The Japanese term Hikikomori is used to describe a clinical condition in which young people present a prolonged social withdrawal and isolation. Hikikomori syndrome represents an emergent worldwide phenomenon but is still poorly reported and often misdiagnosed. This study investigates and describes an Italian hikikomori adolescent group. Socio-demographic and psychopathological profiles and the relationship between hikikomori and psychopathological conditions were analyzed. No gender difference, a medium–high intellectual level, and no correlation with socioeconomic status were highlighted among the clinical group. The relationship between social withdrawal and social anxiety was significant while no correlation was found with depressive symptoms. The presence of Hikikomori syndrome was also significant in Italian adolescents, suggesting that hikikomori is not a culture-bound syndrome related to the Japanese cultural context, but rather a syndrome occurring in the upper-medium class.

Background: Some studies have demonstrated the high impact of headache and migraine in several areas of children and adolescents' life. In recent years, there has been an increase in scientific interest in the relationship between migraine and emotional regulation, investigating the possible consequences of emotional dysregulation on physical and mental health. While some studies have been carried out on the relationship between alexithymia and headache or migraine (especially in adults), no data exist on relationship between Theory of Mind (TOM), metacognition, and alexithymia in children and adolescents with migraine. Methods: Children with diagnosis of migraine without aura (MWoA) (36 males and 34 females) were compared to a healthy control group (31 males and 39 females). The age range was from 8 to 13 years in both groups. All children completed the Alexithymia Questionnaire for Children (AQC) for the assessment of alexithymia levels and the Domain of Social Perception included in the NEPSY-II to evaluate levels of TOM. Metacognitive development was evaluated with Io e La Mia Mente for children aged between 8 and 10 years and with Metacognitions Questionnaire for Children (MCQ-C) for children from 11 to 13. Results: There were no differences between children with MWoA and the control group in metacognitive abilities; only in the subscale “Negative Meta Worrying” of MCQ-C girls scored higher than boys, regardless of the group they were part of. Also, in the NEPSY-II subscale there were no statistically significant differences between the two groups. Children with MWoA scored higher in the AQC subscales “Difficulty Identifying Feelings” and “Difficulty Describing Feelings” than controls. Moreover, children between 8 and 10 years statistically differed from older children in “Difficulty Identifying Feelings” and in Total Score. Conclusion: Our data suggest that children with MWoA have no metacognitive and TOM problems compared to a healthy group. The experimental group showed higher traits of alexithymia, confirming what suggested by other studies in the literature. Future research will have to focus on migraine with aura and tension-type headache to evaluate any differences with children with MWoA.

BACKGROUND:It is widely recognised that there are associations between headache, psychiatric comorbidity and attachment insecurity in both adults and children. The aims of this study were: 1) to compare perceived attachment security and anxiety in children and adolescents with migraine without aura and a healthy control group; 2) to test whether the child's perceived security of attachment to the mother and the father mediated the association between migraine and anxiety.METHODS:One hundred children and adolescents with Migraine without Aura were compared with a control group of 100 children without headache. The Security Scale (measures perceived security of attachments) and the Self-Administered Psychiatric Scales for Children and Adolescents, a measure of anxiety symptoms, were administered to all participants.RESULTS:The clinical group had lower attachment security than the control group and higher scores on all anxiety scales. Anxiety was negatively correlated with attachment. Children's attachment to their mother mediated the increase in global anxiety in the clinical group. Insecure paternal attachment was associated with greater insecurity in maternal attachment, suggesting that there is a complex pathway from migraine to anxiety symptoms mediated by perceived insecurity of paternal attachment and hence also by perceived insecurity of maternal attachment.CONCLUSION:These results suggest that insecure parental attachment may exacerbate anxiety in children and adolescents with migraine and point to the importance of multimodal interventions, perhaps taking account of family relationships, for children and adolescents with migraine.

Several scientific studies report a close relationship between sleep and headache: sleep changes may reflect the onset and increase of both duration and frequency of headache attacks. Variations in sleep architecture, together with a poor sleep hygiene in children, may indeed be responsible for the onset of headache and its development into a chronic disease. For a correct clinical management of children with headache, it is therefore fundamental to investigate their sleep habits, architecture and potential disturbances, in order to develop adequate therapeutic plans for both sleep and headache.

Background: This study aims to determine if surviving siblings of children who died from Sudden Infant Dead Syndrome (SIDS) had behavioural or psychological problems and if their mothers had suffered from alexithymia. Methods: We have enrolled 39 families (58 children). The “Mourning Group” (MG) consisted in 16 families (28 children) with following characteristics: 1) having an infant die from SIDS; 2) having at least one surviving child aged 6 to 18 years; 3) at least 8 years of mourning. The control group (CG) consisted of 23 families (30 children) free from any kind of mourning experiences. We used CBCL 6-18 questionnaire to assess behavioural and psychological problems on siblings, and TAS-20 in order to measure alexithymia in mothers. Results: Children in the MG compared with children in the CG presented a significantly higher score in CBCL on “social problems”, whilst reported a significantly lower score on “social competencies”. Mothers in the MG compared with mothers in the CG presented significantly lower scores in the externally oriented thinking (subscale F3 of TAS). A positive significant correlation emerged between time of bereavement and difficulty in identifying feelings (subscale F1). Conclusions: Our study confirms the presence of social difficulties in siblings born in families that experienced SIDS and shows that most of the mothers had long lasting difficulties in identifying their feelings.

Headache is one of the most common neurological symptom reported in childhood and adolescence, leading to high levels of school absences and being associated with several comorbid conditions, particularly in neurological, psychiatric and cardiovascular systems. Neurological and psychiatric disorders, that are associated with migraine, are mainly depression, anxiety disorders, epilepsy and sleep disorders, ADHD and Tourette syndrome. It also has been shown an association with atopic disease and cardiovascular disease, especially ischemic stroke and patent foramen ovale (PFO).

Migraine is a very widespread and debilitating disease and, according to the World Health Organization, one of the most common disorders of the nervous system. It is twice as common in females as in males (Le et al ., 2011), and much more prevalent in females over the age of 12 years (Lipton et al ., 2001). In fact, the picture of migraine differs by sex before and after puberty. Under the age of 12 years, boys have a slightly higher incidence of migraine. Thereafter, prevalence increases for both sexes, peaking between ages 35 and 45 years, with an increase in the female-to-male ratio from 2:1 at the age of 20 years to 3.3:1 at the age of 40 years (Lipton et al ., 2001). This higher prevalence in females than males is common in many other chronic pain conditions, although the mechanisms underlying this difference are still poorly understood. Indeed, current knowledge of migraine pathogenesis is based primarily on experimental studies conducted in male animals, and lack of migraine research in female animals limits the clinical relevance given the sex bias in humans. The disproportionate number of females of reproductive age with migraine suggests that hormonal factors may play a role, but the complex pathophysiology indicates that additional factors are likely to be involved. It is now well recognized that: (i) at puberty females begin to demonstrate an increase in migraine prevalence compared to males; (ii) >55% of females have menstrual-related migraine; and (iii) the majority of females show improvement in migraine frequency and/or severity with pregnancy and at the menopause. More recently, migraine research has begun to help expand our understanding of the mechanisms underlying these differences, and how they can impact on treatment choices. Several hypotheses have been proposed to explain these differences in migraine and other …

This review aims to critically analyze the literature studies showing the effectiveness of cognitive-behavioral strategies in the treatment of sleep disorder during the developmental age. About 15-35% of children suffer from sleep disorder. If they are not treated right away, it can persist into adulthood. Recent studies demonstrate an effective cognitive-behavior treatment for these disturbances. In this regard, the most effective method seems to be extinction (standard, with parental presence, graduated), the bedtime routine, scheduled awakenings, and preventive parent education. The procedures of extinction, not only its effectiveness, have limited application for the difficulty that compares to the parents following the procedure of the intervention. They are not able to ignore their children when they are crying for long prolonged period of time. Bedtime routine is relevant in the prevention and treatment of sleep disorders. The scheduled awakenings are a useful technique that teaches parents to change the way they interact with the child's disturbed sleep, allowing recovery. Finally, preventive parental education depends on the parents or caregivers and aims to educate them; during the prenatal or postnatal period with their child's sleep it seems useful in preventing irregular pattern formation and temporal regulation of sleep. The vast majority of children's sleep disruptions seem to resolve only with the cognitive-behavioral intervention, while in some psychopathologic disruptions it is necessary to combine cognitive-behavioral and drug therapy. Literature reviews show that clinical research concerning sleep disruptions is still very limited. In current reviews, there have been diverse investigations on efficacy of cognitive-behavioral interventions and sleep disruptions, highlighting both the strong points and weak points. Therefore, this analysis could be a starting point for developing further research since there is a lack of studies in relation to evidence-based interventions and specific therapeutic factors for each intervention and disturbance.