Kristin Romvig Øvergaard

• Ørbeck, Beate; Manassis, Katharina; Kristensen, Hanne & Øvergaard, Kristin Romvig (2026). Youth with selective mutism: a nationwide patient registry study. European Child and Adolescent Psychiatry. ISSN 1018-8827. doi: 10.1007/s00787-026-03211-3.
• Ørbeck, Beate; Helland, Ingrid B; Adams, Heather R. & Øvergaard, Kristin Romvig (2026). Behavioral and emotional symptoms and quality of life in a national sample of individuals with CLN3 Batten disease. Orphanet Journal of Rare Diseases. 21(1). doi: 10.1186/s13023-026-04436-w. Full text in Research Archive Show summary

  Background CLN3 Batten disease, also known as Juvenile Neuronal Ceroid Lipofuscinosis, is a childhood-onset neurodegenerative disorder caused by mutations in the CLN3 gene, frequently accompanied by emotional and behavioral symptoms. Although these symptoms and a reduced quality of life have been previously reported in individuals with CLN3 disease and their parents, no published comparisons with siblings exist. Furthermore, age and sex differences require further study. In a nationally representative sample (n = 20, age 7-29 years), the present study applied the ASEBA Behavior Checklists, the Inventory of Life Quality to examine the prevalence of emotional and behavioral problems and quality of life in affected individuals and sibling controls. Additionally, we assessed parental quality of life using the Satisfaction With Life Scale. Results We found that individuals with CLN3 disease scored in the borderline clinical range for the ASEBA total problem scores (mean 63.1, SD 11.6), whereas siblings fell within the normal variation range (mean 46.4, SD 11.4). A severely reduced quality of life was reported for both affected individuals and their parents, while siblings scored within the normal range. No significant sex differences were found. Despite facing significant challenges, families also reported strengths in their offspring: grit, determination and a sense of humor in affected individuals, and empathy and dutifulness in sibling controls. Conclusions This study underscores the significant emotional and behavioral challenges faced by individuals with CLN3 Batten disease, which affect the quality of life for them and their parents. These findings emphasize the need for targeted interventions for both the patients and their families.

• Ørbeck, Beate; Helland, Ingrid B; Adams, Heather R. & Øvergaard, Kristin Romvig (2026). Neurodevelopmental and Psychiatric Disorders and the Use of Psychotropic Medications in a National Sample of Individuals With Juvenile Neuronal Ceroid Lipofuscinosis. Journal of Child Neurology. ISSN 0883-0738. doi: 10.1177/08830738251413827. Full text in Research Archive
• Ørbeck, Beate; Helland, Ingrid B; Adams, Heather R. & Øvergaard, Kristin Romvig (2026). Neurodevelopmental and Psychiatric Disorders and the Use of Psychotropic Medications in a National Sample of Individuals With Juvenile Neuronal Ceroid Lipofuscinosis. Journal of Child Neurology. ISSN 0883-0738. doi: 10.1177/08830738251413827. Full text in Research Archive Show summary

  Juvenile neuronal ceroid lipofuscinosis, linked to mutations in the ceroid lipofuscinosis, neuronal 3 (CLN3) gene, is a childhood-onset neurodegenerative disorder. Although mood and behavioral symptoms are described in this group, it's unclear whether these meet diagnostic criteria. We investigated the occurrence of neurodevelopmental and psychiatric disorders in a nationally representative sample, using a semistructured psychiatric interview, as well as the use of psychotropic medication. Ten of 20 individuals met the criteria for one or more current diagnoses, with an additional 5 having past diagnoses, resulting in a lifetime occurrence in 15 individuals. Anxiety disorders were the most frequent diagnostic group, followed by neurodevelopmental disorders. Attention-deficit hyperactivity disorder was the most common single diagnosis. Subthreshold psychiatric symptoms were present in all individuals. Although psychiatric disorders were frequent, few used psychotropic medication. These findings underscore the need for routine monitoring of neurodevelopmental and psychiatric disorders in individuals with CLN3 and the provision of evidence-based treatments.

• Pérez, Tomás Fernando Varnet; Øvergaard, Kristin Romvig; Frigessi, Arnoldo & Biele, Guido (2025). Long-term effect of pharmacological treatment on academic achievement of Norwegian children diagnosed with ADHD: a target trial emulation. International Journal of Epidemiology. ISSN 0300-5771. 54(2), p. 1–11. doi: 10.1093/ije/dyaf010. Full text in Research Archive Show summary

  Background Attention-deficit/hyperactivity disorder (ADHD) is one of the most commonly diagnosed mental disorders in children. For many patients, treatment involves long-term medication in order to reduce symptoms, regulate behaviour, and, hopefully, improve school performance and achievement. However, there is little to no evidence to support a long-term effect on the latter complex outcomes. Methods We utilize a target trial framework to emulate a pretest–posttest control group design and estimate the intention-to-treat effect of ADHD medication on national test scores in children diagnosed with ADHD born between 2000 and 2007 in Norway. The data were obtained through linkage of Norwegian registries (NorPD, Norwegian Prescription Database; NPR, Norwegian Patient Registry; KUHR, Database for Control and Payment of Health Reimbursement; SSB, Statistics Norway; MBRN, Medical Birth Registry of Norway). Results The resulting analytic sample size consisted of 8548 children diagnosed with ADHD, with about 9% missingness in their grade eight national test scores. We find that initiating ADHD medication had a slight positive average effect on national test scores for all three domains: English, numeracy, and reading [standardized mean differences: 0.037 (95% compatibility interval (CI95), −0.003; 0.076), 0.063 (CI95, 0.016; 0.111), 0.071 (CI95, 0.030; 0.111), respectively]. Conclusion We conclude that the estimated long-term average effect of ADHD medication on learning, as measured by the Norwegian national tests, is not clinically relevant. Study strengths include the use of real-world data on ecologically valid and relevant outcomes and the robustness of results across model specifications. Limitations include possibility of unobserved confounding and lack of prescription data.

• Ingeborgrud, Christine Baalsrud; Oerbeck, Beate; Friis, Svein; Pripp, Are Hugo; Zeiner, Pål & Aase, Heidi [Show all 9 contributors for this article] (2024). Do maternal anxiety and depressive symptoms predict anxiety in children with and without ADHD at 8 years? European Child and Adolescent Psychiatry. ISSN 1018-8827. 33, p. 3169–3178. doi: 10.1007/s00787-024-02374-1. Full text in Research Archive Show summary

  Maternal anxiety and depression during pregnancy and early childhood have been associated with child anxiety and attention-deficit/hyperactivity disorder (ADHD). However, previous studies are limited by their short follow-up, few assessments of maternal symptoms, and by not including maternal and child ADHD. The present study aimed to fill these gaps by investigating whether maternal anxiety and depressive symptoms from pregnancy to child age 5 years increase the risk of child anxiety disorders at age 8 years. This study is part of the population-based Norwegian Mother, Father, and Child Cohort Study. Maternal anxiety and depressive symptoms were assessed by the Hopkins Symptom Checklist (SCL) six times from pregnancy through early childhood, and ADHD symptoms by the Adult Self-Report Scale (ASRS). At age 8 years (n = 781), symptoms of anxiety disorders and ADHD were assessed, and disorders classified by the Child Symptom Inventory-4. Logistic regression models estimated the risk of child anxiety depending on maternal symptoms. The mothers of children classified with an anxiety disorder (n = 91) scored significantly higher on the SCL (at all time points) and ASRS compared with the other mothers. In univariable analyses, maternal anxiety and/or depression and ADHD were associated with increased risk of child anxiety (odds ratios = 2.99 and 3.64, respectively), remaining significant in the multivariable analysis adjusted for covariates. Our findings link maternal anxiety, depression, and ADHD during pregnancy and early childhood to child anxiety at age 8 years.

• Øvergaard, Kristin Romvig; Ørbeck, Beate; Friis, Svein; Pripp, Are Hugo; Aase, Heidi & Ingeborgrud, Christine Baalsrud [Show all 7 contributors for this article] (2024). Functional Impairment Related to ADHD From Preschool to School Age. Journal of Attention Disorders. ISSN 1087-0547. 29(3), p. 220–230. doi: 10.1177/10870547241301179. Full text in Research Archive Show summary

  Objective: Children with ADHD often experience functional impairments across various aspects of daily life. This study addresses the dearth of longitudinal research on functional impairment trajectories from preschool to school age in children with symptoms of ADHD and comorbid disorders. Methods: We investigated the extent to which functional impairments were associated with ADHD symptoms, along with behavioral and anxiety symptoms, from age 3.5 to 8 years. Utilizing parent- and teacher-reported data, we analyzed associations between global impairment, and dimension scores (e.g., family; child quality of life (QoL); learning; play/leisure activities; and friends) and symptoms at ages 3.5 and 8 years (n = 783). Results: The mean parent global impairment score increased from 0.31 (standard deviation (SD) = 0.40) to 0.83 (SD = 0.63) from 3.5 to 8 years, while the teacher impairment scores slightly decreased. Specific parent impairment dimension scores, particularly QoL, learning, and friends, significantly increased. Preschool ADHD and comorbid behavioral symptoms reported by parents weakly predicted impairment at 8 years. By age 8 years, impairment and symptoms exhibited moderate to strong correlations for all impairment dimensions. Parents reported greater child impairment during school age across settings compared to preschool, while teachers’ impairment profiles remained consistent across ages. Conclusions: These findings suggest that parents perceive impairment as more pronounced at age 8 years and more strongly associated with symptoms of both ADHD and comorbid disorders than at age 3.5 years. Notably, for teachers, a robust correlation between inattention symptoms and learning impairment was observed, with substantially higher impairment scores reported for boys compared to girls.

• Ingeborgrud, Christine Baalsrud; Ørbeck, Beate; Friis, Svein; Pripp, Are Hugo; Aase, Heidi & Biele, Guido [Show all 8 contributors for this article] (2024). Low perceived social support in mothers during pregnancy and early childhood; associations with anxiety and ADHD symptoms in children at 3 and 8 years. Social Psychiatry and Psychiatric Epidemiology. ISSN 0933-7954. doi: 10.1007/s00127-024-02792-1. Full text in Research Archive Show summary

  Purpose Low perceived social support is associated with adverse effects on maternal mental health, and often coexists with other risk factors for offspring anxiety and attention-deficit/hyperactivity disorder (ADHD). We aimed to investigate whether low maternal social support during pregnancy and early childhood predicted anxiety and ADHD symptoms in children at ages 3.5 and 8 years. Methods This study is part of the longitudinal, population-based Norwegian Mother, Father, and Child Cohort Study. Mothers were queried about perceived social support twice during pregnancy, and again at child ages 18 months and 3 years. They were interviewed about their children’s symptoms of anxiety and ADHD at 3.5 years. At 8 years (n = 781), the Child Symptom Inventory-4 was used to identify children who fulfilled the criteria for anxiety disorders and ADHD. Logistic regression models estimated the risk of child anxiety and ADHD, depending on maternal social support. Results Low maternal social support predicted child anxiety symptoms at both ages 3.5 and 8 years as well as ADHD symptoms at 8 years. When including other maternal stressors and child risk factors, low maternal social support remained a significant predictor for child anxiety symptoms at 3.5 years, and there was a trend towards also predicting child anxiety and ADHD symptoms at 8 years. Conclusion The associations between low maternal social support and child symptoms of anxiety and ADHD found in the present study, suggest that focusing on mothers with low social support may hold significance for child symptoms years later.

• Mørdre, Marianne; Ørbeck, Beate; Hoel, Ragnhild & Øvergaard, Kristin Romvig (2024). Selektive spisemønstre hos barn og unge med autismespekterforstyrrelser – en systematisk litteraturoversikt. Tidsskrift for Den norske legeforening (Tidsskriftet). ISSN 0029-2001. 144(14). doi: 10.4045/tidsskr.24.0193. Full text in Research Archive
• Ingeborgrud, Christine Baalsrud; Ørbeck, Beate; Friis, Svein; Zeiner, Pål; Pripp, Are Hugo & Aase, Heidi [Show all 9 contributors for this article] (2023). Anxiety and depression from age 3 to 8 years in children with and without ADHD symptoms. Scientific Reports. 13(1). doi: 10.1038/s41598-023-42412-7. Full text in Research Archive Show summary

  Abstract Childhood anxiety and depressive symptoms may be influenced by symptoms of attention deficit/hyperactivity disorder (ADHD). We investigated whether parent- and teacher-reported anxiety, depressive and ADHD symptoms at age 3 years predicted anxiety disorders and/or depression in children with and without ADHD at age 8 years. This study is part of the longitudinal, population-based Norwegian Mother, Father and Child Cohort Study. Parents of 3-year-olds were interviewed, and preschool teachers rated symptoms of anxiety disorders, depression and ADHD. At age 8 years (n = 783), Child Symptom Inventory-4 was used to identify children who fulfilled the diagnostic criteria for anxiety disorders and/or depression (hereinafter: Anx/Dep), and ADHD. Univariable and multivariable logistic regression analyses were used. In the univariable analyses, parent-reported anxiety, depressive and ADHD symptoms, and teacher-reported anxiety symptoms at age 3 years all significantly predicted subsequent Anx/Dep. In the multivariable analyses, including co-occurring symptoms at age 3 years and ADHD at 8 years, parent-reported anxiety and depressive symptoms remained significant predictors of subsequent Anx/Dep. At age 3 years, regardless of ADHD symptoms being present, asking parents about anxiety and depressive symptoms, and teachers about anxiety symptoms, may be important to identify children at risk for school-age anxiety disorders and/or depression.

• Hall, Amber M.; Keil, Alexander P.; Choi, Giehae; Ramos, Amanda M.; Richardson, David B. & Olshan, Andrew F. [Show all 15 contributors for this article] (2023). Prenatal organophosphate ester exposure and executive function in Norwegian preschoolers. Environmental Epidemiology. 7(3), p. 1–9. doi: 10.1097/EE9.0000000000000251. Full text in Research Archive Show summary

  Background: Organophosphate esters (OPEs) are ubiquitous chemicals, used as flame retardants and plasticizers. OPE usage has increased over time as a substitute for other controlled compounds. This study investigates the impact of prenatal OPE exposure on executive function (EF) in preschoolers. Methods: We selected 340 preschoolers from the Norwegian Mother, Father, and Child Cohort Study. Diphenyl-phosphate (DPhP), di-n-butyl-phosphate (DnBP), bis(2-butoxyethyl) phosphate (BBOEP), and bis(1,3-dichloro-2-propyl) phosphate (BDCIPP) were measured in maternal urine. EF was measured using the Behavior Rating Inventory of Executive Functioning-Preschool (BRIEF-P) and the Stanford-Binet fifth edition (SB-5). EF scores were scaled so a higher score indicated worse performance. We estimated exposure-outcome associations and evaluated modification by child sex using linear regression. Results: Higher DnBP was associated with lower EF scores across multiple rater-based domains. Higher DPhP and BDCIPP were associated with lower SB-5 verbal working memory (β = 0.49, 95% CI = 0.12, 0.87; β = 0.53, 95% CI = 0.08, 1.02), and higher BBOEP was associated with lower teacher-rated inhibition (β = 0.34, 95% CI = 0.01, 0.63). DPhP was associated with lower parent-reported BRIEF-P measures in boys but not girls [inhibition: boys: 0.37 (95% CI = 0.03, 0.93); girls: –0.48 (95% CI = –1.27, 0.19); emotional control: boys: 0.44 (95% CI = –0.13, 1.26); girls: –0.83 (95% CI = –1.73, –0.00); working memory: boys: 0.49 (95% CI = 0.03, 1.08); girls: –0.40 (95% CI = –1.11, 0.36)]. Fewer sex interactions were observed for DnBP, BBOEP, and BDCIPP, with irregular patterns observed across EF domains. Conclusions: We found some evidence prenatal OPE exposure may impact EF in preschoolers and variation in associations by sex.

• Øvergaard, Kristin; Ørbeck, Beate; Friis, Svein; Pripp, Are Hugo; Aase, Heidi & Biele, Guido [Show all 9 contributors for this article] (2023). Early and repeated screening detects children with persistent attention-deficit/hyperactivity disorder. European Child and Adolescent Psychiatry. ISSN 1018-8827. doi: 10.1007/s00787-023-02284-8. Full text in Research Archive Show summary

  Abstract Preschool screening of attention-deficit/hyperactivity disorder (ADHD) has been found too inaccurate to be clinically useful. This may be due to the known instability of ADHD symptoms from preschool onwards, and the use of a single screening only. We hypothesized that by identifying a group of children with persistent ADHD from preschool to school age and repeating the screening, the clinical usefulness of screening would increase. This study is part of the prospective longitudinal, population-based Norwegian Mother, Father and Child Cohort Study, with a diagnostic parent interview at 3.5 years and follow-up with parent questionnaires at ages 5 and 8 years ( n  = 707). We identified a group classified with ADHD at all three time points (persistent ADHD). We then used the Child Behavior Checklist ADHD DSM-oriented scale at ages 3.5 and 5 years to investigate the accuracies of single- and two-stage screening at different thresholds to identify children with persistent ADHD. About 30% of the children were classified with ADHD at least once across time (at ages 3.5, 5, and/or 8 years), but only 4% ( n  = 30) had persistent ADHD. At all thresholds, the two-stage screening identified children with persistent ADHD more accurately than single screening, mainly due to a substantial reduction in false positives. Only a small group of children were classified with persistent ADHD from preschool to school age, underlining that future screening studies should distinguish this group from those with fluctuating symptoms when estimating screening accuracies. We recommend a two-stage screening process to reduce false positives.

• Øvergaard, Kristin; Ørbeck, Beate; Friis, Svein; Pripp, Are Hugo; Aase, Heidi & Biele, Guido [Show all 9 contributors for this article] (2022). Attention-deficit/hyperactivity disorder from preschool to school age: change and stability of parent and teacher reports. European Child and Adolescent Psychiatry. ISSN 1018-8827. doi: 10.1007/s00787-022-02019-1. Full text in Research Archive Show summary

  Abstract Identifying attention-deficit/hyperactivity disorder (ADHD) in pre-schoolers may improve their development if treated, but it is unclear whether ADHD symptoms from this age are stable enough to merit treatment. We aimed to investigate the stability of parent- and teacher-reported ADHD symptoms and ADHD classified above the diagnostic symptom thresholds, including for hyperactivity-impulsivity (HI), inattention and combined presentations from age 3 to 8 years. This study is part of the longitudinal, population-based Norwegian Mother, Father and Child Cohort Study. At child age 3 years, parents were interviewed and teachers rated ADHD symptoms. At age 8 years, parents ( n  = 783) and teachers ( n  = 335) reported ADHD symptoms by the Child Symptom Inventory-4. We found a significant reduction in the mean number of parent-reported ADHD and HI symptoms from age 3 to 8 years, but otherwise similar mean numbers. Parent-reported ADHD symptoms were moderately correlated between ages, while correlations were low for teachers. A total of 77/108 (71%) of the children classified with parent-reported HI presentation at age 3 years were no longer classified within any ADHD presentation at age 8 years, the only clear trend across time for either informant. There was a low to moderate parent–teacher-agreement in the number of reported symptoms, and very low informant agreement for the classified ADHD presentations. Overall, clinicians should exercise caution in communicating concern about HI symptoms in preschool children. Age 3 years may be too early to apply the ADHD diagnostic symptom criteria, especially if parents and teachers are required to agree.

• Thistle, Jake E.; Ramos, Amanda; Roell, Kyle R.; Choi, Giehae; Manley, Cherrel K. & Hall, Amber M. [Show all 16 contributors for this article] (2022). Prenatal organophosphorus pesticide exposure and executive function in preschool-aged children in the Norwegian Mother, Father and Child Cohort Study (MoBa). Environmental Research. ISSN 0013-9351. 212(Part D). doi: 10.1016/j.envres.2022.113555. Full text in Research Archive Show summary

  Introduction: Prenatal exposure to organophosphorus pesticides (OPPs) has been associated with neurodevelopmental deficits in children, however evidence linking OPPs with specific cognitive mechanisms, such as executive function (EF), is limited. Objective: This study aims to evaluate the association between prenatal exposure to OPPs with multiple measures of EF in preschool-aged children, while considering the role of variant alleles in OPP metabolism genes. Methods: We included 262 children with preschool attention-deficit/hyperactivity disorder (ADHD), and 78 typically developing children, from the Preschool ADHD substudy of the Norwegian, Mother, Father, and Child Cohort Study. Participants who gave birth between 2004 and 2008 were invited to participate in an on-site clinical assessment when the child was approximately 3.5 years; measurements of EF included parent and teacher rating on Behavior Rating Inventory of Executive Function-Preschool (BRIEF-P), and three performance-based assessments. We measured OPP metabolites in maternal urines collected at ∼17 weeks' gestation to calculate total dimethyl- (ΣDMP) and diethyl phosphate (ΣDEP) metabolite concentrations. We estimated multivariable adjusted β's and 95% confidence intervals (CIs) corresponding to a change in z-score per unit increase in log-ΣDMP/DEP. We further characterized gene-OPP interactions for maternal variants in PON1 (Q192R, M55L), CYP1A2 (1548T > C), CYP1A1 (IntG > A) and CYP2A6 (-47A > C). Results: Prenatal OPP metabolite concentrations were associated with worse parent and teacher ratings of emotional control, inhibition, and working memory. A one log-∑DMP increase was associated with poorer teacher ratings of EF on the BRIEF-P (e.g. emotional control domain: β = 0.55, 95% CI: 0.35, 0.74), when weighted to account for sampling procedures. We found less consistent associations with performance-based EF assessments. We found some evidence of modification for PON1 Q192R and CYP2A6 -47A > C. Association with other variants were inconsistent. Conclusions: Biomarkers of prenatal OPP exposure were associated with more adverse teacher and parent ratings of EF in preschool-aged children.

• Hall, Amber M.; Ramos, Amanda M.; Drover, Samantha S. M.; Choi, Giehae; Keil, Alexander P. & Richardson, David B. [Show all 16 contributors for this article] (2022). Gestational organophosphate ester exposure and preschool attention-deficit/hyperactivity disorder in the Norwegian Mother, Father, and Child cohort study. International Journal of Hygiene and Environmental Health. ISSN 1438-4639. 248. doi: 10.1016/j.ijheh.2022.114078. Full text in Research Archive
• Biele, Guido; Øvergaard, Kristin Romvig; Friis, Svein; Zeiner, Pål & Aase, Heidi (2022). Cognitive, emotional, and social functioning of preschoolers with attention deficit hyperactivity problems. BMC Psychiatry. 22. doi: 10.1186/s12888-021-03638-9. Full text in Research Archive
• Ørbeck, Beate; Berntsen, Hans Jørgen & Øvergaard, Kristin (2022). Hvor nøyaktig identifiserer screeninginstrumentet Social Communication Questionnaire autismespekterforstyrrelser i BUP? Tidsskrift for Norsk psykologforening (Psykologtidsskriftet). ISSN 0332-6470. 59(9), p. 810–817. doi: 10.52734/4853DTCx. Full text in Research Archive Show summary

  Background: The accuracy of the Norwegian Social Communication Questionnaire (SCQ) in identifying autism spectrum disorder (ASD) within child psychiatry is not known. Method: We investigated the accuracy of SCQ in identifying clinically diagnosed ASD and ASD classified by the Developmental, Dimensional and Diagnostic Interview (3Di) and the Autism Diagnostic Observation Schedule (ADOS-2). Results: The SCQ cut-off of 15 showed low sensitivity (Se) for correct classification of clinically diagnosed ASD (Se = 38%) and ADOS-2 classified ASD (Se = 30%) with 78% and 76% specificity (SP), respectively. For 3Di classified ASD, Se was somewhat higher (49%) and had good specificity (86%), with the best positive predictive value (.73). Conclusions/Implications: The SCQ showed low accuracy in identifying a clinical ASD diagnosis in child psychiatry. However, children with SCQ scores at or above threshold had a high risk of also being categorised with ASD according to the 3Di. We recommend that future studies include more detailed information about the basis for the final diagnostic conclusions. Furthermore, SCQ's characteristics should be evaluated in samples of children within a broad range of ASD that includes individuals with delayed development. Investigation of the suitability of other screening instruments for ASD for diagnostic work in child psychiatric clinics is also needed. Keywords: Autism Diagnostic Observation Schedule (ADOS-2), Developmental, Dimensional and Diagnostic Interview (3Di), sensitivity; specificity, Social Communication Questionnaire (SCQ)

• Manley, Cherrel K.; Villanger, Gro Dehli; Thomsen, Cathrine; Mancineiras, Enrique Cequier; Sakhi, Amrit Kaur & Reichborn-Kjennerud, Ted [Show all 16 contributors for this article] (2022). Prenatal Exposure to Organophosphorus Pesticides and Preschool ADHD in the Norwegian Mother, Father and Child Cohort Study. International Journal of Environmental Research and Public Health (IJERPH). ISSN 1661-7827. 19(13), p. 1–16. doi: 10.3390/ijerph19138148. Full text in Research Archive Show summary

  Prenatal organophosphorus pesticide (OPP) exposure has been associated with child attention-deficit/hyperactivity disorder (ADHD) in agricultural communities and those that are exposed to residentially applied insecticides. To examine this association in populations that are exposed primarily through diet, we estimate the associations between prenatal OPP exposure and preschool ADHD in the Norwegian Mother, Father and Child Cohort Study (MoBa), and describe modification by paraoxonase 1 (PON1) gene variants. We used participants from the MoBa Preschool ADHD Sub-study (n = 259 cases) and a random sample of MoBa sub-cohort participants (n = 547) with birth years from 2004 to 2008. Prenatal urinary dialkylphosphate (DAP) metabolites (total diethylphosphate [∑DEP] and total dimethylphosphate [∑DMP]) were measured by an ultra-performance liquid chromatography-time-of-flight system and summed by molar concentration. Maternal DNA was genotyped for coding variants of PON1 (Q192R and L55M). We used a multivariable logistic regression to calculate the odds ratios (OR) and 95% confidence intervals, adjusted for maternal education, parity, income dependency, age, marital status, ADHD-like symptoms, pesticide use, produce consumption, and season. We found no associations between DAP metabolite concentrations and preschool ADHD. The adjusted ORs for exposure quartiles 2–4 relative to 1 were slightly inverse. No monotonic trends were observed, and the estimates lacked precision, likely due to the small sample size and variation in the population. We found no evidence of modification by PON1 SNP variation or child sex. Maternal urinary DAP concentrations were not associated with preschool ADHD.

• Biele, Guido; Lekhal, Ratib; Øvergaard, Kristin Romvig; Wang, Mari Vaage; Brandlistuen, Ragnhild Eek & Friis, Svein [Show all 7 contributors for this article] (2022). The effect of special educational assistance in early childhood education and care on psycho-social difficulties in elementary school children. Child and Adolescent Psychiatry and Mental Health (CAPMH). 16. doi: 10.1186/s13034-022-00442-5. Full text in Research Archive Show summary

  Background Three to seven percent of pre-schoolers have developmental problems or child psychiatric disorders. Randomized controlled trials (RCTs) indicate that interventions in early childhood education and care (ECEC) improve long-term outcomes of children from disadvantaged backgrounds. It is unknown if such effects generalize beyond the well-structured context of RCTs and to children who may not have a disadvantaged background but have developmental problems or psychiatric disorders. Methods We used data from the population-based Norwegian Mother, Father and Child Cohort Study, recruiting pregnant women from 1999 to 2009, with child follow-up from ages 6, 18, and 36 months to ages 5, 7, and 8 years. This sub-study included 2499 children with developmental problems or psychiatric disorders at age five. We investigated the effects of special educational assistance at age five on mother-reported internalizing, externalizing, and communication problems at age eight. We analysed bias due to treatment by indication with directed acyclic graphs, adjusted for treatment predictors to reduce bias, and estimated effects in different patient groups and outcome domains with a hierarchical Bayesian model. Results In the adjusted analysis, pre-schoolers who received special educational assistance had on average by 0.1 (0.04–0.16) standardised mean deviation fewer psycho-social difficulties in elementary school. Conclusion In a sample of children from mostly higher socioeconomic backgrounds we estimate a positive effects of special educational assistance during the transition from preschool to the school years. It may therefore be considered as an intervention for pre-schoolers with developmental or behaviour problems. More research with improved measurements of treatment and outcomes is needed to solidify the findings and identify success factors for the implementation of special educational assistance in ECEC.

• Øvergaard, Kristin Romvig; Ørbeck, Beate; Friis, Svein; Pripp, Are Hugo; Aase, Heidi & Zeiner, Pål (2021). Predictive validity of attention-deficit/hyperactivity disorder from ages 3 to 5 Years. European Child and Adolescent Psychiatry. ISSN 1018-8827. 31, p. 1093–1102. doi: 10.1007/s00787-021-01750-5. Full text in Research Archive Show summary

  We investigated to what extent parent-rated attention-deficit/hyperactivity disorder (ADHD) and impairment at age 3 years predicted elevated ADHD symptoms at age 5 years, and whether teacher-rated ADHD symptoms improved these predictions. This study is part of the longitudinal, population-based Norwegian Mother, Father and Child Cohort Study. Parents of 3-year-old children (n = 1195) were interviewed about ADHD and impairment, and teachers rated child ADHD symptoms by the Strengths and Difficulties Questionnaire or the Early Childhood Inventory-4. At 5 years of age, the children (n = 957) were classified as ADHD-positive or -negative using Conners’ Parent Rating Scale. Relying solely on parent-rated ADHD or impairment at age 3 years did moderately well in identifying children with persistent elevation of ADHD symptoms, but gave many false positives (positive predictive values (PPVs): .40–.57). A small group of children (n = 20, 13 boys) scored above cut-off on both parent-rated ADHD and impairment, and teacher-rated ADHD symptoms, although adding teacher-rated ADHD symptoms slightly weakened the predictive power for girls. For this small group, PPVs were .76 for boys and .64 for girls. Limiting follow-up to these few children will miss many children at risk for ADHD. Therefore, we recommend close monitoring also of children with parent-reported ADHD symptoms and/or impairment to avoid delay in providing interventions. Clinicians should also be aware that teachers may miss ADHD symptoms in preschool girls.

• Berntsen, Hans Jørgen; Ørbeck, Beate & Øvergaard, Kristin Romvig (2021). Utredning av autismeforstyrrelser i BUP - Hvor godt samsvar er det mellom instrumenter og endelig klinisk diagnose? Tidsskrift for Norsk psykologforening (Psykologtidsskriftet). ISSN 0332-6470. 58(10), p. 848–854. doi: 10.52734/N27qU88p. Full text in Research Archive
• Choi, Giehae; Villanger, Gro Dehli; Drover, Samantha S.M.; Sakhi, Amrit Kaur; Thomsen, Cathrine & Nethery, Rachel C. [Show all 15 contributors for this article] (2021). Prenatal phthalate exposures and executive function in preschool children. Environment International. ISSN 0160-4120. 149. doi: 10.1016/j.envint.2021.106403. Full text in Research Archive Show summary

  Background Prenatal phthalate exposure has been linked with altered neurodevelopment, including externalizing behaviors and attention-deficit hyperactivity disorder (ADHD). However, the implicated metabolite, neurobehavioral endpoint, and child sex have not always been consistent across studies, possibly due to heterogeneity in neurodevelopmental instruments. The complex set of findings may be synthesized using executive function (EF), a construct of complex cognitive processes that facilitate ongoing goal-directed behaviors. Impaired EF can be presented with various phenotypes of poor neurodevelopment, differently across structured conditions, home/community, or preschool/school. We evaluated the relationship between prenatal phthalate exposure and comprehensive assessment of preschool EF. Methods Our study comprised 262 children with clinically significant/subthreshold ADHD symptoms and 78 typically developing children who were born between 2003 and 2008 and participated in the Preschool ADHD Substudy, which is nested within a population-based prospective cohort study, the Norwegian Mother, Father, and Child Cohort (MoBa). Twelve phthalate metabolites were measured from urine samples that their mothers had provided during pregnancy, at 17 weeks’ gestation. All children, at approximately 3.5-years, took part in a detailed clinical assessment that included parent-and teacher-rated inventories and administered tests. We used instruments that measured constructs related to EF, which include a parent-and teacher-reported Behavior Rating Inventory of Executive Function-Preschool (BRIEF-P) and three performance-based tests: A Developmental NEuroPSYchological Assessment (NEPSY), Stanford-Binet intelligence test V (SB5), and the cookie delay task (CDT). The standard deviation change in test score per interquartile range (IQR) increase in phthalate metabolite was estimated with multivariable linear regression. We applied weighting in all models to account for the oversampling of children with clinically significant or subthreshold symptoms of ADHD. Additionally, we assessed modification by child sex and potential co-pollutant confounding. Results Elevated exposure to mono-benzyl phthalate (MBzP) during pregnancy was associated with poorer EF, across all domains and instruments, in both sex. For example, an IQR increase in MBzP was associated with poorer working memory rated by parent (1.23 [95% CI: 0.20, 2.26]) and teacher (1.13 [0.14, 2.13]) using BRIEF-P, and administered tests such as SB5 (no-verbal: 0.19 [0.09, 0.28]; verbal: 0.13 [0.01, 0.25]). Adverse associations were also observed for mono-n-butyl phthalate (MnBP) and mono-iso-butyl phthalate (MiBP), although results varied by instruments. EF domains reported by parents using BRIEF-P were most apparently implicated, with stronger associations among boys (e.g., MnBP and inhibition: 2.74 [1.77, 3.72]; MiBP and inhibition: 1.88 [0.84, 2.92]) than among girls (e.g., MnBP and inhibition: −0.63 [−2.08, 0.83], interaction p-value: 0.04; MiBP and inhibition: −0.15 [−1.04, 0.74], interaction p-value: 0.3). Differences by sex, however, were not found for the teacher-rated BRIEF-P or administered tests including NEPSY, SB5, and CDT. Conclusion and relevance Elevated mid-pregnancy MBzP, MiBP, and MnBP were associated with more adverse profiles of EF among preschool-aged children across a range of instruments and raters, with some associations found only among boys. Given our findings and accumulating evidence of the prenatal period as a critical window for phthalate exposure, there is a timely need to expand the current phthalate regulations focused on baby products to include pregnancy exposures.

• Kamai, Elizabeth M.; Villanger, Gro Dehli; Nethery, Rachel C.; Thomsen, Cathrine; Sakhi, Amrit Kaur & Drover, Samantha S.M. [Show all 14 contributors for this article] (2021). Gestational Phthalate Exposure and Preschool Attention Deficit Hyperactivity Disorder in Norway. Environmental Epidemiology. 5(4). doi: 10.1097/EE9.0000000000000161. Full text in Research Archive Show summary

  Prenatal phthalate exposure has been linked to altered neurobehavioral development in both animal models and epidemiologic studies, but whether or not these associations translate to increased risk of neurodevelopmental disorders is unclear. We used a nested case-cohort study design to assess whether maternal urinary concentrations of 12 phthalate metabolites at 17 weeks gestation were associated with criteria for Attention Deficit Hyperactivity Disorder (ADHD) classified among 3-year-old children in the Norwegian Mother, Father and Child Cohort Study (MoBa). Between 2007 and 2011, 260 children in this substudy were classified with ADHD using a standardized, on-site clinical assessment; they were compared with 549 population-based controls. We modeled phthalate levels both linearly and by quintiles in logistic regression models adjusted for relevant covariates and tested for interaction by child sex. Children of mothers in the highest quintile of di-iso-nonyl phthalate (∑DiNP) metabolite levels had 1.70 times the odds of being classified with ADHD compared with those in the lowest quintile (95% confidence interval [CI] = 1.03 to 2.82). In linear models, there was a trend with the sum of di-2-ethylhexyl phthalate metabolites (∑DEHP); each natural log-unit increase in concentration was associated with 1.22 times the odds of ADHD (95% CI = 0.99 to 1.52). In boys, but not girls, mono-n-butyl phthalate exposure was associated with increased odds of ADHD (odds ratio [OR] 1.42; 95% CI = 1.07 to 1.88). Additional adjustment for correlated phthalate metabolites attenuated estimates. These results suggest gestational phthalate exposure may impact the behavior of children as young as 3 years.

• Ørbeck, Beate; Øhre, Beate; Zeiner, Pål; Pripp, Are Hugo; Wagner, Karine & Øvergaard, Kristin Romvig (2021). What can a national patient registry tell us about psychiatric disorders and reasons for referral to outpatient services in youth with hearing loss? Nordic Journal of Psychiatry. ISSN 0803-9488. doi: 10.1080/08039488.2021.1979095. Full text in Research Archive Show summary

  Background: Studies of reasons for referral to the Child and Adolescent Mental Health Services (CAMHS) and subsequent psychiatric disorders are missing in youth with Hearing loss (HL). Aims: To examine the referral reasons to CAMHS and the clinically diagnosed psychiatric disorders in youth with HL among the nationally representative population. Methods: The study population was a youth with HL referred to CAMHS and registered in the national Norwegian Patient Registry (NPR) during the years 2011–2016. The results were also compared with some data published from CAMHS for the General Youth Population (GenPop). Results: Among youth with HL, 18.1% had also been referred to CAMHS compared to about 5% in GenPop, at mean age 9.1 years, >70% before age 13 years vs. 46% in the GenPop. Boys with HL comprised 57% and were referred about two years earlier than girls with HL. Compared to the GenPop, youth with HL were referred more frequently for suspected neurodevelopmental- and disruptive disorders, and less frequently for suspected emotional disorders. Girls with HL were referred for suspected Attention-Deficit/Hyperactivity Disorder (ADHD) at about the same rate as boys with HL in the 7–12 year age group. The most frequently registered psychiatric disorders were ADHD: 29.8%, anxiety disorders: 20.4%, and autism spectrum disorders: 11.0%, while disruptive disorders constituted about 5.0%. Conclusions: Youth with HL were referred to CAMHS more often, but earlier than the GenPop, mostly due to ADHD disorders. Although more rarely referred for suspected anxiety disorders, these were frequently diagnosed, suggesting that anxiety was not recognized at referral in youth with HL

• Oerbeck, Beate; Overgaard, Kristin Romvig; Hjellvik, Vidar; Lien, Lars & Bramness, Jørgen G (2021). The Use of Antidepressants, Antipsychotics, and Stimulants in Youth Residential Care. Journal of child and adolescent psychopharmacology. ISSN 1044-5463. 31(5), p. 350–357. doi: 10.1089/cap.2020.0123. Full text in Research Archive Show summary

  Objectives: To assess the use of three commonly prescribed psychotropic medications in youth placed in residential care (RC). Methods: Participants were youth aged 0-20 years placed in RC institutions at least once during 2016. Data on filled prescriptions were taken from the Norwegian Prescription Database to compare the use of antidepressants, antipsychotics, and stimulants in RC with the age and gender adjusted general child population (GenPop) and how this co-varied with reasons for RC placement, age and gender. Results: 1856 children and adolescents were identified in RC, with mean age 14 (range 0-20 years), 46% girls, 81% ≥13 years. Among those, 423 or 23% used any of the three psychotropics, significantly more than the 3.7% in GenPop. The prevalence ratios RC/GenPop were 6.6 for antidepressants, 17.9 for antipsychotics, and 4.4 for stimulants. The median number of days per year for the dispensed defined daily doses varied from 8.3 to 244.0 for the different antipsychotics, indicating short time use for most. Polypharmacy was not frequent in RC, as only 26% used ≥ 2 classes of medication, but still significantly more frequent than the 10% in GenPop. Youth placed in RC for serious behavior problems had significantly higher use of stimulants than those with other placement reasons. Psychotropics were not used below age 6 years, and while the use of antidepressants and antipsychotics overall increased with age, stimulants were mostly used by 6 to16 year olds. The girl/boy ratio for any psychotropic medication use in RC was 1.4 (CI: 1.1-1.6), significantly higher than the corresponding ratio in GenPop: 1.0 (CI: 0.9-1.0). Conclusion: The present findings do not necessarily suggest an overtreatment with medication in RC. However, the frequent short-term use of antipsychotics, presumably for non-psychotic symptoms, is a concern, as it may reflect that the youth are not provided with the recommended first-line psychological treatments.

• Ørbeck, Beate; Øvergaard, Kristin Romvig; Attwood, Tony & Bjåstad, Jon Fauskanger (2021). “Less stress”: a pilot study on a cognitive behavioral treatment program for anxiety in children with autism spectrum disorders. Scandinavian Journal of Child and Adolescent Psychiatry and Psychology. 09, p. 30–40. doi: 10.21307/sjcapp-2021-005. Full text in Research Archive Show summary

  Background: Comorbid anxiety disorders are prevalent in children with autism spectrum disorders (ASD), but only a minority receives adequate treatment for anxiety. Cognitive behavioral therapy (CBT) has been shown to be effective in treating anxiety disorders. The objectives of the present pilot study were to test the feasibility of the CBT program “Less stress” for comorbid anxiety disorders in children with ASD and explore whether an improvement in diagnostic outcomes for anxiety disorders and symptoms of anxiety was found after treatment. Method: Participants were ten children diagnosed with ASD and anxiety disorders (eight boys, mean age = 9.5 years, range 8 - 12 years). The ”Less Stress” program includes three months of weekly treatment sessions followed by three monthly booster sessions. Five therapists participated. A standardized semi-structured diagnostic interview with the mothers was used to assess comorbid disorders. Child anxiety symptoms were measured with the Revised Child Anxiety and Depression Scale (RCADS). Results: The therapists found the manual easy to use but adaptations were necessary, particularly shorter sessions due to frequent (n = 7) comorbid Attention-Deficit/Hyperactivity Disorder. The participants found the program useful and the parents noted that they had learned methods they could continue using after the end of the program. Eight of ten children completed the treatment. Seven of the eight completers benefited from the program. Five of those seven children were free from all anxiety disorders, while two had fewer anxiety disorders. On a group level, a significant mean reduction of anxiety symptoms (RCADS) was found after treatment. Conclusions: The therapists found the “Less stress” program to be a feasible intervention in a sample of children with ASD and comorbid anxiety. The significant reduction of anxiety after treatment is promising, but a replication in a larger and more rigorous study is needed to investigate the effectiveness of the intervention.

• Overgaard, Kristin Romvig; Ørbeck, Beate; Wagner, Karine; Friis, Svein; Øhre, Beate & Zeiner, Pål (2021). Youth with hearing loss: Emotional and behavioral problems and quality of life. International Journal of Pediatric Otorhinolaryngology. ISSN 0165-5876. 145. doi: 10.1016/j.ijporl.2021.110718. Full text in Research Archive
• Ørbeck, Beate; Furu, Kari; Zeiner, Pål; Aase, Heidi; Reichborn-Kjennerud, Ted & Pripp, Are Hugo [Show all 7 contributors for this article] (2020). Child and Parental Characteristics of Medication Use for Attention-Deficit/Hyperactivity Disorder. Journal of child and adolescent psychopharmacology. ISSN 1044-5463. 30(7), p. 456–464. doi: 10.1089/cap.2019.0019. Full text in Research Archive Show summary

  Objectives: To investigate child and parental characteristics of medication use for attention-deficit/hyperactivity disorder (ADHD). Methods: Participants were part of the prospective population-based Norwegian Mother, Father and Child Cohort study (MoBa) (n = 114,500 children, 95,000 mothers, and 75,000 fathers). This cohort was linked to the Norwegian Prescription Database (NorPD) and the Norwegian Patient Registry (NPR) to compare child and parental characteristics in children medicated and not medicated for ADHD during years 2008–2013. Results: One thousand seven hundred and sixty-four children (74% boys) with ADHD (International Classification of Diseases [ICD-10]: F90 and F98.8) were identified. One thousand three hundred and sixty-two (77%) used medication. Boys and girls did not differ in the use of ADHD medication (both 77%). Mean age at first prescription was 9 years in both boys and girls, and age at ADHD diagnosis was 8 years in medicated and unmedicated children. Significantly more hyperkinetic conduct disorders (F90.1), and significantly fewer with attention-deficit disorder (F98.8) were found among the medicated children compared to the unmedicated children. The medicated children also had a significantly lower global functioning (Child Global Assessment Scale). Child disruptive symptoms reported in the MoBa child age 3 year questionnaire were significantly higher in children who used medication compared to the nonusers (t = 2.2, p = 0.03), and group differences in ADHD symptoms at age 3 years were close to significant (t = 1.8, p = 0.07). Other preschool child and parental characteristics were not significantly different in the two groups. Conclusion: In this large birth cohort study, where a great majority of children with ADHD used medication, only child characteristics were significantly associated with the use of medication. We could not replicate previous findings suggesting that “environmental factors,” such as parental education and psychopathology, drive medication use. The small differences between medicated and unmedicated children in this cohort study, where a majority used medication, might be due to strong established clinical practices where medication is offered as a treatment option, particularly for hyperkinetic conduct disorder in an egalitarian high-income society.

• Villanger, Gro Dehli; Drover, Samantha S.M.; Nethery, Rachel C.; Thomsen, Cathrine; Sakhi, Amrit Kaur & Øvergaard, Kristin Romvig [Show all 11 contributors for this article] (2020). Associations between urine phthalate metabolites and thyroid function in pregnant women and the influence of iodine status. Environment International. ISSN 0160-4120. 137. doi: 10.1016/j.envint.2020.105509. Full text in Research Archive Show summary

  Background Human populations, including susceptible subpopulations such as pregnant women and their fetuses, are continuously exposed to phthalates. Phthalates may affect the thyroid hormone system, causing concern for pregnancy health, birth outcomes and child development. Few studies have investigated the joint effect of phthalates on thyroid function in pregnant women, although they are present as a mixture with highly inter-correlated compounds. Additionally, no studies have investigated if the key nutrient for thyroid health, iodine, modifies these relationships. Methods In this study, we examined the cross-sectional relationships between concentrations of 12 urinary phthalate metabolites and 6 plasma thyroid function biomarkers measured mid-pregnancy (~17 week gestation) in pregnant women (N = 1072), that were selected from a population-based prospective birth cohort, The Norwegian Mother, Father and Child Cohort study (MoBa). We investigated if the phthalate metabolite-thyroid function biomarker associations differed by iodine status by using a validated estimate of habitual dietary iodine intake based on a food frequency questionnaire from the 22nd gestation week. We accounted for the phthalate metabolite mixture by factor analyses, ultimately reducing the exposure into two uncorrelated factors. These factors were used as predictors in multivariable adjusted linear regression models with thyroid function biomarkers as the outcomes. Results Factor 1, which included high loadings for mono-iso-butyl phthalate (MiBP), mono-n-butyl phthalate (MnBP), and monobenzyl phthalate (MBzP), was associated with increased total triiodothyronine (TT3) and free T3 index (fT3i). These associations appeared to be driven primarily by women with low iodine intake (<150 µg/day, ~70% of our sample). Iodine intake significantly modified (p-interaction < 0.05) the association of factor 1 with thyroid stimulating hormone (TSH), total thyroxine (TT4) and free T4 index (fT4i), such that only among women in the high iodine intake category (≥150 µg/day, i.e. sufficient) was this factor associated with increased TSH and decreased TT4 and FT4i, respectively. In contrast, factor 2, which included high loadings for di-2-ethylhexyl phthalate metabolites (∑DEHP) and di-iso-nonyl phthalate metabolites (∑DiNP), was associated with a decrease in TT3 and fT3i, which appeared fairly uniform across iodine intake categories. Conclusion We find that phthalate exposure is associated with thyroid function in mid-pregnancy among Norwegian women, and that iodine intake, which is essential for thyroid health, could influence some of these relationships.

• Ørbeck, Beate; Øvergaard, Kristin Romvig; Bergman, R Lindsey; Pripp, Are Hugo & Kristensen, Hanne (2020). The Selective Mutism Questionnaire: Data from typically developing children and children with selective mutism. Clinical Child Psychology and Psychiatry. ISSN 1359-1045. 25(4), p. 754–765. doi: 10.1177/1359104520914695. Full text in Research Archive
• Ørbeck, Beate; Øvergaard, Kristin Romvig; Hjellvik, Vidar; Bramness, Jørgen Gustav; Hansen, Berit M Hjelde & Lien, Lars (2020). The Use of Sleep Medication in Youth Residential Care. Journal of child and adolescent psychopharmacology. ISSN 1044-5463. 30(5), p. 335–341. doi: 10.1089/cap.2019.0172. Full text in Research Archive Show summary

  Objectives: To investigate the use of sleep medication and concomitant psychotropic medication in children and adolescents placed under residential care (RC). Methods: Participants were youth 0–20 years of age placed in RC institutions at least once during 2016. Data on filled prescriptions were taken from the Norwegian Prescription Database to compare the use of sleep medication in RC with the general child population (GenPop) and how it covaried with gender, age, reasons for RC placement, and concomitant use of other psychotropic medications (antidepressants, anxiolytics, antipsychotics, and psychostimulants). Results: A total of 2171 youths were identified in RC at mean age 14 years (82% ‡ 13 years). Seventeen percent (371/2171) used sleep medications (melatonin 11%, alimemazine 7%, and benzodiazepines/z-hypnotics 2%) significantly more than the 2.3% who used in GenPop. The girl/boy ratio for medication use in RC was 1.8 (95% confidence interval [CI] = 1.5–2.2), not significantly different from the corresponding ratio in GenPop (1.4; 95% CI = 1.3–1.5). The use of sleep medication increased with age. When comparing reasons for placement in RC, medication use was particularly low among unaccompanied minor asylumseekers (2%). About half of the youths used concomitant psychotropic medication, with clear gender differences; Girls used about twice as much antidepressants, anxiolytics, and antipsychotics, whereas boys used 1.3 times more psychostimulants. Conclusion: Youths in RC used more sleep medication and concomitant psychotropic medication than the GenPop, most likely reflecting the increased psychosocial strain and mental disorders reported in this population. Further studies of prevalence, assessment, and treatment of sleep problems in RC populations are warranted.

• Øvergaard, Kristin Romvig; Ørbeck, Beate; Friis, Svein; Biele, Guido; Pripp, Are Hugo & Aase, Heidi [Show all 7 contributors for this article] (2019). Screening With an ADHD-Specific Rating Scale in Preschoolers: A Cross-Cultural Comparison of the Early Childhood Inventory-4. Psychological Assessment. ISSN 1040-3590. 31(8), p. 985–994. doi: 10.1037/pas0000722. Full text in Research Archive
• Skogheim, Thea Steen; Villanger, Gro Dehli; Weyde, Kjell Vegard Fjeldheim; Engel, Stephanie M.; Suren, Pål & Øie, Merete Glenne [Show all 13 contributors for this article] (2019). Prenatal exposure to perfluoroalkyl substances and associations with symptoms of attention-deficit/hyperactivity disorder and cognitive functions in preschool children. International Journal of Hygiene and Environmental Health. ISSN 1438-4639. 223(1), p. 80–92. doi: 10.1016/j.ijheh.2019.10.003. Full text in Research Archive Show summary

  BACKGROUND: Perfluoroalkyl substances (PFASs) are persistent organic pollutants that are suspected to be neurodevelopmental toxicants, but epidemiological evidence on neurodevelopmental effects of PFAS exposure is inconsistent. We investigated the associations between prenatal exposure to PFASs and symptoms of attention-deficit/hyperactivity disorder (ADHD) and cognitive functioning (language skills, estimated IQ and working memory) in preschool children, as well as effect modification by child sex. MATERIAL AND METHODS: This study included 944 mother-child pairs enrolled in a longitudinal prospective study of ADHD symptoms (the ADHD Study), with participants recruited from The Norwegian Mother, Father and Child Cohort Study (MoBa). Boys and girls aged three and a half years, participated in extensive clinical assessments using well-validated tools; The Preschool Age Psychiatric Assessment interview, Child Development Inventory and Stanford-Binet (5th revision). Prenatal levels of 19 PFASs were measured in maternal blood at week 17 of gestation. Multivariable adjusted regression models were used to examine exposure-outcome associations with two principal components extracted from the seven detected PFASs. Based on these results, we performed regression analyses of individual PFASs categorized into quintiles. RESULTS: PFAS component 1 was mainly explained by perfluoroheptane sulfonate (PFHpS), perfluorooctane sulfonate (PFOS), perfluorohexane sulfonate (PFHxS) and perfluorooctanoic acid (PFOA). PFAS component 2 was mainly explained by perfluorodecanoic acid (PFDA), perfluoroundecanoic acid (PFUnDA) and perfluorononanoic acid (PFNA). Regression models showed a negative association between PFAS component 1 and nonverbal working memory [β = -0.08 (CI: -0.12, -0.03)] and a positive association between PFAS component 2 and verbal working memory [β = 0.07 (CI: 0.01, 0.12)]. There were no associations with ADHD symptoms, language skills or IQ. For verbal working memory and PFAS component 2, we found evidence for effect modification by child sex, with associations only for boys. The results of quintile models with individual PFASs, showed the same pattern for working memory as the results in the component regression analyses. There were negative associations between nonverbal working memory and quintiles of PFOA, PFNA, PFHxS, PFHpS and PFOS and positive associations between verbal working memory and quintiles of PFOA, PFNA, PFDA and PFUnDA, with significant relationships mainly in the highest concentration groups. CONCLUSIONS: Based on our results, we did not find consistent evidence to conclude that prenatal exposure to PFASs are associated with ADHD symptoms or cognitive dysfunctions in preschool children aged three and a half years, which is in line with the majority of studies in this area. Our results showed some associations between PFASs and working memory, particularly negative relationships with nonverbal working memory, but also positive relationships with verbal working memory. The relationships were weak, as well as both positive and negative, which suggest no clear association - and need for replication.

• Ørbeck, Beate; Øvergaard, Kristin Romvig; Pripp, Are Hugo; Aase, Heidi; Reichborn-Kjennerud, Ted & Zeiner, Pål (2019). Adult ADHD Symptoms and Satisfaction With Life: Does Age and Sex Matter? Journal of Attention Disorders. ISSN 1087-0547. 23(1), p. 3–11. doi: 10.1177/1087054715612257. Full text in Research Archive Show summary

  Objective:To investigate adult ADHD symptoms and satisfaction with life, with a focus on age and sex differences. Method: This study is based on parents in the Norwegian Mother and Child Cohort Study (MoBa). The Adult Self- Report Scale (ASRS-6) and Satisfaction With Life Scale (SWLS) scores were analyzed from 33,210 men and 41,983 women from young to middle adulthood. Results: Mean ASRS total score was significantly higher in men, where 5.1% scored above cutoff, compared with 2.9% in women. Factor loadings supported the two ASRS subscales: Inattention (Inatt) and Hyperactivity-Impulsivity (HyImp) in both sexes. A significant decline with age was found on HyImp, whereas Inatt scores were reasonably stable in men and u-curved in women. High ASRS scores were associated with lower SWLS, but poor satisfaction with life was found only in high-scoring women. Conclusion: Our findings suggest caution to age and sex when using the ASRS-6.

• Øvergaard, Kristin Romvig; Ørbeck, Beate; Aase, Heidi; Torgersen, Svenn; Reichborn-Kjennerud, Ted & Zeiner, Pål (2018). Emotional Lability in Preschoolers With Symptoms of ADHD. Journal of Attention Disorders. ISSN 1087-0547. 22(8), p. 787–795. doi: 10.1177/1087054715576342. Full text in Research Archive Show summary

  OBJECTIVE: The aim of this study was to examine occurrence of emotional lability (EL) in preschoolers with ADHD symptoms versus controls. METHOD: The study was part of the Norwegian Mother and Child Cohort Study (MoBa) at the Norwegian Institute of Public Health. In the present study, 495 preschoolers were clinically examined. Symptoms of ADHD, anxiety, and oppositional defiant disorder (ODD) were measured with the Preschool Age Psychiatric Assessment Interview. An EL measure was obtained from the Emotional Control subscale of the Behavior Rating Inventory of Executive Function-Preschool Version (BRIEF-P), which parents and teachers completed. RESULTS: EL was significantly more frequent in the ADHD group compared with controls (25% vs. 7%, p < .001). By parent report, EL correlated significantly with ADHD-, anxiety-, and ODD symptoms. By teacher report, EL was significantly correlated only with hyperactivity-impulsivity. CONCLUSION: EL appears identifiable in young preschoolers and was particularly associated with ODD in children with ADHD symptoms.

• Øvergaard, Kristin Romvig; Ørbeck, Beate; Friis, Svein; Pripp, Are Hugo; Biele, Guido & Aase, Heidi [Show all 7 contributors for this article] (2018). Attention-Deficit/Hyperactivity Disorder in Preschoolers: The Accuracy of a Short Screener. Journal of the American Academy of Child and Adolescent Psychiatry. ISSN 0890-8567. 57(6), p. 428–435. doi: 10.1016/j.jaac.2018.03.008. Full text in Research Archive Show summary

  Objective Although early and accurate screening is required for the remediation of attention-deficit/hyperactivity disorder (ADHD), possible gender differences have not been extensively studied. We examined the classification accuracy of the parent and preschool teacher version of the Strengths and Difficulties Questionnaire (SDQ) hyperactivity−inattention (HI) subscale in girls and boys. Method The study was part of the Norwegian Mother and Child Cohort Study (MoBa). Parents and preschool teachers rated a total of 238 girls and 276 boys (mean age 3.5 years) with the SDQ HI subscale. Blinded to the parent and teacher ratings, interviewers classified the children by ADHD diagnoses with the Preschool Age Psychiatric Assessment Interview. Results Areas under the curves for the parent HI subscale scores were good for both girls and boys (0.87 and 0.80, respectively). Preschool teacher classifications were fair (0.76) for girls and poor (0.62) for boys, a significant difference (p = .017). The subscale accurately identified children without ADHD at low parent scores (≤4), and fairly accurately identified ADHD at high scores (≥9), with maximum probabilities of finding true cases of 0.75 in girls and 0.55 in boys. Intermediate scores gave the best balance between sensitivity and specificity with low probabilities of correctly identifying children with ADHD. Conclusion The parental SDQ HI subscale was useful for screening for ADHD in preschool girls and boys. For preschool teachers, the subscale was useful for screening girls.

• Ørbeck, Beate; Øvergaard, Kristin Romvig; Stein, Murray B; Pripp, Are Hugo & Kristensen, Hanne (2018). Treatment of selective mutism: a 5-year follow-up study. European Child and Adolescent Psychiatry. ISSN 1018-8827. 27(8), p. 997–1009. doi: 10.1007/s00787-018-1110-7. Full text in Research Archive Show summary

  Selective mutism (SM) has been defined as an anxiety disorder in the Diagnostic and statistical manual of mental disorders (DSM-5). Cognitive Behavioral Therapy (CBT) is the recommended approach for SM, but prospective long-term outcome studies are lacking. Reports from the children themselves, and the use of more global quality of life measures, are also missing in the literature. We have developed a school-based CBT intervention previously found to increase speech in a pilot efficacy study and a randomized controlled treatment study. Continued progress was found in our one-year follow up studies, where older age and more severe SM had a significant negative effect upon outcome. In the present study, we provide 5-year outcome data for 30 of these 32 children with SM who completed the same CBT for mean 21 weeks (sd 5, range 8-24) at mean age 6 years (10 boys). Mean age at the 5-year follow-up was 11 years (range 8-14). Outcome measures were diagnostic status, the teacher- and parent rated Selective Mutism questionnaires, and child rated quality of life and speaking behavior. At the 5-year follow-up, 21 children were in full remission, five were in partial remission and four fulfilled diagnostic criteria for SM. Seven children (23%) fulfilled criteria for social phobia, and separation anxiety disorder, specific phobia and/or enuresis nocturna were found in a total of five children (17%) . Older age- and severity at baseline and familial SM were significant negative predictors of outcome. Treatment gains were maintained on the teacher- and parent questionnaires. The children rated their overall quality of life as good. Although most of them talked outside of home, 50% still experienced it as somewhat challenging. These results point to the long-term effectiveness of CBT for SM, but also highlight the need to develop more effective interventions for the subset of children with persistent symptoms. Keywords: selective mutism; child anxiety; CBT; quality of life; self-report

• Øvergaard, Kristin Romvig; Madsen, Kathrine Bang; Ørbeck, Beate; Friis, Svein & Obel, Carsten (2018). The predictive validity of the Strengths and Difficulties Questionnaire for child attention-deficit/hyperactivity disorder. European Child and Adolescent Psychiatry. ISSN 1018-8827. 28(5), p. 625–633. doi: 10.1007/s00787-018-1226-9. Full text in Research Archive
• Ørbeck, Beate; Øvergaard, Kristin Romvig; Aspenes, Stian Thoresen; Pripp, Are Hugo; Mørdre, Marianne & Aase, Heidi [Show all 8 contributors for this article] (2017). ADHD, comorbid disorders and psychosocial functioning: How representative is a child cohort study? Findings from a national patient registry. BMC Psychiatry. 17:23. doi: 10.1186/s12888-017-1204-7. Full text in Research Archive Show summary

  Background: Cohort studies often report findings on children with Attention Deficit Hyperactivity Disorder (ADHD) but may be biased by self-selection. The representativeness of cohort studies needs to be investigated to determine whether their findings can be generalised to the general child population. The aim of the present study was to examine the representativeness of child ADHD in the Norwegian Mother and Child Cohort Study (MoBa). Methods: The study population was children born between January 1, 2000 and December 31, 2008 registered with hyperkinetic disorders (hereafter ADHD) in the Norwegian Patient Registry during the years 2008–2013, and two groups of children with ADHD were identified in: 1. MoBa and 2. The general child population. We used the multiaxial International Classification of Diseases (ICD-10) and compared the proportions of comorbid disorders (axes I–III), abnormal psychosocial situations (axis V) and child global functioning (axis VI) between these two groups. We also compared the relative differences in the multiaxial classifications for boys and girls and for children with/without axis I comorbidity, respectively in these two groups of children with ADHD. Results: A total of 11 119 children were registered with ADHD, with significantly fewer in MoBa (1.45%) than the general child population (2.11%), p < 0.0001. The proportions of comorbid axis I, II, and III disorders were low, with no significant group differences. Compared with the general child population with ADHD, children with ADHD in MoBa were registered with fewer abnormal psychosocial situations (axis V: t = 7.63, p < .0001; d = -.18) and better child global functioning (axis VI: t = 7.93, p < 0.0001; d = .17). When analysing relative differences in the two groups, essentially the same patterns were found for boys and girls and for children with/without axis I comorbidity. Conclusions: Self-selection was found to affect the proportions of ADHD, psychosocial adversity and child global functioning in the cohort. However, the differences from the general population were small. This indicates that studies on ADHD and multiaxial classifications in MoBa, as well as other cohort studies with similar self-selection biases, may have reasonable generalisability to the general child population.

• Ørbeck, Beate; Øvergaard, Kristin Romvig; Pripp, Are Hugo; Reichborn-Kjennerud, Ted; Aase, Heidi & Zeiner, Pål (2017). Early predictors of ADHD: Evidence from a prospective birth cohort. Journal of Attention Disorders. ISSN 1087-0547. 24(12), p. 1685–1692. doi: 10.1177/1087054717696765. Full text in Research Archive Show summary

  Objective: To identify preschool predictors of registered ADHD diagnoses and compare two ADHD rating scales, Child Behavior Checklist (CBCL) and Conners’ Parent Rating Scale (CPRS-R:S). Method: The Norwegian Mother and Child Cohort study (MoBa) is a prospective population-based cohort study. The sample were singletons whose mothers responded to MoBa questionnaires at child age 3 years (n = 57,986) and 5 years (n = 32,377). ADHD diagnoses were obtained from the Norwegian Patient Register. Predictors were child gender, development and symptoms, and maternal ADHD symptoms. We used Cox proportional hazard regression analyses. Results: In all final models, ADHD symptoms at age 3 and 5 years predicted later ADHD: Age 3, CBCL: hazard ratio (HR) = 3.23 (CI [2.59, 4.02]); age 5, CBCL: HR = 10.30 (CI [7.44, 14.26]); and age 5 CPRS-R:S: HR = 5.92 (CI [4.95, 7.07]). Conclusion: The findings underline the importance of taking early parent-reported symptoms seriously. Both rating scales were useful for predicting ADHD.

• Skogan, Annette Holth; Egeland, Jens; Zeiner, Pål; Øvergaard, Kristin Romvig; Ørbeck, Beate & Reichborn-Kjennerud, Ted [Show all 7 contributors for this article] (2016). Factor structure of the Behavior Rating Inventory of Executive Functions (BRIEF-P) at age three years. Child Neuropsychology: A Journal of Normal and Abnormal Development in Childhood and Adolescence. ISSN 0929-7049. 22(4), p. 472–492. doi: 10.1080/09297049.2014.992401. Full text in Research Archive Show summary

  The preschool period is an important developmental period for the emergence of cognitive self-regulatory skills or executive functions (EF). To date, evidence regarding the structure of EF in preschool children has supported both unitary and multicomponentmodels. The aimof the present study was to test the factor structure of early EF as measured by the Behavior Rating Inventory of Executive Function-Preschool version (BRIEF-P). BRIEF-P consists of five subscales and three broader indexes, hypothesized to tap into different subcomponents of EF. Parent ratings of EF from a nonreferred sample of children recruited from the Norwegian Mother and Child Cohort Study (N = 1134; age range 37–47 months) were subjected to confirmatory factor analyses (CFA). Three theoretically derived models were assessed; the secondorder three-factor model originally proposed by the BRIEF-P authors, a “true” first-order one-factor model and a second-order one-factor model. CFA fit statistics supported the original three-factor solution. However, the difference in fit was marginal between this model and the second-order one-factor model. A follow-up exploratory factor analysis (EFA) supported the existence of several factors underlying EF in early preschool years, with a considerable overlap with the five BRIEF-P subscales. Our results suggest that some differentiation in EF has taken place at age 3 years, which is reflected in behavior ratings. The internal consistency of the BRIEF-P five clinical subscales is supported. Subscale interrelations may, however, differ at this age from those observed in the preschool group as a whole. Keywords: Executive function; BRIEF-P; Preschool; Factor analysis; Development.

• Øvergaard, Kristin Romvig; Aase, Heidi; Torgersen, Svenn & Zeiner, Pål (2016). Co-Occurrence of ADHD and Anxiety in Preschool Children. Journal of Attention Disorders. ISSN 1087-0547. 20(7), p. 573–580. doi: 10.1177/1087054712463063. Full text in Research Archive
• Skogan, Annette Holth; Øvergaard, Kristin Romvig; Baumgartner, Nina; Urnes, Anne-Margrethe; Ørbeck, Beate & Aase, Heidi [Show all 9 contributors for this article] (2016). Eksekutiv funksjon i tidlig førskolealder-funn fra den norske ADHD-studien. Nevropsykologi : Medlemsblad for Norsk Nevropsykologisk Forening. ISSN 1500-8347. 18(1), p. 4–13. Full text in Research Archive
• Ørbeck, Beate; Manassis, Katharina; Øvergaard, Kristin Romvig & Kristensen, Hanne (2015). Selektiv mutisme. In Rey, Joseph M. (Eds.), IACAPAP Textbook of Child and Adolescent Mental Health. International Association for Child and Adolescent Psychiatry and Allied Professions. ISSN 9780646574400. p. 1–23. doi: 10.1016/b978-0-12-813004-9.00011-6. Full text in Research Archive
• Manassis, Katharina; Ørbeck, Beate & Øvergaard, Kristin Romvig (2015). The use of medication in selective mutism: a systematic review. European Child and Adolescent Psychiatry. ISSN 1018-8827. 25(6), p. 571–578. doi: 10.1007/s00787-015-0794-1. Full text in Research Archive Show summary

  Despite limited evidence, selective serotonin reuptake inhibitors (SSRIs) and monoamine oxidase inhibitors (MAOIs) are used to reduce symptoms of selective mutism (SM) in children unresponsive to psychosocial interventions. We review existing evidence for the efficacy of these medications, limitations of the literature, and resulting treatment considerations. Bibliographic searches were conducted in Medline, Embase, PsycInfo, Web of Science and Cochrane up to June 2015. Two reviewers independently sought studies of children with SM as primary psychiatric diagnosis, which reported response to medication treatment. Abstracts were limited to those reporting original data. Two reviewers independently assessed the ten papers reporting on >2 subjects regarding study design, key results, and limitations. Heterogeneity of designs mandated a descriptive summary. Symptomatic improvement was found for 66/79 children treated with SSRIs and 4/4 children treated with phenelzine. Only 3/10 studies had unmedicated comparison groups and only two were double-blinded. This review may be affected by publication bias, missed studies, and variability of outcome measures in included studies. Although there is some evidence for symptomatic improvement in SM with medication, especially SSRIs, it is limited by small numbers, lack of comparative trials, lack of consistent measures, and lack of consistent reporting on tolerability. The clinician must weigh this paucity of evidence against the highly debilitating nature of SM, and its adverse effects on the development of those children whose progress with psychosocial interventions is limited or very slow. Studies of optimal dosage and timing of medications in relation to psychosocial treatments are also needed.

• Øvergaard, Kristin Romvig; Aase, Heidi; Torgersen, Svenn; Reichborn-Kjennerud, Ted; Ørbeck, Beate & Myhre, Anne Margrethe [Show all 7 contributors for this article] (2014). Continuity in features of anxiety and attention deficit/hyperactivity disorder in young preschool children. European Child and Adolescent Psychiatry. ISSN 1018-8827. 23(9), p. 743–752. doi: 10.1007/s00787-014-0538-7. Full text in Research Archive Show summary

  Anxiety disorders and Attention Deficit / Hyperactivity Disorder (ADHD) develop before school age, but little is known about early developmental pathways. Here we test two hypotheses: first, that early signs of anxiety and ADHD at 18 months predict symptoms of anxiety and ADHD at age 3½ years; second, that emotional dysregulation at 18 months predicts the outcome of co-occurring anxiety and ADHD at age 3½ years. The study was part of the prospective Norwegian Mother and Child Cohort Study (MoBa) at the Norwegian Institute of Public Health. The 628 participants were clinically assessed at 3½ years. Questionnaire data collected at 18 months were categorized into early behavioural scales of anxiety, ADHD, and emotional dysregulation. We investigated continuity in features of anxiety and ADHD from 18 months to 3½ years of age through logistic regression analyses. Anxiety symptoms at 3½ years were predicted by early signs of anxiety (Odds ratio [OR] = 1.41, CI = 1.15-1.73) and emotional dysregulation (OR = 1.33, CI = 1.15-1.54). ADHD symptoms at 3½ years were predicted by early signs of ADHD (OR = 1.51, CI = 1.30-1.76) and emotional dysregulation (OR = 1.31, CI = 1.13-1.51). Co-occurring Anxiety and ADHD symptoms at 3½ years were predicted by early signs of anxiety (OR = 1.43, CI = 1.13-1.84), ADHD (OR = 1.30, CI = 1.11-1.54), and emotional dysregulation (OR = 1.34, CI = 1.13-1.58). We conclude that there were modest continuities in features of anxiety and ADHD through early preschool years, while emotional dysregulation at age 18 months was associated with symptoms of anxiety, ADHD, and co-occurring anxiety and ADHD at age 3 ½ years.

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• Pérez, Tomás Fernando Varnet; Øvergaard, Kristin Romvig; Frigessi, Arnoldo & Biele, Guido (2024). Design-aware imputation in a target trial of ADHD pharmaceutical treatment on Norwegian national test scores: the case of simultaneous outcomes. Full text in Research Archive
• Pérez, Tomás Fernando Varnet; Biele, Guido; Frigessi, Arnoldo & Øvergaard, Kristin Romvig (2023). Synthetic data for unidentified Bayesian multiple bias models an application to ADHD interventions for academic achievement. Full text in Research Archive
• Hoel, Ragnhild Elisabet; Ørbeck, Beate; MØRDRE, MARIANNE & Øvergaard, Kristin Romvig (2022). Smell and taste in youth referred for evaluation of autism. Full text in Research Archive
• Øvergaard, Kristin Romvig & Ørbeck, Beate (2020). Barn med nevrodegenerativ sykdom og tvangshandlinger. Tidsskrift for Den norske legeforening (Tidsskriftet). ISSN 0029-2001. doi: 10.4045/tidsskr.19.0703. Full text in Research Archive
• Ørbeck, Beate & Øvergaard, Kristin Romvig (2019). ADHD-symptomer og livskvalitet hos voksne- betyr alder og kjønn noe? Best Practice Psykiatri/Nevrologi. 2, p. 26–27. Full text in Research Archive
• Øvergaard, Kristin Romvig & Ørbeck, Beate (2019). ADHD hos førskolebarn - Er det kjønnsforskjeller ved bruk av et kartleggingsskjema. Best Practice Psykiatri/Nevrologi. 3, p. 16–17. Full text in Research Archive
• Ørbeck, Beate & Øvergaard, Kristin Romvig (2019). Behandling av selektiv mutisme – hvordan går det med barna etter 5 år? Best Practice Psykiatri/Nevrologi. 3, p. 14–15. Full text in Research Archive
• Skogheim, Thea Steen; Villanger, Gro Dehli; Biele, Guido; Haug, Line Småstuen; Sabaredzovic, Azemira & Suren, Pål [Show all 11 contributors for this article] (2018). Prenatal exposure to perfluoroalkyl substances and associations with ADHD symptoms and cognitive functions in children. Full text in Research Archive
• Skogheim, Thea Steen; Villanger, Gro Dehli; Biele, Guido; Haug, Line Småstuen; Sabaredzovic, Azemira & Suren, Pål [Show all 11 contributors for this article] (2018). Prenatal exposure to perfluoroalkyl substances and associations with attention-deficit/hyperactivity disorder symptoms and cognitive functions in children. Full text in Research Archive
• Ørbeck, Beate; Øvergaard, Kristin Romvig; Villabø, Marianne; Skirbekk, Benedicte; Atwood, Tony & Bjåstad, Jon Fauskanger (2018). “Less stress” -a pilot study on a cognitive behavioral treatment program for anxiety in children with autism spectrum disorders. Full text in Research Archive
• Øvergaard, Kristin Romvig; Ørbeck, Beate; Friis, Svein; Biele, Guido; Aase, Heidi & Zeiner, Pål (2018). Inattention in pre-School ADHD- are there gender differences? Full text in Research Archive
• Ørbeck, Beate; Aase, Heidi; Zeiner, Pål; Furu, Kari; Reichborn-Kjennerud, Ted & Øvergaard, Kristin Romvig (2018). ADHD medication in children: Preliminary findings from a prospective cohort study. Full text in Research Archive
• Øvergaard, Kristin Romvig & Ørbeck, Beate (2018). Forløp av angst- og ADHD-symptomer hos unge førskolebarn – er emosjonell dysregulering av betydning? BestPractice Psykiatri/Nevrologi/Geriatri. 9(32), p. 28–29. Full text in Research Archive
• Øvergaard, Kristin Romvig; Ørbeck, Beate; Friis, Svein; Pripp, Are Hugo; Biele, Guido & Aase, Heidi [Show all 7 contributors for this article] (2018). Dr Øvergaard et al. Reply. Journal of the American Academy of Child and Adolescent Psychiatry. ISSN 0890-8567. 57(9), p. 701–702. doi: 10.1016/j.jaac.2018.05.021. Full text in Research Archive
• Ørbeck, Beate; Øvergaard, Kristin Romvig; Zeiner, Pål; Jensen, J.; Hompland, E. & Balstad, Lill Kristin [Show all 10 contributors for this article] (2018). Less Stress – a pilot study on a program for anxiety in children with ASD. Full text in Research Archive
• Madsen, Kathrine Bang; Øvergaard, Kristin Romvig; Ørbeck, Beate & Obel, Carsten (2017). Parental psychiatric problems increase severity of ADHD symptoms and comorbidity in their Children. Full text in Research Archive
• Ørbeck, Beate & Øvergaard, Kristin Romvig (2017). Behandling av selektiv mutisme- og hva med bruk av medikamenter? BestPractice Psykiatri/Nevrologi/Geriatri. 8(29), p. 30–31. Full text in Research Archive
• Øvergaard, Kristin Romvig & Ørbeck, Beate (2015). Emosjonell labilitet og ADHD-symptomer i førskolealder. Best practice psykiatri /nevrologi. p. 42–44. Full text in Research Archive
• Ørbeck, Beate; Øvergaard, Kristin Romvig; Kristensen, Hanne & Manassis, Katharina (2015). Selective mutism: a challenge to assess and treat. long-term follow-up results of a psychosocial intervention and a review of pharmacological treatment. Full text in Research Archive Show summary

  ABSTRACT: Background: Selective mutism (SM) describes children who consistently do not speak in certain social situations, while they talk freely in other situations. SM is now understood as an anxiety disorder (DSM-5), but knowledge is still sparse on effective interventions, and long-term outcome. How the affected children view quality of life and their own speaking behavior is rarely described. More understanding on quantitative symptom measures, when to apply a categorical diagnosis of SM, and the effect of pharmacological treatment, is also needed. Aims: To increase knowledge about SM by presenting long term outcome in the form of categorical and continuous measures of SM, as reported by parents, teachers, and children 4-6 years after completion of a home- and school based treatment we developed in 2007. Finally, to present an overview of pharmacological treatment. Materials and methods: Three presentations report follow-up results from 30 children, (aged 3-9 years at study inclusion). I. Diagnosis of SM: The Anxiety Disorders Interview Schedule and the Kiddie-SADS-PL, II. The SM questionnaires: rated by parents (SMQ) and teachers (SSQ), and III. The Children’s own voices: The Inventory of Life Quality (ILC). Included here is also an overview of the treatment, which includes defocused communication, psychoeducation, and behavioural techniques (sliding-in-technique with rewards). Finally; IV.Pharmacotherapy in SM: A review study, including treatment guidelines. Results: I. The majority did not have SM at follow-up. II. A continuous increase was reported in speaking behavior on the SM questionnaires. III. Children rated their overall quality of life as good. Those who still fulfilled diagnostic criteria for SM, or were in remission, scored themselves significantly lower than children who longer had SM. IV. Studies of pharmacotherapy suggest symptomatic improvement of SM with selective serotonin reuptake inhibitors, but are limited by small numbers and few comparative trials. Conclusions: The long-term follow-up results supported a home- and school based intervention for children with SM, and the SM questionnaires were sensitive measures of symptom improvement. Although the children reported their life quality as good, half of the children still found it somewhat difficult to talk outside home. The pharmocotherapy study indicates the need for further research, especially on optimal dosage and optimal timing in relation to psychosocial treatments. Keywords; Selective Mutism, Diagnosis, Treatment, Long-term follow- up, Quality of life, Pharmacotherapy

• Øvergaard, Kristin Romvig; Ørbeck, Beate; Aase, Heidi; Reichborn-Kjennerud, Ted & Zeiner, Pål (2014). Disruptive Mood Dysregulation disorder in preschool children; concurrent associated symptoms and early predictors. Full text in Research Archive
• Zeiner, Pål; Ørbeck, Beate; Øvergaard, Kristin Romvig; Reichborn-Kjennerud, Ted & Aase, Heidi (2013). Symptoms of Attention-Deficit/Hyperactivity Disorder (ADHD) in an adult population sample. Full text in Research Archive
• Øvergaard, Kristin Romvig; Zeiner, Pål & Aase, Heidi (2011). Impairment in Preschoolers with Symptoms of Attention Deficit Hyperactivity Disorder and Anxiety. Full text in Research Archive

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