Chinese music therapy to treat depression in children and adolescents: The BARIT-Model

Depression is broadly considered a global epidemic. In China it ranks among the most prevalent mental disorders and is seriously affecting the younger generation (prevalence between 4% and 41%), hence the necessity to foster health education and sustainable resilience. Meta-synthetic construction resulted in a music-based model of educational therapy comprising five principles, beauty, activation, responsiveness, immersion and transformation, hence the name ‘BARIT-model’: (i) referring to anthropological, psychological and neuroscientific aesthetics, the approach benefits from the healing power of aesthetic experience, (ii) behavioural activation is widely regarded as an efficient approach to treat depression. Different from conventional cognitive behavioural therapy, the BARIT-model involves artistic activities such as music improvisation, sound scene improvisation, vocal experiments or creative variations of Chinese martial arts, (iii) responsiveness concerns the qualitative similarity of emotion and music, alongside the patients’ feeling of being ‘understood’ by what they are listening to, (iv) while depressive mood tends to occupy the whole person, music immersion can help to escape that ‘pathological cage’, (v) finally, traumatic roots of depression need therapeutic processing, such as artistic symbolisation, intermodal transformation and relabelling of traumata as potential source of creative performance. The BARIT-model is part of a comprehensive project to improve mental health in Chinese children and adolescents through arts-based methods for classroom education, which encompasses ‒ in addition to depression ‒ attention deficit hyperactivity disorders, oppositional defiant disorders, anxiety disorders, stress-related disorders and burnout syndromes, eating disorders such as anorexia nervosa or binge eating, as well as disorders related to the COVID-19 pandemic, e.g. developmental syndromes caused by lockdown and social distancing.

Reward Dysfunction in General and Specific Psychopathology in Children and Adults

Background: Reward dysfunction has been implicated in many psychiatric disorders such as attention-deficit/hyperactivity disorders, depression, and substance use disorders. However, psychiatric comorbidities are common, and the specificity of reward dysfunction to individual psychopathologies is unknown. The objective of this study was to evaluate the association between reward functioning and specific or general psychopathologies. Methods: 1044 adults and their 1215 children (ages 6-12) completed various measures of the Positive Valence System domain from the Research Domain Criteria (RDoC), which included the Delayed and Probability Discounting Tasks, Energy Expenditure for Reward Task, and Iowa Gambling Task. Children also completed the Experienced Pleasure Scale for children, while adults completed the Temporal Experience of Pleasure Scale and the Behavioral Activation System tasks. Psychopathology was assessed using the Child Behavior Checklist (CBCL) for children and the Adult Self Report (ASR) for parents. Results: One general factor identified via principal factors factor analysis explained the majority of variance in psychopathology in both groups. Reward measures in both adults and children were significantly associated with general psychopathology as well as most specific psychopathologies. Some associations between reward and psychopathology did not hold following removal of general psychopathology; nonetheless, certain reward constructs were uniquely associated with specific disorder problems but not general psychopathology. Conclusion: Disorder problem specific associations with reward functioning can be identified after removal of comorbidity. General propensity toward psychopathology is significantly but not uniquely correlated with reward dysfunction. Altogether, this may have broader implications for future study of the role of reward in disease pathogenesis.

Chromosomal Microarray in Children With Developmental Delay: The Experience of a Tertiary Center in Korea

Background and Objectives: Chromosomal microarray (CMA) is a first-tier genetic test for children with developmental delay (DD), intellectual disability (ID), autism spectrum disorders (ASDs), and multiple congenital anomalies (MCA). In this study, we report our experiences with the use of CMA in Korean children with unexplained DD/ID.Methods: We performed CMA in a cohort of 308 children with DD/ID between January 2010 and September 2020. We also retrospectively reviewed their medical records. The Affymetrix CytoScan 750 K array with an average resolution of 100 kb was used to perform CMA.Results: Comorbid neurodevelopmental disorders were ASD (37 patients; 12.0%), epilepsy (34 patients; 11.0%), and attention deficit hyperactivity disorders (12 patients; 3.9%). The diagnostic yield was 18.5%. Among the 221 copy number variants (CNVs) identified, 70 CNVs (57 patients; 18.5%) were pathogenic. Deletion CNVs were more common among pathogenic CNVs (PCNVs) than in non-PCNVs (P < 0.001). The size difference between PCNVs and non-PCNVs was not significant (P = 0.023). The number of included genes within CNV intervals was significantly higher in PCNVs (average 8.6; 0–347) than in non-PCNVs (average 47.5; 1–386) (P < 0.001). Short stature and hearing difficulty were also more common in the PCNV group than in the non-PCNV group (P = 0.010 and 0.070, respectively).Conclusion: This study provides additional evidence for the usefulness of CMA in genetic testing of children with DD/ID in Korea. The pathogenicity of CNVs correlated with the number of included genes within the CNV interval and deletion type of the CNVs, but not with CNV size.

Changes in Sleep Patterns and Disorders in Children and Adolescents with Attention Deficit Hyperactivity Disorders and Autism Spectrum Disorders during the COVID-19 Lockdown

Background. The COVID-19 lockdown determined important changes in the sleep of a large percentage of the world population. We assessed the modifications of reported sleep patterns and disturbances in Italian children and adolescents with autism spectrum disorders (ASD) or attention deficit hyperactivity disorders (ADHD), compared to control children, before and during the COVID-19 lockdown in Italy. Methods. Parents of 100 ASD, 236 ADHD patients, and 340 healthy children filled out an anonymous online survey and a modified version of the Sleep Disturbance Scale for Children (SDSC), advertised via social media, to evaluate sleep patterns and disturbances of their children before and during the lockdown. Results. Before the lockdown, bedtime and risetime were not different between the three groups. During the lockdown, ADHD children tended to have a later bedtime and risetime than ASD and controls, while ASD children tended to maintain similar bedtime and risetime. Overall, during the lockdown, a reduced sleep duration significantly differentiated clinical groups from controls. Anxiety at bedtime, difficulties in falling asleep, and daytime sleepiness increased in all groups during the lockdown. Hypnic jerks, rhythmic movement disorders, night awakenings, restless sleep, sleepwalking, and daytime sleepiness increased in ASD and ADHD patients, in particular. Conclusions. This is the first study comparing sleep habits and disorders in ASD and ADHD during the lockdown showing specific differences consistent with the core characteristics of two neurodevelopmental disorders.

Informative value of referral letters from general practice for child and adolescent mental healthcare

Although referral letters (RLs) form a nodal point in a patient’s care journey, little is known about their informative value in child and adolescent mental healthcare. To determine the informative value of RLs to child and adolescent psychiatry, we conducted a chart review in medical records of minors registered at specialized mental healthcare between January 2015 and December 2017 (The Netherlands). Symptoms indicated in RLs originating from general practice (N = 723) were coded and cross-tabulated with the best estimate clinical classifications made in psychiatry. Results revealed that over half of the minors in the sample were classified in concordance with at least one reason for referral. We found fair to excellent discriminative ability for indications made in RLs concerning the most common psychiatric classifications (95% CI AUC: 60.9–70.6 for anxiety disorders to 90.5–100.0 for eating disorders). Logistic regression analyses suggested no statistically significant effects of gender, age, severity or mental healthcare history, with the exception of age and attention deficit hyperactivity disorders (ADHD), as RLs better predicted ADHD with increasing age (OR = 1.14, 95% CI 1.03–1.27). Contextual problems, such as difficulties studying, problems with parents or being bullied were indicated frequently and associated with classifications in various disorder groups. To conclude, general practitioners’ RLs showed informative value, contrary to common beliefs. Replication studies are needed to reliably incorporate RLs into the diagnostic work-up.

Clinical evolution of perinatal pathology. Dialogues with the Teacher

Here are reported the data of investigating clinical evolution of perinatal brain pathology performed under the auspices of Professor V.A. Karlov. Analysis of the data obtained revealed an importance for detecting ante- and intranatal predictors for most relevant neurological disorders in childhood: neonatal seizures, some epilepsy forms, headache and attention deficit / hyperactivity disorders. The speaker argues for the necessity to conduct topical diagnostics of the nervous system disturbances in neonates and justifies a relationship between early and delayed neurological disorders in diverse pediatric periods.

Comparing Bender-Gestalt Test and Quantitative Electroencephalography for Brain Trauma Diagnosis in Depressive and Attention Deficit Hyperactivity Disorders

Background: Some experts assert there is an association between traumatic brain injury and cognitive impairments such as attention deficit hyperactivity disorder (ADHD) and depressive disorder. Furthermore, children and adults with ADHD struggle with focusing, organizing tasks, and feeling restless. They might experience sadness, guilt, irritability, low self-confidence and helplessness. In this regard, ADHD and depressive disorder occasionally occur together. We aimed to compare the clinical application of the Bender-Gestalt test (BGT) and electroencephalography in screening brain damage in the patients with the mentioned disorders. Methods: This was a cross-sectional study to assess diagnostic accuracy. Eighty patients with depression (n=35) and ADHD (n=45) resulting from brain damage aged 10-35 years who had been referred by the psychologist or psychiatrist to Imam Hossein Clinic in Yazd. Both the BGT and quantitative electroencephalography (QEEG) results existed in their files. Patients with any serious medical, other psychiatric disorders or history of drug dependency were excluded. Paired t test was used to analyze the differences. Results: The brain damage score was different in the two tests. Based on the paired t test, the BGT was a more valid screening test. Also, the score of the two tests were different in the depression and ADHD mean scores (P<0.05). Conclusion: BGT was a more reliable tool compared to QEEG for diagnosing brain damage within the patients with the mentioned disorders.

Investigating the Mechanism of Sodium Binding to SERT Using Direct Simulations

The serotonin transporter (SERT) terminates neurotransmission by transporting serotonin from the synapse into the pre-synaptic nerve terminal. Altered SERT function leads to several neurological diseases including depression, anxiety, mood disorders, and attention deficit hyperactivity disorders (ADHD). Accordingly SERT is the target for their pharmacological treatments, but also targeted by multiple drugs of abuse. Transport of serotonin by SERT is energized by the transmembrane electrochemical gradient of sodium. We used extensive molecular dynamics simulations to investigate the process of sodium binding to SERT, which is the first step in the transport cycle that leads to serotonin uptake. Comparing data from 51 independent simulations, we find a remarkably well-defined path for sodium entry and could identify two transient binding sites, while observing binding kinetics that are comparable to experimental data. Importantly, the structure and dynamics of the sodium binding sites indicate that sodium binding is accompanied by an induced-fit mechanism that leads to new conformations and reduces local dynamics.

Learning and Attention Deficit/Hyperactivity Disorders as Risk Factors for Prolonged Concussion Recovery in Children and Adolescents

Objective: Examine pre-existing learning disorders (LD) and attention deficit/hyperactivity disorders (ADHD) as risk factors for prolonged recovery and increased symptomology following pediatric mild traumatic brain injury (mTBI). Methods: We conducted a retrospective cohort study of children/adolescents (5-17 years) with mTBI who presented to a Children’s Minnesota Concussion Clinic between April 2018 and March 2019. Differences across strata of pre-existing conditions (present vs. absent) in time to recovery measures were estimated via Kaplan–Meier and Cox proportional hazards analyses and differences in symptom trajectories were examined via linear mixed-effects regression models. Regression models were adjusted for age, sex and other confounders. Results: In our cohort of 680 mTBI patients, those with LD (n = 70) or ADHD (n = 107) experienced significantly longer median durations of symptoms (58 and 68 days, respectively) than those without (43 days). Accordingly, LD was significantly associated with delayed symptom recovery (adjusted hazard ratio (aHR) = 1.63, 95% CI: 1.16–2.29), return to school (1.47, 1.08–2.00), and return to physical activity (1.50, 1.10–2.04). Likewise, ADHD was associated with delayed recovery (1.69, 1.28–2.23), return to school (1.52, 1.17–1.97) and physical activity (1.55, 1.19–2.01). Further, patients with LD or ADHD reported, on average, significantly more concussion symptoms and higher vision symptom scores throughout recovery versus those without. There was no evidence that concussion or vision symptom recovery trajectories varied over time between those with/without LD or ADHD (joint P-interactions > 0.05). Conclusion: Pre-existing LD and ADHD are risk factors for prolonged and more symptomatic mTBI recovery in youth. These results can inform clinical concussion management and recovery expectations.