Introduction. Sleeping difficulties are common in children with attention deficit hyperactivity disorder (ADHD). A sleep intervention with weighted blankets was designed to increase current understanding of using weighted blankets to target childrens individual needs in connection with sleep and daytime functioning. Aim. To explore how children with ADHD and sleeping difficulties experience the use of weighted blankets. Methods. An explorative qualitative design in which 26 children with ADHD and sleeping difficulties, 615 years old, were interviewed about a sleep intervention with weighted blankets. Four categories emerged from qualitative content analysis. Results. Childrens experiences revealed that the use of weighted blankets 1) requires a commitment, by adjusting according to needs and preferences and adapting to the environment; 2) improves emotional regulation by feeling calm and feeling safe; 3) changes sleeping patterns by creating new routines for sleep and improving sleep quality; and 4) promotes everyday participation by promoting daily function and balancing activity and sleep. Conclusions. Using weighted blankets promoted childrens management of daily life with ADHD and sleeping difficulties. Occupational therapists can improve the assessment and delivery of weighted blankets tailored to individual needs based on increased knowledge from the children themselves.

Background: The schedule for affective disorders and schizophrenia for school-age children (K-SADS) is one of the most commonly used standardized diagnostic interviews in child and adolescent psychiatry. Validity studies are scarce, and limited to concurrent validity with other measures and clinical diagnoses. Aims: To evaluate the K-SADS interview in an outpatient child and adolescent psychiatry (CAP) setting with a Longitudinal Expert All Data (LEAD) procedure. Methods: CAP residents performed a K-SADS-PL interview with the revised 2009 version containing the new PDD section on 239 clinically referred outpatients of 6–17 years old and their parent(s). A consensus LEAD diagnosis by two senior clinicians 1.2 (SD = 0.6) years later was based on clinical records including the K-SADS and subsequent information from further assessments, information from teachers and other informants, outcome of treatment, and at least three visits after the K-SADS. Results: Predictive validity for K-SADS vs LEAD diagnoses were good-to-excellent for broader categories of anxiety disorders (κ = 0.94), depressive (κ = 0.91), behavioural (κ = 0.91) and tic (κ = 0.81) disorders, good for ADHD (κ = 0.80), and good-to-moderate for autism spectrum disorders (κ = 0.62). Bipolar, psychotic, and eating disorders were too few to be analysed. Conclusion: The K-SADS diagnoses elicited from an interview with the child and one from parents on one occasion have an excellent validity for most major child psychiatric disorders. ADHD can be reliably diagnosed at one visit, but clinicians need to stay alert for possible undiagnosed ADHD. Diagnosing autism with K-SADS-PL 2009 version at one visit is not advisable.

To evaluate screening efficiency and suggest cut-offs for parent and child Mood and Feelings Questionnaire (MFQ) and the short version (SMFQ) in unselected help seeking child- and adolescent psychiatric outpatients for subgroups of 6–12 versus 13–17 year olds and boys versus girls. Eligible for inclusion were newly admitted outpatients age 6–17 years (n = 5908) in four Swedish child- and adolescent psychiatry clinics. They were prompted consecutively and n = 307 accepted a specific day for assessment until time slots randomly were filled. We prospectively validated the MFQ (33 items) and SMFQ (13 items) in patients (n = 186) using receiver operating characteristics against a reference test of Longitudinal Expert All Data DSM-IV depression based on a Kiddie-Schedule for Affective Disorders and Schizophrenia and 1.2 (sd .6) years of follow-up. A depressive disorder was confirmed in 59 (31.7%) patients ranging from 14.0% for girls 6–12 years to 53.3% for girls 13–17 years. SMFQ performed roughly equivalent to MFQ. Adolescent score on SMFQ discriminated fairly for boys with Area Under Curve .77 (95% confidence interval .59–.81) and good (.82, .69–.91) for girls and parent ratings for adolescent girls (.85, .73–.93), but not for boys. Depression in children below age 13 could not be discriminated by MFQ or SMFQ whether filled in by child and mostly also when filled in by parent. Favouring maximum kappa value, the optimal cut-off was for MFQ self-report girls ≥32 versus boys ≥11 and for SMFQ self-report girls ≥17 versus boys ≥ 6. Suggested clinical SMFQ cut-offs for girls were ≥12 and for boys ≥ 6. MFQ and SMFQ can, with gender-based cut-offs, be used for screening in clinical populations of adolescents but not in children. Parent MFQ and SMFQ can be used for adolescent girls but not boys. SMFQ is sufficient for screening.

We evaluated the clinical utility of the Swedish SCARED-R in child- and adolescent psychiatric outpatients (n = 239) and validated it against Longitudinal Expert All Data (LEAD) DSM IV diagnoses based on the Children’s Schedule for Affective Disorders and Schizophrenia (KSADS) and subsequent clinical work-up and treatment outcome. The SCARED-R total score and subscales had acceptable sensitivity/specificity for child and parent reports for cut-offs based on Receiver Operating Characteristics (ROC) curves, with mostly moderate area under the curve. Sensitivity ranged from 75% (parent rated social anxiety) to 79% [child rated Generalized Anxiety Disorder (GAD)]. Specificity, ranged from 60% for child-rated GAD to 88% for parent rated social anxiety. Parent-child agreement was moderate, and each informant provided unique information contributing to most diagnoses. In conclusion, the SCARED-R is useful for screening anxiety symptoms in clinical populations. However, it cannot replace interview based diagnoses, nor is it adequate to use just one informant.

The Child Behavior Checklist (CBCL) and Youth Self-Report (YSR) are widely used measures of psychiatric symptoms and lately also adapted to the DSM. The incremental validity of adding the scales to each other has not been studied. We validated the DSM subscales for affective, anxiety, attention deficit/hyperactivity (ADHD), oppositional defiant (ODD), conduct problems (CD), and obsessive-compulsive disorder (OCD) in consecutively referred child and adolescent psychiatric outpatients (n = 267) against LEAD DSM-IV diagnoses based on the K-SADS-PL and subsequent clinical work-up. Receiver operating characteristic analyses showed that the diagnostic efficiency for most scales were moderate with an area under the curve (AUC) between 0.70 and 0.90 except for CBCL CD, which had high accuracy (AUC>0.90) in line with previous studies showing the acceptable utility of the CBCL DSM scales and the YSR affective, anxiety, and CD scales, while YSR ODD and OCD had low accuracy (AUC<0.70). The findings mostly reveal incremental validity (using logistic regression analyses) for adding the adolescent to the parent version (or vice versa). Youth and parent ratings contributed equally to predict depression and anxiety disorders, while parent ratings were a stronger predictor for ADHD. However, the youth ADHD rating also contributed. Adding young people as informants for ODD and OCD or adding the parent for CD did not improve accuracy. The findings for depression, anxiety disorders, and ADHD support using more than one informant when conducting screening in a clinical context.

Exercise can improve health among adolescents with depression. Understanding facilitators for and barriers to maintaining exercise among adolescents with depression may increase adherence to exercise and consequently improve health. The aim was to explore adolescents’ experiences of facilitators for and barriers to maintaining exercise after a group-based exercise intervention for depression. Interviews (n = 14) were conducted 12 months after the exercise intervention. A qualitative content analysis was used to extract facilitators and barriers. Facilitators for maintaining exercise among adolescents with depression were (1) greater self-esteem by having companionship while exercising and by achieving exercise results and (2) having a supportive environment in terms of accessibility and coaching. Barriers to maintaining exercise were (1) disease burden due to fatigue, social anxiety, and a lack of drive, and (2) lack of a supportive environment including a lack of social support, as well as structural support. In conclusion, facilitating enhanced self-esteem and continuous support for exercising are important for adolescents with depression to maintain exercise. The disease burden of depression is a substantial barrier that needs to be considered to maintain exercise. The findings can contribute to the development of services that promote and coordinate exercise as a treatment among adolescents with depression.