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Tammimies, K., Li, D., Rabkina, I., Stamouli, S., Becker, M., Nicolaou, V., . . . Bölte, S. (2019). Association between Copy Number Variation and Response to Social Skills Training in Autism Spectrum Disorder. Scientific Reports, 9, Article ID 9810.
Open this publication in new window or tab >>Association between Copy Number Variation and Response to Social Skills Training in Autism Spectrum Disorder
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2019 (English)In: Scientific Reports, ISSN 2045-2322, E-ISSN 2045-2322, Vol. 9, article id 9810Article in journal (Refereed) Published
Abstract [en]

Challenges in social communication and interaction are core features of autism spectrum disorder (ASD) for which social skills group training (SSGT) is a commonly used intervention. SSGT has shown modest and heterogeneous effects. One of the major genetic risk factors in ASD is rare copy number variation (CNV). However, limited information exists whether CNV profiles could be used to aid intervention decisions. Here, we analyzed the rare genic CNV carrier status for 207 children, of which 105 received SSGT and 102 standard care as part of a randomized clinical trial for SSGT. We found that being a carrier of rare genic CNV did not have an impact on the SSGT outcome measured by the parent-report Social Responsiveness Scale (SRS). However, when stratifying by pathogenicity and size of the CNVs, we identified that carriers of clinically significant and large genic CNVs (> 500 kb) showed inferior SRS outcomes at post-intervention (P = 0.047 and P = 0.036, respectively) and follow-up (P = 0.008 and P = 0.072, respectively) when adjusting for standard care effects. Our study provides preliminary evidence that carriers of clinically significant and large genic CNVs might not benefit as much from SSGT as non-carriers. Our results indicate that genetic information might help guide the modifications of interventions in ASD.

Place, publisher, year, edition, pages
NATURE PUBLISHING GROUP, 2019
National Category
Neurology
Identifiers
urn:nbn:se:uu:diva-391011 (URN)10.1038/s41598-019-46396-1 (DOI)000474335800007 ()31285490 (PubMedID)
Funder
Swedish Research Council, 921-2014-6999Swedish Research Council FormasSwedish Foundation for Strategic Research , ICA14-0028EU, FP7, Seventh Framework Programme, 115300Forte, Swedish Research Council for Health, Working Life and Welfare, 259-2012-24Vinnova, 259-2012-24Stockholm County Council, 20130314Stockholm County Council, 20170415The Swedish Brain FoundationÅke Wiberg Foundation
Available from: 2019-08-21 Created: 2019-08-21 Last updated: 2019-08-21Bibliographically approved
Ssegonja, R., Alaie, I., Philipson, A., Hagberg, L., Sampaio, F., Möller, M., . . . Feldman, I. (2019). Depressive disorders in adolescence, recurrence in early adulthood, and healthcare usage in mid-adulthood: A longitudinal cost-of-illness study. Journal of Affective Disorders, 258, 33-41
Open this publication in new window or tab >>Depressive disorders in adolescence, recurrence in early adulthood, and healthcare usage in mid-adulthood: A longitudinal cost-of-illness study
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2019 (English)In: Journal of Affective Disorders, ISSN 0165-0327, E-ISSN 1573-2517, Vol. 258, p. 33-41Article in journal (Refereed) Published
Abstract [en]

Background: Depression in adolescence is associated with increased healthcare consumption in adulthood, but prior research has not recognized the heterogeneity of depressive disorders. This paper investigated the additional healthcare usage and related costs in mid-adulthood for individuals with adolescent depression, and examined the mediating role of subsequent depression in early adulthood.

Methods: This study was based on the Uppsala Longitudinal Adolescent Depression Study, initiated in Sweden in the early 1990s. Depressive disorders were assessed in adolescence (age 16-17) and early adulthood (age 19-30). Healthcare usage and related costs in mid-adulthood (age 31-40) were estimated using nationwide population-based registries. Participants with specific subtypes of adolescent depression (n = 306) were compared with matched non-depressed peers (n = 213).

Results: Women with persistent depressive disorder (PDD) in adolescence utilized significantly more healthcare resources in mid-adulthood. The association was not limited to psychiatric care, and remained after adjustment for individual and parental characteristics. The total additional annual cost for a single age group of females with a history of PDD at a population level was estimated at 3.10 million USD. Depression recurrence in early adulthood mediated the added costs for psychiatric care, but not for somatic care.

Limitations: Primary health care data were not available, presumably resulting in an underestimation of the true healthcare consumption. Estimates for males had limited precision due to a relatively small male proportion.

Conclusions: On a population level, the additional healthcare costs incurred in mid-adulthood in females with a history of adolescent PDD are considerable. Early treatment and prevention should be prioritized.

Place, publisher, year, edition, pages
ELSEVIER, 2019
Keywords
Adolescence, Depression, Direct costs, Adulthood, Psychiatric healthcare, Non-psychiatric healthcare
National Category
Psychiatry Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:uu:diva-393715 (URN)10.1016/j.jad.2019.07.077 (DOI)000482176400004 ()31382102 (PubMedID)
Funder
Swedish Research Council, 2014-10092Forte, Swedish Research Council for Health, Working Life and WelfareSwedish Research Council FormasVinnova
Available from: 2019-09-30 Created: 2019-09-30 Last updated: 2020-02-22Bibliographically approved
Shanks, E., Jonsson, U., Wiklund, S. & Rozental, A. (2019). Harmful care. To what extent is terminology from medicine and clinical psychology applicable to out‐of‐home care?. Child & Family Social Work
Open this publication in new window or tab >>Harmful care. To what extent is terminology from medicine and clinical psychology applicable to out‐of‐home care?
2019 (English)In: Child & Family Social Work, ISSN 1356-7500, E-ISSN 1365-2206Article in journal (Refereed) Epub ahead of print
Abstract [en]

Research concerning outcomes for children who have been placed in out‐of‐home care has indicated that the care may have unwanted consequences. However, there has been no coherent terminology for differentiating between different types of such unwanted consequences. In this article therefore, we attempt to disentangle different aspects of potentially harmful care for looked after children, as well as to discuss potential pathways to more systematically approach and report adverse events for this group. In this endeavour, we turn to two adjacent disciplines, medicine and psychology, where these issues have received more interest. The applicability of the concepts used in these fields is discussed, and it is concluded that although they provide some help in categorizing different aspects of harmful care, the complexity of out‐of‐home care makes existing models difficult to adopt without adjustments. This has consequences for the possibility of evaluating care in research, as well as for monitoring adverse events in practice. Importantly, the causality will often be unknown. We therefore suggest that it is essential to shed more light on how decisions should be made about when to intervene or not in out‐of‐home care, despite limited information.

Place, publisher, year, edition, pages
John Wiley & Sons, 2019
Keywords
adverse events, looked‐after children, malpractice, negative effects, out‐of‐home care
National Category
Social Work Health Care Service and Management, Health Policy and Services and Health Economy
Identifiers
urn:nbn:se:uu:diva-396758 (URN)10.1111/cfs.12661 (DOI)
Funder
Swedish National Board of Health and Welfare
Available from: 2019-06-24 Created: 2019-11-08Bibliographically approved
Ssegonja, R., Nystrand, C., Feldman, I., Sarkadi, A., Langenskiöld, S. & Jonsson, U. (2019). Indicated preventive interventions for depression in children and adolescents: A meta-analysis and meta-regression. Preventive Medicine, 118, 7-15
Open this publication in new window or tab >>Indicated preventive interventions for depression in children and adolescents: A meta-analysis and meta-regression
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2019 (English)In: Preventive Medicine, ISSN 0091-7435, E-ISSN 1096-0260, Vol. 118, p. 7-15Article, review/survey (Refereed) Published
Abstract [en]

Depression contributes about 2% to the global burden of disease. A first onset of depressive disorder or subsyndromal depressive symptoms is common in adolescence, indicating that early prevention is a priority. However, trials of preventive interventions for depression in youths show conflicting results. This systematic review and meta-analysis investigated the effectiveness of group-based cognitive behavioral therapy (GB-CBT) as a preventive intervention targeting subsyndromal depression in children and adolescents. In addition, the impact of different covariates (type of comparator and use of booster sessions) was assessed. Relevant articles were identified from previous systematic reviews, and supplemented with an electronic search spanning from 01/09/2014 to 28/02/2018. The retrieved articles were assessed for eligibility and risk of bias. Relevant data were extracted. Intervention effectiveness was pooled using a random-effects model and the impact of covariates assessed using meta-regression. 38 eligible articles (34 trials) were obtained. The analysis showed GB-CBT to significantly reduce the incidence (relative risk 0.43, 95% CI 0.21-0.87) and symptoms (Cohen's d -0.22, 95% CI -0.32 to -0.11) of depression at post-test compared to all controls. Comparisons with passive comparators suggested that the effect decayed over time. However, compared to active controls, a significant intervention effect was evident only after 12 month or more. Our results suggest that the preventive effect of GB-CBT wears off, but still lasts longer than the effect of active comparators. Only a few studies included booster sessions, precluding firm conclusions. Future studies should clarify to what extent maintenance strategies can prolong the preventive effect of GB-CBT.

Keywords
Depression, Dysthymia, Cognitive-behavioral therapy, Meta-analysis, Meta-regression, Indicated prevention interventions
National Category
Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:uu:diva-375899 (URN)10.1016/j.ypmed.2018.09.021 (DOI)000454933300002 ()30287331 (PubMedID)
Funder
Swedish Research Council, 2014-10092Forte, Swedish Research Council for Health, Working Life and WelfareSwedish Research Council FormasVINNOVA
Available from: 2019-02-04 Created: 2019-02-04 Last updated: 2020-02-22Bibliographically approved
Jonsson, U., Olsson, N. C., Coco, C., Görling, A., Flygare, O., Råde, A., . . . Bölte, S. (2019). Long-term social skills group training for children and adolescents with autism spectrum disorder: a randomized controlled trial.. European Child and Adolescent Psychiatry, 28(2), 189-201
Open this publication in new window or tab >>Long-term social skills group training for children and adolescents with autism spectrum disorder: a randomized controlled trial.
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2019 (English)In: European Child and Adolescent Psychiatry, ISSN 1018-8827, E-ISSN 1435-165X, Vol. 28, no 2, p. 189-201Article in journal (Refereed) Published
Abstract [en]

Social skills group training (SSGT) is widely used for intellectually able children and adolescents with autism spectrum disorder (ASD). Previous studies indicate small to moderate effects on social communication capacities. The duration of most available programs is relatively short, and extended training might lead to further improvement. This randomized controlled trial compared an extended 24-week version of the SSGT program KONTAKT with standard care. The weekly sessions gradually shifted in content from acquisition of new skills to real-world application of the acquired skills. A total of 50 participants with ASD (15 females; 35 males) aged 8-17 years were included. The study was conducted at two child and adolescent psychiatry outpatient units in Sweden. The primary outcome was the Social Responsiveness Scale-Second Edition (SRS-2) rated by parents and blinded teachers. Secondary outcomes included parent- and teacher-rated adaptive behaviors, trainer-rated global functioning and clinical severity, and self-reported child and caregiver stress. Assessments were made at baseline, posttreatment, and at 3-months follow-up. Parent-rated SRS-2 scores indicated large effects posttreatment [- 19.2; 95% CI - 29.9 to - 8.5; p < .001, effect size (ES) = 0.76], which were maintained at follow-up (- 20.7; 95% CI - 31.7 to - 9.7; p < .0001, ES = 0.82). These estimates indicate substantially larger improvement than previously reported for shorter SSGT. However, the effects on teacher-rated SRS-2 and most secondary outcomes did not reach statistical significance. Our results suggest added benefits of extended SSGT training, implying that service providers might reach better results by optimizing the delivery of SSGT.

Keywords
Autism, Group training, Long-term, Neurodevelopmental disorder, Social skills
National Category
Psychiatry
Research subject
Child and Youth Psychiatry
Identifiers
urn:nbn:se:uu:diva-360236 (URN)10.1007/s00787-018-1161-9 (DOI)000457572400005 ()29748736 (PubMedID)
Funder
Stockholm County CouncilSwedish Research Council
Note

De två första författarna delar förstaförfattarskapet.

Available from: 2018-09-11 Created: 2018-09-11 Last updated: 2019-03-05Bibliographically approved
Alaie, I., Låftman, S. B., Jonsson, U. & Bohman, H. (2019). Parent-youth conflict as a predictor of depression in adulthood: a 15-year follow-up of a community-based cohort.. European Child and Adolescent Psychiatry
Open this publication in new window or tab >>Parent-youth conflict as a predictor of depression in adulthood: a 15-year follow-up of a community-based cohort.
2019 (English)In: European Child and Adolescent Psychiatry, ISSN 1018-8827, E-ISSN 1435-165XArticle in journal (Refereed) Epub ahead of print
Abstract [en]

Experiencing conflictual relations with one's parents while growing up has been linked to onset, recurrence, and worse treatment outcome of adolescent depression. While this suggests that significant problems in the parent-youth relationship make depressive disorders more relentless, it is not clear whether this effect lasts into adulthood. Our aim was to examine if major and minor conflict with parents while growing up predicts depression in adulthood in youth with and without a history of depression. We utilized data from the Uppsala Longitudinal Adolescent Depression Study. This community-based cohort was assessed with structured diagnostic interviews both at age 16-17 and at follow-up 15 years later. The analyses included 382 individuals (227 with a history of child or adolescent depression; 155 peers without such a history). Binary logistic regression was used, adjusting for sex, disruptive behavior disorders, and additional family-related adversities. Among individuals with adolescent depression, major conflict with parents was strongly associated with adult depression (adjusted OR 2.28, 95% CI 1.07-4.87). While major conflict with parents was rare among non-depressed controls, a non-significant association of similar magnitude was still observed. Minor conflict, on the other hand, was not significantly associated with adult depression. Overall, conflict with parents did not predict adult anxiety disorders, substance use, suicidal behavior, somatoform disorders, or psychotic disorders. In conclusion, major parent-youth conflict during upbringing seems to be linked with an increased risk of depression in adulthood. These findings underscore the need to consider contextual/familial factors in the prevention and clinical management of early-life depression.

Keywords
Adolescent depression, Adulthood, Cohort study, Epidemiology, Family conflict, Longitudinal design
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:uu:diva-396745 (URN)10.1007/s00787-019-01368-8 (DOI)31302772 (PubMedID)
Available from: 2019-11-08 Created: 2019-11-08 Last updated: 2020-02-19Bibliographically approved
Jonsson, U., Coco, C., Fridell, A., Brown, S., Berggren, S., Hirvikoski, T. & Bölte, S. (2019). Proof of concept: the TRANSITION program for young adults with autism spectrum disorder and/or attention deficit hyperactivity disorder.. Scandinavian Journal of Occupational Therapy, 1-13
Open this publication in new window or tab >>Proof of concept: the TRANSITION program for young adults with autism spectrum disorder and/or attention deficit hyperactivity disorder.
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2019 (English)In: Scandinavian Journal of Occupational Therapy, ISSN 1103-8128, E-ISSN 1651-2014, p. 1-13Article in journal (Refereed) Epub ahead of print
Abstract [en]

Background: The support needs of people with neurodevelopmental disorders are not sufficiently met during the initial years of adulthood.Aim: To evaluate feasibility and preliminary effects of a novel programme designed to empower young adults with autism spectrum disorder (ASD) and/or attention deficit hyperactivity disorder (ADHD) to make progress within significant life domains (i.e. work, education, finance, housing/household management, health, leisure/participation in society, and relationships/social network).Material and Method: TRANSITION is a 24-week programme that combines group-based workshops with personalised support based on goal attainment scaling. The study enrolled 26 young adults (50% females; age 17-24 years) in the normative intellectual range, diagnosed with ASD (n = 8), ADHD (n = 4), or both (n = 14). The intervention was delivered by the regular staff of publicly funded psychiatric services in Stockholm, Sweden.Results: The programme was possible to implement with minor deviations from the manual. Participants and staff generally viewed the intervention positively, but also provided feedback to guide further improvement. There was a high degree of attendance throughout, with 21 participants (81%) completing the programme. All completers exceeded their predefined goal expectations within at least one domain.Conclusions: The TRANSITION-programme is a promising concept that deserves further evaluation.

Keywords
Young adulthood, functional impairment, intervention, neurodevelopmental disorders, social service, support
National Category
Medical and Health Sciences
Identifiers
urn:nbn:se:uu:diva-405261 (URN)10.1080/11038128.2019.1695933 (DOI)31790309 (PubMedID)
Available from: 2020-02-27 Created: 2020-02-27 Last updated: 2020-02-27
Alaie, I., Philipson, A., Ssegonja, R., Hagberg, L., Feldman, I., Sampaio, F., . . . Jonsson, U. (2019). Uppsala Longitudinal Adolescent Depression Study (ULADS). BMJ Open, 9(3), Article ID e024939.
Open this publication in new window or tab >>Uppsala Longitudinal Adolescent Depression Study (ULADS)
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2019 (English)In: BMJ Open, ISSN 2044-6055, E-ISSN 2044-6055, Vol. 9, no 3, article id e024939Article in journal (Refereed) Published
Abstract [en]

Purpose: To present the Uppsala Longitudinal Adolescent Depression Study, initiated in Uppsala, Sweden, in the early 1990s. The initial aim of this epidemiological investigation was to study the prevalence, characteristics and correlates of adolescent depression, and has subsequently expanded to include a broad range of social, economic and health-related long-term outcomes and cost-of-illness analyses.

Participants: The source population was first-year students (aged 16-17) in upper-secondary schools in Uppsala during 1991-1992, of which 2300 (93%) were screened for depression. Adolescents with positive screening and sex/age-matched peers were invited to a comprehensive assessment. A total of 631 adolescents (78% females) completed this assessment, and 409 subsequently completed a 15year follow-up assessment. At both occasions, extensive information was collected on mental disorders, personality and psychosocial situation. Detailed social, economic and health-related data from 1993 onwards have recently been obtained from the Swedish national registries for 576 of the original participants and an age-matched reference population (N=200 000).

Findings to date: The adolescent lifetime prevalence of a major depressive episode was estimated to be 11.4%. Recurrence in young adulthood was reported by the majority, with a particularly poor prognosis for those with a persistent depressive disorder or multiple somatic symptoms. Adolescent depression was also associated with an increased risk of other adversities in adulthood, including additional mental health conditions, low educational attainment and problems related to intimate relationships.

Future plans: Longitudinal studies of adolescent depression are rare and must be responsibly managed and utilised. We therefore intend to follow the cohort continuously by means of registries. Currently, the participants are approaching mid-adulthood. At this stage, we are focusing on the overall long-term burden of adolescent depression. For this purpose, the research group has incorporated expertise in health economics. We would also welcome extended collaboration with researchers managing similar datasets.

National Category
Psychiatry Public Health, Global Health, Social Medicine and Epidemiology
Identifiers
urn:nbn:se:uu:diva-389609 (URN)10.1136/bmjopen-2018-024939 (DOI)000471144900167 ()30826765 (PubMedID)
Funder
Swedish Research Council, 2014-10092Forte, Swedish Research Council for Health, Working Life and WelfareStiftelsen Söderström - Königska sjukhemmet
Available from: 2019-07-22 Created: 2019-07-22 Last updated: 2019-07-22Bibliographically approved
Berggren, S., Fletcher-Watson, S., Milenkovic, N., Marschik, P. B., Bölte, S. & Jonsson, U. (2018). Emotion recognition training in autism spectrum disorder: A systematic review of challenges related to generalizability.. Developmental Neurorehabilitation, 21(3), 141-154
Open this publication in new window or tab >>Emotion recognition training in autism spectrum disorder: A systematic review of challenges related to generalizability.
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2018 (English)In: Developmental Neurorehabilitation, ISSN 1751-8423, E-ISSN 1751-8431, Vol. 21, no 3, p. 141-154Article in journal (Refereed) Published
Abstract [en]

PURPOSE: To assess the generalizability of findings from randomized controlled trials (RCTs) evaluating emotion recognition (ER) training for children and adolescents with autism spectrum disorder (ASD).

METHODS: We present a systematic review and narrative synthesis of the determinants of external validity in RCTs on ER training. Generalizability of the findings across situations, populations, settings, treatment delivery, and intervention formats was considered.

RESULTS: We identified 13 eligible studies. Participants were predominantly boys with ASD in the normative IQ range (IQ > 70), with an age span from 4 to 18 years across studies. Interventions and outcome measures were highly variable. Several studies indicated that training may improve ER, but it is still largely unknown to what extent training effects are translated to daily social life.

CONCLUSION: The generalizability of findings from currently available RCTs remains unclear. This underscores the importance of involving children with ASD and their caregivers in informed treatment decisions.

Keywords
Asperger syndrome, autism, child psychiatry, emotion, intervention, neurodevelopmental disorders, technology training
National Category
Neurosciences Pediatrics
Identifiers
urn:nbn:se:uu:diva-321449 (URN)10.1080/17518423.2017.1305004 (DOI)000427274000001 ()28394669 (PubMedID)
Available from: 2017-05-05 Created: 2017-05-05 Last updated: 2018-05-18Bibliographically approved
Ssegonja, R., Nystrand, C., Feldman, I., Sarkadi, A., Langenskiöld, S. & Jonsson, U. (2018). Indicated Preventive Interventions for Depression in Children and Adolescents: A Meta-Analysis And Meta-Regression. Value in Health, 21, S181-S181
Open this publication in new window or tab >>Indicated Preventive Interventions for Depression in Children and Adolescents: A Meta-Analysis And Meta-Regression
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2018 (English)In: Value in Health, ISSN 1098-3015, E-ISSN 1524-4733, Vol. 21, p. S181-S181Article in journal, Meeting abstract (Other academic) Published
Place, publisher, year, edition, pages
Elsevier, 2018
National Category
Health Care Service and Management, Health Policy and Services and Health Economy
Identifiers
urn:nbn:se:uu:diva-366684 (URN)10.1016/j.jval.2018.04.1234 (DOI)000438630000353 ()
Available from: 2018-11-23 Created: 2018-11-23 Last updated: 2018-11-23Bibliographically approved
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ORCID iD: ORCID iD iconorcid.org/0000-0002-5761-2943

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