Masum Öztürk

Aims: Attention-deficit hyperactivity disorder (ADHD) is characterized by impairing and age-inappropriate inattention, hyperactivity, and impulsivity. Extended-release guanfacine hydrochloride (GXR) is a selective α2A-adrenergic agonist approved as mono- and adjunctive therapy to psychostimulant medications for ADHD. This multicenter retrospective study aimed to assess patients with ADHD initiating treatment with GXR as mono- and adjunctive therapy in a non-Western, real-world clinical setting. Methods: The study was designed as a naturalistic, Patient-Reported Outcome Measures (PROMs)-based, clinic-based, multi-center study; thirty-two child and adolescent psychiatry clinics from 26 cities located in seven geographical regions of Türkiye were included. Clinicians evaluated ADHD symptom severity at baseline and at the end of the 6th month with Clinical Global Impressions (CGI)-Severity, Improvement, and Adverse Effect scales while parents evaluated symptoms with the DSM-IV-Based Screening Scale for Disruptive Behavior Disorders. Adverse effects after GXR treatment were determined from patient records. Dose equivalents for stimulants, antidepressants, antipsychotics, and mood stabilizers used concurrently with GXR were calculated. Univariate and bivariate analyses along with linear mixed models were used to model change. Logistic regression was used to evaluate predictors of treatment response in sensitivity analysis. Results: Five hundred and sixty-seven patients ( n = 437, 77.1% male) with a mean age of 11.2 ( SD = 2.8) years were enrolled. Comorbid diagnoses were common (82.4%) along with combination therapy (85.0%). GXR at a median dose of 2.0 to 3.0 mg/day was associated with improvement and the rate of adverse effects was low. GXR showed differential symptom-domain effects, with greater improvement in hyperactive-impulsive (HI) compared to inattentive (IA) symptoms. Children with comorbid autism spectrum disorder (ASD; n = 175, 30.0% of the sample) showed notable clinical improvement. Response was modified by baseline symptom severity. Conclusion: GXR may be a viable treatment option for children and adolescents with ADHD and various comorbidities among Turkish youth in real-world clinical populations, with baseline symptom severity as a potential modifier of response. The differential response favoring HI symptoms and notable effectiveness in comorbid ASD represent clinically important findings of this naturalistic, PROM-based study.

Depression is one of the most prevalent mental illnesses and contributes significantly to the global burden of disease. It is associated with deterioration in family and peer relationships, as well...

Objective: Cannabis is among the most commonly used substances by adolescents and is frequently associated with the development of addiction. Various individual, environmental and psychological factors are associated with the onset and maintenance of cannabis use disorder (CUD). Our study aimed to compare levels of depression, anxiety, stress, perceived cognitive flexibility and metacognitive beliefs in adolescents diagnosed with CUD with those in a healthy control (HC) group. Another objective was to investigate the relationship between CUD severity and these parameters within the CUD group. Methods: Our study included a total of 69 patients aged 12–18 years with a diagnosis of CUD and 83 age‐ and gender‐matched HC subjects. Participants completed the Sociodemographic Data Form, Addiction Profile Index (API), Metacognition Scale–Children and Adolescents Form (MCQ‐C), Cognitive Flexibility Scale (CFS) and Depression‐Anxiety‐Stress Scale (DASS‐21). Results: Patients with CUD had significantly higher MCQ‐C total scores ( p = 0.033), higher levels of superstition‐punishment‐responsibility beliefs ( p = 0.001) and higher DASS‐21 scores ( p < 0.001) compared to the HC group. Perceived cognitive flexibility was significantly lower in the CUD group ( p < 0.001). Higher levels of negative metacognitive beliefs ( p = 0.006) and total emotional symptoms in the CUD group were positively associated with CUD severity ( p < 0.001, F = 7.512, R ² = 0.365). Conclusion: These results demonstrate the significant association between metacognitive beliefs, accompanying emotional symptoms and perceived cognitive flexibility in adolescents with CUD. Our findings highlight the importance of addressing these psychological correlates during treatment planning. Interventions targeting not only substance use reduction but also these associated cognitive and metacognitive factors may be beneficial for improving treatment outcomes.

Background: This study aimed to compare serum high mobility group box-1 (HMGB1) and high-sensitivity C-reactive protein (hs-CRP) levels in individuals diagnosed with attention-deficit/hyperactivity disorder (ADHD) with those of a control group. Methods: The study included adolescents aged 12–18 years diagnosed with ADHD and healthy controls. Diagnostic assessment was performed using the K-SADS-PL interview; ADHD symptom severity was evaluated with the Turgay DSM-IV Disruptive Behavior Disorders Rating Scale (T-DSM-IV-S), and autism-like symptoms were assessed with the ASSQ. Serum HMGB1 and hs-CRP levels were measured by ELISA. Results: Serum HMGB1 levels in the ADHD group (21.17 ± 12.17 ng/mL) were significantly lower compared to the control group (36.37 ± 21.88 ng/mL) (p < 0.001). In contrast, hs-CRP levels did not differ between the groups (p = 0.888). No significant association was found between HMGB1 and ADHD symptom severity; however, a significant positive correlation was identified with the ASSQ communication problems subscale (r = 0.401, p = 0.013). ROC analysis revealed moderate discriminative power (AUC = 0.738, cut-off value = 24.50 ng/mL; sensitivity 68.9%, specificity 74.3%). Conclusions: Serum HMGB1 levels were lower in adolescents with ADHD than in healthy controls, whereas hs-CRP levels did not differ between groups. The association between HMGB1 and communication problems suggests a possible relationship with specific neurodevelopmental dimensions; however, these findings are preliminary and hypothesis-generating and require replication in larger pediatric samples.

Objectives: The primary objective of this study was to investigate the relationship between different types of sleep problems and specific behavioural difficulties in children and adolescents with autism spectrum disorder (ASD), compared with typically developing children (TDC). Method: We compared 40 children and adolescents with ASD and normal intellectual functioning with 50 TDC using the Sleep Disturbance Scale for Children (SDSC), the Conners' Parent Rating Scale‐Revised Short (CPRS‐RS) and the Repetitive Behaviour Scale‐Revised (RBS‐R). Results: Participants with ASD had significantly higher scores on CPRS‐RS inattention, hyperactivity and stereotyped, self‐injurious, compulsive, routine, sameness and restricted behaviours, in addition to higher RBS‐R scores. The ASD group also scored higher on the SDSC initiating and maintaining sleep subscale. Correlation analyses demonstrated significant associations between repetitive behaviours and multiple domains of sleep disturbances in the ASD group, whereas no significant correlations remained after Bonferroni correction in the TDC group. Regression analyses revealed that sleep breathing problems were associated with RBS‐R Total ( β = 0.590, p = 0.001); arousal/waking with compulsive behaviours ( β = 0.394, p = 0.014); and sameness behaviours with both timing ( β = 0.542, p = 0.012) and overall sleep problems ( β = 0.516, p = 0.002) in the ASD group. Conclusions: In this study, sameness behaviours, compulsive behaviours and total RBS‐R scores were significantly associated with several sleep problems in children and adolescents with ASD. These findings add to the literature demonstrating robust associations between specific types of sleep problems and particular behavioural difficulties in this population.

Objective: This study aimed to evaluate serum levels of the microglia‐regulating cytokines IL‐34 and CSF‐1, as well as T‐helper cytokines IL‐12, IFN‐γ, IL‐4, IL‐10, TGF‐β, IL‐17 and IL‐23, in individuals with autism and healthy controls, and to investigate the relationships between these parameters and the severity of autism symptoms. Methods: The study sample consisted of 42 children diagnosed with autism spectrum disorder (ASD) and 40 healthy participants. The severity of autism in the patient group was assessed using the Childhood Autism Rating Scale (CARS). Serum levels of IL‐34, CSF‐1, IL‐12, IFN‐γ, IL‐4, IL‐10, TGF‐β, IL‐17 and IL‐23 were measured using the ELISA method. Results: Serum levels of IL‐34, CSF‐1, IFN‐γ, IL‐4, IL‐10 and IL‐17 were significantly higher in the ASD group compared to the control group. IL‐34, CSF‐1, IFN‐γ, IL‐4, IL‐10 and IL‐17 showed significant discriminative power in distinguishing ASD ( p < 0.05). ROC analysis indicated that IL‐10 had the highest area under the curve (AUC = 0.743; p < 0.001), and Delong test results demonstrated that its discriminative ability was statistically stronger than that of the other parameters. No significant correlations were observed between the examined cytokine levels and autism severity. Conclusion: Our findings indicate that IL‐34 and CSF‐1, along with T‐helper–related cytokines (IFN‐γ, IL‐4, IL‐10 and IL‐17), were elevated in the ASD group. These alterations may reflect underlying pathophysiological processes. However, due to the cross‐sectional design and limited sample size, the findings should be interpreted with caution, and their clinical utility requires further investigation in larger, longitudinal studies.

Background: Migration can have significant psychological and social impacts on adolescents. This study aimed to determine the prevalence of migration history in adolescents and to examine the relationship between migration and depression levels, body image, and peer relationships. Methods: The study included 211 adolescents aged 10–18 years without chronic medical illnesses. Participants were compared with those with and without a migration history in terms of depression levels, peer relationships, body image, and smoking. Results: 31.3% of the participants were found to have a migration history. No significant difference was found in depression scores between the groups with and without a migration history (p>0.05). However, adolescents with a migration history were found to have more negative peer relationships (p=0.02) and to engage in regular exercise more frequently (p=0.012). Furthermore, depression scores were found to increase with increasing age at migration. Conclusion: This study suggests that migration is not a direct determining factor in depression in adolescents; However, it has been observed to negatively impact peer relationships. Participation in sports activities is thought to be protective against the negative effects of migration on mental health. Based on these findings, it is recommended that migration history be considered in mental health assessments for adolescents and that social support mechanisms be strengthened. Findings highlight the need for psychosocial screening in pediatric clinical settings.

Objective: Social safeness and pleasure play an important role in adolescent mental health and are influenced by early attachment experiences. In recent years, exposure to phubbing has emerged as a potential digital risk that may negatively affect these functions. This study examines the mediating effect of perceived phubbing on the relationship between parental attachment and adolescents’ social safeness and pleasure. Methods: A cross-sectional study was conducted with 138 adolescents (Mean age = 16.2 ± 1.03 years) recruited from an outpatient child and adolescent psychiatry clinic.Participants completed the Social Safeness and Pleasure Scale, the Generic Scale of Being Phubbed, and the Parent and Peer Attachment Scale. Structural equation modeling was used to test direct and indirect pathways. Results: Parental attachment was positively associated with social safeness and pleasure (β = 0.402, p < 0.001) and negatively associated with perceived phubbing (β = –0.376, p = 0.002). Perceived phubbing, in turn, predicted lower social safeness (β = –0.246, p = 0.012). Among phubbing dimensions, only the “feeling ignored” subscale significantly mediated the link between parental attachment and social safeness (indirect effect: β = 0.087, p = 0.033). The model accounted for 28.7% of the variance in social safeness and pleasure. Conclusions: Secure parental attachment appears to enhance adolescents’ social safeness and pleasure both directly and indirectly by reducing perceived phubbing—particularly feelings of being ignored. This study provides a unique theoretical contribution to the literature by placing phubbing, a digital interaction pattern, within an attachment-based framework.

Background: Emerging evidence suggests that dysregulated immune homeostasis may play a role in the pathophysiology of ADHD; however, comprehensive profiling of T-helper (Th) cell subsets and microglial regulatory cytokines remains limited. Methods: This cross-sectional study included adolescents aged 12 to 18 years with ADHD ( n = 45) and healthy controls ( n = 41). Serum levels of Th1 (IL-12 and IFN-γ), Th2 (IL-4), Th17 (IL-17 and IL-23), Treg (IL-10 and TGF-β), and microglia regulatory cytokines (IL-34 and CSF-1) were measured by ELISA. ROC curve and logistic regression analyses were performed to determine the diagnostic and predictive value of the parameters in distinguishing ADHD. Results: Significant increases in IL-12, IL-17, IL-23, IL-4, and IL-10 levels were observed in the ADHD group compared to the control group. IL-12 and IL-17 showed the highest diagnostic yield (AUC = 0.77). IL-12 remained a strong independent predictor in multivariate analysis (OR = 55.88, P = .015). IFN-γ and TGF-β did not differ significantly between the groups. CSF-1 levels did not differ between the groups, while IL-34 showed an increase that approached statistical significance in the ADHD group ( P = .052; AUC = 0.622). Conclusions: Our results reveal a profile of Th1/Th17-dominated proinflammatory activation, partially compensatory Th2/Treg modulation, and potentially IL-34-mediated microglial divergence in ADHD. IL-12 and IL-17 showed the highest discriminatory performance; however, their AUC values (~0.77) remained at a moderate level. Our findings highlight the need for multidimensional immunophenotyping and point toward novel immune-targeted therapeutic strategies.