<p><strong>Introduction: </strong>The Reading the Mind in the Eyes Test is a widely used test for measuring aspects of social cognition. The aim of the present study was to provide results from a group of typically developing Swedish children (age 9-12) and to compare these results with children and adults in other Swedish and English studies, as well as results from a group of children with Asperger syndrome. <strong>Method: </strong>A Swedish version of the child version of the test was completed by 83 controls and by six children with Asperger syndrome. Results were compared between the two groups and with data from other studies. <strong>Results: </strong>The children in the current study did not differ on scores compared to children in the same age group in other studies. The children in the current study scored significantly lower than adults in an earlier study. The results from the children with Asperger syndrome did not differ significantly to the results from the controls.</p>

The negative impact of war on child mental health has been repeatedly documented. Still, the majority of children exposed to ethnic and political violence show no signs of clinical disorder. In Western countries of exile, these findings have prompted a variety of attempts to evaluate refugee children, in the hope of identifying and offering support to those children “at risk”. This study critically examines one such attempt. The aims are fourfold: 1. to describe the range and pattern of child trauma-stress exposure and mental health reactions as captured on clinician semi-structured interview; 2. to critically compare clinician assessment with independent parent, child and teacher reports; 3. to identify factors of potential risk or protective import for child mental health; 4. to draw clinical implications: from whom and by what means can children at risk be reasonably identified? The target of our study was the entire population of Bosnian-Serbian-Croatian speaking child refugee families assigned to Umeå and surrounding municipalities during 1994-95. Fifty families, containing 90 children aged one month to 20 years, were included in the study. Assessment occurred in two phases. First, a semi-structured interview was conducted that inquired broadly as to the child’s family background, trauma-stress exposure, emotional-behavioral problems, patterns of family functioning, and future hopes. Second, standardized self-report questionnaires were administered, separately to parent and child, to provide alternative appraisal of the child’s war exposure, mental health symptoms, coping strategies, and social network. Teacher evaluation of child cognitive-social functioning as well as emotional-behavioral problems was also obtained. Clinician semi-structured interview revealed the child’s pre-war period as preponderantly good, and provided richly detailed narratives of child exposure during war and resettlement that clustered into a limited number of type-stories. Independent parent assessment captured the same broad strokes of child war exposure; but both approaches – fixed questionnaire and semi-structured interview – showed specific areas of blindness. Teenage self-report offered a disparate but equally rich account of war exposure, while that of primary school child was significantly less detailed. Nearly half of the study children (48%) were identified on clinician interview with one or more mental health problem “demanding further attention”. Depressiveness was the single most prevalent symptom (31%), followed by posttraumatic reactions (23%) and anxiety-regressiveness (15%). Independent symptom appraisal by parent and primary school child was largely concordant with that of clinician, while teenagers made similar assessment as to who was in distress, but defined the nature of that distress differently. Teacher report stood apart, identifying fewer inward emotional problems and asserting the cognitive-social competence of the vast majority of study children. Trauma-stress exposure during both war and resettlement presented as an unequivocal risk to mental health, but accounted for only part of outcome variance. Additional factors of strong import related broadly to “living in the present”. Parent impairment of daily routines, child dissatisfaction with school and an ongoing quarrelsome relationship presented as risk factors. Protection was associated with parent maintenance of a warm family climate and of concrete physical-emotional caring, child social ties to physically present others, including teacher; and above all, a family sense of hope for the future. Results support the general robustness of our semi-structured approach. Exploring the child’s present well-being in narrative relation to past and future, our assessment captured and gave meaning to the complexity of child exposure and behavior. At the same time, independent parent and child appraisals provided an additional richness to the retelling and evaluation of child experience. Particularly the apartness of teacher report underscores the need to incorporate an outside-world vantage point in the process of risk assessment.

Children and parents who visited child and adolescent psychiatry (CAP) for the first time were interviewed in the presence of their therapists about the first meeting. The interview was intended to make the attendants describe in their own words what the meeting was like for them. The interview was repeated after six months to get complementary information. Research assistants, reflectors, helped the interviewer to prevent from bias and to hold on to the theme. The grounded theory approach was utilised in papers I, II, and III, and qualitative content analysis was used in paper IV. Children appreciated the therapist being in an active as well as in a more passive but alert position, moving between asking adjusted questions and including the parents. The therapists’ skill of listening was also important to them. For the parents, it was important what happened between their child and the therapists. They questioned their own role and presence. Also, they focused on the plan for the meeting and for the coming process. Certain things that happened in the dialogue were useful after the meeting. The results indicate that what was helpful was connected to family therapy matters rather than psychiatric ones. The therapists balanced between a psychiatric and a family therapeutic position, and it was a dilemma for them how to best fulfil their assignment in the organisation as they perceived it. Two competing discourses were found in the first meeting; Structuring, which stood for structure, planning and expertise, while Collaboration represented negotiations of how to work together, empowerment and emotional aspects. The Structuring discourse tended to dominate. Both discourses consisted of valuable elements that needed to be included to ensure that the atmosphere would not be too strict or too flexible. The findings are tentative because of the lack of studies to compare to, and because of the few interviews made. / Det första möte som sker mellan familjemedlemmar och personal antas ha stor betydelse för hur den fortsatta kontakten artar sig. Det är ett tillfälle när var och en kan vara öppen för intryck och nyfiken på hur kommunikationen utvecklas och vilken hjälp som ska till. Förutsättningarna för mötet är etablerade på många plan. Föräldrarna och barnen har tidigare erfarenheter av både personliga och professionella kontakter, och de har förväntningar på vad som ska eller bör ske under det första samtalet. Personalen befinner sig i ett sammanhang där de har förväntningar på sig från organisationen. De har utbildning och erfarenhet och har anammat organisationens kultur och vanor i större eller mindre utsträckning. Både inom det psykiatriska eller det psykoterapeutiska området har det varit brist på studier som rör det första samtalet mellan professionell och patient/klient. Detta väckte ett intresse att studera området närmare. Syftet med studien var därför att försöka ta reda på mer om det första mötet ansikte mot ansikte mellan personal och familjemedlemmar. Vad händer där och hur upplevs det här mötet av dem som deltar? Ytterligare ett syfte var att försöka ta reda på vilka diskurser som påverkar det som sker mellan deltagarna. Vilka underliggande meningar har deltagarnas tankar och sätt att bete sig, och som har förankring i allmänna föreställningar om hur ett möte av det här slaget går till? Hur framträder det i deltagarnas kommunikation med varandra? För att finna svar på dessa frågor gjordes forskningsintervjuer inom två veckor respektive sex månader efter det första mötet på BUP (barn- och ungdomspsykiatrin). Vid intervjuerna deltog de som varit närvarande vid det första samtalet, d v s personal, föräldrar och barn. Intervjuaren hade till sin hjälp forskningsassistenter, reflektörer, vars uppgift var att bidra till att alla fick komma till tals och att man höll fokus på hur det var under det första samtalet. Fyra delstudier genomfördes. I de tre första användes analysmetoden grundad teori, och i den fjärde kvalitativ innehållsanalys. Den första delstudien lyfte fram barnens perspektiv. Barnen uppskattade om behandlarna befann sig ömsom i en aktiv ömsom i en passiv position, där de samtidigt var alerta i förhållande till barnen. De gillade att behandlarna å ena sidan anpassade sig och sina frågor till barnen och å andra sidan tog med föräldrarna i samtalet. Behandlarnas förmåga att lyssna och att hjälpa barnen att uttrycka sig var viktig för barnen. De tog också upp vikten av att behandlarna höll reda på tiden, så att samtalet inte blev för långt för dem. För föräldrarna, i delstudie II, visade det sig vara avgörande vad som skedde mellan deras barn och behandlarna. De ifrågasatte sin egen roll i mötet, och var tveksamma till om de borde vara närvarande eller inte. Dessutom var de inriktade på hur upplägget av samtalet såg ut och hur den fortsatta planeringen skulle bli. Vissa teman och yttranden i dialogen kunde vara till nytta för samspelet därhemma. Fynden i delstudien antyder att det som var till hjälp snarare låg på ett familjeterapeutiskt plan än ett psykiatriskt. I delstudie III framkom att behandlarna nedtonade sin egen insats och lyfte fram det viktiga i familjemedlemmarnas bidrag till hur mötet blev. Behandlarna balanserade mellan ett psykiatriskt och ett familjeterapeutiskt förhållningssätt. De mest tillfredsställande arbetsuppgifterna rörde att lyssna på barns och föräldrars berättelser och att hitta sätt att uppmuntra och stödja deras vägar till att må och fungera bättre. De önskade möta familjemedlemmarna på deras villkor, men hade också att samla information för bedömning och fortsatt planering. Det innebar ett dilemma för dem hur de bäst skulle kunna uppfylla de uppgifter som de uppfattade att BUP-organisationen gett dem. Två konkurrerande diskurser framträdde i delstudie IV. De var inflätade i varandra och stod att finna hos var och en av parterna barn, föräldrar och behandlare. Det syntes pågå balanserande eller konkurrens mellan de sociala röster som ingick i diskurserna. Diskursen Strukturering innehöll sociala röster som rörde exempelvis inramning av mötet, expertis och kategoriseringar medan diskursen Samarbete inriktades mot aspekter som öppenhet, sam-skapande och en utvidgad dialog. Om diskursen Strukturering skulle överväga blev följden antingen ett undertryckande och okänsligt förhållningssätt och diskursen Samarbete skulle om den övervägde kunna skapa ett otydligt eller alltför flexibelt förhållningssätt. Den förra diskursen tycktes dominera, men båda diskurserna syntes innehålla delar som behövdes för att det första mötet skulle uppfattas som givande. Fynden i studien är preliminära av två skäl. Dels finns få eller inga studier att jämföra med; dels var antalet intervjuer begränsat.

Introduction: The Reading the Mind in the Eyes Test is a widely used test for measuring aspects of social cognition. The aim of the present study was to provide results from a group of typically developing Swedish children (age 9-12) and to compare these results with children and adults in other Swedish and English studies, as well as results from a group of children with Asperger syndrome. Method: A Swedish version of the child version of the test was completed by 83 controls and by six children with Asperger syndrome. Results were compared between the two groups and with data from other studies. Results: The children in the current study did not differ on scores compared to children in the same age group in other studies. The children in the current study scored significantly lower than adults in an earlier study. The results from the children with Asperger syndrome did not differ significantly to the results from the controls.

Submitted by Luciana Sebin (lusebin@ufscar.br) on 2016-09-23T12:52:25Z No. of bitstreams: 2 DissAJB.pdf: 1713853 bytes, checksum: 52cf08e7304aa279d9734f5f3aceaea9 (MD5) DissAJB.pdf: 1713853 bytes, checksum: 52cf08e7304aa279d9734f5f3aceaea9 (MD5) / Approved for entry into archive by Marina Freitas (marinapf@ufscar.br) on 2016-09-27T19:21:16Z (GMT) No. of bitstreams: 2 DissAJB.pdf: 1713853 bytes, checksum: 52cf08e7304aa279d9734f5f3aceaea9 (MD5) DissAJB.pdf: 1713853 bytes, checksum: 52cf08e7304aa279d9734f5f3aceaea9 (MD5) / Approved for entry into archive by Marina Freitas (marinapf@ufscar.br) on 2016-09-27T19:21:23Z (GMT) No. of bitstreams: 2 DissAJB.pdf: 1713853 bytes, checksum: 52cf08e7304aa279d9734f5f3aceaea9 (MD5) DissAJB.pdf: 1713853 bytes, checksum: 52cf08e7304aa279d9734f5f3aceaea9 (MD5) / Made available in DSpace on 2016-09-27T19:21:31Z (GMT). No. of bitstreams: 2 DissAJB.pdf: 1713853 bytes, checksum: 52cf08e7304aa279d9734f5f3aceaea9 (MD5) DissAJB.pdf: 1713853 bytes, checksum: 52cf08e7304aa279d9734f5f3aceaea9 (MD5) Previous issue date: 2016-02-24 / Fundação de Amparo à Pesquisa do Estado de São Paulo (FAPESP) / Under the approach of social studies of Science and technology (STS), tis research has analyzed issues in the current constitution of the mental health field that has taken care of children and adolescents in Brazil. Based on Pierre Bourdieu’s theoretical contribution, a case study was carried out in a Centro de Atenção Psicossocial (CAPSi), in a country in the state of São Paulo, in order to analyzed the institutionalized relations by the multiprofessionals that work in this Center, which is an apparatus implemented by the National Mental Health Policy (PNSM). The methodology was elaborated on corresponding literature to the theme of this research, and the case study was carried out through semi structured interviews with some professionals from CAPSi, through direct observation of the CAPSi’s team meetings, through meetings between the constituting service network to the municipal mental health, and by analyzed the Minutes Meeting of CAPSi’s team. The analysis of the data showed evidence of the dominance of psychiatric science in the epistemological basis that build concepts and institutions mental disorders care, as well as the existence of conflicting paradigms, the psychopharmalogical trivialization, considerations about children and adolescents social leadership and about the non recognition of CAPSi as healthcare institution by the municipal services and by the scholar and juridical fields. With the results of this research, it is expected to contribute to the STS studies and to researchers interested in the theme, intending to generate reflections and reviews about the efficiency and effectivenss of care for children and adolescents diagnosed with mental disorders, and the social position of children and adolescents. / Sob a abordagem dos estudos sociais da ciência e da tecnologia (CTS), buscou-se nesta pesquisa compreender a constituição atual do campo da saúde mental voltado aos cuidados de infantojuvenis no Brasil. A partir do uso do aporte teórico de Pierre Bourdieu, foi realizado um estudo de caso em um Centro de Atenção Psicossocial Infantojuvenil (CAPSi), em um município no interior do estado de São Paulo, para analisar as relações institucionalizadas pelos multiprofissionais atuantes nesse Centro, que se dá como um aparato implementado pela Política Nacional de Saúde Mental (PNSM). Os métodos investigativos utilizados deram-se por levantamento bibliográfico correspondente à temática da pesquisa, e o estudo de caso foi realizado através de entrevistas semi-estruturada a alguns profissionais do CAPSi, por observação direta em reuniões da equipe do CAPSi e em reuniões entre os serviços constitutivos da rede de atendimento à saúde mental municipal, e por análise de Atas de reuniões da equipe CAPSi. A análise dos dados resultou em apontamentos sobre a dominância científico psiquiátrica na base epistemológica que constrói conceitos e instituições de cuidado à doença mental, sobre a existência de paradigmas em conflito, sobre a banalização e vulgarização psicofarmacológica, sobre considerações relativas ao protagonismo social infantojuvenil e sobre o irreconhecimento do CAPSi como instituição de cuidados em saúde pelos serviços municipais e pelos campos escolar e jurídico. Com a conclusão dessa pesquisa, objetiva-se contribuições aos estudos CTS e aos pesquisadores que abordam a temática estudada, almejando-se reflexões e revisões sobre a eficiência e eficácia dos cuidados aos infantojuvenis diagnosticados com doença mental, e ao lugar social das crianças e adolescentes. / FAPESP: 2014/06638-0

Submitted by Cláudia Bueno (claudiamoura18@gmail.com) on 2015-10-16T20:26:47Z No. of bitstreams: 2 Dissertação - Ciro Mendes VArgas - 2014.pdf: 4522341 bytes, checksum: 6f69856baba60e9b908a309d91ea0294 (MD5) license_rdf: 23148 bytes, checksum: 9da0b6dfac957114c6a7714714b86306 (MD5) / Approved for entry into archive by Luciana Ferreira (lucgeral@gmail.com) on 2015-10-19T13:36:27Z (GMT) No. of bitstreams: 2 Dissertação - Ciro Mendes VArgas - 2014.pdf: 4522341 bytes, checksum: 6f69856baba60e9b908a309d91ea0294 (MD5) license_rdf: 23148 bytes, checksum: 9da0b6dfac957114c6a7714714b86306 (MD5) / Made available in DSpace on 2015-10-19T13:36:27Z (GMT). No. of bitstreams: 2 Dissertação - Ciro Mendes VArgas - 2014.pdf: 4522341 bytes, checksum: 6f69856baba60e9b908a309d91ea0294 (MD5) license_rdf: 23148 bytes, checksum: 9da0b6dfac957114c6a7714714b86306 (MD5) Previous issue date: 2014-09-30 / Information about pediatric and adolescent patients admitted to specialized psychiatric hospitals are rare and there are few data on the epidemiological profile of these patients. Two studies were conducted in order to investigate this population. Aiming to review the literature concerning this issue, the first study found 17 relevant articles that indicated conduct disorder and affective disorders as most prevalent diagnostics among the studies. There was gender balance. There was no ethnic differences. In the second study, were analyzed medical charts of 1318 patients under 18 years old admitted from January 2001 to December 2011 at a referral hospital in child psychiatric hospitalization. The most frequent diagnosis was Bipolar Disorder (35.4%). There was a significant male majority in bipolar disorder, organic mental disorder and substance-related disorder, female majority in depressive disorder and dissociative disorder. Prevalence of bipolar and related substance in the range 15-18 years and prevalence of organic mental disorder and attention-deficit hyperactivity disorder in the range of 10 to 14 years. Psychiatric family history occurred in greater frequency in the range 10-18 years. Comorbidities were present in 46.2% of the sample. The psychotic syndrome was the most frequent described. In an overview of the two studies, externalizing disorders were more common in younger children and males, and internalizing disorders in older children and females. / Informações sobre pacientes crianças e adolescentes internados em hospitais psiquiátricos especializados são raras e existem poucos dados sobre o perfil epidemiológico desses pacientes. Dois estudos foram realizados no intuito de investigar essa população. Com o objetivo de revisar a literatura concernente a este tema o primeiro estudo encontrou 17 artigos relevantes que indicaram os transtornos de conduta e transtornos afetivos como predominantes entre os diagnósticos dos estudos. Houve equilíbrio entre os gêneros. Não houve diferença étnica. No segundo estudo, foram analisados prontuários de um total de 1318 pacientes menores de 18 anos internados de janeiro de 2001 a dezembro de 2011 em um hospital referência em internação psiquiátrica infantil. O diagnóstico mais frequente foi o Transtorno Bipolar (35,4%). Houve significante maioria masculina no transtorno bipolar, transtorno relacionado à substância e transtorno mental orgânico, maioria feminina no transtorno depressivo e transtorno dissociativo. Predominância do transtorno bipolar e transtorno relacionado à substância na faixa de 15 a 18 anos e do transtorno mental orgânico e déficit atencional e hiperatividade na faixa de 10 a 14 anos. Antecedentes familiares psiquiátricos ocorreram em maior frequência na faixa de 10 a 18 anos. Comorbidades estiveram presentes em 46,2% da amostra. A síndrome psicótica foi a mais frequente descrita. Em uma visão geral dos dois estudos, os transtornos externalizantes foram mais comuns em crianças menores e do sexo masculino, e os transtornos internalizantes, em crianças maiores e do sexo feminino.

Denna kvalitativa intervjustudie syftar till att undersöka hur samverkan ser ut mellan skola, Barn och ungdomspsykiatrin (BUP) samt socialtjänsten i arbetet med att hjälpa barn och ungdomar i åldrarna 0 till 18 år som lider av psykisk ohälsa. Studien grundar sig i sex stycken semistrukturerade intervjuer med två skolkuratorer, två socialsekreterare från socialtjänsten samt två kuratorer från BUP. Resultaten visar att det finns flertal hindrande och möjliggörande faktorer vid samverkan. Resultaten visar att då professionella konsulterar med varandra kring svåra frågor rörande unga som lider av psykisk ohälsa främjas samsyn och samverkan möjliggörs. Vidare visar resultaten att förutsättningar för samverkan inom organisationer bygger på att ledningar uppnår domänkonsensus, för att på så sätt komma överens om hur aktörer skall samverka / This qualitative interview study aims to investigate the collaboration between school, children and adolescent psychiatry and the social service with the intent to help children and adolescents aged 0 to 18 who suffer from mental health problems. The study is based on six semistructured interviews with two school counselors, two employees from the social services and two counselors from children and adolescent psychiatry (BUP). The results show that there are several obstructive and enabling factors when collaborating. The results show that when professionals consult with each other about difficult issues regarding young people suffering from mental illness, it promotes consensus and enables cooperation. Furthermore, the results show the prerequisites for collaboration within organizations is based on the fact that the management reaches domain consensus, in order to agree on how professionals shall collaborate.

Abstract Bullying behaviour is present in the daily life of many adolescents, but research into the serious problems related to this behaviour is still scarce. The aim of this work was to investigate the putative associations of bullying behaviour with psychiatric disorders, substance use, suicidality and criminal offences in a sample of under-age adolescent inpatients in Northern Finland. The epidemiologically unselected sample of 12–17-year-old inpatients in need of acute psychiatric hospitalization in a closed ward consisted of 508 adolescents admitted to Unit 70 in Oulu University Hospital during a defined 5-year period. These subjects were interviewed during their hospitalization using the diagnostic semi-structured Schedule for Affective Disorder and Schizophrenia for School-Age Children Present and Lifetime (K-SADS-PL), to identify their psychiatric disorders in terms of DSM-IV and to obtain data on bullying behaviour, substance use, suicidality and somatic diseases. Data on possible criminal offences were extracted from the criminal records of the Finnish Legal Register Centre. Being a bully and a bully-victim (i.e. a person who bullies others and is also bullied) increased the likelihood of externalizing disorders in general, and more specifically of conduct disorders, by over 14-fold in the boys and over 10-fold in the girls. Among the boys being a victim of bullying elevated the risk of internalizing disorders in general, and more specifically of anxiety disorders, by over 3-fold. Also, being a victim of bullying was statistically significantly associated with chronic somatic diseases (e.g. allergy, asthma and epilepsy), but only among the boys, the odds ratio (OR) being over 2-fold. Furthermore, being a bully increased the likelihood of substance-related disorders by over 2-fold in the boys and over 5-fold in the girls. In addition, examination of the use of substances of various types showed that being a bully increased the risk of regular daily smoking and alcohol use in both sexes and also led to more severe substance use such as cannabis and hard drugs among girls. Being a victim of bullying and bullying others both increased the risk of serious suicide attempts in the girls by over 2 and 3-fold respectively. Furthermore, bullying behaviour was also associated with violent crimes, but not with non-violent crimes, but psychiatric disorders were significant mediating factors in this association of bullying behaviour with criminality, however. The findings imply that involvement in bullying behaviour is more likely to be a risk factor for inward-directed harmful behaviour than outward-directed aggression, and also suggest that victimized boys are in general more vulnerable than victimized girls, whereas bullying girls have more problems than bullying boys. / Tiivistelmä Kiusaaminen on hyvin yleinen ilmiö nuorten keskuudessa, mutta siihen mahdollisesti liittyviä vakavia ongelmia on tutkittu vähän. Tässä tutkimuksessa analysoitiin kiusaamiskäyttäytymisen yhteyttä mielenterveyshäiriöihin, itsetuhoisuuteen ja rikollisuuteen psykiatrisessa osastohoidossa olleiden alaikäisten nuorten keskuudessa. Kiusaamiskäyttäytymistermi kattaa sekä kiusaajien, kiusattujen että kiusaaja-kiusattujen toiminnan. Tutkimusaineistoon kuului 508 12–17 -vuotiasta nuorta, jotka olivat hoidossa suljetulla psykiatrisella akuuttihoito-osastolla Oulun yliopistollisessa sairaalassa 1.4.2001 ja 31.3.2006 välisenä aikana. Osastohoidon aikana nuoret tutkittiin käyttäen puolistrukturoitua K-SADS-PL -haastattelua, jonka avulla määritettiin nuorten mielenterveyshäiriöt DSM-IV -diagnoosiluokituksen mukaisesti ja saatiin tiedot nuorten kiusaamiskäyttäytymisestä, päihteiden käytöstä, itsetuhoisuudesta ja somaattisista sairauksista. Oikeusrekisterikeskuksen rikosrekisteristä saatiin tutkittavien rikosrekisteritiedot. Tämä tutkimus osoitti, että nuorilla, jotka ovat kiusaajia tai kiusaaja-kiusattuja, on yli kymmenkertainen riski käytöshäiriöihin verrattuna nuoriin, jotka eivät ole osallistuneet kiusaamiskäyttäytymiseen. Kiusatuilla pojilla on yli kolminkertainen riski ahdistuneisuushäiriöihin. Lisäksi kiusatuksi joutuminen on pojilla yhteydessä kroonisiin somaattisiin sairauksiin kuten allergiaan, astmaan ja epilepsiaan. Tytöillä, jotka kiusaavat, on yli viisinkertainen riski päihdehäiriöihin. Pojilla, jotka kiusaavat, vastaava riski on kaksinkertainen. Molemmilla sukupuolilla toisten kiusaaminen on yhteydessä säännölliseen tupakointiin sekä alkoholin käyttöön ja tytöillä myös kannabiksen ja muiden huumeiden käyttöön. Tytöillä, jotka ovat kiusattuja tai kiusaavat, on yli kaksinkertainen riski vakaviin itsemurhayrityksiin. Lisäksi tämä tutkimus osoitti, että kiusaaminen on yhteydessä väkivaltarikollisuuteen, mutta tätä selittävät merkittävästi nuorten mielenterveyshäiriöt. Tämän tutkimuksen tulokset viittaavat siihen, että nuorilla, jotka altistuvat kiusaamiskäyttäytymiselle, on muita suurempi riski itsensä vahingoittamiseen useilla eri tavoilla. Sen sijaan kiusaamisen ja toisiin kohdistuvan väkivallan yhteys on lievempi. Sukupuolten välisiä eroja tarkasteltaessa havaittiin, että haavoittuvaisimpia ovat kiusaavat tytöt ja kiusatut pojat.

Abstract Conduct disorder (CD) among girls is a common but seldom studied psychiatric disorder. The aim of this study was to examine risk factors for CD, the factor structure of CD symptoms, suicidal behaviour, comorbid disorders and nicotine dependence of adolescent girls with CD in an inpatient sample in Northern Finland. The study subjects were 508 12- to 17-year-old inpatients treated in an acute psychiatric ward, Unit 70, at Oulu University Hospital between April 2001 and March 2006. These adolescents were interviewed using the Schedule for Affective Disorder and Schizophrenia for School-Age Children Present and Lifetime (K-SADS-PL) to obtain psychiatric diagnoses according to the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-IV). In addition, the European Addiction Severity Index (EuropASI) was used to obtain information on somatic health, family situation and delinquency. From the data collected, 63 girls and 92 boys fulfilled the criteria for current DSM-IV-diagnosed conduct disorder. It was observed that, although the number of symptoms and severity of CD was lower among girls compared to boys, the level of functioning was lowered to the same degree. Physical abuse increased the risk for violent CD, and living apart from at least one biological parent increased the risk for both violent and non-violent CD among girls. The results of this study also suggest a gender difference in the factor structure and developmental model of CD. Alcohol dependence increased the risk for suicide attempt and self-mutilation almost fourfold among girls with CD. Girls with CD had more comorbid affective and anxiety disorders than boys. Girls with CD also had more self-reported allergies. Finally, the number of CD symptoms was positively correlated with the level of nicotine dependence (ND) among both girls and boys, and a gender difference was found in the correlation between symptom subscales and the level of ND. The findings suggest that gender differences exist in conduct disorder. Special attention should be paid to the prevention, identification and treatment of CD among girls. It seems that, among girls with CD, the well-being of primary family is important in prevention. Alcohol dependence and depression in girls with CD should be treated with special care. DSM-IV might not always be sensitive enough to diagnose CD among girls, and this should be considered when behavioural symptoms are evaluated in girls. / Tiivistelmä Tyttöjen käytöshäiriö on vähän tutkittu mutta yleinen psykiatrinen häiriö. Tässä tutkimuksessa analysoitiin tyttöjen käytöshäiriön riskitekijöitä, oireiden faktorirakennetta, käytöshäiriöisten itsetuhoisuutta, samanaikaista psykiatrista ja somaattista sairastavuutta sekä nikotiiniriippuvuutta psykiatrisessa osastohoidossa olleiden alaikäisten nuorten keskuudessa. Tutkimusaineistoon kuului 508 12–17-vuotiasta nuorta, jotka olivat hoidossa psykiatrisella akuuttihoito-osastolla Oulun yliopistollisessa sairaalassa 1.4.2001–31.3.2006 välisenä aikana. Nuoret haasteteltiin käyttämällä puolistrukturoitua Schedule for Affective Disorder and Schizophrenia for School-Age Children Present and Lifetime (K-SADS-PL) -haastattelua, jonka avulla määritettiin nuorten psykiatriset diagnoosit Diagnostic and Statistical Manual of Mental Disorders, fourth edition (DSM-IV) -diagnoosiluokituksen mukaisesti. Lisäksi potilaat haastateltiin European Addiction Severity Index (EuropASI) -haastattelulla, josta saatiin tietoa fyysisestä terveydentilasta, perhetilanteesta ja rikollisuudesta. Aineiston nuorista 63 tyttöä ja 92 poikaa täyttivät käytöshäiriön kriteerit. Tämä tutkimus osoitti, että vaikka nykyisten DSM-IV-kriteerien perusteella tytöillä käytöshäiriön vaikeusaste oli aiempien tutkimusten tapaan poikia alhaisempi ja oireiden määrä vähäisempi, oli tyttöjen toimintakyky silti yhtä huono kuin poikien. Fyysinen perheväkivalta lisäsi tyttöjen riskiä väkivaltaiseen käytöshäiriöön ja asuminen erossa vähintään yhdestä biologisesta vanhemmasta lisäsi riskiä sekä väkivaltaiseen että ei-väkivaltaiseen käytöshäiriöön. Käytöshäiriöoireiden faktorianalyysi osoitti, että tytöillä ja pojilla oli eroa oireiden faktorirakenteessa eikä tyttöjen oireiden jako selkeästi noudattanut Loeberin esittämää polkumallia. Alkoholiriippuvuus lisäsi käytöshäiriöisillä tytöillä riskiä itsemurhan yrittämiseen ja itsensä vahingoittamiseen lähes 4-kertaiseksi. Käytöshäiriöisillä tytöillä oli poikia enemmän mieliala- ja ahdistushäiriöitä samanaikaisina psykiatrisina häiriöinä. Somaattisista häiriöistä käytöshäiriöiset tytöt raportoivat poikia enemmän allergioita. Käytöshäiriön oireiden määrä oli yhteydessä sekä tytöillä että pojilla nikotiiniriippuvuuden voimakkuuteen. Tyttöjen ja poikien välillä oli eroa nikotiiniriippuvuuteen korreloivissa oireryhmissä. Tämän tutkimuksen tulosten perusteella tyttöjen ja poikien käytöshäiriöllä on eroavaisuuksia. Tyttöjen käytöshäiriön ennaltaehkäisyyn, tunnistamiseen ja hoitoon tulee kiinnittää erityistä huomiota. Primaariperheen hyvinvointi näyttäisi olevan tärkeää ennaltaehkäisyssä. Käytöshäiriöisen tytön hoidossa tulee kiinnittää erityinen huomio alkoholin käyttöön sekä depression hoitoon itsetuhoisuuden ehkäisemiseksi. DSM-IV ei ehkä nykyisellään ole riittävän herkkä työkalu tyttöjen käytöshäiriön diagnosoimiseksi, ja tähän tulisi kiinnittää huomiota kun käyttäytymisellään oireilevia tyttöjä hoidetaan.

Att lyckas i skolan är den viktigaste faktorn för att också lyckas i livet och är än mer viktig för elever som har diagnosen adhd, eftersom de har större risk att hamna i en negativ livsspiral. Skolan har ett kompensatoriskt uppdrag och specialpedagogen kan vara en viktig del i att hjälpa till med att skapa en integrerad och bra lärmiljö för elever med diagnosen adhd. Elevhälsoarbetet i skolan förutsätter en hög grad av samverkan med olika interna och externa aktörer. Barn- och ungdomspsykiatrin är en av dessa. Syftet med denna studie är att belysa personalens beskrivningar av framgångsfaktorer och utmaningar i samarbetet mellan personal, på barn- och ungdomspsykiatrin och skolors elevhälsa, för att kunna stödja elever som har diagnosen adhd i deras utveckling och lärande. Den här kvalitativa studien bygger på intervjuer med personal från dessa verksamheter. Intervjuerna bestod av både fokusgruppsintervjuer och individuella semistrukturerade intervjuer. Intervjuerna transkriberades och sammanställdes utifrån studiens frågeställningar. Studiens urval var målinriktad och gjordes enligt bekvämlighetsprincipen. Informanterna från elevhälsan arbetade i en glesbygdskommun och deltagarna från barn- och ungdomspsykiatrin var verksamma i en stad men samverkar med informanterna i elevhälsan. Resultatet i studien visar att både skolan och barn- och ungdomspsykiatrin tycker att samverkan och samarbete mellan parterna är viktiga och nödvändiga. De största utmaningarna i samverkan tycks vara otydliga ramar för hur samarbetet ska fungera och oklarheter kring de olika professionernas uppdrag. De långa väntetiderna till barn- och ungdomspsykiatrin skapar också oro vid samverkan. I studien framkom också att samverkan i glesbygdskommuner innebär försvårande omständigheter. Resultatet tyder på att tydligare samverkansavtal bör arbetas fram och att all berörd personal bör göras delaktiga. / Success in school is the most important factor for success in life, and it is even more important for students with an ADHD-diagnosis, since they are in more danger of developing a negative spiral in life. Education has a compensatory duty and teachers in special education can be an important part in helping to create an integrated and meaningful learning environment for students with an ADHD-diagnosis. The work with the student health team within a school demands a high degree of cooperation between different internal and external players. BUP (child and adolescent psychiatry), which provides specialist care for children with mental health problems, is one of these players. The intention of this paper is to illustrate the personnel’s descriptions of not only the factors for success but the challenges as well, when it comes to the cooperation between the school´s student health team and BUP´s work to support students with the ADHD-diagnosis with their development and their learning. This qualitative study is based on interviews with personnel from these different arenas. The interviews where made with both focus groups, as well as semi structured interviews. The interviews where transcribed and compiled based on the intentions of this study. The selection was targeted and made according to the comfort principle. The informants from the student health team worked in a rural municipality, while the participants from BUP where based in a nearby city, but worked with the informants from the student health team. The result of the study shows that the school, as well as, BUP believes that cooperation and collaboration between these different arenas are important and necessary. The main challenges seem to be the lack of a defined framework that specifies how the cooperation should work as well as confusion about the responsibilities of the different professions. The long wait to BUP is also a cause for concern while striving for cooperation. The study also showed that cooperation within rural municipalities involves complicating circumstances. The result indicates that more clearly defined frameworks for cooperation should be developed and that all concerned personnel should be involved.