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In a growing body of literature, poor sleep quality has been associated with externalizing problems. In adults, anxiety was found to mediate the relationship, and callous-unemotional (CU) traits were found to moderate it. We sought to examine these relationships in a child population. We examined these relationships in 239 clinic-referred youth (age 6–17) in Singapore with externalizing behavior problems. Parent- but not child-rated sleep problems were associated with increased parent-rated externalizing problems. This association was partially mediated by anxiety. Unlike in adults, CU traits did not moderate the relationship. Sleep problems were associated with externalizing problems regardless of the level of CU traits. It is possible externalizing behaviors may lead children to internalize experiences, leading to anxiety about their behaviors. Another possibility is externalizing behaviors may lead to more stressful life experiences due to negative reactions children with externalizing behaviors receive from parents, teachers, or peers. Regardless, the partial mediation found indicates anxiety may be an important factor to consider in future interventions focused on improving sleep as a means to reduce externalizing problems.

Child and adolescent psychiatry has an opportunity to adapt alongside the advancements in medical knowledge, post-graduate training, epidemiological realities and clinical service models. Here, we are guided by the mental health needs of our community’s young and their families in our review of child and adolescent psychiatry training in Australia and New Zealand. We recognise that training must respond to clinical demand and service reform while ensuring a range of clinical and educational experiences to deliver expectable competencies in order to produce child and adolescent psychiatrists that meet the communities’ needs now and in the future. We argue that training programmes be subject to rigorous evaluation by embedding continuing cycles of improvement including regular review and international bench marking.

Background Autistic adolescents have greater predisposition to depression and suicidality than neurotypical adolescents. Early detection is essential for timely treatment. The Patient Health Questionnaire 9-item (PHQ-9) is a brief screen for depression. The study examines the validity of the PHQ-9 for detecting major depressive disorder (MDD) in autistic youths. Methods English speaking youths aged 10–18 years, with DSM-IV/DSM-5/ICD-10 diagnosis of Autism Spectrum Disorder (ASD), and their parents presenting to a child psychiatric service were invited to participate between May 2018 to August 2020. Participants completed the respective self- and parent-rated PHQ-9 independently. MDD was verified using the MINI-Kid (Mini-International Neuropsychiatric Interview, Kid version). Results One hundred one youth, mean (SD) age 14.6 (2.3), were enrolled. 27 (27%) met criteria for current MDD. Mean total PHQ-9 scores, percentage ratings for severity of symptoms of depression, functional impairment, dysthymia and suicidality were compared. Areas under the ROC curve and statistically optimal cutoffs were determined. Parents rated depressive symptoms severity lower than their children. The PHQ-9 displayed low sensitivity with high false negative rates at conventional, adjusted and proposed cutoffs. Conclusions Future studies should improve on the validity and reliability of existing depression screening tools, or develop more appropriate screening methods of depression, for autistic youths.

Background Current treatment practices for comorbid conditions of autism spectrum disorder (ASD) and attention deficit hyperactivity disorder (ADHD) remain limited. This study examined the feasibility of an EEG brain-computer interface (BCI) programme for children with ASD and co-occurring ADHD. Method Twenty children were randomised to the intervention or waitlist-control group. Intervention consisted of thrice-weekly sessions of BCI-based training over 8 weeks. Both groups were followed up 4 weeks later. The BCI-based programme comprised of a series of attention and gaze-modulated games aimed to train social cognitive skills. Results All participants completed at least 20 training sessions and none dropped out of the study. No severe adverse events were reported. Side effects included mild headaches, fatigue, irritability and self-injurious behaviours. All were addressed within the same session. Feedback from therapists indicated that participants’ interest and motivation could be sustained with appropriate supports. Change scores indicated greater improvement in the intervention group compared to the waitlist-control on ADHD symptoms as measured on the ADHD rating scale; no significant differences were observed on social deficits on the Social Responsiveness Scale (SRS). Pooled data suggests that pre-post improvements could be maintained. Conclusions Findings indicate the BCI-based program is tolerable for most participants. Positive effects were also reported for ADHD symptoms. A future large clinical trial will incorporate appropriate controls to ascertain the efficacy of our training programme.