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.

Prevalence of type 2 diabetes mellitus, metabolic syndrome, and related morbidities in overweight and obese children

Objectives The aim of the study was to determine the prevalence of metabolic syndrome (MetS), type 2 diabetes mellitus (T2DM), and other comorbidities in overweight and obese children in Malatya, Turkey. Methods Retrospective cross-sectional study. We studied 860 obese and overweight children and adolescents (obese children Body mass index (BMI) >95th percentile, overweight children BMI >85th percentile) aged between 6 and 18 years. The diagnosis of MetS, impaired glucose tolerance (IGT), impaired fasting glucose (IFG), and T2DM were defined according to modified the World Health Organization criteria adapted for children. Other comorbidities were studied. Results Subjects (n=860) consisted of 113 overweight and 747 obese children of whom 434 (50.5%) were girls. MetS was significantly more prevalent in obese than overweight children (43.8 vs. 2.7%, p<0.001), and in pubertal than prepubertal children (41.1 vs. 31.7%, p<0.001). Mean homeostasis model assessment for insulin ratio (HOMA-IR) was 3.6 ± 2.0 in the prepubertal and 4.9 ± 2.4 in pubertal children (p<0.001). All cases underwent oral glucose tolerance test and IGT, IFG, and T2DM were diagnosed in 124 (14.4%), 19 (2.2%), and 32 (3.7%) cases, respectively. Insulin resistance (IR) was present in 606 cases (70.5%). Conclusions Puberty and obesity are important risk factors for MetS, T2DM, and IR. The prevalence of MetS, T2DM, and other morbidities was high in the study cohort. Obese children and adolescents should be carefully screened for T2DM, insulin resistance, hyperinsulinism, dyslipidemia, hypertension, IGT, and IFG. The prevention, early recognition, and treatment of obesity are essential to avoid associated morbidities.

Immediate and Sustained Effects of Neurofeedback and Working Memory Training on Cognitive Functions in Children and Adolescents with ADHD: A Multi-Arm Pragmatic Randomized Controlled Trial

Objective: To evaluate the effects of neurocognitive training methods on targeted cognitive functions in children and adolescent with ADHD. Method: A pragmatic four-arm randomized controlled trial compared two types of neurofeedback (Slow Cortical Potential and Live Z-score) and Working-memory training (WMT) with treatment as usual. N = 202 participants with ADHD aged 9 to 17 years were included. A battery of cognitive function tests was completed pretreatment, posttreatment, and after 6-months. Results: The effects of WMT on spatial and verbal working-memory were superior to neurofeedback and treatment as usual at posttreatment, but only partially sustained at follow-up. No other consistent effects were observed. We found no clear indications that effects were moderated by ADHD presentation, ongoing medication, age, or sex. Conclusion: The sustained effects of neurocognitive training on cognitive functioning in children and adolescents with ADHD may be limited. Future research should focus on more personalized forms of neurocognitive training.

Electroencephalogram utilization and psychiatric comorbidities among children and adolescents with epilepsy in rural Southwestern Uganda

Objective This study aimed at describing routine electroencephalogram (EEG) findings among children and adolescents with a clinical diagnosis of epilepsy and determines how interictal EEG abnormalities vary with the psychiatric comorbidities. Methods We conducted a cross-sectional study among children and adolescents with epilepsy aged 5–18 years receiving care from a regional referral hospital in Southwestern Uganda. Psychiatric comorbidities were assessed using an adapted parent version of Child and Adolescent Symptom Inventory-5. Thirty-minute EEG samples were taken from routine EEG recordings that were locally performed and remotely interpreted for all participants. Results Of the 140 participants, 71 (50.7%) had normal EEG findings and 51 (36.4%) had epileptiform abnormalities while 18 (12.9%) had non-epileptiform. Of those who had epileptiform abnormalities on EEG, 23 (45.1%) were focal, 26 (51.0%) were generalized, and 2 (3.9%) were focal with bilateral spread. There was no significant association between the different psychiatric comorbidities and the interictal EEG abnormalities. Conclusions Among children and adolescents with a clinical diagnosis of epilepsy in Southwestern Uganda, only 36% showed epileptiform abnormalities on their EEG recordings. There was no association between the interictal EEG abnormalities and psychiatric comorbidities.