Background: Orphanhood is a major consequence of the HIV/AIDS epidemic in sub-Saharan Africa. There is little evidence concerning psychological problems for AIDS-orphaned children. This thesis explores the relationship between orphanhood status and mental health. It also examines mediating influences of environmental risk and protective factors, and interactions between factors, on children’s psychological problems. Methods: 1200 isiXhosa-speaking children were interviewed, using standardised questionnaires, in deprived urban settlements of Cape Town. A qualitative stage with 60 AIDS-orphaned children, 42 caregivers and 20 professionals explored participant perceptions of risk and protective factors. A quantitative stage compared 1025 AIDS-orphaned children to control groups of other-orphans and non-orphans. Data were analysed with t-tests, chi-sq, anovas, regression and log-linear analyses. The study took place in collaboration with Cape Town Child Welfare. Results: AIDS-orphaned children reported more depression (p<.001), peer relationship problems (p<.001), post-traumatic stress (p<.001), suicidal ideation (p<.05), delinquency (p<.001) and conduct problems (p<.001) than other-orphans and non-orphans. Anxiety showed no differences. Compared to Western norms, AIDS-orphaned children showed higher levels of internalising problems and delinquency, but lower levels of conduct problems. These differences remained when controlling for socio-demographic factors. A number of factors strongly mediated the relationship between AIDS-orphanhood and mental health. These include poverty-related factors (food, education and social security, p<.001). caregiving-related factors (caregiver illness, p<.001, excessive housework p<.001, being a streetchild, p<.001) and AIDS-related stigma (p<.001). Cumulative effects were also found. Food insecurity and AIDS-related stigma interacted to raise likelihood of disorder from 19% to 83%, and orphanhood status and bullying interacted to raise likelihood from 12% to 76%. Conclusions: This thesis shows clear evidence of heightened psychological problems amongst AIDS-orphaned children. It also indicates mediating factors and points to areas of possible intervention. The South African Ministry of Social Development plans to scale up the study to a national survey of AIDS-orphanhood.

Depression in adolescence is a major health problem, associated with poor psychological function and key risk factors both for later illness and suicidal behaviours. The antidepressant fluoxetine is commonly used in this population and it is shown to have a favourable benefit-to-risk profile. However, controversy still exists about the use of antidepressants in young people and there is little research focusing on underlying mechanisms of wanted and unwanted actions in this group. This doctoral thesis aims to investigate, for the first time, the acute effects of fluoxetine on emotional processing, using a combination of behavioural and neuroimaging techniques. The aim is to achieve a greater understanding of the mechanisms underlying fluoxetine use in depressed adolescents, in light of differences seen in their clinical presentation and response to antidepressant drugs. In the first study (Chapter Two), a single dose of fluoxetine was shown to decrease the recognition of anger in a sample of young adult volunteers, an effect not previously seen in acute studies of older participants. This effect may be particularly relevant for the treatment of adolescent depression, in which symptoms of anger and irritability are often prominent. Beyond this, fluoxetine was shown to increase the recognition of positive vs. negative facial information, and also exerted an anxiolytic-like influence, eliminating the emotion-potentiated startle effect. However, no influence was seen in measures of attentional vigilance to threat. In an attempt to overcome methodological limitations of this study, a paradigm was developed that is particularly sensitive to the detection of automatic biases towards threatening information (Chapter Three). Chapter Four describes a neuroimaging study with depressed adolescents, in which a single dose of fluoxetine was found to reduce amygdala activity in response to anger. Early changes in amygdala activity to fear correlated with decreased symptoms of anxiety and depression in the first 7-10 days of treatment. Chapter Five explores the effects of acute fluoxetine in a sample of high trait anger males. This study replicated the finding that fluoxetine acts to increase the recognition of positive information, whilst showing preliminary evidence for a reduction in attentional vigilance to angry faces. Overall, fluoxetine was found to decrease the processing of anger across studies. This effect was seen alongside a broader influence on positive vs. negative information and anxiolytic-like properties. Together, these results indicate that fluoxetine has direct effects on processes that are especially relevant to adolescent depression and suggest a potential cognitive mechanism for the efficacy of this particular antidepressant in adolescent patients.

Att barn blir utsatta för våld är i dagens samhälle inte ovanligt. Våld är ett komplicerat ämne att prata om med barn då barnen behöver lita på den som frågar, inte känna sig trängda och samtidigt åsidosätta sin lojalitet till en nära person för att våga berätta. Syftet med vår studie har varit att utifrån en triangulering, en kombination av kvalitativ och kvantitativ metod, undersöka hur yrkesverksamma inom barn- och ungdomspsykiatrin arbetar i kontakten med barn för att upptäcka om barnet utsätts för våld i hemmet och att uppmärksamma om eventuellt glapp finns mellan riktlinjer och verklighet. Undersökningen gjordes genom en enkät med 23 svarande som redovisas genom en deskriptiv analys av de kvantitativa frågorna samt en innehållsanalys av de kvalitativa frågorna. Resultatet visar att yrkesverksamma inom barn- och ungdomspsykiatrin idag frågar barn om de har utsatts för någon typ av våld när misstanke uppstår snarare än på rutin. Arbetsplatsens riktlinjer är bekanta för de flesta svarande och de vet hur de ska gå vidare om de får reda på att ett barn utsatts för våld. De yrkesverksammas upplevelser kring att fråga skiljer sig mellan olika typerna av våld och det är svårare att närma sig ämnet sexuellt våld än att prata om fysiskt våld. Trots olika svar på våra frågor kring att fråga om det förekommer våld i hemmet finns det ett genomgående tema: Det handlar om att fråga på ett sådant sätt att ingen känner sig trängd eller kränkt. / That children are exposed to violence is nothing unusual in the society of today. Violence is a complicated topic to talk about with children because the child has to trust the person who asks, not feel repressed and also, to tell someone about what has happened means to override their loyalty to a person close to them. The aim of our study has been, through a triangulation, a combination of qualitative and quantitative method, to investigate how the child and adolescent psychiatry work in the contact with children to discover if there is violence in the family, and whether they have knowledge of the workplace guidelines in the subject. The survey was conducted through a questionnaire with 23 respondents reported by a descriptive analysis of the quantitative material and a content analysis of the qualitative. The result shows that professionals in child and adolescent psychiatry today ask children if they have suffered any kind of violence when the suspicion arises rather than routine. Workplace guidelines are familiar to most respondents, and they know how they should proceed if they find out that a child is exposed to violence. The professionals' experiences on the issue differ between different types of violence and it is difficult to approach the topic of sexual violence than it is to talk about physical violence. Despite the various answers to our questions around the topic to ask if there is violence in the family, there is a consistent theme: It's all about to question in such a way that no one feels cornered or offended.

<p>Diagnosen Asperger syndrom är ett relativt nytt begrepp inom autismspektrumet. För bara 20 år sedan var syndromet relativt okänt världen över. År 1988 hölls den första internationella kongressen i London och där presenterades de första diagnoskriterierna av makarna Gillberg. Efter kongressen har ytterliggare tre kriterier uppkommit. Vi vill undersöka hur elever med Asperger syndrom uppfattar sin skolgång. Vi vill även undersöka hur lärare och föräldrar till barn med diagnosen upplever barnets skolsituation. </p><p>Vi har utfört en kvalitativ studie, där vi med hjälp av sju ungdomar med diagnosen Asperger syndrom, fyra lärare som arbetar med barn i behov av särskilt stöd och två föräldrar som har barn med diagnosen Asperger syndrom. Resultatet av intervjuerna visar att eleverna är väl medvetna om vad som krävs av skola och lärarna för att de ska känna delaktighet i undervisningen. Vår studie visar att regelbunden kontakt med hemmet är mycket viktigt för både barnet, föräldern och läraren. Denna studie ger tänkvärd information för pedagoger och föräldrar som antingen arbetar eller kommer i kontakt med barn med diagnosen Asperger syndrom.</p>

<p><strong>Syftet</strong> med denna studie var att belysa hur sjuksköterskor kan upptäcka och identifiera signaler hos barn som växer upp i en destruktiv miljö av alkoholmissbruk. <strong>Metod </strong>som användes för att belysa syftet var beskrivande litteraturstudie. Databaser som användes vid sökningen av valda källor var Medline(PubMed) och Cinahl. Andra sökstrategier var manuellsökning i valda källor. <strong>Huvudresultatet </strong>visade att barn till föräldrar med tungt alkoholmissbruk framförallt mådde psykiskt dåligt, det tog sig uttryck som depression och utåtagerande beteende. Barns ohälsa i samband med att växa upp i dysfunktionella miljöer relaterat till alkoholmissbruk tog även sig uttryck i återkommande psykosomatiska symtom samt kognitiva brister. Risken för att barn skulle fara illa kopplades även till den känslomässiga miljön som rådde i hemmet. Tecken på ohälsa behövde dock inte vara en följd av en ogynnsam uppväxtmiljö utan kunde härledas till genetiska faktorer. <strong>Slutsatsen </strong>är, för att kunna identifiera barn som befaras fara illa i sitt hem krävs goda kunskaper om problemets komplexitet. För att utgöra en viktig länk i detta arbete som sjuksköterska krävs förutom kunskap även utarbetade riktlinjer. Virginia Hendersons omvårdnadsteori kan enligt författarna utgöra ett gott stöd i att bedöma varje enskild situation, utifrån dess orsak och verkan baserade tänkande.</p><p><strong> </strong></p>

<p>Det finns elever som trycker ner andra i sin omgivning. När det är dags för rast finns det de som säger ”vad äcklig du är” och skrattar åt sin jämnåriga skolkamrat. Samtidigt sprider sig nya tekniker som gör skolan ännu mer försvarslös mot mobbning än tidigare. Inte ens i det egna hemmet kan ett barn vara garanterad att få slippa sin plågoande. Vad är egentligen mobbning? Hur tänker en mobbare? Och hur ser en vanlig skolmiljö ut år 2007?</p>

<p>Lås in pedofilerna och kasta bort nyckeln. Tvångskastrera våldtäktsmännen. Samhällets dom mot sexualbrottslingarna är hård och vägen tillbaka för många omöjlig.</p><p>Möt sexualbrottslingen och de som arbetar med män vars handlingar väcker avsky.</p>

Det finns elever som trycker ner andra i sin omgivning. När det är dags för rast finns det de som säger ”vad äcklig du är” och skrattar åt sin jämnåriga skolkamrat. Samtidigt sprider sig nya tekniker som gör skolan ännu mer försvarslös mot mobbning än tidigare. Inte ens i det egna hemmet kan ett barn vara garanterad att få slippa sin plågoande. Vad är egentligen mobbning? Hur tänker en mobbare? Och hur ser en vanlig skolmiljö ut år 2007?

Background: Child labour is a very common global problem. There are an estimated over 250 million in the world, and about 7.5 million child labourers in Ethiopia. Most of the studies available to date focus on the social, political, and economical issues, but very little on mental health or psychosocial problems of child labourers. There is no study describing the epidemiology of psychiatric disorders among this group of children. Aims: 1. to assess the level of awareness and attitude of an urban community on child labour. 2. to describe the patterns of child labour and the experiences of child labourers in the informal sector with emphasis to child domestic labour. 3. to determine the risk factors contributing to child abuse and psychiatric disorders in child labourers. Method: An initial qualitative survey, using key informants in a Rapid Assessment Procedure, was conducted in a central urban area of Addis Ababa, to determine the knowledge, attitude, and intervention priorities of the people on child labour. A cross-sectional quantitative study informed by this initial survey was conducted in a sampled population of 5-15 year old child labourers and non-economically active controls. Information about possible risk factors, socio-demography and child abuse were gathered using a questionnaire different from that used for mental health assessment. An Amharic translation of the Diagnostic Interview for Children and Adolescents (DICA) was used to collect data for symptoms of mental disorders and diagnosis was made according to the American Psychiatric Association (APA) Diagnostic and Statistical Manual, 3rd edition (DSM-III-R) criteria. Data analysis was done using Statistical Package for Social Sciences (SPSS) software. Results: Domestic labour, working in the streets, and in private enterprises were the three main types of child labour identified. These types of child labour were identified by 82% (n=158) key informants, who thought child labour was a social problem, mainly resulting from poverty, and associated with abuse. In the quantitative study (5-15 year old sample) 528 child labourers and 472 non-labourers were included in the study. Of the child labourers, 34% were engaged in domestic labour, 57% working in the streets, and 9% in private enterprises. Over half of the child labourers worked for more than 9 hours daily. The prevalence of child abuse was 43.9% and 17.2% among child labourers and controls, respectively (OR=3.7, 95% CI: 2.74, 5.09; p&lt;0.001). Emotional abuse was the commonly encountered abuse compared to other types (OR=3.06, 95% CI: 2.23-4.20; p&lt; 0.001). Child domestics and street labourers were the most vulnerable group. The prevalence of any DSM-III-R psychiatric disorder was 20.1% and 12.5% among child labourers and controls, respectively and the difference was statistically significant (OR=1.89, 95% CI: 1.34-2.67, p&lt;0.01). Controlling for all socio-demographic factors, child labour status was the only significant factor in determining DSM-III-R diagnosis. Discussion: In a comparable group of child labourers and controls, child labourers were found to be a high-risk group for different types of abuse and psychiatric disorders. Although parental unemployment and low maternal education were associated with child labour, the only factor that was associated with psychiatric morbidity was being a child labourer. It seems that poverty is not the only reason for child labour; hence its mere alleviation alone is unlikely to dramatically improve the risk for child labour and mental health of the children. There are many motivating reasons to be a child labourer, and likewise various positive and negative maintaining factors. Therefore, not all child labourers are prepared to stop their paid job altogether in order to become a full time student. Recommendation: Education of all children and parents is a keystone to prevent child labour and the associated consequences. In enforcing legislations on child labour, the government, non-governmental organisation (NGO), and the public should view child labour as a menace in children’s development, with risk of psychiatric disorders. Policy design should accommodate the interests of children. It is recommended to do a cohort and a larger size study, in order to further examine the association of various risk factors, and psychiatric disorders in a comparative and similar vulnerable group of children.

The main aim of this thesis has been to investigate trauma and dissociation among Swedish adolescents and to evaluate the psychometric properties such as reliability and various kinds of validity of three screening instruments for assessment of dissociation and other symptoms of post traumatic stress. The three instruments in question have been Dis-Q-Sweden, A-DES and TSCC, the symptoms measured by these instruments are neither easy to capture nor easy for the adolescent to talk about. Therefore these self report scales are essential. A second aim has been to compare the results with results from other countries and to develop preliminary Swedish norms for the clinician to use. Age and gender differences have been looked upon as well as assessed symptoms connected to known experienced trauma/sexual and/or physical abuse and self-reported trauma in normal and clinical populations. The populations, in this thesis have been children and adolescents age 10 -19 years old from the general population; the clinical groups have had the same age range. All children and adolescents in the clinical groups have been sexually and/or physically abused. Participants have answered the questionnaires Dis-Q-Sweden, A-DES and/or TSCC and their answers have been statistically analysed. All three instruments have been shown to have good reliability, such as internal consistency and test-retest. Validity has been established through factor analyses, concurrent, and criterion related validity. Clinical groups with known experienced trauma/sexual abuse and/or physical abuse gave significantly higher scores on all the instruments compared to normative groups. Also self-reported trauma in a normative group gave significantly higher scores even if the significances are not as high as between the normative and clinical groups. Girls scored significantly higher than boys in both the clinical and normative groups. Girls in the age range 14-15 years old gave the significantly highest scores on both Dis-Q-Sweden and ADES. Swedish adolescents gave lower mean scores on all three instruments than have been reported from other studies in other countries. The scores from the clinical groups gave about the same mean as have been reported elsewhere. The conclusion from this thesis is that all the three questionnaires Dis-Q-Sweden, A-DES and TSCC have shown satisfactory psychometrics properties and can very well be used by Swedish clinicians in Child and Adolescents Psychiatry.