Adolescent Psychiatry - Current Issue

Fasting in Ramadan, a holy month in Islam, is considered a religious obligation to Muslims after puberty. Fasting during Ramadan entails abstinence from consuming food and liquids, as well as abstaining from other activities, including smoking and sexual activity, from dawn until sunset. Literature exists regarding the management of multiple medical conditions impacted by the month of fasting; however, limited literature exists to guide the management of Attention-Deficit/Hyperactivity Disorder (ADHD) during Ramadan.

This systematic review employed a PUBMED search which was conducted using keywords ((ADHD) AND (Muslims)) OR ((ADHD) AND (FASTING)) OR ((ADHD) AND (RAMADAN)) OR ((RAMADAN) AND (MANAGEMENT)) and search strategies to find existing literature on ADHD management during Ramadan or while fasting.

Eight hundred and sixty-one results were obtained. Of these, full texts of clinical trials, systematic reviews, reviews, randomized control trials, and meta-analyses resulted in 303 results that were screened by title or abstract for relevance to the topic. The duplicate articles were removed. Eighty-nine results were incorporated into this paper, including full articles, book excerpts, and online articles.

Muslim adolescents may face challenges with academic and social functioning as they navigate psychosocial changes in the context of Ramadan. ADHD management options should be discussed with individuals who are planning to fast. Pharmacologic management options include continuing on the current regimen, dose adjustment to mitigate side effect exacerbation, a change in medication class, or a change in medication formulation. For severe cases or cases with comorbid conditions, continued fasting may not be recommended. In these cases, the patient should attempt to seek counsel with their community’s religious scholar in collaboration with their medication provider. Ultimately, there are limitations in the available data, and there is a need for further investigation into the impacts of fasting during Ramadan on individuals with ADHD and the effectiveness of interventions to promote treatment adherence.

This systematic review aimed at exploring the impact of the coronavirus pandemic on adolescents’ psychosomatic problems and whether the pandemic differentially impacted different genders. It also explored whether particular clusters of psychosomatic problems, viz., psychological, somatic, and musculoskeletal, manifested more post-pandemic than before.

An extensive search of eight electronic databases for studies published/conducted between 2014-2018 for pre-pandemic prevalence of psychosomatic problems among adolescents (11-17 years) and for studies published and conducted between 2019-2023 during/post-pandemic prevalence resulted in the final selection of 38 studies. This included 25 pre-pandemic studies, six studies published and conducted during/after the pandemic, and seven studies that reported pre-post-pandemic comparison. The review was reported following PRISMA guidelines. ROBINS-E tool was used for assessing the risk of bias while the JBI Critical Appraisal Tools were used to assess study quality.

Findings showed that sleep problems and headaches dominated adolescent psychosomatic problems pre-pandemic. Sleep problems continued to be the most common problem post-pandemic, followed by stomach ache and feeling low, dizziness, irritability, appetite loss, tension, and difficulty concentrating. In general, females reported more psychosomatic symptoms, though limited research explored gender differences. Only one study found improved psychosomatic health post-pandemic, more so for boys than girls. Psychological complaints increased post-pandemic; however, results were mixed about somatic and musculoskeletal complaints after the pandemic. Some studies found no change in post-pandemic psychosomatic symptoms.

Gender-specific, tailored training programs are crucial for enhancing resilience and coping to mitigate the impact of the pandemic on adolescents’ psychosomatic health.

The developmental period of late adolescence is when significant identity formation takes place, especially for college students (Erikson, 1968). However, traumatic experiences can affect identity development and lead to extreme identity distress. With exposure to trauma, executive functioning can also diminish, leading to a decrease in self-control and greater sensitivity.

Although trauma affects both executive functioning and identity, the possible direct link between identity and executive function has not been adequately explored. Among a college sample (N = 507), those who experienced trauma reported higher levels of identity distress, ruminative identity exploration, and lower levels of executive functioning.

It was hypothesized that identity variables plus PTSD would better predict executive functioning than PTSD alone. The hypothesis was supported, suggesting the incremental validity of using identity in addition to PTSD to predict executive functioning scores.

Implications of this study include the need to consider identity development in the treatment and prevention of PTSD, as well as trauma history, in interventions aimed at promoting positive identity development in youth.

Posttraumatic Stress Disorder (PTSD) is a prevalent psychological response among those who survive earthquakes.

This study investigates the relationships between sociodemographic and clinical differences and symptoms of avoidance, re-experiencing, and hyperarousal, which are key indicators of PTSD in adolescents.

Research data were collected through online surveys using a simple random sampling method. The sample group consisted of 178 adolescents who met the inclusion criteria. Data were collected using the Personal Information Form (PIF) and the Posttraumatic Stress Disorder Symptoms Scale-Self-Report Scale (PSS-SR) for Children.

Of the participants, 77% were female, with a mean age of 16.99. A total of 84.3% lived with their families. The rate of those trapped under debris during the earthquake was 97.2%. During the earthquake, 84.8% of adolescents were injured, and 25.8% lost a family member due to the earthquake. Female participants showed significantly higher total trauma, re-experiencing, and hyperarousal scores than males (p<0.05). Those physically injured during the earthquake had significantly lower total trauma and avoidance scores compared to those not injured (p<0.05). Participants who lost a family member during the earthquake had significantly lower total trauma, re-experiencing, and hyperarousal scores compared to those who did not lose a family member (p<0.05).

Females exhibited more PTSD symptoms compared to males. Those not injured or who did not lose a family member during the earthquake showed more PTSD symptoms than those who experienced injury or loss.