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5-Jahres-Verlauf der LRS
(2017)
Fragestellung: Untersucht wird der Verlauf von Kindern mit Lese-Rechtschreibstörungen (LRS) über gut 5 Jahre unter Berücksichtigung des Einflusses des Geschlechts der Betroffenen. Außerdem werden Auswirkungen der LRS auf das spätere Schriftsprachniveau und den Schulerfolg überprüft. Methodik: Eingangs wurden 995 Schüler zwischen 6 und 16 Jahren untersucht. Ein Teil dieser Kinder ist nach 43 sowie 63 Monaten nachuntersucht worden. Eine LRS wurde diagnostiziert, wenn für das Lesen bzw. Rechtschreiben das doppelte Diskrepanzkriterium von 1.5 Standardabweichungen zur nonverbalen Intelligenz und dem Mittelwert der Klassenstufe erfüllt war und gleichzeitig keine Minderbegabung vorlag. Ergebnisse: Die LRS weist über einen Zeitraum von 63 Monaten eine hohe Störungspersistenz von knapp 70 % auf. Der 5-Jahres-Verlauf der mittleren Lese- und Rechtschreibleistungen wurde nicht vom Geschlecht beeinflusst. Trotz durchschnittlicher Intelligenz blieben die LRS-Schüler in der Schriftsprache mindestens eine Standardabweichung hinter durchschnittlich und etwa 0.5 Standardabweichungseinheiten hinter unterdurchschnittlich intelligenten Kindern zurück. Der Schulerfolg der LRS-Schüler glich dem unterdurchschnittlich intelligenter Kinder und fiel deutlich schlechter aus als bei durchschnittlich intelligenten Kontrollkindern. Schlussfolgerungen: Eine LRS stellt ein erhebliches Entwicklungsrisiko dar, was frühzeitige Diagnostik- und Therapiemaßnahmen erfordert. Dafür sind reliable und im Hinblick auf die resultierenden Prävalenzraten sinnvolle, allgemein anerkannte Diagnosekriterien essenziell.
Background: Medical training is very demanding and associated with a high prevalence of psychological distress. Compared to the general population, medical students are at a greater risk of developing a psychological disorder. Various attempts of stress management training in medical school have achieved positive results on minimizing psychological distress; however, there are often limitations. Therefore, the use of a rigorous scientific method is needed. The present study protocol describes a randomized controlled trial to examine the effectiveness of a specifically developed mindfulness-based stress prevention training for medical students that includes selected elements of cognitive behavioral strategies (MediMind).
Methods/Design: This study protocol presents a prospective randomized controlled trial, involving four assessment time points: baseline, post-intervention, one-year follow-up and five-year follow-up. The aims include evaluating the effect on stress, coping, psychological morbidity and personality traits with validated measures. Participants are allocated randomly to one of three conditions: MediMind, Autogenic Training or control group. Eligible participants are medical or dental students in the second or eighth semester of a German university. They form a population of approximately 420 students in each academic term. A final total sample size of 126 (at five-year follow-up) is targeted. The trainings (MediMind and Autogenic Training) comprise five weekly sessions lasting 90 minutes each. MediMind will be offered to participants of the control group once the five-year follow-up is completed. The allotment is randomized with a stratified allocation ratio by course of studies, semester, and gender. After descriptive statistics have been evaluated, inferential statistical analysis will be carried out with a repeated measures ANOVA-design with interactions between time and group. Effect sizes will be calculated using partial η-square values.
Discussion: Potential limitations of this study are voluntary participation and the risk of attrition, especially concerning participants that are allocated to the control group. Strengths are the study design, namely random allocation, follow-up assessment, the use of control groups and inclusion of participants at different stages of medical training with the possibility of differential analysis.
Background: Medical training is very demanding and associated with a high prevalence of psychological distress. Compared to the general population, medical students are at a greater risk of developing a psychological disorder. Various attempts of stress management training in medical school have achieved positive results on minimizing psychological distress; however, there are often limitations. Therefore, the use of a rigorous scientific method is needed. The present study protocol describes a randomized controlled trial to examine the effectiveness of a specifically developed mindfulness-based stress prevention training for medical students that includes selected elements of cognitive behavioral strategies (MediMind).
Methods/Design: This study protocol presents a prospective randomized controlled trial, involving four assessment time points: baseline, post-intervention, one-year follow-up and five-year follow-up. The aims include evaluating the effect on stress, coping, psychological morbidity and personality traits with validated measures. Participants are allocated randomly to one of three conditions: MediMind, Autogenic Training or control group. Eligible participants are medical or dental students in the second or eighth semester of a German university. They form a population of approximately 420 students in each academic term. A final total sample size of 126 (at five-year follow-up) is targeted. The trainings (MediMind and Autogenic Training) comprise five weekly sessions lasting 90 minutes each. MediMind will be offered to participants of the control group once the five-year follow-up is completed. The allotment is randomized with a stratified allocation ratio by course of studies, semester, and gender. After descriptive statistics have been evaluated, inferential statistical analysis will be carried out with a repeated measures ANOVA-design with interactions between time and group. Effect sizes will be calculated using partial.-square values.
Discussion: Potential limitations of this study are voluntary participation and the risk of attrition, especially concerning participants that are allocated to the control group. Strengths are the study design, namely random allocation, follow-up assessment, the use of control groups and inclusion of participants at different stages of medical training with the possibility of differential analysis.
Epigenetic modulations are a hypothesized link between environmental factors and the development of psychiatric disorders. Research has suggested that patients with depression or bipolar disorder exhibit higher methylation levels in the glucocorticoid receptor gene NR3C1. We aimed to investigate whether NR3C1 methylation changes are similarly associated with externalizing disorders such as aggressive behavior and conduct disorder. NR3C1 exon 1F methylation was analyzed in young adults with a lifetime diagnosis of an externalizing disorder (N = 68) or a depressive disorder (N = 27) and healthy controls (N = 124) from the Mannheim Study of Children at Risk. The externalizing disorders group had significantly lower NR3C1 methylation levels than the lifetime depressive disorder group (p = 0.009) and healthy controls (p = 0.001) This report of lower methylation levels in NR3C1 in externalizing disorders may indicate a mechanism through which the differential development of externalizing disorders as opposed to depressive disorders might occur.
Interindividual variability in the regulation of the human stress system accounts for a part of the individual's liability to stress-related diseases. These differences are influenced by environmental and genetic factors. Early childhood adversity is a well-studied environmental factor affecting an individual's stress response which has been shown to be modulated by gene environment interaction (GxE). Neuropeptide Y (NPY) plays a role in stress regulation and genetic variation in NPY may influence stress responses. In this study, we analyzed the association of a common variant in the NPY gene promoter, rs16147, with cortisol and ACTH responses to acute psychosocial stress in young adults from the Mannheim Study of Children at Risk (MARS), an ongoing epidemiological cohort study following the outcome of early adversity from birth into adulthood. We found evidence of a GxE interaction between rs16147 and early adversity significantly affecting HPA axis responses to acute psychosocial stress. These findings suggest that the neurobiological mechanisms linking early adverse experience and later neuroendocrine stress regulation are modulated by a gene variant whose functional relevance is documented by increasing convergent evidence from in vitro, animal and human studies.
Anmerkungen
(2004)
Anpassung der Psychotherapie-Richtlinien zur Zulassung psychotherapeutischer Verfahren und Methoden
(2006)
The present study aimed to examine the extent to which the co-occurrence of ADHD and smoking in adolescents could be attributed to common genetic, environmental and psychopathological factors. Data are from an ongoing prospective study of the outcome of early risk factors. At age 15 years, 305 adolescents completed self-report questionnaires measuring tobacco consumption and deviant peer affiliations. Lifetime psychiatric diagnoses were obtained using standardized interviews. DNA was genotyped for the dopamine D4 receptor (DRD4) gene exon III polymorphism. Adolescents with a lifetime diagnosis of ADHD displayed significantly higher smoking activity than non-ADHD controls. A major component of this association could be accounted for by deviant peer affiliations and the comorbidity with oppositional-defiant and conduct disorder, while a minor part was attributable to DRD4 in males but not in females. These findings suggest that the association of ADHD with smoking relies on risk factors shared by the two behaviors.
Association between pubertal stage at first drink and neural reward processing in early adulthood
(2017)
Puberty is a critical time period during human development. It is characterized by high levels of risk-taking behavior, such as increased alcohol consumption, and is accompanied by various neurobiological changes. Recent studies in animals and humans have revealed that the pubertal stage at first drink (PSFD) significantly impacts drinking behavior in adulthood. Moreover, neuronal alterations of the dopaminergic reward system have been associated with alcohol abuse or addiction. This study aimed to clarify the impact of PSFD on neuronal characteristics of reward processing linked to alcohol-related problems. One hundred sixty-eight healthy young adults from a prospective study covering 25 years participated in a monetary incentive delay task measured with simultaneous EEG-fMRI. PSFD was determined according to the age at menarche or Tanner stage of pubertal development, respectively. Alcohol-related problems in early adulthood were assessed with the Alcohol Use Disorder Identification Test (AUDIT). During reward anticipation, decreased fMRI activation of the frontal cortex and increased preparatory EEG activity (contingent negative variation) occurred with pubertal compared to postpubertal first alcohol intake. Moreover, alcohol-related problems during early adulthood were increased in pubertal compared to postpubertal beginners, which was mediated by neuronal activation of the right medial frontal gyrus. At reward delivery, increased fMRI activation of the left caudate and higher feedback-related EEG negativity were detected in pubertal compared to postpubertal beginners. Together with animal findings, these results implicate PSFD as a potential modulator of psychopathology, involving altered reward anticipation. Both PSFD timing and reward processing might thus be potential targets for early prevention and intervention.
Variation in the gene encoding for the norepinephrine transporter (NET, SLC6A2) has repeatedly been linked with ADHD, although there is some inconsistency regarding the association with specific genes. The variants for which most consistent association has been found are the NET variants rs3785157 and rs28386840. Here, we tested for their association with ADHD diagnosis and ADHD-related phenotypes during development in a longitudinal German community sample. Children were followed from age 4 to age 15, using diagnostic interviews to assess ADHD. Between the ages of 8 and 15 years, the Child Behavior Checklist (CBCL) was administered to the primary caregivers. The continuous performance task (CPT) was performed at age 15. Controlling for possible confounders, we found that homozygous carriers of the major A allele of the functional promoter variant rs28386840 displayed a higher rate of ADHD lifetime diagnosis. Moreover, homozygous carriers of the minor T allele of rs3785157 were more likely to develop ADHD and showed higher scores on the CBCL externalizing behavior scales. Additionally, we found that individuals heterozygous for rs3785157 made fewer omission errors in the CPT than homozygotes. This is the first longitudinal study to report associations between specific NET variants and ADHD-related phenotypes during the course of development. (C) 2015 Elsevier Ireland Ltd. All rights reserved.
Background: Clock genes govern circadian rhythms and shape the effect of alcohol use on the physiological system. Exposure to severe negative life events is related to both heavy drinking and disturbed circadian rhythmicity. The aim of this study was 1) to extend previous findings suggesting an association of a haplotype tagging single nucleotide polymorphism of PER2 gene with drinking patterns, and 2) to examine a possible role for an interaction of this gene with life stress in hazardous drinking.
Methods: Data were collected as part of an epidemiological cohort study on the outcome of early risk factors followed since birth. At age 19 years, 268 young adults (126 males, 142 females) were genotyped for PER2 rs56013859 and were administered a 45-day alcohol timeline follow-back interview and the Alcohol Use Disorders Identification Test (AUDIT). Life stress was assessed as the number of severe negative life events during the past four years reported in a questionnaire and validated by interview.
Results: Individuals with the minor G allele of rs56013859 were found to be less engaged in alcohol use, drinking at only 72% of the days compared to homozygotes for the major A allele. Moreover, among regular drinkers, a gene x environment interaction emerged (p = .020). While no effects of genotype appeared under conditions of low stress, carriers of the G allele exhibited less hazardous drinking than those homozygous for the A allele when exposed to high stress.
Conclusions: These findings may suggest a role of the circadian rhythm gene PER2 in both the drinking patterns of young adults and in moderating the impact of severe life stress on hazardous drinking in experienced alcohol users. However, in light of the likely burden of multiple tests, the nature of the measures used and the nominal evidence of interaction, replication is needed before drawing firm conclusions.
Ziel der Vorschultestbatterie ist es, Teilleistungsstörungen bereits vor Schulbeginn zu erkennen und damit einer frühzeitigen Förderung zuzuführen. Das diagnostische Vorgehen zeichnet sich durch eine hohe Durchführungsökonomie und einen breiten Anwendungs-bereich aus. Insgesamt werden bei Vierjährigen die allgemeine Intelligenz, die Artikulation, die expressive und die rezeptive Sprache sowie die Visuomotorik in 20 bis 25 Minuten erfasst, bei den Fünfjährigen kommen zusätzlich noch Prüfungen der Aufmerksamkeit hinzu, was die Durchführung um fünf bis zehn Minuten gegenüber den Vierjährigen verlängert. Die vorliegende Testbatterie kann auch im Rahmen von Schuleingangsuntersuchungen verlässlich eingesetzt werden.
Leistungsdiagnostik in der Klinischen Kinder- und Jugendpsychologie muss neben den klassischen Gütekriterien den Beitrag eines Testverfahrens zur Diagnosestellung, die Größe und Repräsentativität der Normstichprobe, seine Differenzierungsfähigkeit im unteren Leistungsbereich sowie die Ökonomie berücksichtigen. Ziel der BUEVA ist es, Teilleistungsstörungen bereits vor Schulbeginn zu erkennen und damit einer frühzeitigen Förderung zuzuführen. Das diagnostische Vorgehen zeichnet sich durch eine hohe Durchführungsökonomie aus, wodurch der verkürzten Aufmerksamkeitsspanne der Kinder Rechnung getragen wird. Insgesamt werden bei Vierjährigen die allgemeine Intelligenz, die Artikulation, die expressive und die rezeptive Sprache sowie die Visuomotorik in 20 bis 25 Minuten erfasst, bei den Fünfjährigen kommen zusätzlich noch Prüfungen der Aufmerksamkeit hinzu, was die Durchführung um fünf Minuten gegenüber den Vierjährigen verlängert. Die vorliegende Testbatterie weist eine gute prädiktive Validität auf und kann auch im Rahmen von Schuleingangsuntersuchungen verlässlich eingesetzt werden. Die Testbatterie differenziert vor allem im subnormalen Leistungsbereich. Dies wird durch eine relativ hohe Zahl leichter Items sowie durch einfache Instruktionen erreicht. Zur Diagnostik von besonderen Begabungen ist die vorliegende Testbatterie also nicht geeignet. Schlüsselwörter: Früherkennung, Vorschulalter, Basisdiagnostik, allgemeine Intelligenz, Artikulation, expressive, rezeptive Sprache, Visuomotorik, Aufmerksamkeit, umschriebene Entwicklungsstörung
Recent studies have emphasized an important role for neurotrophins, such as brain-derived neurotrophic factor (BDNF), in regulating the plasticity of neural circuits involved in the pathophysiology of stress-related diseases. The aim of the present study was to examine the interplay of the BDNF Val(66)Met and the serotonin transporter promoter (5-HTTLPR) polymorphisms in moderating the impact of early-life adversity on BDNF plasma concentration and depressive symptoms. Participants were taken from an epidemiological cohort study following the long-term outcome of early risk factors from birth into young adulthood. In 259 individuals (119 males, 140 females), genotyped for the BDNF Val(66)Met and the 5-HTTLPR polymorphisms, plasma BDNF was assessed at the age of 19 years. In addition, participants completed the Beck Depression Inventory (BDI). Early adversity was determined according to a family adversity index assessed at 3 months of age. Results indicated that individuals homozygous for both the BDNF Val and the 5-HTTLPR L allele showed significantly reduced BDNF levels following exposure to high adversity. In contrast, BDNF levels appeared to be unaffected by early psychosocial adversity in carriers of the BDNF Met or the 5-HTTLPR S allele. While the former group appeared to be most susceptible to depressive symptoms, the impact of early adversity was less pronounced in the latter group. This is the first preliminary evidence indicating that early-life adverse experiences may have lasting sequelae for plasma BDNF levels in humans, highlighting that the susceptibility to this effect is moderated by BDNF Val(66)Met and 5-HTTLPR genotype.
Postpartale Depressionen sind häufige und schwerwiegende psychische Erkrankungen mit ungünstigem Einfluss auf die kindliche Entwicklung. Als Haupttransmissionsweg gilt die frühe Mutter-Kind-Interaktion. Über die langfristigen Auswirkungen auf die Kinder im Erwachsenenalter und die Rolle der Interaktion liegen kaum Ergebnisse vor. Im Rahmen der Mannheimer Risikokinderstudie wurden postpartale Depressionen bis zwei Jahre nach der Geburt erfasst. Die kindliche Entwicklung wurde fortlaufend und die Mutter-Kind-Interaktion im Alter von 3 Monaten standardisiert erhoben. 28 Kinder postpartal depressiver und 107 Kinder gesunder Mütter konnten mit 25 Jahren untersucht werden. Beeinträchtigungen der kognitiven und psychischen Entwicklung bei Kindern postpartal depressiver Mütter waren bis ins Erwachsenenalter nachweisbar. Responsives bzw. sensitives mütterliches Verhalten wirkte der negativen Entwicklung entgegen. Dies betont die Bedeutung einer hohen Qualität der Mutter-Kind-Interaktion für die Entwicklung von Risikokindern.
Postpartale Depressionen sind häufige und schwerwiegende psychische Erkrankungen mit ungünstigem Einfluss auf die kindliche Entwicklung. Als Haupttransmissionsweg gilt die frühe Mutter-Kind-Interaktion. Über die langfristigen Auswirkungen auf die Kinder im Erwachsenenalter und die Rolle der Interaktion liegen kaum Ergebnisse vor. Im Rahmen der Mannheimer Risikokinderstudie wurden postpartale Depressionen bis zwei Jahre nach der Geburt erfasst. Die kindliche Entwicklung wurde fortlaufend und die Mutter-Kind-Interaktion im Alter von 3 Monaten standardisiert erhoben. 28 Kinder postpartal depressiver und 107 Kinder gesunder Mütter konnten mit 25 Jahren untersucht werden. Beeinträchtigungen der kognitiven und psychischen Entwicklung bei Kindern postpartal depressiver Mütter waren bis ins Erwachsenenalter nachweisbar. Responsives bzw. sensitives mütterliches Verhalten wirkte der negativen Entwicklung entgegen. Dies betont die Bedeutung einer hohen Qualität der Mutter-Kind-Interaktion für die Entwicklung von Risikokindern.
Background: Recently, first evidence has been reported for a geneparenting interaction (G x E) with regard to adolescent alcohol use. The present investigation set out to extend this research using the catechol-O-methyltransferase (COMT) Val158Met polymorphism as a genetic susceptibility factor. Moreover, the current study examined whether a potential G x E would be consistent with one of two models of geneenvironment interplay (genetic vulnerability vs. differential susceptibility). Methods: Data were collected as part of an ongoing epidemiological cohort study following the outcome of early risk factors from birth into adulthood. Two hundred and eighty-five participants (130 males, 155 females) were genotyped for the COMT Val(158) Met polymorphism and were administered an alcohol interview, providing measures of current frequency and amount of drinking at ages 15 and 19 years. Information on three dimensions of perceived parenting behavior was obtained from the 15-year-olds. Results: Adolescents homozygous for the Met allele showed higher drinking activity at age 19 years when their parents had engaged in less supervision or were less involved, while their drinking activity was reduced under conditions of favorable parenting. No such relationship was found in individuals carrying the Val allele. Conclusions: The present findings correspond with the pattern of results predicted by the differential susceptibility hypothesis, suggesting that environmental variation would have a greater impact in individuals carrying a genetic susceptibility such that, in this group, exposure to negative environmental conditions would result in more adverse outcomes and the experience of favorable conditions would lead to more positive outcomes.
Child Aggression as a Source and a Consequence of Parenting Stress: A Three-Wave Longitudinal Study
(2015)
This longitudinal study examined the links between child aggression and parenting stress over 4years. Child aggression was hypothesized to contribute to parenting stress, which should increase aggression. Parents and teachers of 239 German children aged between 6 and 15years completed measures of child aggression at Time 1 and Time 3, complemented by children's self-reports of aggression at Time 3. Parents rated their child-focused and parent-focused stress at an intermediate measurement Time 2. Child-focused stress mediated the path from Time 1 to Time 3 aggression in boys and girls, whereas parent-focused stress was unrelated to Time 3 aggression. The findings help to understand the continuity of aggressive behavior in childhood and adolescence and highlight the need to intervene early with families susceptible to parenting stress.
The psycho-social development of both preterm and term children (n=347) whose mothers reported tocolytic treatment was assessed at the ages of 2, 4.5, 8 years. Term children exposed to tocolysis showed a higher rate of psychiatric disorders as well as poorer cognitive and motor performance than controls. In the preterm children no adverse impact of tocolysis could be found. The results are discussed concerning possible ways in which tocolytic treatment may influence child development. Restrictions because of the preliminary character of this study and the need of further prospective studies to clarify the developmental impact of tocolysis are also considered.
Child regulative temperament as a mediator of parenting in the development of depressive symptoms
(2017)
Child temperament as well as parenting behaviors have been linked to adolescent depression. Beyond their main effects, the interplay between these factors is of interest. For example, in an interactive model, a differential susceptibility of temperamental variants to parenting has been suggested. However, so far, the differential susceptibility hypothesis has mostly been studied with a focus on externalizing disorders. On the other hand, parenting may shape the child’s temperament and vice versa in a transactional process. In a prospective, longitudinal at-risk sample (163 boys, 176 girls), we assessed emotional (easy–difficult) and regulative (self-control) temperament at ages 4.5, and 8 years, respectively, as well as parenting quality at age 4.5 years using the HOME inventory. Hierarchical linear regression analysis was used to investigate the prediction of depressive symptoms at age 11, measured by the Child Depression Inventory, including interaction terms between the temperament variable and parenting. We additionally tested whether parenting was mediated by child temperament. As previously reported, both self-control and parenting were longitudinally associated with preadolescent depressive symptoms. There were no interactive effects between temperament and parenting. However, the effects of parenting were partly mediated by self-control. Our data do not support a differential susceptibility of temperamental variants in the development of preadolescent depression. However, our results are in line with the assumption that parenting may shape young children’s temperament, with positive parenting in the early childhood fostering the development of regulative temperament.
Aims: To investigate whether concurrent alcohol and tobacco use during early adolescence characterizes a subgroup that differs from users of one substance only regarding several risk factors for later substance use problems. Methods: Participants were from a prospective longitudinal cohort study of 384 children at risk for later psychopathology, with the majority being born with obstetric complications and psychosocial adversities. Assessments of adolescent drug consumption and related intrapersonal characteristics were obtained at age 15. Results: Compared to consumers of alcohol only, 15-year-olds drinking and smoking during the same time period (past 4 weeks) had significantly higher levels of consumption and more excessive use of alcohol, started drinking at an earlier age, had higher scores on the Fagerstrom Test for Nicotine Dependence, and more cannabis use. This group could be distinguished from users of alcohol only by higher novelty seeking and more positive alcohol effect expectancies. Compared to consumers of tobacco only, concurrent users reported higher nicotine dependence and more cannabis use. No significant differences were observed regarding frequency and age at initiation of tobacco use, tobacco-related sensitivity, self- efficacy and instrumentality as well as novelty seeking. Conclusions: Concurrent alcohol and tobacco use during early adolescence is associated with characteristics that are well known as risk factors for later alcohol use problems and dependence and that should be targeted by prevention programs.
Depression
(2012)
This longitudinal study investigated patterns of developmental problems across depression, aggression, and academic achievement during adolescence, using two measurement points two years apart (N = 1665; age T1: M = 13.14; female = 49.6%). Latent Profile Analyses and Latent Transition Analyses yielded four main findings: A three-type solution provided the best fit to the data: an asymptomatic type (i.e., low problem scores in all three domains), a depressed type (i.e., high scores in depression), an aggressive type (i.e., high scores in aggression). Profile types were invariant over the two data waves but differed between girls and boys, revealing gender specific patterns of comorbidity. Stabilities over time were high for the asymptomatic type and for types that represented problems in one domain, but moderate for comorbid types. Differences in demographic variables (i.e., age, socio-economic status) and individual characteristics (i.e., self-esteem, dysfunctional cognitions, cognitive capabilities) predicted profile type memberships and longitudinal transitions between types.
Dichte und Struktur von Lebensereignissen in Mannheim und Rostock in der Nachwendezeit 1989 - 1995
(1996)
Es werden Befunde aus einer prospektiven Laengsschnittstudie praesentiert, in der 321 Probanden im Alter von 8, 13, 18 und 25 Jahren untersucht werden konnten; ihre Dunkelfelddelinquenz wurde mit 18 und 25 Jahren erfasst. Wir suchten nach Assoziationen zur Delinquenzentwicklung und erwarteten Unterschiede zwischen auf das Jugendalter beschraenkter gegenueber ins fruehe Erwachsenenalter fortgesetzter sowie spaet, d.h. nach dem Alter von 18 Jahren, beginnender Delinquenz. Wir fanden gemeinsame Risikofaktoren und fuer die drei Verlaufstypen spezifische Risikokonstellationen, die eher im Jugendalter als in der Kindheit identifiziert wurden. Widrige familiaere Bedingungen, Entwicklungsverzoegerungen und psychische Stoerungen scheinen mit Delinquenz als eher persistentem Verhalten assoziiert.
Fragestellung: Prospektive Bedeutung von Risikofaktoren des Kindes- und Jugendalters für externalisierende und internalisierende Störungen. Methode: Prospektive Längsschnittstudie vom Grundschul- zum frühen Erwachsenenalter. 321 Personen nahmen an allen Untersuchungen im Alter von 8, 13, 18 und 25 Jahren teil. Ergebnisse: Es zeigte sich, daß psychische Störungen in hohem Maße geschlechtsabhängig sind. Besonders groß waren die Unterschiede im frühen Erwachsenenalter, wobei internalisierende Störungen bei Frauen und externalisierende Störungen bei Männern deutlich überwogen. Externalisierende Störungen des Erwachsenenalters ließen sich besser vorhersagen als internalisierende Störungen. Dies ließ sich vor allem durch die größere prädiktive Bedeutung früher Risikofaktoren bis zum Alter von 8 Jahren erklären. Für die Vorhersage internalisierender Störungen war hingegen der Einfluß der Risikofaktoren des späten Jugendalters und des Übergangs zum Erwachsenenalter größer. 10% der untersuchten Stichprobe wies persistente Störungen auf und stellt damit eine Hochrisikogruppe dar. Dieser Verlaufstyp zeichnet sich durch stabil hohe Risikokonstellationen zu allen Untersuchungszeitpunkten aus. Schlüsselwörter: Risikofaktoren, Prävalenz, Geschlechtsunterschiede, Verlaufstypen, externalisierende Störungen, internalisierende Störungen, psychische Störungen, Kindes- und Jugendalter, Erwachsenenalter Childhood and adolescent predictors of mental disorders from childhood to early adulthood. Abstract. Objectives: Prospective impact of child and adolescent risk factors on externalizing and internalizing disorders. Methods: Prospective longitudinal study from childhood to early adulthood. 321 persons participated at age 8, 13, 18 and 25 years. Results: Sex differences in the prevalence rates of mental disorders were found. The highest differences were found in early adulthood. Females showed higher rates of internalizing disorders, whereas males showed higher rates of externalizing disorders. Externalizing disorders in adulthood could be predicted better than internalizing disorders. This result could be explained by the greater predictive power of childhood risk factors for externalizing disorders. Risk factors of adolescence and the transmission period to adulthood played a more prominent role in the prediction of internalizing disorders. 10% of the studied sample showed persistent disorders and was identified as a high-risk sample. This developmental pattern of mental disorders shows stable risk constellations from childhood to adulthood. Key words: risk factors, prevalence, sex differences, developmental patterns, externalizing disorders, internalizing disorders, mental disorders, childhood and adolescence, adulthood
Die Mannheimer Risikokinderstudie untersucht die psychische Entwicklung und ihre Störungen bei Kindern mit unterschiedlich ausgeprägten Risiken mit dem Ziel, Empfehlungen für die Verbesserung der Prävention, Früherkennung und Frühbehandlung von psychischen Störungen bei Kindern abzuleiten. Dazu begleitet sie eine Kohorte von anfangs 384 Kindern in ihrer Entwicklung von der Geburt bis zum Erwachsenenalter. Die Erhebungen fanden in regelmäßigen Abständen statt, beginnend im Alter von 3 Monaten, mit 2 Jahren, 4;6, 8, 11, 15, 19, 22, 23 und 25 Jahren. Geplant ist eine weitere Erhebung mit ca. 30 Jahren.
Die Mannheimer Risikokinderstudie untersucht die psychische Entwicklung und ihre Störungen bei Kindern mit unterschiedlich ausgeprägten Risiken mit dem Ziel, Empfehlungen für die Verbesserung der Prävention, Früherkennung und Frühbehandlung von psychischen Störungen bei Kindern abzuleiten. Dazu begleitet sie eine Kohorte von anfangs 384 Kindern in ihrer Entwicklung von der Geburt bis zum Erwachsenenalter. Die Erhebungen fanden in regelmäßigen Abständen statt, beginnend im Alter von 3 Monaten, mit 2 Jahren, 4;6, 8, 11, 15, 19, 22, 23 und 25 Jahren. Geplant ist eine weitere Erhebung mit ca. 30 Jahren.
Die Validität des autobiographischen Gedächtnisses wird kontrovers diskutiert, bislang fehlen prospektive Längsschnittstudien weitgehend. Die vorliegende Studie überprüft die Validität des autobiographischen Gedächtnisses anhand der Daten einer prospektiven epidemiologischen Längsschnittstudie, die in vier Untersuchungswellen 399 achtjährige Kinder bis zum Alter von 25 Jahren begleitete. Im Alter von 25 Jahren wurden die Erinnerungsleistungen der Probanden an Kernfakten, Erziehungsstil der Eltern, eigene psychische Probleme sowie Lebensereignisse aus Kindheit und Jugend mit Hilfe eines voll strukturierten Fragebogens erhoben. Mit Ausnahme der Kernfakten waren die Erinnerungsleistungen durchweg schlecht, intelligente Probanden zeigten insgesamt bessere Erinnerungsleistungen, junge Erwachsene mit psychischen Störungen berichteten vermehrt auch früher nicht vorhandene Symptome. Die retrospektive Erfassung früherer Lebensereignisse, der Beziehung zu den Eltern und psychischer Auffälligkeiten im Rahmen von Risikostudien und klinischen Studien ist sehr bedenklich. Schlüsselwörter: Autobiographisches Gedächtnis, Entwicklungspsychopathologie, Epidemiologie, Langzeitstudie, Methodik
Objective: A difficult or undercontrolled temperament, as well as harsh parental discipline or a lack of warmth, has long been regarded as risk factors for the development of externalizing problems. In addition, it has been suggested that children with difficult temperament are especially susceptible to rearing influences. We investigated the impact of early temperament and parenting and their interactions on externalizing behavior at school age.
Methods: Participants were 148 boys and 160 girls from a prospective longitudinal study on a high-risk sample. At ages 3 months and 2 years, temperament was assessed by a highly structured parent interview and standardized behavioral observations. Maternal parenting was assessed by videotaped behavioral observation and a parent questionnaire. Externalizing problems at age 8 years were measured by the Child Behavior Checklist.
Results: Using hierarchical linear regression analyses, we found that externalizing problems were predicted by psychosocial adversity and poor self-control, whereas no main effect for restrictive parenting or maternal empathy was found. Fearful-inhibited boys were positively affected by empathic and sensitive parenting, whereas girls who were low in self-control and/or fearful developed less externalizing problems with restrictive parenting.
Conclusion: Our results partly support the differential susceptibility hypothesis. In addition, they point toward gender-specific pathways in the development of externalizing problems.
Background: Children’s spontaneous focusing on numerosity (SFON) is related to numerical skills. This study aimed to examine (1) the developmental trajectory of SFON and (2) the interrelations between SFON and early numerical skills at pre-school as well as their influence on arithmetical skills at school. Method: Overall, 1868 German pre-school children were repeatedly assessed until second grade. Nonverbal intelligence, visual attention, visuospatial working memory, SFON and numerical skills were assessed at age five (M = 63 months, Time 1) and age six (M = 72 months, Time 2), and arithmetic was assessed at second grade (M = 95 months, Time 3). Results: SFON increased significantly during pre-school. Path analyses revealed interrelations between SFON and several numerical skills, except number knowledge. Magnitude estimation and basic calculation skills (Time 1 and Time 2), and to a small degree number knowledge (Time 2), contributed directly to arithmetic in second grade. The connection between SFON and arithmetic was fully mediated by magnitude estimation and calculation skills at pre-school. Conclusion: Our results indicate that SFON first and foremost influences deeper understanding of numerical concepts at pre-school and—in contrast to previous findings –affects only indirectly children’s arithmetical development at school.
Background:
Children’s spontaneous focusing on numerosity (SFON) is related to numerical skills. This study aimed to examine (1) the developmental trajectory of SFON and (2) the interrelations between SFON and early numerical skills at pre-school as well as their influence on arithmetical skills at school.
Method:
Overall, 1868 German pre-school children were repeatedly assessed until second grade. Nonverbal intelligence, visual attention, visuospatial working memory, SFON and numerical skills were assessed at age five (M = 63 months, Time 1) and age six (M = 72 months, Time 2), and arithmetic was assessed at second grade (M = 95 months, Time 3).
Results:
SFON increased significantly during pre-school. Path analyses revealed interrelations between SFON and several numerical skills, except number knowledge. Magnitude estimation and basic calculation skills (Time 1 and Time 2), and to a small degree number knowledge (Time 2), contributed directly to arithmetic in second grade. The connection between SFON and arithmetic was fully mediated by magnitude estimation and calculation skills at pre-school.
Conclusion:
Our results indicate that SFON first and foremost influences deeper understanding of numerical concepts at pre-school and—in contrast to previous findings –affects only indirectly children’s arithmetical development at school.
Background: Recent animal and human studies indicate that the exposure to alcohol during early adolescence increases the risk for heavy alcohol use in response to stress. The purpose of this study was to examine whether this effect may be the consequence of a higher susceptibility to develop "drinking to cope" motives among early initiators. Methods: Data from 320 participants were collected as part of the Mannheim Study of Children at Risk, an ongoing epidemiological cohort study. Structured interviews at age 15 and 19 were used to assess age at first alcohol experience and drunkenness. The young adults completed questionnaires to obtain information about the occurrence of stressful life events during the past 4 years and current drinking habits. In addition, alcohol use under conditions of negative states was assessed with the Inventory of Drinking Situations. Results: The probability of young adults' alcohol use in situations characterized by unpleasant emotions was significantly increased the earlier they had initiated the use of alcohol, even when controlling for current drinking habits and stressful life events. Similar results were obtained for the age at first drunkenness. Conclusions: The findings strengthen the hypothesis that alcohol experiences during early adolescence facilitate drinking to regulate negative affect as an adverse coping strategy which may represent the starting point of a vicious circle comprising drinking to relieve stress and increased stress as a consequence of drinking.
This longitudinal study from Germany examined the dynamic progression of antisocial behavior in childhood and adolescence based on the social interactional model by Patterson, DeBaryshe, and Ramsey. It examined the link between antisocial behavior, social rejection, academic failure, and affiliation with deviant peers in a sample of 1,657 children and youths aged between 6 and 15 years who were studied at three measurement waves (T1 to T3) over a time period of about 5 years. Teachers rated the children on all variables, parents additionally provided ratings of antisocial behavior and social rejection. Latent structural equation modeling yielded the predicted positive paths from antisocial behavior at T1 to social rejection and academic failure at T2. As predicted, affiliation with deviant peers at T2 was positively associated with social rejection and academic failure at the same measurement point. Finally, affiliation with deviant peers at T2 significantly predicted antisocial behavior at T3.
Early maternal care may counteract familial liability for psychopathology in the reward circuitry
(2018)
Reward processing is altered in various psychopathologies and has been shown to be susceptible to genetic and environmental influences. Here, we examined whether maternal care may buffer familial risk for psychiatric disorders in terms of reward processing. Functional magnetic resonance imaging during a monetary incentive delay task was acquired in participants of an epidemiological cohort study followed since birth (N = 172, 25 years). Early maternal stimulation was assessed during a standardized nursing/playing setting at the age of 3 months. Parental psychiatric disorders (familial risk) during childhood and the participants’ previous psychopathology were assessed by diagnostic interview. With high familial risk, higher maternal stimulation was related to increasing activation in the caudate head, the supplementary motor area, the cingulum and the middle frontal gyrus during reward anticipation, with the opposite pattern found in individuals with no familial risk. In contrast, higher maternal stimulation was associated with decreasing caudate head activity during reward delivery and reduced levels of attention deficit hyperactivity disorder (ADHD) in the high-risk group. Decreased caudate head activity during reward anticipation and increased activity during delivery were linked to ADHD. These findings provide evidence of a long-term association of early maternal stimulation on both adult neurobiological systems of reward underlying externalizing behavior and ADHD during development.
The ralationship between early mother-infant interaction at 3 mo old, biological and psychosocial risks, and later social withdrawal was examined using a hierarchical logistics regression approach. A group of childeren (N=20; aged 4.5-8 yrs old) who were stabily socially withdrawn and a control group of healthy children (N=143) were formed. Variables were entered into the regression models in the follwing order: At first, biological and psychosocial risks and sex, followed by mother and child variables separately, while in a final regression model all of the variables were entered at once. The results show that child behaviors (smilling and gazing) as well as maternal behaviors (facial and motor responsiveness) significantly predict social withdrawal in middle childhood. Among the risks only biolgical risks significantly contribute to later child outcome. These results suggest that a dysfunctional interaction pattern between mother and infant may be a precursor of childhood social withdrawal.
Objective: We investigated in a high-risk sample the differential impact of biological and psychosocial risk factors on antisocial behaviour pathways. Method: One hundred and thirty-eight boys and 155 girls born at differing degrees of obstetric and psychosocial risk were examined from birth until adolescence. Childhood temperament was assessed by a highly-structured parent-interview and standardized behavioural observations, adolescent temperament was measured by self-report. Neurodevelopmental variables were assessed by age-specific developmental tests. Emotional and behaviour problems were measured at the ages of 8 and 15 by the Achenbach scales. Results: In both genders, psychosocial adversity and early self-control temperament were strongly associated with early-onset persistent (EOP) antisocial behaviour. Psychosocial adversity and more severe externalizing problems differentiated the EOP from childhood-limited (CL) pathway. In girls, adolescent-onset (AO) antisocial behaviour was strongly associated with novelty seeking at 15 years. Conclusion: Our findings emphasize the need for early support and intervention in psychosocially disadvantaged families.
There is converging evidence suggesting a particular susceptibility to the addictive properties of nicotine among adolescents. The aim of the current study was to prospectively ascertain the relationship between age at first cigarette and initial smoking experiences, and to examine the combined effects of these characteristics of adolescent smoking behavior on adult smoking. It was hypothesized that the association between earlier age at first cigarette and later development of nicotine dependence may, at least in part, be attributable to differences in experiencing pleasurable early smoking sensations. Data were drawn from the participants of the Mannheim Study of Children at Risk, an ongoing epidemiological cohort study from birth to adulthood. Structured interviews at age 15, 19 and 22 years were conducted to assess the age at first cigarette, early smoking experiences and current smoking behavior in 213 young adults. In addition, the participants completed the Fagerstrom Test for Nicotine Dependence. Adolescents who smoked their first cigarette at an earlier age reported more pleasurable sensations from the cigarette, and they were more likely to be regular smokers at age 22. The age at first cigarette also predicted the number of cigarettes smoked and dependence at age 22. Thus, both the age of first cigarette and the pleasure experienced from the cigarette independently predicted aspects of smoking at age 22.
EEG coherence analysis for examining an automatizational deficit in dyslexia - a pilot study Objectives: Do dyslexic children exhibit a general automatizational deficit as well as a phonological deficit? Methods: In 1,6 children aged 9-11 years the reaction time, the number of mistakes and EEG (19 scalp electrodes) were measured in three experiments (verbal and nonverbal). The EEG data was baseline-corrected and after a fast fourier transformation, analyzed with the coherence tool of the Brainvision(C) Software. Results: The dyslexic group made more mistakes than the control group on all tasks but their reaction times were significantly longer only on the verbal tasks. There were no coherence differences on the nonverbal task. On the language-dependent tasks the dyslexics showed higher total-frontal and lower left-frontal coherences only in the theta-frequency range, while in the alpha and beta frequency ranges coherences did not differ. Conclusions: A language-dependent cognitive automatizational deficit in the dyslexic group is assumed that is depicted by the higher synchronization of total-frontal coherences (involvement of the central executive) and is based on the less established functional coupling of cortical subsystems for language processing
This study presents the evaluation of a computer-based learning program for children with developmental dyscalculia and focuses on factors affecting individual responsiveness. The adaptive training program Calcularis 2.0 has been developed according to current neuro-cognitive theory of numerical cognition. It aims to automatize number representations, supports the formation and access to the mental number line and trains arithmetic operations as well as arithmetic fact knowledge in expanding number ranges. Sixty-seven children with developmental dyscalculia from second to fifth grade (mean age 8.96 years) were randomly assigned to one of two groups (Calcularis group, waiting control group). Training duration comprised a minimum of 42 training sessions à 20 min within a maximum period of 13 weeks. Compared to the waiting control group, children of the Calcularis group demonstrated a higher benefit in arithmetic operations and number line estimation. These improvements were shown to be stable after a 3-months post training interval. In addition, this study examines which predictors accounted for training improvements. Results indicate that this self-directed training was especially beneficial for children with low math anxiety scores and without an additional reading and/or spelling disorder. In conclusion, Calcularis 2.0 supports children with developmental dyscalculia to improve their arithmetical abilities and their mental number line representation. However, it is relevant to further adapt the setting to the individual circumstances.
This study presents the evaluation of a computer-based learning program for children with developmental dyscalculia and focuses on factors affecting individual responsiveness. The adaptive training program Calcularis 2.0 has been developed according to current neuro-cognitive theory of numerical cognition. It aims to automatize number representations, supports the formation and access to the mental number line and trains arithmetic operations as well as arithmetic fact knowledge in expanding number ranges. Sixty-seven children with developmental dyscalculia from second to fifth grade (mean age 8.96 years) were randomly assigned to one of two groups (Calcularis group, waiting control group). Training duration comprised a minimum of 42 training sessions à 20 min within a maximum period of 13 weeks. Compared to the waiting control group, children of the Calcularis group demonstrated a higher benefit in arithmetic operations and number line estimation. These improvements were shown to be stable after a 3-months post training interval. In addition, this study examines which predictors accounted for training improvements. Results indicate that this self-directed training was especially beneficial for children with low math anxiety scores and without an additional reading and/or spelling disorder. In conclusion, Calcularis 2.0 supports children with developmental dyscalculia to improve their arithmetical abilities and their mental number line representation. However, it is relevant to further adapt the setting to the individual circumstances.
Efficacy of Psychotherapy with Children and Adolescents
Psychotherapeutic interventions require empirical as well as scientific assessment. Specifically, the proven efficacy of psychotherapy for children and adolescents is essential. Thus, studies examining treatment efficacy and meta-analyses are necessary to compare effect sizes of individual therapeutic interventions between treatment groups and waiting control groups. Assessment of 138 primary studies from 1993-2009 documented the efficacy of psychotherapy for children and adolescents. Furthermore, behavioural therapy outperformed non-behavioural interventions, as 90 % of behavioural interventions showed larger effect sizes compared to non-behavioural psychotherapy. Analysis of moderator variables demonstrated an improved treatment efficacy for individual therapy, inclusion of the family, treatment of internalised disorders, and in clinical samples. Stability of psychotherapeutic treatment effects over time was demonstrated.
Background: Several studies have reported higher smoking rates among adolescents with externalizing disorders (attention-deficit hyperactivity disorder and conduct disorder) as compared to healthy controls. Objective: To follow the association between childhood externalizing disorders and smoking during development, to determine the type of problems most strongly related to later tobacco use, and to control for the influence of covarying factors. Methods: Participants were from a longitudinal study of a birth cohort of 384 children born with different perinatal and psychosocial risks. Standardized assessments of behavioral disorders between 2 and 11 years and of tobacco use at age 15 were obtained. Results: 15-year-olds with externalizing disorders between 2 and 11 years reported higher tobacco use than those without a history of disorder. This association could be followed back into early childhood and held up even after controlling for covariates. Conclusions: The findings suggest that childhood externalizing disorders may represent an independent risk factor for elevated tobacco use in adolescence
Entspannungsverfahren
(2002)
Systematische Formen in der Entspannung unterscheiden sich von individuellen Formen dadurch, dass sie schneller und gezielter erlernt und in den bestimmten Belastungssituationen eingesetzt werden können. Die Entspannung von Kindern kann über einen kognitiven, imaginativen oder einen sensorischen Zugang erfolgen. Dem kognitiven Zugang ist das autogene Training zuzuordnen. Das autogene Training besteht aus fünf Teilbereichen (Übung der Schwere, der Wärme, der Atmung, des Sonnengeflechtes, Herzübung und Stirnübung). Imaginative Verfahren sind meist Phantasiegeschichten, in die zum Teil Übungen des autogenen Trainings oder der progressiven Muskelrelaxation eingebaut sind. Progressive Muskelrelaxation nach Jacobson umfasst die Anspannung und die Entspannung von 16 Muskelgruppen, die je nach Erfordernis auch auf bis zu vier Übungen zusammengefaßt werden können. Jede einzelne Übung besteht aus einer Anspannungs- und einer Entspannungsphase denen Phasen des Einspürens bzw. Nachspürens vor- bzw. nachgeschaltet werden können. Insbesondere bei Jugendlichen ist die progressive Muskelrelaxation dem autogenen Training vorzuziehen. Auch für Kinder wurden zwischenzeitlich spezielle PMR- Trainingsverfahren entwickelt. Entspannungsverfahren werden in der Klinischen Kinderpsychologie vor allem ergänzend zur Behandlung von Verhaltensauffälligen sowie Kindern mit psychosomatischen Problemen angewendet. Häufig sind Entspannungsmethoden Bestandteil einer Verhaltenstherapie und bereiten eine in vivo oder in sensu Desensibilisierung vor. Weitere Indikationen sind chronische Krankheiten zur Linderung der sekundären psychischen Folgen, Minderung chronischer Schmerzen und vor angstauslösenden oder schmerzhaften operativen Eingriffen. Für viele der Anwendungsbereiche stehen Evaluationen noch aus.
Entspannungsverfahren
(2008)
Entwicklung und Persistenz von Hell- und Dunkelfelddelinquenz im Jugend- und frühen Erwachsenenalter
(2002)
Ziel der Untersuchung war die Bedeutung der Dunkelfelddelinquenz für die Prognose der Delinquenzentwicklung und die Bedeutung psychiatrischer Auffälligkeiten für Entstehen und Verlauf psychischer Störungen zu klären. Die Stichprobe bestand aus 281 25-Jährigen, die im Alter von 8, 13 und 18 Jahren psychiatrisch untersucht, und die mit 18 und 25 Jahren bezüglich ihrer Dunkelfelddelinquenz befragt worden waren. Es ergab sich ein klarer Zusammenhang erhöhter Dunkelfelddelinquenzraten mit gerichtlich bestrafter Delinquenz im Jugendalter. Bei Einbeziehung der Dunkelfelddelinquenz in die Prognose mußte die Wahrscheinlichkeit für den Ausblick auf delinquenten Karrieren von 76 % auf 44 % nach unten korrigiert werden, entsprechend stieg der Anteil von erwachsener als auch fortgesetzter Delinquenz. Die Mehrheit der später gerichtlich bestraften Jugendlichen und jungen Erwachsenen war im Alter von 8 und 13 Jahren psychiatrisch unauffällig gewesen. Als überlegene Prädiktoren stellten sich umschriebene Entwicklungsstörungen und widrige familiäre Bedingungen im Grund- und Hauptschulalter heraus. Als Konsequenz muß die Dunkelfelddelinquenz bei der Verlaufsprognose delinquenten Verhaltens im Jugendalter berücksichtigt werden. Präventive Überlegungen müssen sich auf Kinder mit umschriebenen Entwicklungsstörungen und solche, die in widrigen familiären Verhältnissen leben, mehr konzentrieren als auf Kinder mit hyperkinetischen und dissozialen Störungen. Schlüsselwörter: Delinquenz, Dunkelfelddelinquenz, Entwicklung und Verlauf
Entwicklung von Risikokindern im Schulalter : die langfristigen Folgen frühkindlicher Belastungen
(2000)
Entwicklungsdiagnostik
(2010)
Entwicklungspsychopathologie
(1998)
Enuresis
(2008)
Die meisten Kinder werden mit 2 bis 4 Jahren am Tage und in der Nacht trocken. Gemäß den klinisch- diagnostischen Leitlinien der ICD-10 (WHO 1993) spricht man von einer Enuresis, wenn es am Tag oder in der Nacht zu einem Entleeren der Blase in die Kleidung bzw. das Bett kommt, die relativ zum geistigen Entwicklungsstand der Person abnorm ist und nicht auf organische Ursachen zurückgeführt werden kann. Die Störungen der Blasenkontrolle dürfen nicht als Folge einer neurologischen Erkrankung, epileptischer Anfälle oder einer strukturellen Anomalie der ableitenden Harnwege auftreten. Gemäß den Forschungskriterien der ICD-10 (WHO 1994) muss das einnässende Kind nach seinem Lebens- und geistigen Alter mindestens 5 Jahre alt sein, um von einer nichtorganischen Enuresis (F 98.0) zu sprechen (in den klinisch-diagnostischen Leitlinien wird ein geistiger Entwicklungsstand gefordert, der mindestens dem eines Vierjährigen entspricht). Um die Diagnose zu erhalten, müssen Kinder unter 7 Jahren zumindest 2mal monatlich, 7-jährige oder ältere Kinder wenigstens einmal im Monat einnässen. Die Symptomdauer sollte mindestens 3 Monate betragen. In der Literatur wird synonym zum Begriff der "nichtorganischen Enuresis" häufig die Bezeichnung "funktionelle Enuresis" verwendet. Auch nach dem DSM-IV (Saß et al. 1996) sollten die Kinder für die Diagnose einer Enuresis (307.6) zumindest ein Entwicklungsalter von 5 Jahren aufweisen und die Symptomatik muss wenigstens seit 3 Monaten bestehen. Im Unterschied zur ICD-10 wird das Einnässen erst dann als klinisch bedeutsam beurteilt, wenn es mindestens 2mal wöchentlich auftritt. Ist dies nicht gegeben, kann die Diagnose dennoch gestellt werden, wenn durch das Einnässen klinisch bedeutsames Leiden hervorgerufen wird oder Beeintraechtigungen in sozialen, schulischen (beruflichen) oder anderen wichtigen Funktionsbereichen entstehen. Die Forderung eines 2mal wöchentlichen Einnässens erscheint deutlich zu streng, während das ein- bzw. 2malige Einnässen pro Monat ein sehr weiches Kriterium darstellt. V. Gontard (1998b) empfiehlt, Einnässen dann als klinisch bedeutsam einzuschätzen, wenn dies mindestens einmal wöchentlich auftritt.