Ctr, VA USA.
    Gustafsson, Per
    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.
    Murphy, Brian
    Evidera, MA USA.
    Reynolds, Matthew
    Evidera, MA USA.
    Coghill, David R.
    Univ Melbourne, Australia; Univ Melbourne, Australia; Murdoch Childrens Res Inst, Australia; Univ Dundee, Scotland.
    Spalding, William M.
    Shire, MA USA.
    Weight and Height in Children and Adolescents with Attention-Deficit/Hyperactivity Disorder: A Longitudinal Database Study Assessing the Impact of Guanfacine, Stimulants, and No Pharmacotherapy2019In: Journal of child and adolescent psychopharmacology, ISSN 1044-5463, E-ISSN 1557-8992, Vol. 29, no 4, p. 285-304Article in journal (Refereed)
    Abstract [en]

    Objectives: To assess the impact of long-term pharmacotherapy with guanfacine immediate- or extended-release (GXR), administered alone or as an adjunctive to a stimulant, on weight and height in children and adolescents with attention-deficit/hyperactivity disorder (ADHD). Methods: Data were extracted from U.S. Department of Defense medical records for patients 4-17 years of age at index date (initiation of any study medication following a year without ADHD medications, or diagnosis if unmedicated) with weight/height measurements for the analysis period (January 2009-June 2013) and the previous year (baseline). Longitudinal weight and height z-scores were analyzed using multivariable regression in three cohorts: guanfacine (initial period of guanfacine exposure), first-line stimulant monotherapy (initial period of exposure), and unmedicated. Guanfacine cohort subgroups were based on previous/concurrent stimulant exposure. Results: The weight analyses included 47,910 patients (66.8% male) and the height analyses 41,248 (67.2% male). Mean initial exposure in the weight analyses was 237 days (standard deviation [SD] = 258, median = 142) for guanfacine and 257 days (SD = 284, median = 151) for first-line stimulant monotherapy, and was similar in the height analyses. Modeling indicated that guanfacine monotherapy was not associated with clinically meaningful deviations from normal z-score trajectories for weight (first-line, n = 943; nonfirst-line, n = 796) or height (first-line, n = 741; nonfirst-line, n = 644). In patients receiving guanfacine adjunctive to a stimulant, modeled weight (n = 1657) and height (n = 1343) z-scores followed declining trajectories. In this subgroup, mean standardized weight/height had decreased during previous stimulant monotherapy. For first-line stimulant monotherapy, modeled weight (n = 32,999) and height (n = 28,470) z-scores followed declining trajectories during year 1. In the unmedicated cohort, modeled weight (n = 11,515) and height (n = 10,050) z-scores were stable. Conclusions: Guanfacine monotherapy (first-line or nonfirst-line) was not associated with marked deviations from normal growth in this modeling study of children and adolescents with ADHD. In contrast, growth trajectories followed an initially declining course with stimulants, whether given alone or with adjunctive guanfacine.

  • 59.
    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.

  • 60.
    Svedin, Carl Göran
    et al.
    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.
    Priebe, Gisela
    Institutionen för psykologi, Lunds universitet.
    Wadsby, Marie
    Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Medicine and Health Sciences.
    Jonsson, Linda
    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.
    Fredlund, Cecilia
    Linköping University, Department of Clinical and Experimental Medicine, Division of Neuro and Inflammation Science. Linköping University, Faculty of Medicine and Health Sciences.
    Unga sex och Internet – i en föränderlig värld2015Report (Other academic)
    Abstract [sv]

    Avdelningen för barn och ungdomspsykiatri vid Linköpings universitet fick i uppdrag av Stiftelsen Allmänna Barnhuset att tillsammans med Statistiska Centralbyrån (SCB) genomföra en kvantitativ studie bland unga i gymnasieskolans år 3. Avtalets huvudfokus var att samla in kunskap om ungdomars sexualitet, erfarenheter av övergrepp, sexuell exponering, sexuell exponering via digitala medier i enlighet med Regeringsbeslut S2013/8825/FST. Inom ramen för uppdraget skulle samråd med Ungdomsstyrelsen och Folkhälsomyndigheten tas och undersökningen skulle ske i samarbete med Lunds Universitet.

    Samtidigt med detta gavs ett uppdrag från socialförvaltnings utvecklingsenhet i Stockholms stad, om en komplettering genom en vidgad datainsamling i Stockholms stad. Detta uppdrag skulle framför allt fokusera på barn och ungdomar i sexhandel/prostitution samt de som skadar sig själva med sex. Då de två studierna använt en identisk enkät och det i analyserna av materialet visat sig vara väldigt små skillnader mellan de två dataseten så redovisas i denna rapport det sammanlagda materialet.

    Detta är den tredje stora nationella studien på området om ungdomars sexualitet och utsatthet för sexuella övergrepp och sexuell exploatering. Den första studien Ungdomars sexualitet –attityder och erfarenheter (Svedin &Priebe, 2004) var ett uppdrag inom ramen för den statliga utredningen Sexuell exploatering av barn i Sverige (SOU, 2004:71). Den andra undersökningen Unga, sex och internet (Svedin & Priebe, 2009) genomfördes på uppdrag av Ungdomsstyrelsen i avsikt att genomföra en kvantitativ studie bland unga i gymnasieskolans år 3 samt bland Riksförbundet för homosexuella, bisexuella och transpersoners rättigheters (RFSL) medlemmar i relevant ålder. Dessa två studier, vars vetenskapliga publikationer presenteras i bilaga 1, har inom centrala områden använt samma enkät vilket möjliggör en jämförelse med den aktuella studien men också att studera trender över tid. Att just kunna jämföra olika undersökningar med varandra och över tid är tämligen unikt vilket ofta rekommenderas från olika håll. Samtidigt som centrala frågeområden som t.ex. sexuella övergrepp och sexuell exploatering behållits så har andra områden bytts ut. I denna rapport är områden som själskadebeteende, sex som självskadebeteende, människohandel för sexuella syften samt mobbing nya (enkäten bilaga 2).

  • 61.
    Thulin, Johanna
    et al.
    Department of Social Work, Linnaeus University, Växjö, Sweden.
    Kjellgren, Ceclia
    Department of Social Work, Linnaeus University, Växjö, Sweden.
    Nilsson, Doris
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences. Region Östergötland, Local Health Care Services in Central Östergötland, Department of Child and Adolescent Psychiatry in Linköping.
    Children’s disclosure of physical abuse: the process of disclosing and the responses from social welfare workers2019In: Child Care in Practice, ISSN 1357-5279, E-ISSN 1476-489XArticle in journal (Refereed)
    Abstract [en]

    Children experiencing physical abuse by their parents are left with several difficult decisions. The present study aims at exploring the process of disclosing the abuse and the responses from social welfare workers from a child perspective, in a Swedish context. Data was obtained from in depth interviews with 15 children with a history of child physical abuse. A qualitative content analysis was conducted in order to capture the children's experiences. Disclosing abuse was described as a process including several judgements from the child. Children describe their everyday life before disclosing, with an escalation of violence making them think they have to act in order to prevent further abuse. They made several well-thought decisions and selected a trustworthy recipient. The decision to disclose was often made out of fear, but the fear could remain after the disclosure, not knowing what will happen next. Children seem to lose control over how their abuse narratives are handled after disclosing. The recipient and social welfare worker was acting but not informing or consulting the child. Children emphasize the importance of trustworthy and competent adults when disclosing physical abuse. Ethical issues and implications for practice are discussed.

    Practitioner messages

    • Disclosure is to be seen as a process, including several judgements by the child.

    • Children emphasize the importance of trustworthy and competent adults when choosing to disclose physical abuse.

    • Social welfare workers should inform and include children in their decision making.

  • 62.
    Thulin, Johanna
    et al.
    Linnéuniveristet, Sweden.
    Kjellgren, Ceclia
    Linnéuniversitetet, Sweden.
    Nilsson, Doris
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences. Region Östergötland, Local Health Care Services in Central Östergötland, Department of Child and Adolescent Psychiatry in Linköping.
    Children's experiences with an intervention aimed to prevent further physical abuse2019In: Child & Family Social Work, ISSN 1356-7500, E-ISSN 1365-2206, Vol. 24, no 1, p. 17-24Article in journal (Refereed)
    Abstract [en]

    Although many children across cultures are victims of physical abuse, few treatment models target these children and their parents. In Sweden, Combined Parent–Child Cognitive Behavioural Therapy for families at risk for child physical abuse has been successfully used according to pretreatment and posttreatment studies. However, few studies have explored how physically abused children experience treatment. This study includes 20 physically abused children aged 9–17 who completed Combined Parent–Child Cognitive Behavioural Therapy. Children had a positive overall impression of the treatment and highlighted addressing the abuse, as well as processing their experiences as particularly essential. Children described a positive transformation in their family life as a result of treatment, including violence cessation and bonding among family members. Children experienced the intervention as inclusive and child‐friendly. The implications of the promising findings are discussed.

  • 63.
    Thulin, Johanna
    et al.
    Department of Social Work, Linnaeus University, Växjö, Sweden.
    Nilsson, Doris
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences. Region Östergötland, Local Health Care Services in Central Östergötland, Department of Child and Adolescent Psychiatry in Linköping.
    Kjellgren, Ceclia
    Department of Social Work, Linnaeus University, Växjö, Sweden.
    Youth Reports of Parental Strategies and sense of Coherence: Are experienced of Being Victim of Physical Abuse Reflected2019In: Young - Nordic Journal of Youth Research, ISSN 1103-3088, E-ISSN 1741-3222, Vol. 27, no 5, p. 502-519Article in journal (Refereed)
    Abstract [en]

    This article explores adolescent’s reports of parental strategies and sense of coherence (SOC). Building on the suggested impact of child physical abuse, this study compares reports from a group of physically abused youth and a group of non-abused youth. Independent t-test, correlations and hierarchical linear regression analysis were computed. Findings indicate that parents’ use of corporal punishment could affect how youth report their parent’s parental strategies. Physically abused youth report less parental involvement and positive parenting as well as more inconsistent parenting than non-abused youth. Furthermore, physically abused youth report a significant lower SOC than non-abused youth. Being a victim of physical abuse had a unique contribution on SOC, even after controlling for other parental strategies. Taken together, the results suggest that child physical abuse affects both the youth’s inner SOC as well as their reports of parental strategies in several ways. Implications for practice are discussed in this article.

  • 64.
    Thulin, Johanna
    et al.
    Linnéuniversitetet, Växjö, Sweden.
    Nilsson, Doris
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences. Region Östergötland, Local Health Care Services in Central Östergötland, Department of Child and Adolescent Psychiatry in Linköping.
    Svedin, Carl Göran
    Linköping University, Department of Clinical and Experimental Medicine, Barnafrid. 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.
    Kjellgren, Ceclia
    Linnéuniversitetet, Växjö, Sweden.
    Outcomes of CPC-CBT in Sweden Concerning Psychosocial Well-Being and Parenting Practice: Children’s Perspectives2019In: Research on social work practice, ISSN 1049-7315, E-ISSN 1552-7581, p. 1-9Article in journal (Refereed)
    Abstract [en]

    Purpose:

    This study explores the outcome of the intervention combined parent child–cognitive behavioral therapy (CPC-CBT) for physically abused children.

    Method:

    This study includes a clinical sample of children (n = 62) referred to Child Welfare Service due to reports of child physical abuse who completed CPC-CBT. A pretest/posttest design was applied to assess changes on the Trauma Symptom Checklist for Children (TSCC) after treatment and was compared with normative values. In addition, the occurrence of corporal punishment from pre to posttest was explored.

    Results:

    Children reported a significant decrease in parental use of corporal punishment after treatment and a significant reduction in symptoms associated with trauma (decreased to normal values for TSCC). The positive changes remained at the 6-month follow-up.

    Conclusions:

    The CPC-CBT intervention seemed to decrease parental use of corporal punishment and increase the well-being of children. Clinical implications are discussed.

  • 65.
    Timpka, Toomas
    et al.
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Health Sciences. Region Östergötland, Center for Health and Developmental Care, Center for Public Health.
    Janson, Staffan
    Karlstad University, Sweden.
    Jacobsson, Jenny
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences.
    Ekberg, Joakim
    Linköping University, Department of Medical and Health Sciences, Division of Community Medicine. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center for Health and Developmental Care, Center for Public Health.
    Dahlström, Örjan
    Linköping University, Department of Behavioural Sciences and Learning, Disability Research. Linköping University, Faculty of Arts and Sciences. Linköping University, The Swedish Institute for Disability Research.
    Kowalski, Jan
    Karolinska Institute, Sweden.
    Bargoria, Victor
    Linköping University, Department of Medical and Health Sciences. Linköping University, Faculty of Medicine and Health Sciences. Moi University, Kenya.
    Mountjoy, Margo
    McMaster University, Canada.
    Svedin, Carl Göran
    Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Health Sciences. Region Östergötland, Local Health Care Services in Central Östergötland, Department of Child and Adolescent Psychiatry in Linköping.
    Protocol Design for Large-Scale Cross-Sectional Studies of Sexual Abuse and Associated Factors in Individual Sports: Feasibility Study in Swedish Athletics2015In: Journal of Sports Science and Medicine (JSSM), ISSN 1303-2968, Vol. 14, no 1, p. 179-187Article in journal (Refereed)
    Abstract [en]

    To ensure health and well-being for their athletes, sports organizations must offer preventive measures against sexual abuse. The aim of this study was to design and evaluate feasibility of a research protocol for cross-sectional epidemiological studies of sexual abuse in athletics. Examination of the requirements on the study of sexual abuse in athletics was followed by iterated drafting of protocol specifications and formative evaluations. The feasibility of the resulting protocol was evaluated in a national-level study among elite athletics athletes (n = 507) in Sweden. The definition of sexual abuse, the ethical soundness of the protocol, reference populations and study of co-morbidity, and the means for athlete-level data collection were identified as particularly complex issues in the requirements analyses. The web-based survey defined by the protocol facilitates anonymous athlete self-reporting of data on exposure to sexual abuse. 198 athletes (39%) fully completed the feasibility survey. 89% (n = 177) reported that they agreed with that the questions in the survey were important, and 95% (n = 189) reported that they answered truthfully to all questions. Similarly, 91% (n = 180) reported that they did not agree with that the questions were unpleasant for them. However, 16% (n = 32) reported that they did not find the survey to be of personal value, and 12% (n = 23) reported that the survey had caused them to think about issues that they did not want to think about. Responding that participation was not personally gratifying was associated with training more hours (p = 0.01). There is a scarcity of research on the prevention of sexual abuse in individual sports. The present protocol should be regarded as a means to overcome this shortcoming in athletics. When implementing the protocol, it is necessary to encourage athlete compliance and to adapt the web-based survey to the particular infrastructural conditions in the sports setting at hand.

  • 66.
    Topooco, Naira
    et al.
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences.
    Berg, Matilda
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences.
    Johansson, Sofie
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences.
    Liljethörn, Lina
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences.
    Radvogin, Ella
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences.
    Vlaescu, George
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences.
    Bergman Nordgren, Lise
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences. Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.
    Zetterqvist, Maria
    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.
    Andersson, Gerhard
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences.
    Chat- and internet-based cognitive-behavioural therapy in treatment of adolescent depression: randomised controlled trial2018In: Bjpsych Open, ISSN 2056-4724, Vol. 4, no 4, p. 199-207Article in journal (Refereed)
    Abstract [en]

    Background

    Depression is a major contributor to the burden of disease in the adolescent population. Internet-based interventions can increase access to treatment.

    Aims

    To evaluate the efficacy of internet-based cognitive–behavioural therapy (iCBT), including therapist chat communication, in treatment of adolescent depression.

    Method

    Seventy adolescents, 15–19 years of age and presenting with depressive symptoms, were randomised to iCBT or attention control. The primary outcome was the Beck Depression Inventory II (BDI-II).

    Results

    Significant reductions in depressive symptoms were found, favouring iCBT over the control condition (F(1,67) = 6.18, P < 0.05). The between-group effect size was Cohen's d = 0.71 (95% CI 0.22–1.19). A significantly higher proportion of iCBT participants (42.4%) than controls (13.5%) showed a 50% decrease in BDI-II score post-treatment (P < 0.01). The improvement for the iCBT group was maintained at 6 months.

    Conclusions

    The intervention appears to effectively reduce symptoms of depression in adolescents and may be helpful in overcoming barriers to care among young people.

    Declaration of interest

    N.T. and G.A. designed the programme. N.T. authored the treatment material. The web platform used for treatment is owned by Linköping University and run on a non-for-profit basis. None of the authors receives any income from the programme.

  • 67.
    Tordön, Rikard
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Barnafrid. Linköping University, Faculty of Medicine and Health Sciences.
    Svedin, Carl Göran
    Linköping University, Department of Clinical and Experimental Medicine, Barnafrid. 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.
    Fredlund, Cecilia
    Linköping University, Department of Clinical and Experimental Medicine, Center for Social and Affective Neuroscience. Linköping University, Faculty of Medicine and Health Sciences.
    Jonsson, Linda
    Linköping University, Department of Clinical and Experimental Medicine, Barnafrid. 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.
    Pribe, Gisela
    Linköping University, Department of Clinical and Experimental Medicine, Barnafrid. Linköping University, Faculty of Medicine and Health Sciences.
    Sydsjö, Gunilla
    Linköping University, Department of Clinical and Experimental Medicine, Division of Children's and Women's health. Linköping University, Faculty of Medicine and Health Sciences. Region Östergötland, Center of Paediatrics and Gynaecology and Obstetrics, Department of Gynaecology and Obstetrics in Linköping.
    Background, experience of abuse, and mental health among adolescents in out-of-home care: a cross-sectional study of a Swedish high school national sample2019In: Nordic Journal of Psychiatry, ISSN 0803-9488, E-ISSN 1502-4725, Vol. 73, no 1, p. 16-23Article in journal (Refereed)
    Abstract [en]

    PURPOSE: To compare experiences for adverse events, especially sexual abuse, and mental health in a group of high school students in out-of-home care with a representative sample of peers of the same age and similar educational attainment living with their parents.

    MATERIALS AND METHODS: A sample of 5839 students in the third year of Swedish high school, corresponding to a response rate of 59.7%, answered a study specific questionnaire. Data from 41 students living in out-of-home care were compared with data from peers not in out-of-home care in a cross-sectional analyze.

    RESULTS: Students in out-of-home care had more often an immigrant background and a non-heterosexual orientation, had more often experienced physical and penetrative sexual abuse, and more often sought healthcare for mental problems. Disclosure of sexual abuse was less common, and acts of persuasion or adults' use of their social position was more common among students in out-of-home care.

    CONCLUSIONS: Even where the protective factor 'senior educational attainment' is present, risks for abuse and poor mental health are evident for adolescents in out-of-home care. Disclosure of adversity, when it has occurred, ought to be higher among these adolescents with regular contact with social services, but our findings indicate tendencies for the opposite. We therefore suggest routines to be established to screen for adverse life events and mental health actively, along with general and systematic assessments of adversity and mental health during care.

  • 68.
    van Vliet, J. S.
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Medicine and Health Sciences.
    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.
    Duchén, Karel
    Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Region Östergötland, Center of Paediatrics and Gynaecology and Obstetrics, Department of Paediatrics in Linköping. Linköping University, Faculty of Medicine and Health Sciences.
    Nelson Follin, Nina
    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 Paediatrics in Linköping. Karolinska University Hospital, Sweden.
    Social inequality and age-specific gender differences in overweight and perception of overweight among Swedish children and adolescents: a cross-sectional study2015In: BMC Public Health, ISSN 1471-2458, E-ISSN 1471-2458, Vol. 15, no 628Article in journal (Refereed)
    Abstract [en]

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

  • 69.
    van Vliet, Jolanda S.
    et al.
    Linköping University, Department of Clinical and Experimental Medicine, Division of Clinical Sciences. Linköping University, Faculty of Medicine and Health Sciences.
    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.
    Nelson Follin, Nina
    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 Paediatrics in Linköping. Karolinska University Hospital, Sweden.
    Feeling ‘too fat’ rather than being ‘too fat’ increases unhealthy eating habits among adolescents – even in boys2016In: Food & Nutrition Research, ISSN 1654-6628, E-ISSN 1654-661X, Vol. 60, article id 29530Article in journal (Refereed)
    Abstract [en]

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

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

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

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

  • 70.
    Waller, Rosalind
    et al.
    Linköping University, Department of Behavioural Sciences and Learning. Linköping University, Faculty of Educational Sciences.
    Tholander, Michael
    Linköping University, Department of Behavioural Sciences and Learning, Education, Teaching and Learning. Linköping University, Faculty of Educational Sciences.
    Nilsson, Doris
    Linköping University, Department of Behavioural Sciences and Learning, Psychology. Linköping University, Faculty of Arts and Sciences. Region Östergötland, Local Health Care Services in Central Östergötland, Department of Child and Adolescent Psychiatry in Linköping.
    "You will have these ones!": Six women's experiences of being pressured to make a contraceptive choice that did not feel right2017In: Social Sciences, ISSN 2076-0760, E-ISSN 2076-0760, Vol. 6, no 4, article id 114Article in journal (Refereed)
    Abstract [en]

    This study aims to contribute to an understanding of women’s experiences of contraceptive counselling, and of being pressured to make a contraceptive choice that did not feel right. Six women in Sweden participated insemi-structured interviews, which were analysed through interpretative phenomenological analysis. The results were organised into three themes: (1)The normalisation process, i.e., the ways in which the women experienced using the contraceptive were being promoted as a natural part of womanhood; (2)Drawing the shortest straw, i.e., the women’s experiences of encountering insensitive caregivers; and (3) Feeling like a guinea pig,i.e., the women’s sense of not being allowed to control the situation and make their own choices. In conclusion, the experience of not being respected in the healthcare system could lead to consequences not only for women’s sense ofself-efficacy with regard to contraceptives, but also for their willingness to engage in renewed counselling. The caregivers’ communicative skills are, therefore, of prime importance.

  • 71.
    Wennberg, Birgitta
    et al.
    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.
    Janeslätt, Gunnel
    Uppsala University, Sweden; Centre for Clinical Research Dalarna, Falun, Sweden.
    Kjellberg, Anette
    Linköping University, Department of Social and Welfare Studies, Division of Occupational Therapy. Linköping University, Faculty of Medicine and Health Sciences.
    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.
    Effectiveness of time-related interventions in children with ADHD aged 9-15 years: a randomized contolled study2018In: European Child and Adolescent Psychiatry, ISSN 1018-8827, E-ISSN 1435-165X, Vol. 27, no 3, p. 329-342Article in journal (Refereed)
    Abstract [en]

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

  • 72.
    Zetterqvist, Maria
    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.
    Nonsuicidal Self-Injury in Adolescents: Characterization of the Disorder and the Issue of Distress and Impairment.2017In: Journal of Suicide and Life-threatening Behaviour, ISSN 0363-0234, E-ISSN 1943-278X, Vol. 47, no 3, p. 321-335Article in journal (Refereed)
    Abstract [en]

    Nonsuicidal self-injury disorder (NSSID) is a condition in need of further study to assess the validity of the potential diagnosis and its suggested criteria. This study examined the NSSID diagnosis and investigated the distress/impairment criterion by comparing community adolescents who met all criteria for NSSID (n = 186) to adolescents with five or more nonsuicidal self-injury (NSSI) episodes (n = 314), and to a group of adolescents who met all criteria but negated that their NSSI caused them any distress or impairment, thus failing to meet criterion E (n = 29). The NSSID group delimited from the ≥ 5 NSSI group by reporting significantly more frequent and severe self-injurious thoughts and behaviors, as well as having more experiences of negative life events and higher levels of trauma symptoms. There were also some differences between the NSSID group and adolescents without distress/impairment, which together contribute valuable information on the potential NSSID diagnosis, as well as the discussion of criterion E.

  • 73.
    Zetterqvist, 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. Region Östergötland, Local Health Care Services in Central Östergötland, Department of Child and Adolescent Psychiatry in Linköping.
    Svedin, Carl Göran
    Linköping University, Department of Clinical and Experimental Medicine, Barnafrid. 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.
    Fredlund, Cecilia
    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.
    Priebe, Gisela
    Linköping University, Department of Clinical and Experimental Medicine, Barnafrid. Linköping University, Faculty of Medicine and Health Sciences. Lund Univ, Sweden.
    Wadsby, Marie
    Linköping University, Department of Clinical and Experimental Medicine, Center for Social and Affective Neuroscience. Linköping University, Faculty of Medicine and Health Sciences.
    Jonsson, Linda
    Linköping University, Department of Clinical and Experimental Medicine, Barnafrid. 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.
    Self-reported nonsuicidal self-injury (NSSI) and sex as self-injury (SASI): Relationship to abuse, risk behaviors, trauma symptoms, self-esteem and attachment2018In: Psychiatry Research, ISSN 0165-1781, E-ISSN 1872-7123, Vol. 265, p. 309-316Article in journal (Refereed)
    Abstract [en]

    This study focuses on a conceptually unexplored behavior among adolescents who report deliberately using sex as a means of self-injury. In a large high school-based sample (n = 5743), adolescents who engaged in sex as self injury (SASI, n = 43) were compared to adolescents who reported direct nonsuicidal self-injury (NSSI, n = 933) and those who reported both NSSI and SASI (n = 82). Re.sults showed that significantly more adolescents with SASI had experience of penetrating sexual abuse, as well as more sexual partners compared to those with NSSI. The SASI group also had higher levels of self-reported trauma symptoms, such as dissociation, posttraumatic stress and sexual concerns compared to those with NSSI, suggesting a distinct relationship between sexual abuse, trauma symptoms and engaging in sex as self-injury. There was no difference between the SASI and NSSI groups regarding experiences of emotional and physical abuse, self-esteem, parental care or overprotection or symptoms of depression, anxiety and anger. Adolescents who engaged in both NSSI + SASI stood out as a more severe and burdened group, with more experience of abuse, risk behaviors and impaired psychosocial health. Adolescents with traumatic experiences such as sexual abuse need to be assessed for SASI and vice versa.

  • 74.
    Åkerman, Ingrid
    et al.
    Barnafrid – Nationellt kunskapscentrum, Linköping.
    Jonsson, Linda
    Linköping University, Department of Clinical and Experimental Medicine, Barnafrid. 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.
    Kunskapsbehov inom socialtjänsten om våld mot barn2017Report (Other academic)
    Abstract [sv]

    Syftet med den aktuella studien var att skapa ett underlag för hur ett socialtjänstnätverk i Barnafrids regi skulle kunna utvecklas. Därför undersöktes socialsekreterares uppfattning av hur de ser på den kompetens de redan har samt vad de är i behov av för vidare kunskap gällande våld och andra övergrepp mot barn. Ytterligare frågeställningar rörde vilken typ av kunskapsstöd som behövs, vilka kommunikativa lösningar kunskapen ska paketeras i samt hur de önskar att ett nätverk för socialtjänsten ska utformas. Nedan sammanfattas några huvuddrag från rapporten:

    • Det finns ett stort behov av kunskap bland svenska socialsekreterare om våld och andra övergrepp mot barn. Behovet beskrevs som något större bland socialsekreterare från mindre kommuner (< 50 000 invånare) och från socialsekreterare anställda kortare tid inom socialtjänsten (0-2 år).
    • Det behövs både generell kunskap om våld mot barn men också fördjupad kunskap inom mer specifika områden såsom nyanlända familjer, ensamkommande barn, hedersrelaterad våldsproblematik samt arbetsverktyg för risk och skyddsbedömningar.
    • Deltagarna önskade lättillgängliga manualer och guidelines som stöd i akuta eller särskilda situationer. Att kunna ta del av information via regionala konferenser/utbildningsdagar samt via en uppdaterad hemsida var prioriterat. Även kunskapspåfyllning via nationella föreläsningar var efterfrågat.
    • Mer än hälften av de svarande upplevde behov av en konsultationstelefon dit man kan ringa och få råd och stöd i svåra och komplicerade ärenden.
    • Mindre prioriterat var kunskap genom webbutbildningar, appar, frågelåda med svar via mejl och chattforum med andra verksamma.

    Sammanfattningsvis visar studien att det viktigaste är att socialsekreterare kan känna sig trygga och säkra när de utför sitt arbete. Det innebär ett arbete där barnets bästa alltid sätts i främsta rummet! Utifrån resultaten från denna studie kvarstår en hel del arbete för att uppnå det.

    Denna studie liksom tidigare undersökningar (se t.ex. Barnskyddsutredningen, 2009; Socialstyrelsen, 2016) pekar på brister och behov, såväl i grundutbildning, introduktionsutbildning som på specialistutbildning för de som ansvarar för myndighetsutövning inom den svenska sociala barn- och ungdomsvården. Personal inom socialtjänsten måste få kontinuerlig tillgång till en flora av olika former av kunskap som innebär både teoretisk och praktisk kunskap om hur man arbetar med barn som utsatts för våld. Utifrån resultaten bedömer vi också att det bland annat finns ett behov av såväl ett kunskapsbaserat socialtjänstnätverk som en konsultationstelefon. Detta är något Barnafrid – Nationellt kunskapscentrum mot våld och andra övergrepp mot barn vore en naturlig värd för i en framtid.

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