Browsing by Subject "lastenpsykiatria"

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  • Maasalo, Katri (Helsingin yliopisto, 2020)
    Emotional symptoms are symptoms of anxiety and depression that are included in the broad dimension of internalising symptoms encompassing feelings and behaviours such as fearfulness, worry, sadness, and withdrawal. Elevated levels of emotional symptoms are prevalent in children and often a precursor of adolescent and adulthood mental health disorders, such as major depression, one of the leading causes of disability in Finland and worldwide. The prevention of depression is a global challenge. Although major depression is a relatively rare condition in childhood, the more common emotional symptoms and subthreshold conditions of depression in childhood have been identified as possible targets for preventive action in the battle against depression. Results of studies involving adolescent participants suggest that examining the precursors of depression at the symptom level could aid in recognising individuals at risk for escalation to more severe disorders. Depressed mood, an emotional symptom that is one of the core symptoms of depression, has been associated with a future risk of psychopathology and may also cause current impairment, increasing the importance of early detection. However, there has not been much research on depressed mood in children. The present study examined the associations between emotional problems and depressed mood and three suggested risk factors for emerging, prolonging, and escalating emotional symptoms: inhibitory control, sleep problems, and co-occurring behaviour problems. The aim of the study was to provide data that would aid in the early recognition and prevention of emotional problems. Cross-sectional questionnaire data from the Strengths and Diffculties Questionnaire (SDQ) and the Quality of Life Questionnaire 17D were used in studies I–III, and the go/no-go task was used to assess children’s inhibitory control in the longitudinal study IV. The first study examined the prevalence of emotional problems and depressed mood in a population-based sample of 1,714 children aged 4–12. The associations of emotional problems and depressed mood with conduct problems and hyperactivity, as well as with child and family factors were also examined. In the population-based sample, 5.8% of the children had emotional problems and 16.0% had depressed mood. Both emotional problems and depressed mood were associated with sleep problems, illness or disability in children, and not living with both parents. Emotional problems and depressed mood were both significantly associated with conduct problems and hyperactivity. Of the emotional symptoms, depressed mood had the strongest association with both conduct problems and hyperactivity. The second study examined the prevalence of emotional problems and depressed mood in a child psychiatric outpatient sample of 862 children aged 6–12 and the associations of emotional problems and depressed mood with conduct problems and hyperactivity. The impact of depressed mood on children’s global functioning was also assessed. In the clinical sample, 13.1% of the children had emotional problems, and 59.4% had depressed mood. Emotional problems and depressed mood were signi􀂿cantly associated with conduct problems but not hyperactivity. Irrespective of diagnosis, depressed mood was consistently associated with poorer global functioning. The third study examined the associations of child-reported sleep problems and emotional symptoms in a child psychiatric outpatient sample of 432 children aged 6–12. Child-reported sleep problems were the most common among children with depression or anxiety, and sleep problems were significantly associated with depressive disorders. Even among children with attention-deficit/hyperactivity disorder or oppositional de􀂿ant or conduct disorder, sleep problems were associated with emotional symptoms, suggesting that child-reported sleep problems are indicative of subthreshold emotional problems in these children. The fourth study assessed the association between inhibitory control skills and internalizing symptoms in a sample of 2,874 children aged 7–9 using a longitudinal design with a statistical model that distinguishes within-person variance from between-person variance between the constructs. Over the course of the study, the association between inhibitory control and internalizing symptoms was explained at the between-person level. This 􀂿nding supports the hypothesis that among children at this developmental stage, inhibitory control and emotional symptoms are associated as trait-like constructs. However, no cross-lagged associations suggesting a potential causal relationship were found. The findings of these four studies suggest that depressed mood is associated with similar risk factors as emotional problems in general. When emotional problems are associated with conduct problems or hyperactivity, this association is mostly explained by depressed mood. The global functioning level was poorer among child psychiatric patients with depressed mood than among those with normal mood. The findings also suggest that when a child has a sleep problem, it is useful to evaluate the presence of emotional problems and depressed mood. The association between emotional problems and inhibitory control suggests they could have a shared background.
  • Kähkönen, Nea (Helsingin yliopisto, 2022)
    Ahdistuneisuushäiriöt ovat hyvin yleisiä autismikirjon lapsilla. Neurotyypillisten lasten ahdistuneisuushäiriöiden hoidossa on pitkään käytetty kognitiivis-behavioraalista psykoterapiaa. Autismikirjon häiriöt tuovat kognitiivis-behavioraalisen psykoterapian käyttöön kuitenkin lisähaasteita. On otettava huomioon lapsen mahdolliset vaikeudet esimerkiksi ahdistuksen aiheuttamien fyysisten tuntemusten tunnistamisessa ja sosiaalisessa vuorovaikutuksessa sekä kognitiiviset eroavaisuudet neurotyypillisiin lapsiin verrattuna. Monilla autismikirjon lapsilla on myös vaikeuksia terapiassa opittujen taitojen soveltamisessa arkielämään. Kognitiivis-behavioraalista psykoterapiaa on muokattu autismikirjon lapsille sopivaksi monilla keinoilla. Tapaamiset ovat yleensä hieman tavanomaista pidempiä, ja psykoterapiaan on tuotu lisää konkretiaa esimerkiksi käyttämällä visuaalisia elementtejä ja tarjoamalla lapselle valmiita vaihtoehtoja valintatilanteissa. Kognitiivis-behavioraalisessa psykoterapiassa on mahdollisuuksien mukaan hyödynnetty lapsen erityisiä mielenkiinnon kohteita sekä pyritty vahvistamaan lapsen itsenäisyyttä arjen toimissa. Altistusharjoitteet ovat tärkeä osa kognitiivis-behavioraalista psykoterapiaa myös autismikirjon lapsilla, ja niitä toteutetaankin sekä terapiatapaamisissa että niiden ulkopuolella. Altistusharjoitteiden organisoimisessa tarvitaan yleensä vanhempien ja koulun tukea. Vanhempien aktiivinen osallistuminen lapsen psykoterapiaan on osoittautunut hyödylliseksi myös lapsen motivoinnin ja psykoterapiassa opittujen taitojen soveltamisen kannalta. Ryhmämuotoisen kognitiivis-behavioraalisen psykoterapian etuna on se, että lapsi pääsee samalla vuorovaikuttamaan ikätovereidensa kanssa turvallisessa ympäristössä. Tässä kirjallisuuskatsauksessa tarkasteltujen artikkelien perusteella modifioitu kognitiivis-behavioraalinen psykoterapia vaikuttaa olevan tehokas hoitomuoto ahdistuneisuushäiriöihin erityisesti kouluikäisillä lapsilla, joilla on kognitiivisesti hyvätasoinen autismikirjon häiriö. Erilaisia terapiamuotoja vertailevaa tutkimusta tarvitaan kuitenkin lisää, jotta voidaan tarkemmin arvioida, ovatko hyvät hoitotulokset seurausta nimenomaan kognitiivis-behavioraalisesta psykoterapiasta vai saadaanko samankaltaisia tuloksia muillakin terapiamuotoisilla hoidoilla.
  • Paavonen, E. Juulia; Huhdanpää, Hanna; Raaska, Hanna; Repokari, Leena (2021)
    LÄHTÖKOHDAT Pelot ja ahdistuneisuushäiriöt ovat lapsilla yleisiä, joten perusterveydenhuollossa joudutaan usein arvioimaan niihin liittyvää hoidon tarvetta. MENETELMÄT Selvitimme ahdistuneisuuden vuoksi erikoissairaanhoitoon ohjautuneiden lasten oirekuvaa, hoitoa ja jatkohoidon tarvetta potilasasiakirjamerkinnöistä. Aineisto poimittiin systemaattisella otannalla ajalta 17.5.2018–27.9.2019. Siihen sisällytettiin kaikki lapset (n = 181), joilla oli masennus-, ahdistus- tai pakko-oireita ja jotka olivat niiden takia ohjautuneet tutkittaviksi lastenpsykiatrian tutkimus-, akuutti- ja konsultaatioyksikköön. Lopullinen aineisto käsitti 80 lasta, joilla oli ensisijaisesti pelko- tai ahdistusoireita. TULOKSET Valtaosa lapsista hyötyi lyhyestä fokusoidusta käyttäytymisterapeuttisesta hoitointerventiosta, ja yli puolella (55,7 %) käyntimäärä erikoissairaanhoidossa jäi vähäiseksi (≤ 8 käyntiä). PÄÄTELMÄT Suuri osa ahdistusoireisista lapsista voitaisiin hoitaa jo perustasolla. Psykoedukaation lisäksi tulisi tarjota apua oireiden hallintaan yksilöllisesti tai ryhmässä.
  • Aholainen, Anne (2001)
    Tässä tutkimuksessa tarkastellaan oikeudellisten ulottuvuuksien, oikeudellisen sääntelyn ja lainkäytön, vaikutusta lastenpsykiatrien työhön ja asiantuntijuuteen. Tutkimusongelma koostuu kolmesta kysymyksestä: minkälaiset ja missä määrin oikeudelliset ulottuvuudet esiintyvät lastenpsykiatrien työssä, miten oikeudelliset ulottuvuudet vaikuttavat lapsuuden asiantuntijuuteen ja missä mielessä niiden vaikutuksesta voi puhua lastenpsykiatrien asiantuntemuksen oikeudellistumisena. Tutkimusongelmaa lähestytään lastenpsykiatrien omakohtaisten kokemusten ja heidän ammattikuntansa kehityksestä tekemien havaintojen pohjalta. Näkökulmaa lastenpsykiatrien kokemuksille luodaan monivivahteisen ja -tasoisen oikeudellistumiskäsitteen ympärillä käydystä sekä erilaisten asiantuntijuuksien kohtaamisesta käydystä keskustelusta. Aineisto muodostuu kahdeksan lastenpsykiatrin teemahaastattelusta. Lisäaineistona on käytetty lastenpsykiatriaa koskevaa kansainvälistä artikkeliaineistoa sekä suomalaista keskustelua oikeuden ja psykiatrian välisistä suhteista. Analysointimenetelmänä on käytetty analyyttisen induktion yleisperiaatteita. Lastenpsykiatrien oikeudelliset kokemukset järjestyvät kolmen pääteeman alle. Ensimmäinen on arjen juridiikka. Sääntely on normaalisti sujuvassa arjessa näkymätöntä, mutta tänä päivänä se tulee yhä useammin esiin häiriötiloina. Arjen juridiset ongelmat liittyvät vanhempien ja lasten oikeuksien väliseen tasapainotteluun ja sosiaalityöntekijöiden monimutkaisuviin ongelmiin, jotka heijastuvat lastenpsykiatrienkin työhön. Tuloksena muodolliset menettelytavat ovat nousseet tärkeiksi, josta joissakin tapauksissa on ollut seurauksena lastenpsykiatrin ammatillisen intuition kärsiminen. Toisena teemana on asiantuntijatodistajuus oikeudellisissa prosesseissa. Ongelmallisiksi nousevat erot oikeudellisessa ja lastenpsykiatrisessa asiantuntijatiedossa, rooliongelmat ja prosessointihaluiset vanhemmat. Siitä, miten lastenpsykiatri kokee asemansa oikeudessa, löytyy mielenkiintoinen asetelma: onko hän todistaja vai asiantuntija. Edeltävä koetaan oikeuden juoksupoikana toimimiseksi. Jälkimmäisenä oltaisiin tasa-arvoisemmassa asemassa oikeuden kanssa. Kolmantena teemana on suurempi todennäköisyys joutua kanteen tai valituksen kohteeksi. Todennäköisyys on yhä melko pieni, mutta se herättää ajatuksia omasta oikeusturvasta ja sen toimivuudesta, ja tarpeesta suojata itseä ja työyhteisöä oikeudelliselta haavoittuvaisuudelta. Nämä tilanteet ovat usein myös mediajulkisuudessa muiden asiantuntijoiden arvioitavana. Teemoista nousee kuva oikeudellistuvasta lapsuuden asiantuntijuudesta ja sen haasteista. Haasteet näkyvät eettisessä keskustelussa, josta esille nousevat priorisoinnin, koventuvien rangaistusten vaatimusten ja vallanetiikan kysymykset. Oikeuden vaikutukset lastenpsykiatrien asiantuntijuuteen löytyvät oikeuden nostamista vasta-asiantuntijoista ja lastenpsykiatrien omasta asemasta oikeudessa erityistiedon haltijoina. Näiden kahden osapuolen välistä kommunikaatiota käydään lapsen etu -käsitteen kautta. Oikeuden vaikutus lastenpsykiatreihin on kaksitahoista. Arkityön puolella toimintakäytännöt ovat muodollistuneet ja sidottu enemmän ulkopuoliseen valvontaan. Tätä voi pitää oikeudellistumisena. Tunne-elämän normittaminen ja oikeusprosessien puolella lastenpsykiatrien käyttö asiantuntijatodistajina on vienyt lastenpsykiatrit oikeudelliselle reviirille. Tätä voi katsoa kahdesta näkökulmasta. Oikeuskehityksen näkökulmasta tätä voidaan pitää oikeuden materialisoitumisena. Lastenpsykiatrien näkökulmasta oikeus toisaalta nostaa heidän asiantuntijuutensa merkitystä, toisaalta oikeus taas alistaa sen omiin käytäntöihinsä.
  • Karjalainen, Piia (Helsingin yliopisto, 2021)
    This thesis uses a randomized controlled trial (RCT) study setting to investigate the effectiveness of a parenting intervention (the Incredible Years®, IY) in modifying children’s behaviour problems, parenting practices and parents’ psychological well-being among families in child protection and other special support services. The study also explored parent’s perceptions of the program. A systematic review of the literature confirmed that there is solid research evidence on the effectiveness of parenting programs on child behaviour and parenting practices. However, the review also revealed a lack of evidence of the effectiveness of these programs with families in touch with child protection services (CPS). The study examined the effects of the intervention on child problem behaviour, parenting practices and parent’s well-being. Participants in the study were 3–7-year-old children with behaviour problems (N = 102, intervention group N = 50, control group N = 52) and their parents (N = 122). Parents in the intervention group received 19 sessions of the long IY Preschool Basic parenting program and the controls received treatment as usual (TAU), while on the waiting list (WL) for the next available parent group organized after the study. Results of the study show that child problem behaviour decreased more in the intervention group in comparison to control group before and after the intervention, when measured by using scale scores of ECBI Problem and cut-offs for clinically relevant cases (ECBI Problem and CBCL External). The intervention also increased positive parenting practices, although changes in parental stress or parents’ psychological well-being in the intervention group did not differ from parents in the control group. Child behaviour problems decreased at one year follow-up in both the intervention (N = 44) and the control groups (N = 45), although no differences between the groups were evident at the follow-up. The positive changes in child behaviour at home were not evident at day care or school at baseline, post-intervention or one-year follow-up, and there were no significant differences between the groups. The study also compared parents with (N = 43) and without (N = 19) CPS contact in terms of their satisfaction with the IY® Parenting Program. Satisfaction scores ranged between 5.8 and 6.2 (max 7) for all studied intervention domains. Mean attendance rate in the group sessions was 11.5 (SD 5.9), and 74% of participants attended at least nine out of 19 sessions. No group differences were found in satisfaction or attendance between CPS and non-CPS parents. Parents in CPS committed well to the program and found it as useful as parents without CPS contact. The results of the present study indicate promising evidence that parenting interventions such as the IY® parenting program may be effective in terms of child conduct problems in the short term in families within the CPS context. Sustaining the positive effects and generalizing them to day care and school contexts remains challenging in the context of child protection and other family support services in real-life conditions. IY® parenting program appears to be acceptable to parents involved in CPS, and their engagement to the program can be considered as reasonably good. Key words: child behaviour problems, parenting, parenting program, intervention, evidence-based, child protection services
  • Huhdanpää, Hanna; Morales-Munoz, Isabel; Aronen, Eeva T.; Pölkki, Pirjo; Saarenpää-Heikkilä, Outi; Paunio, Tiina; Kylliäinen, Anneli; Paavonen, E. Juulia (2019)
    Objective: Sleep difficulties are associated with cognitive and behavioral problems in childhood. However, it is still unclear whether early sleep difficulties are related to later development. We studied whether parent-reported sleep duration, night awakenings, and parent-reported sleep problems in early childhood are associated with symptoms of inattention and hyperactivity at the age of 5 years. Method: Our study is based on the Child-Sleep birth cohort initially comprising 1673 families, of which 713 were retained at the age of 5 years. We used the Brief Infant Sleep Questionnaire and the Infant Sleep Questionnaire, which were filled out by the parents when their child was 3, 8, and 24 months and 5 years old. Symptoms of inattention and hyperactivity at the age of 5 years were assessed using the Strengths and Difficulties Questionnaire and the Five-to-Fifteen questionnaire. Results: Sleep duration at the age of 3, 8, and 24 months was associated with inattentiveness at 5 years of age. Moreover, parent-reported sleep problems at the age of 24 months were related to both inattentive and hyperactive symptoms at the age of 5 years. Finally, at the age of 5 years, parent-reported sleep problems and night awakenings were associated with concurrent symptoms of inattention and hyperactivity. Conclusion: Our findings suggest that certain sleep characteristics related to sleep quality and quantity in early childhood are associated with inattentiveness and hyperactivity at the age of 5 years. Interestingly, sleep duration in early childhood is consistently related to inattention at the age of 5 years.
  • Morales-Munoz, Isabel; Kantojärvi, Katri; Uhre, Veli-Matti; Saarenpää-Heikkilä, Outi; Kylliäinen, Anneli; Pölkki, Pirjo; Himanen, Sari-Leena; Karlsson, Linnea; Karlsson, Hasse; Paavonen, E. Juulia; Paunio, Tiina (2021)
    Purpose: No previous research has examined the impact of the genetic background of diurnal preference on children´s sleep. Here, we examined the effects of genetic risk score for the liability of diurnal preference on sleep development in early childhood in two population-based cohorts from Finland. Participants and methods: The primary sample (CHILD-SLEEP, CS) comprised 1420 infants (695 girls), and the replication sample (FinnBrain, FB; 962 girls) 2063 infants. Parent-reported sleep duration, sleep-onset latency and bedtime were assessed at three, eight, 18 and 24 months in CS, and at six, 12 and 24 months in FB. Actigraphy-based sleep latency and efficiency were measured in CS in 365 infants at eight months (168 girls), and in 197 infants at 24 months (82 girls). Mean standard scores for each sleep domain were calculated in both samples. Polygenic risk scores (PRS) were used to quantitate the genetic risk for eveningness (PRSBestFit) and morningness (PRS10kBest). Results: PRSBestFit associated with longer sleep-onset latency and later bedtime, and PRS10kBest related to shorter sleep-onset latency in CS. The link between genetic risk for diurnal preference and sleep-onset latency was replicated in FB, and meta-analysis resulted in associations (P<0.0005) with both PRS-values (PRSBestFit: Z=3.55; and PRS10kBest: Z=-3.68). Finally, PRSBestFit was related to actigraphy-based lower sleep efficiency and longer sleep latency at eight months. Conclusion: Genetic liability to diurnal preference for eveningness relates to longer sleep-onset during the first two years of life, and to objectively measured lowered sleep efficiency. These findings enhance our understanding on the biological factors affecting sleep development, and contribute to clarify the physiological sleep architecture in early childhood.
  • Morales-Munoz, Isabel; Partonen, Timo; Saarenpää-Heikkilä, Outi; Kylliäinen, Anneli; Pölkki, Pirjo; Porkka-Heiskanen, Tarja; Paunio, Tiina; Paavonen, E. Juulia (2019)
    Background: Chronotype is a construct contributing to individual differences in sleep-wake timing. Previous studies with children have found that evening-types exhibit greater sleep difficulties. Infant sleep quality can be modulated by several factors, such as parental characteristics. We examined the association between parental circadian preference and sleep in early childhood. Methods: This study was based on a longitudinal birth cohort, with several measurement points. We used information regarding parental questionnaires during pregnancy and children's sleep measures at three, eight, 18 and 24 months. In total, 1220 mothers, 1116 fathers, 993 infants at three months, 990 infants at eight months, 958 children at 18 months, and 777 children at 24 months were analyzed. Parental circadian preference was measured using the Horne-Ostberg Morningness-Eveningness Questionnaire. Concerning children's sleep, we used the Brief Infant Sleep Questionnaire (BISQ) and the Infant Sleep Questionnaire (ISQ) at each time point. Results: Maternal circadian preference was associated with infants' circadian rhythm development at three, eight, 18 and 24 months. Furthermore, increased maternal eveningness was also related to short sleep during daytime at three months, and nighttime at three and eight months, to long sleep-onset latency at three, 18 and 24 months, to late bedtime at three, eight and 18 months, and to sleep difficulties at eight and 24 months. Paternal circadian preference was not associated with any sleep variable at any time point. Conclusion: Maternal circadian preference is related to several sleep difficulties in early childhood, and it may be considered a potential risk factor for the onset of early sleeping problems. (c) 2018 Elsevier B.V. All rights reserved.
  • Repokari, Leena (Helsingin yliopisto, 2008)
    Infertility treatments are relatively easily available in most Western countries today, but the psychological consequences of these high-tech treatments have scarcely been addressed. The purpose of this controlled longitudinal study was to explore the early environment of the infant born by assisted reproductive treatment (ART). We focused on the parents mental well-being, marital relations and experience of parenting. In addition to this, we assessed parent child interaction and parents mental representations of their child after long-standing infertility and several unsuccessful ART attempts. The subjects were infertile couples who achieved a singleton pregnancy by in vitro fertilization (IVF) or intracytoplasmic sperm injection (ICSI). The control group comprised of spontaneously conceiving couples with singleton pregnancies. ART women showed fewer depressive symptoms than controls during pregnancy and after delivery, but the difference vanished by the end of the child s first year. ART men consistently had lower levels of anxiety symptoms, sleeping difficulties, and social dysfunction than control men. Control women experienced a decrease in dyadic consensus during the child s first year, which did not happen among ART women. After the child was born, ART men reported a higher level of sexual affection compared with control men. Psychic symptoms and stressful life events were differently related to marital relations in ART and control groups. The parenting experiences of ART mothers were in general at a higher level, compared with controls, and they changed in a positive direction during the child s first year. Fathering experiences were at the same level in both groups, and they changed positively in both groups by the end of the child s first year. The parenting experiences of ART mothers and fathers were more resilient to certain child-related stressors than those of control group. Both mothers and fathers with long-term infertility showed more sensitive behaviour with their child in toddler-age than in infancy. Correspondingly, children s cooperation increased. Mothers often mentioned a fear of miscarriage and difficulty in creating representations of the child during pregnancy. Descriptions of the infants were mainly rich, vivid and loaded with positive features. In conclusion, ART parents in general seem to adapt well to the transition to parenthood. Former infertility and ART do not seem to constitute a risk for parents mental health, marital relations or experience of parenting. Even longstanding infertility with several unsuccessful treatment attempts did not create a risk as regards parenting behaviour or parents mental representations of their child. In this group, however, women were found to have fear for losing the child and difficulty in creating representations of the child during pregnancy, which in some cases may indicate need for psychosocial support. Even though our results are encouraging, infertility and infertility treatments are generally considered as a stressful experience. It is a challenge for health authorities to recognize those couples who need professional help to overcome the distressing experiences of infertility and ART.