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Schizophrenia is a neurodevelopmental disorder associated with deficits in cognitive development and childhood psychopathology. Previous studies have focused on older children and the few studies of early childhood have yielded inconsistent findings. We studied cognitive development and psychopathology in children at familial high risk (FHR) of schizophrenia and matched controls from 1 to 6 years and hypothesized that FHR children would show consistent deficits across cognitive and behavioral measures in early childhood. Cognitive development in children at high familial risk for schizophrenia or schizoaffective disorder (n = 33) and matched healthy controls (n = 66) was assessed at 1 and 2 years with the Mullen Scales of Early Learning, and at 4 and 6 years with the Stanford Binet Intelligence Scales, BRIEF-P/BRIEF and CANTAB. Psychopathology was assessed at 4 and 6 years with the BASC-2. General linear models were used to examine differences on outcome scores, and chi-square analyses were used to explore differences in the proportion of "at risk" or "below average" score profiles. FHR children scored significantly lower than controls on Mullen Composite at age 2, and demonstrated broad deficits in IQ, executive function and working memory and 4 and 6 years. FHR children were also rated as significantly worse on most items of the BASC-2 at ages 4 and 6. Children at FHR for schizophrenia demonstrate abnormal cognitive development and psychopathology at younger ages than previously detected, suggesting that early detection and intervention needs to be targeted to very early childhood. [ABSTRACT FROM AUTHOR]

Previous meta-analyses considering associations between parental depression (PD) and child symptoms have considered PD based primarily on self-report of depression symptoms. The present meta-analysis, in contrast, evaluated the effect of parents' clinically-diagnosed depressive disorders (PDD) on child internalizing and externalizing symptoms and considered both family- and study-level variables that influenced the strength of these effects. We examined 111 effect sizes nested in 40 studies including a clinical assessment of parents' major or persistent depressive disorder and measures of children's internalizing or externalizing behaviors published between 2000 and 2020. We used a multi-level meta-analytic framework to account for nesting of multiple effect sizes within studies. PDD was associated with children's internalizing (weighted mean r = 0.211) and externalizing (weighted mean r = 0.204) behaviors. Family- and study-level variables moderated these relations, including the inclusion of fathers in the sample, the specific measure of internalizing behavior, reporting of diagnostic reliability, and informant for problem behaviors. Limitations include exclusive consideration of internalizing and externalizing symptoms (versus other symptom types or problems) and the limited number of father-only studies from which to base conclusions about the relative effect of maternal vs. paternal depression. The similarity between the current findings and previous meta-analyses suggests that researchers studying the effects of PD may be able to bypass more exhaustive clinical interviews for less burdensome depression symptom inventories. Furthermore, our findings suggest that researchers and clinicians should consider how PD impacts not just child depressive symptoms, but myriad problem behaviors. • Parental depression is a risk factor for child psychopathology. • The current meta-analysis considers the impact of clinically diagnosed parental depressive disorders on children's symptoms. • Effects of parental depressive disorders on child symptoms are moderated by family- and study-level factors. [ABSTRACT FROM AUTHOR]

Adverse childhood experiences (ACEs) increase risk for mental illness in women and their children, and dysregulation of the hypothalamic-pituitary-adrenal axis may play a role. The impact of ACEs on the hypothalamic-pituitary-adrenal axis may be strongest when ACEs occur prepubertally and in people who are exposed to abuse ACEs. To test this, we measured salivary cortisol in 96 mother-infant dyads while mothers were separated from their infants, who were experiencing a laboratory stressor. Mothers completed the Adverse Childhood Experiences Questionnaire; ACEs that occurred prepubertally (pACEs) were measured, and mother-infant dyads were grouped based on maternal pACE history as follows: no pACEs, ≥1 pACEs with abuse, or ≥1 pACEs but no abuse. Mothers with ≥1 pACEs exhibited decreases in cortisol (relative to preinfant stressor), which differed significantly from the cortisol increase experienced by mothers with no pACEs, regardless of abuse presence (p =.001) or absence (p =.002). These pACE groups did not differ from one another (p =.929). Significant sex differences in infant cortisol were observed in infants of mothers with ≥1 pACEs (regardless of abuse) but not in infants of mothers with no pACEs. When mothers had experienced ≥1 pACEs, males showed decreases in cortisol in response to a stressor whereas females demonstrated increases, and males and females differed significantly when their mothers had ≥1 pACEs with (p =.025) and without (p =.032) abuse. Regardless of maternal exposure to childhood abuse, in response to a stressor, pACEs were associated with lower cortisol response in mothers and sex differences in 6-month-old infants, with males showing a lower cortisol response than females. [ABSTRACT FROM AUTHOR]

Exposure to fathers' positive parenting has been associated reducing mental disorder symptoms during adolescence, evidence on the mechanisms underlying this association is lacking. One potential mechanism linking fathers' positive parenting and mental disorders is environmental sensitivity (ES). Here we studied whether the increased positive behaviors of both parents (1) separately, (2) relatively, (3) and jointly predict reduced depression, attention deficit hyperactivity disorder (ADHD) symptoms, suicidal ideation (SI), and increased well-being in Chinese adolescents. Additionally we investigated (4) whether ES moderates these relationships. This study involving 7010 Chinese adolescents (55.6 % girls) aged 15 to 18 from six junior high schools in Shaanxi, China was conducted at four timepoints. ES was assessed using the Highly Sensitive Child (HSC) scale at ages 15 and 16, parental positive behaviors using the Parental Bonding Instrument (PBI) at ages 16 and 17, and psychopathology symptoms using the 9-item Patient Health Questionnaire (PHQ-9), Strengths and Difficulties Questionnaire (SDQ), and Positive and Negative Suicide Ideation (PANSI) Inventory at ages 17 and 18. (1) Multilevel analyses revealed that increased positive parenting predicted reduced psychiatric disorder symptoms and improved well-being; (2) trend interaction indicated that the compensatory effect of fathers' positive parenting was stronger in alleviating mental problems in adolescents than that of mothers'; (3) Simple slope analyses suggested that both high levels of fathers' and mothers' positive parenting predicted fewer subsequent psychiatric disorder symptoms, particularly for sensitive adolescents. This study was limited to its generalizability to the Western Chinese adolescents. Substantial differences in the effects of positive paternal and maternal parenting highlight the important role of fathers' positive parenting in mental development, especially for highly sensitive adolescents. • The present study builds upon previous research by examining whether longitudinal increases in ES during adolescence is a mechanism by which positive paternal parenting is associated with fewer occurrences of psychopathology, and also helps to explain compensatory effects of positive paternal and maternal parenting. • We observed a predominant effect of fathers on Chinese adolescents' development compared with mother. • We found that father played a more substantial role in the association between adolescents' ES and psychiatric disorder symptoms. • These results contribute to a deeper understanding of the influence of fathers on contemporary conceptualizations of developmental psychopathology and adolescent mental health. [ABSTRACT FROM AUTHOR]

• Most depressed youths had changes in symptoms associated with specific CBT modules. • The types of CBT modules associated with changes varied across youths. • Behavioral activation was most frequently associated with decreases in symptoms. • Baseline characteristics did not predict the type of modules that were impactful. • There may be many pathways to symptom improvement for youths with depression. Prior research suggests that the effects of specific cognitive-behavioral therapy (CBT) modules on symptom outcomes can be estimated. We conducted a study utilizing idiographic and nomothetic methods to clarify which CBT modules are most effective for youth depression, and for whom they are most effective. Thirty-five youths received modular CBT for depression. Interrupted time series models estimated whether the introduction of each module was associated with changes in internalizing symptoms, whereby significant symptom reduction would suggest a therapeutic response to the module. Regression models were used to explore whether participant characteristics predicted subgroups of youths based on their estimated response to certain types (e.g., cognitive) of modules, and whether group membership was associated with posttreatment outcomes. Thirty youths (86%) had at least one module associated with a significant change in internalizing symptoms from premodule delivery to postmodule delivery. The specific modules associated with these changes varied across youths. Behavioral activation was most frequently associated with symptom decreases (34% of youths). No participant characteristics predicted estimated response to module type, and group membership was not significantly associated with posttreatment outcomes. Youths display highly heterogeneous responses to treatment modules, indicating multiple pathways to symptom improvement for depressed youths. [ABSTRACT FROM AUTHOR]

There has been a long-standing appreciation in child and adolescent psychiatry for the influence of the family or caregiver. In clinical practice, parents are routinely identified as both a key biological and a key environmental figure in child psychopathology. This is perhaps best represented by the identified patient construct, which recognizes that while symptoms in a child are often the explicit driver for a family to present for psychiatric care, these symptoms do not occur in a vacuum. Instead, within a family systems theory framework, the manifestation of symptoms in a child represents the broader reciprocal relationship between a child and their family unit. [ABSTRACT FROM AUTHOR]

To examine the additive or moderating influences of caregiver COVID-19–related stress, social support, and discrimination on children's behavior problems across racially diverse populations. In this Environmental influences on Child Health Outcomes (ECHO) cohort study (N = 1,999 caregiver/child pairs), we operationalized caregiver COVID-19–related stress in 2 ways: first, as the number of stressors (eg, financial concerns, social distancing); and second, as the level of pandemic-related traumatic stress symptoms reported via questionnaires administered between April 2020 and August 2022. At the same assessment visit, caregivers also reported their current levels of discrimination, and a subsample (n = 968) reported their emotional and instrumental support. Either concurrently or at a later assessment visit, caregivers reported on their children's internalizing and externalizing behavior problems using the Child Behavior Checklist for Ages 6-18 (CBCL/6-18). Multivariable analyses controlling for maternal education, marital status, child age, and child sex revealed that COVID-19–related stress (caregiver stressors and symptoms) and discrimination were positively associated, and that perceived support was negatively associated with child internalizing and externalizing behavior problems. Unexpectedly, neither emotional nor instrumental support attenuated the relationship between caregiver COVID-19–related stressors nor traumatic stress symptoms and child behavior problems. In the subset of Black American participants, caregiver perceived discrimination moderated the relationship between caregiver COVID-19 traumatic stress symptoms and child internalizing problems, such that the association was stronger at higher levels of discrimination. Our findings highlight the potential importance of relieving caregiver stress and increasing caregiver social support to optimize children's behavioral outcomes. [ABSTRACT FROM AUTHOR]

Depression is a psychosomatic disorder that affects reproductive health. The number of pregnancies is an important indicator of reproductive health. Multiple pregnancies and births may aggravate the risk of depression in females. However, the evidence of the connection between the number of pregnancies and depression is unclear. We aimed to investigate the relationship between the number of pregnancies and depressive symptoms. We used the National Health and Nutrition Examination Survey (NHANES) data with a total of 17,216 women from 2005 to 2020. The number of pregnancies obtained from the self-report questionnaire. Depressive symptoms were measured by the nine-item patient health questionnaire (PHQ-9). Multivariate logistic regression models were used to examine the risk factors of depression. The restricted cubic spline (RCS) was applied to explore the nonlinear relationship. In addition, subgroup analysis was used to support the accuracy of our findings. We found that the number of pregnancies is positively associated with the prevalence of depression. According to the multivariable logistic regression analysis, pregnant women was 1.52-fold higher than the normal group to experience depression in the fully-adjusted model. No interaction between number of pregnancies and covariates in subgroups. This study was cross-sectional, which limits its ability to draw conclusions about the causal relationship between the number of pregnancies and depression. In the United States, the number of pregnancies was positively associated with the prevalence of depression. It is critical to register the number of pregnancies for monitoring depressive symptoms. • Maternal psychopathology is associated with female reproductive health. • The number of pregnancies is positively associated with the occurrence of depressive symptoms. • It is critical to keep record and track the number of pregnancies in order to monitor the signs of maternal depression. [ABSTRACT FROM AUTHOR]

André Collin (1879–1926) a été le premier ou l'un des tout premiers à s'intéresser au développement neuropsychique du nourrisson avec une thèse portant sur le syndrome infantile psycho-neuromusculaire (1912). Interne de trois grands maîtres de l'aliénisme : Philippe Chaslin (1857–1923), Ernest Dupré (1862–1923) et Jules Séglas (1856–1939) et d'un pédiatre, Auguste Lesage (1862–1927), il a été chef de clinique de Gilbert Ballet (1853–1916) à l'asile Sainte-Anne de 1912 à 1914. A. Collin a assuré des consultations dans différents dispensaires et hôpitaux de Paris (Hérold, Marie-Lannelongue, Loubet), et il a en outre exercé de 1913 et jusqu'à son décès au Patronage de l'enfance situé au 379 rue de Vaugirard (Paris ; XIVe), une institution privée qui recueillait des mineurs livrés au vagabondage ou qui lui étaient confiés par le Tribunal pour Enfants. En 1925 sera annexée à ce patronage une clinique de neuropsychiatrie dirigée par Georges Heuyer (1884–1977). Membre de la Société Médico-Psychologique (1918), A. Collin est l'auteur de nombreuses communications, publications et de quatre ouvrages : Le développement de l'enfant (1914), Traité de médecine légale infantile (1920) publié avec Henri Rollet (1860–1934), Les enfants nerveux (1924) et Convulsions et épilepsie chez les enfants (1926). Des livres qui témoignent de son intérêt pour la psychiatrie et la neurologie de l'enfant. Dans les premières décennies du XXe, l'étude de l'aliénation mentale chez l'enfant marchait au côté de celle de l'adulte mais cherchait à acquérir son indépendance et à se définir. Dès 1915, les travaux de A. Collin reflètent sa préoccupation de spécifier la sémiologie psychopathologique ou neuropathologique chez l'enfant. En 1924, il fonde la psycho-pédiatrie qu'il considérait comme une branche de la puériculture. Il la définit comme l'étude des différentes modalités suivant lesquelles s'effectue chez le tout jeune enfant le passage de la vie végétative et réflexe à la vie consciente et réfléchie c'est-à-dire le passage de la première période du nourrisson où dominent ses réflexes simples à celle de son adaptation sociale où l'enfant est capable d'établir des rapports sociaux entre lui et le milieu nécessaire à son développement. Ayant connu l'introduction de la psychanalyse chez l'enfant, A. Collin montre peu d'enclin pour cette approche (1911). Dans les premières années du XXe siècle, les dénominations des consultations destinées aux troubles neuropsychiques chez l'enfant (centre psycho-pédiatrique, dispensaire médico-pédagogique, consultation de neuropsychiatrie infantile) et de ceux qui les assurent (psycho-pédiatre, spécialiste de psychiatrie infantile, médecin spécialisé en neuropsychiatrie infantile) sont nombreuses, et la psycho-pédiatrie, discipline éphémère, a été assimilée à la neuropsychiatrie infantile qui a pris son autonomie en 1937. A. Collin ayant accordé une place importante à l'étude du développement neurologique précoce de l'enfant, la psycho-pédiatrie figure comme l'une des assises de la neuropédiatrie contemporaine. André Collin (1879–1926) was the first, or one of the very first, to take an interest in the neuropsychological development of infants. During his studies at the School of Medicine in Paris, he wrote a thesis entitled The Infantile Psycho-neuromuscular Syndrome (1912). Previously, had served as an intern to three eminent alienists: Philippe Chaslin (1857–1923), Ernest Dupré (1862–1923) and Jules Séglas (1856–1939) and to a pediatrician, Auguste Lesage (1862–1927). From 1912 to 1914, he was the head of Gilbert Ballet's (1853–1916) clinic at the Sainte-Anne asylum. A. Collin practiced in various clinics and hospitals in Paris (Hérold, Marie-Lannelongue, Loubet), and from 1913 until his death in 1926, he worked at the Patronage de l'enfance, located at 379 rue de Vaugirard (Paris; 14th). It was a private institution founded by Henri Rollet (1860–1934). It took in vagrant minors or those who had been entrusted to it by the Children's Court. In 1925, a neuropsychiatric clinic directed by Georges Heuyer (1884–1977) was annexed to this patronage. A. Collin was a member of the medical-psychological society (1918). He has published numerous papers, publications, and four books: Le développement de l'enfant (1914), Traité de médecine légale infantile (1920), co-authored by Henri Rollet, Les enfants nerveux (1924) and Convulsions et épilepsie chez les enfants (1926). These works are a testament to his interest in child psychiatry and neurology. In the first decades of the 20th century, the study of mental alienation was not significantly different between adults and children, but the discipline dealing with child mental disorders strove to differentiate itself and achieve independence. As early as 1915, the publications of A. Collin reflected his preoccupation with specifying psychopathological or neuropathological semiology in children. In 1924, he founded psychopediatrics, which he considered to be a branch of childcare. He defined it as the study of the different ways in which the very young child makes the transition from a vegetative, reflexive life to a conscious, reflective life, i.e. the transition from the first period in an infant's life, when simple reflexes dominate, to the period of social adaptation when the child can establish social relationships between her/himself and the environment necessary for her/his development. Having experienced the introduction of psychoanalysis for children, Collin demonstrated little inclination for this approach. In his 1911 publication, he examined child urinary incontinence and cited S. Freud (1856–1939), which was rare at this time. In the early years of the 20th century, the institutions where consultations took place (psychopediatric centers, medical-pedagogical clinics, child neuropsychiatric consultations) and those who provided consultations for neuropsychiatric disorders in children (pediatric psychiatrists, child psychiatric specialists, physicians specialized in child neuropsychiatry) were called by many different names. Moreover, psychopediatrics, which was first introduced at the First International Congress of Child Psychiatry organized by G. Heuyer and held from 24 July to 1 August 1937, was a relatively short-lived discipline as it was assimilated into child neuropsychiatry, which became autonomous in 1937. Although A. Collin had passed away by that time, his emphasis on the study of neurological development during early childhood rendered psychopediatrics one of the foundations of contemporary neuropediatrics. [ABSTRACT FROM AUTHOR]

Many babies cared for on a neonatal unit are at risk of adverse neurodevelopmental outcomes. The aim of early intervention (EI), therefore, is to support a child and their family to achieve the best outcome possible. Notably, EI is not one specific thing. The term encompasses a wide range of approaches and interventions that can vary in a number of ways, including who undertakes them, where they happen and when they start. There is debate as to the most effective approach, but the evidence supports the implementation of EI from soon after birth, continuing post-discharge. Furthermore, involving the parents in EI is critical, not only to ensure sustained effects throughout childhood, but also because of the beneficial impact on parental wellbeing. All in all, the evidence shows improved neurodevelopmental outcomes for children exposed to EI, particularly in the short-term. This review will explore what EI means in practice, considering the variations in application, as well as the evidence of benefit. It will also consider the limitations of current research. [ABSTRACT FROM AUTHOR]

The womb is an influential first home. This felicitous phrase is attributed to David Barker, often called the father of the late 20th century developmental origins of health and disease hypothesis, which asserts that maternal experiences during pregnancy are biologically transmitted to, and embedded in, the fetus, shaping child development. 1 Specifically, Barker focused on maternal inadequate nutrition as a key in utero exposure to which the fetus biologically adapts, leading to biologically programmed changes, meaning long-lasting, that potentially put the offspring at risk for future metabolic diseases. 1 In more recent developmental origins of health and disease publications, the impact of affective symptoms in pregnant women—defined broadly to include perceived stress, depression, and anxiety—on fetal and infant brain and behavior development has been identified. There is a third pathway for the familial inheritance of risk for psychiatric illness beyond shared genes and compromised parental postnatal mental health and caregiving: prenatal programming of risk for psychopathology originating in mental health symptoms of mothers. 1 However, despite decades of experimental preclinical studies demonstrating maternal prenatal stress predicting altered offspring outcomes, 2 the alternative interpretation—that shared genes of risk account for the outcomes—has remained challenging to disprove for human studies, perhaps particularly when the mother reports on her own and her child's mental health (a common study design further addressed below). In this context, the article by Chen et al. 3 using polygenic risk scores to provide a single measure of genomic risk for complex phenotypes reports rigorous and original results demonstrating effects of maternal affective symptoms on child psychiatric outcomes while controlling for genomic risk. [ABSTRACT FROM AUTHOR]

It is unclear how the functional brain hierarchy is organized in preschool-aged children, and whether alterations in the brain organization are linked to mental health in this age group. Here, we assessed whether preschool-aged children exhibit a brain organizational structure similar to that of older children, how this structure might change over time, and whether it might reflect mental health. This study derived functional gradients using diffusion embedding from resting state functional magnetic resonance imaging data of 4.5-year-old children (N = 100, 42 male participants) and 6.0-year-old children (N = 133, 62 male participants) from the longitudinal Growing Up in Singapore Towards healthy Outcomes (GUSTO) cohort. We then conducted partial least-squares correlation analyses to identify the association between the impairment ratings of different mental disorders and network gradient values. The main organizing axis of functional connectivity (ie, principal gradient) separated the visual and somatomotor regions (ie, unimodal) in preschool-aged children, whereas the second axis delineated the unimodal−transmodal gradient. This pattern of organization was stable from 4.5 to 6 years of age. The second gradient separating the high- and low-order networks exhibited a diverging pattern across mental health severity, differentiating dimensions related to attention-deficit/hyperactivity disorder and phobic disorders. This study characterized, for the first time, the functional brain hierarchy in preschool-aged children. A divergence in functional gradient pattern across different disease dimensions was found, highlighting how perturbations in functional brain organization can relate to the severity of different mental health disorders. [ABSTRACT FROM AUTHOR]

Depression and anxiety are associated with grey matter changes in subcortical regions in adults and adolescents. Parent psychopathology is associated with offspring brain structure, but it's unclear whether altered brain structure in children is associated with severity of parental depression and anxiety symptoms. We examined 123 youth (Mean age = 13.64; 62% female) with no clinically significant history of depression or anxiety and one parent diagnosed with current or past depressive or anxiety disorders. Parents completed the Mini International Neuropsychiatric Interview to assess diagnostic status and the Beck Depression Inventory-II, and the Generalized Anxiety Disorder-7 to assess current symptom severity. Youth underwent T1 weighted structural Magnetic Resonance Imaging scans. Bivariate analyses revealed higher parental depressive severity was not significantly associated with offspring grey matter. Parental anxiety severity was significantly associated with less left global surface area. When controlling for offspring age, sex and intracranial volume (ICV), offspring right surface area was negatively associated with parental depressive severity at a trend level. In previously depressed parents, greater parental depressive severity was significantly associated with offspring decreased left and right surface area. There were no significant associations between parental anxiety severity in previously depressed parents and offspring subcortical or cortical brain regions. These results highlight associations between parental depressive symptom severity and offspring brain structure and suggest that even within an already high-risk group of adolescents, there may be altered cortical surface area depending on parent symptom severity. This may help identify youth most at risk for developing a mood disorder and could help further early intervention and identification efforts. [ABSTRACT FROM AUTHOR]

Previous studies have found that adolescents with a chronically ill parent may experience more internalizing problems. It is less clear if this association is sex-related, and whether it is specific for functional somatic symptoms (FSSs) or concerns other internalizing or externalizing problems. In a prospective cohort of adolescents, oversampled on emotional and behavioral problems (n = 841; mean age 14.9 years), we examined the association between parental chronic illness and adolescent's FSSs, and internalizing and externalizing problems. Adolescent's internalizing and externalizing symptoms were measured using the Youth Self Report; parental chronic physical illness was reported during an interview. Associations were tested using linear regression analyses taking into account socio-demographic confounders. We also explored gender-interaction effects. Having a chronically ill parent (n = 120; 14.3 %) was associated with more FSS in girls (B = 1.05, 95%CI = [0.23, 1.88], p =.013), but not in boys (sex-interaction: p =.013). In girls, an association was also found between parental chronic illness and more internalizing problems (B = 2.68, 95%CI = [0.41, 4.95], p =.021), but this association disappeared when FSSs were excluded from the Internalizing problem scores. The current study has a cross-sectional design and relied on self-reported parental chronic physical illness what may have induced misclassification. Findings suggest that having a chronically ill parent is associated with more FSSs in adolescent girls and that this association is specific for FSSs instead of general internalizing problems. Girls with a chronically ill parent may profit from interventions to prevent the development of FSSs. • The association between parental chronic illness and adolescent functional somatic complaints was sex-specific. • Parental illness was associated with more functional somatic symptoms only in adolescent girls and not in boys. • The association with parental physical illness was specific for functional somatic symptoms and not for psychopathology in general. [ABSTRACT FROM AUTHOR]

Autism spectrum disorder is one of a group of conditions considered to be a neurodevelopmental disorder. These conditions, including ADHD, language disorders and intellectual disability frequently co-occur. Diagnostic pathways often focus on assessment of a named condition (e.g. autism spectrum disorder) in isolation, resulting in inefficiencies in service delivery; other services look holistically at the child's strengths and needs, and provide a neurodevelopmental diagnostic formulation. However, there is growing support for a change to this neurodevelopmental approach that informs recommendations for ongoing multiagency support and intervention for the child and their family. Whilst there may be different ways to deliver a successful neurodevelopmental pathway, the move to integrated commissioning offers an opportunity to redesign services to bring together teams; for example, CAMHS and child development services could deliver an integrated neurodevelopmental pathway, instead of separate single condition pathways. This paper presents the research and reasoning, as well as potential pitfalls, for services to deliver a neurodevelopmental approach, and what this means for clinical practice. [ABSTRACT FROM AUTHOR]

Children born preterm are at risk of developing neurodevelopmental, cognitive and mental health needs. There is an inverse correlation between gestational age and those needs. Difficulties with communication and language, executive function, learning, coordination, behaviour, and mental health tend to become more obvious as the social and academic demand increases in later childhood. By school age, children born preterm without severe neurodisability have often been discharged from neonatal follow-up programmes and opportunities for early recognition are missed. Long term follow-up with enhanced developmental surveillance as well as raising awareness of the consequences of prematurity in school are essential in identifying the needs of children born preterm, so that timely interventions can be implemented. In this article, we draw attention to the school-age developmental needs of children born preterm and the implications for clinical care for this population. [ABSTRACT FROM AUTHOR]

The nature of adverse effects of parental mental health problems and of the interventions to address them may require specific designs of economic evaluation studies. Nevertheless, methodological guidance is lacking. We aim to understand the broad spectrum of adverse effects from parental mental health problems in children and the economic consequences on an individual and societal level to navigate the design of economic evaluations in this field. We conducted a systematic literature search of empirical studies on children's adverse effects from parental mental illness. We clustered types of impact, identified individual and public cost consequences, and illustrated the results in an impact inventory. We found a wide variety of short- and long-term (mental) health impacts, impacts on social functioning and socioeconomic implications for the children individually, and adverse effects on the societal level. Consequently, public costs can occur in various public sectors (eg, healthcare, education), and individuals may have to pay costs privately. Existing evaluations in this field mostly follow standard methodological approaches (eg, cost-utility analysis using quality-adjusted life-years) and apply a short-time horizon. Our findings suggest applying a long-term time horizon (at least up to early adulthood), considering cost-consequence analysis and alternatives to health-related quality of life and quality-adjusted life-years as outcome measures, and capturing the full range of possible public and private costs. • Programs to prevent adverse effects of parental mental illness in children have shown benefits. Nevertheless, economic evaluations are scarce and methodologically challenging. • We provide an overview on the spectrum of adverse consequences of parental mental illness in children and society and give an orientation on how this knowledge may be translated into the design of an economic evaluation regarding perspective, study type, time horizon, and selection of costs and outcomes. • Economic evaluations of family-focused interventions when parents have a mental illness require careful design and possibly deviation from standard methods (eg, quality-adjusted life-years) to avoid decisions based on misleading cost-effectiveness results. [ABSTRACT FROM AUTHOR]

Preterm birth (<37 weeks gestation) affects over 10% of live births. The last two to three decades have seen an improvement in survival of preterm infants, especially those born at extremes of viability. Preterm birth results in interruption of organ development and maturation that occurs in the last trimester of pregnancy. This increases the risk of short term mortality and morbidity. As an incremental improvement in survival of preterm neonates into adulthood is seen, this has brought to light the long term health needs of this subgroup of the population. Adolescents and adults born preterm are at increased risk of chronic respiratory, cardiovascular, renal, endocrine, visual and hearing problems and adverse neurodevelopmental and mental health outcomes. Better awareness amongst clinicians, targeted follow-up, and screening, would help in early detection and timely intervention to optimize their long term health outcomes and survival. [ABSTRACT FROM AUTHOR]

Trauma-exposed young people are about twice as likely as their unexposed peers to develop mental health problems, which, if left untreated, can have long-term negative consequences.1 There is robust evidence for the effectiveness of individual trauma-focused psychological therapies to improve trauma-related psychopathology, particularly posttraumatic stress disorder (PTSD), in young people.2 However, there are minimal services that provide such specialist treatments in low/middle-income countries where most young people live,3 and services may be severely disrupted at times of extreme stressors, such as war, natural disasters, and other humanitarian crises, when need is greatest.4 Moreover, even in high-income stable regions where child mental health services are established and treatments are available, these health care resources are limited, and can only be accessed by a minority of affected trauma-exposed young people.5 There is therefore a need for research to indicate effective interventions that are more accessible and can be delivered on a greater scale to treat more young people with trauma-related psychopathology.6 The recent meta-analysis by Davis et al. 7 focused on the more accessible intervention of group-based psychological treatment for child PTSD symptoms, and found evidence of effectiveness compared with control conditions. The study provides an important advancement in this field, and also highlights the need for further research to better understand how group interventions can be most usefully implemented. [ABSTRACT FROM AUTHOR]

Introduction: The co-occurrence between major depression disorder (MDD) and conduct disorder (CD) is common across development and represents a significant risk factor for future psychiatric problems and long-term impairment. Large-scale quantitative genetic studies suggest that the MDD-CD co-occurrence may be partly explained by shared genetic vulnerability factors, in line with transdiagnostic models of psychopathology, but no systematic synthesis of the literature is currently available.Methods: We therefore conducted a systematic review of the available genetic literature on the co-occurrence between MDD and CD in children and adolescents. We identified 10 eligible studies, including 5 cross-sectional bivariate/multivariate twin studies, 3 longitudinal bivariate/multivariate twin studies, and 2 latent profile/trajectory twin studies.Results: Most of the reviewed studies found a strong contribution of shared genetic factors on the covariation between depression and conduct problems, in line with the prominent effect of a common genetic liability across development.Limitations: The scientific literature on this psychiatric comorbidity is still limited, as it solely consists of twin studies from high income countries.Conclusion: Considering the joint burden of MDD and CD on youth, families and society worldwide, future studies are needed to better investigate the shared risk processes of these frequently co-occurring conditions, in order to inform new treatments through personalized medicine. [ABSTRACT FROM AUTHOR]

Among children with psychotic-like experiences (PLEs), the presence of co-occurring psychopathology may distinguish children's self-report of clinically significant experiences (i.e., PLEs that are distressing and/or impairing of daily functioning) from reports of more benign experiences. The aim of this study was to examine whether the likelihood of distressing or impairing PLEs differed according to type of co-occurring psychopathology symptoms. A community sample of 5268 children aged 9–12 years were recruited from Greater London, UK. Participants completed the Psychotic-Like Experiences Questionnaire for Children, and the Strengths and Difficulties Questionnaire to measure internalising and externalising problems. Multinomial logistic regressions were used to determine the likelihood of PLEs being distressing and/or impairing (vs. not) among children with different co-occurring symptom profiles (PLEs only; PLEs with internalising problems only – PLE-I; PLEs with externalising problems only – PLE-E; and PLEs with both internalising and externalising problems – PLE-IE). Children with co-occurring internalising and/or externalising problems had greater odds of distressing and/or impairing PLEs compared to children without co-occurring psychopathology (PLEs only). These associations were moderate for PLE-E and strong for PLE-I and PLE-IE, with the greatest odds of distressing and impairing PLEs evident in the presence of internalising plus externalising comorbidities (odds ratios [with 99 % confidence intervals] for PLE-IE relative to PLE- I = 2.00 [1.34–2.99]; PLE-IE relative to PLE-E = 5.46 [3.78–7.90]). These results affirm the importance of screening for the presence and type of co-occurring psychopathology among children with PLEs to demarcate potentially different treatment needs. [ABSTRACT FROM AUTHOR]

Correlations between cognitive ability and psychopathology are well recognized, but prior research has been limited by focusing on individuals with intellectual disability, single-diagnosis psychiatric populations, or few measures of psychopathology. Here, we quantify relationships between full-scale IQ and multiple dimensions of psychopathology in a diverse care-seeking population, with a novel focus on differential coupling between psychopathology dimensions as a function of IQ. A total of 70 dimensional measures of psychopathology, plus IQ and demographic data, were collated for 2,752 children and adolescents from the Healthy Brain Network dataset. We first examined univariate associations between IQ and psychopathology, and then characterized how the correlational architecture of psychopathology differs between groups at extremes of the IQ distribution. Associations with IQ vary in magnitude between different domains of psychopathology: IQ shows the strongest negative correlations with attentional and social impairments, but is largely unrelated to affective symptoms and psychopathy. Lower IQ is associated with stronger coupling between internalizing problems and aggression, repetitive behaviors, and hyperactivity/inattentiveness. Our analyses reveal that variation in general cognitive ability is associated not only with significant and selective shifts in severity of psychopathology, but also in the coupling between different dimensions of psychopathology. These findings have relevance for the clinical assessment of mental health in populations with varying IQ, and may also inform ongoing efforts to improve the measurement of psychopathology and to understand how relationships between cognition and behavior are reflected in brain organization. We worked to ensure sex and gender balance in the recruitment of human participants. We worked to ensure sex balance in the selection of non-human subjects. One or more of the authors of this paper self-identifies as a member of one or more historically underrepresented racial and/or ethnic groups in science. One or more of the authors of this paper received support from a program designed to increase minority representation in science. We actively worked to promote sex and gender balance in our author group. We actively worked to promote inclusion of historically underrepresented racial and/or ethnic groups in science in our author group. While citing references scientifically relevant for this work, we also actively worked to promote sex and gender balance in our reference list. The author list of this paper includes contributors from the location and/or community where the research was conducted who participated in the data collection, design, analysis, and/or interpretation of the work. One or more of the authors of this paper self-identifies as a member of one or more historically underrepresented sexual and/or gender groups in science. [ABSTRACT FROM AUTHOR]

Objective: Computer-assisted child-focused interventions are expected to improve efficiency and personalization of therapist-led treatments for children and adolescents. However, therapist-led, outpatient interventions using computer assistance are lacking for children with oppositional defiant disorder (ODD) or conduct disorder (CD). The present randomized controlled trial examined the efficacy of individualized computer-assisted social skills training for children with aggressive behavior compared to a resource activation intervention.Method: A total of 100 children aged 6-12 years with a diagnosis of ODD/CD and peer-related aggression were randomly (1:1) assigned to either individually delivered computer-assisted social skills training (ScouT) or an individually delivered supportive resource activation treatment (STARK). The primary outcome was parent-rated peer-related aggression, assessed with the respective scale of the Questionnaire for Aggressive Behavior of Children (FAVK) and measured at pre-assessment and after the 16-week intervention (post-assessment). Further parent-, self-, teacher- and/or clinician-rated outcomes included ODD and CD symptoms, a wide range of behavioral and emotional symptoms, callous-unemotional traits, functional impairment, and quality of life.Results: After correcting for multiple testing, analyses of covariance comparing the efficacy of ScouT to the efficacy of STARK yielded small to moderate treatment effects in favor of the ScouT condition regarding parent-rated peer-related aggression (primary outcome; d = -0.64, 95% CI = -1.05, -0.24), parent-rated callous and uncaring traits, and parent-rated quality of life. However, the analyses did not reveal any significant effects for self- or teacher-rated peer-related aggression assessed with the respective scale of the FAVK (self-report: d = -0.21, 95% CI = -0.69, 0.29; teacher rating: d = -0.17, 95% CI = -0.56, 0.22). Moreover, after controlling for multiple comparisons, no significant effects emerged for the following: parent-, self-, and teacher-rated adult-related aggression; parent-, self-, teacher-, and clinician-rated ODD and CD symptoms; parent-, self-, and teacher-rated emotional and behavioral symptoms; and parent-rated functional impairment.Conclusion: According to parent ratings, school-age children with disruptive behavior disorders and peer-related aggression seem to benefit more from individualized, computer-assisted social skills training than from resource activation treatment. However, this conclusion is limited by the missing effects on the clinician-, self-, and teacher-rated measures.Clinical Trial Registration Information: Treatment of Children With Peer Related Aggressive Behavior (ScouT); https://clinicaltrials.gov/; NCT02143427. [ABSTRACT FROM AUTHOR]

Callous-unemotional (CU) traits designate a distinct subgroup of children with early-starting, stable, and aggressive conduct problems. Critically, traditional parenting interventions often fail to normalize conduct problems among this subgroup. The aim of this study was to test whether parent-child interaction therapy (PCIT) adapted to target distinct deficits associated with CU traits (PCIT-CU) produced superior outcomes relative to standard PCIT. In this proof-of-concept trial, 43 families with a 3- to 7-year-old child (M age = 4.84 years, SD = 1.12, 84% male) with clinically significant conduct problems and elevated CU traits were randomized to receive standard PCIT (n = 21) or PCIT-CU (n = 22) at an urban university-based research clinic. Families completed five assessments measuring child conduct problems, CU traits, and empathy. Parents in both conditions reported good treatment acceptability and significantly improved conduct problems and CU traits during active treatment, with no between-group differences. However, linear mixed-effects models showed treatment gains in conduct problems deteriorated for children in standard PCIT relative to those in PCIT-CU during the 3-month follow-up period (ds = 0.4-0.7). PCIT-CU shows promise for sustaining improvements in conduct problems for young children with conduct problems and CU traits, but requires continued follow-up and refinement. [ABSTRACT FROM AUTHOR]

Objective: Maternal prenatal stress and mood symptoms are associated with risk for child psychopathology. Within the Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD) Fetal Growth Studies (ECHO-FGS), a racially and ethnically diverse cohort, we studied associations between prenatal stress and depressive symptoms with child neurobehavior, and potential mediation by fetal growth velocity (FGV) in low-risk pregnancies.Method: For 730 mother-child pairs, we had serial ultrasound measurements, self-reports of prenatal stress and depression, observations of child executive functions and motor skills from 4 to 8 years, and maternal reports of child psychiatric problems. We tested associations between prenatal stress and depressive symptoms with child neurobehavior in regression analyses, and associations with FGV in mixed effect models. Post hoc we tested severity of prenatal symptoms; FGV at 25th, 50th, and 75th percentiles; and moderation by biological sex and by race and ethnicity.Results: Prenatal stress and depressive symptoms were associated with child psychiatric problems, and prenatal depressive symptoms with decrements in executive functions and motor skills, especially in biological male children. Neither prenatal stress nor depressive symptoms were associated with FGV.Conclusion: In one of the largest cohorts with observed child outcomes, and the first with broad representation of race and ethnicity in the United States, we found that prenatal stress and depressive symptoms were associated with greater reports of child psychiatric symptoms. Only prenatal depressive symptoms were associated with observed decrements in cognitive abilities, most significantly in biological male children. Stress during low-risk pregnancies may be less detrimental than theorized. There was no mediation by FGV. These findings support the need to attend to even small changes in prenatal distress, as these may have long-lasting implications. [ABSTRACT FROM AUTHOR]

Intolerance of uncertainty is a transdiagnostic risk factor for fear-related disorders and is associated with higher levels of anxiety in children and adolescents. It is unclear how uncertainty relates to development of psychopathology in children who have experienced trauma in early life. The present study used a fear-potentiated startle paradigm in children to examine associations between uncertainty (assessed as unawareness of a change in reinforcement during fear extinction) and symptoms of anxiety and posttraumatic stress disorder (PTSD), as well as startle potentiation to threat and safety cues. Results showed that unaware children had strong positive associations between trauma exposure and PTSD symptoms, whereas aware children did not. Uncertainty interacted with anxiety in that children who were both unaware and had higher anxiety displayed higher fear-potentiated startle to safety cues and did not show discrimination between threat and safety during fear conditioning. These results suggest that anxious children who persist in associating a threat cue with an aversive event during extinction, after repeated presentations of the no longer reinforced conditioned stimulus, may express psychophysiological phenotypes related to PTSD. • A fear-potentiated startle paradigm examined associations between uncertainty and symptoms of anxiety and PTSD in children • Uncertainty was defined as the lack of contingency awareness of the absence of the aversive stimulus during fear extinction • Children who were both unaware and more anxious had higher fear-potentiated startle to safety cues • Trauma exposure was correlated with PTSD symptoms only children that were unaware of the contingency shift • Intolerance of uncertainty may increase risk for psychopathology in children with trauma exposure [ABSTRACT FROM AUTHOR]

A strong bond between parents and their children is essential in promoting healthy psychological development. Poor quality parent-child relationships can render children vulnerable to various adverse outcomes. Although extensive research has highlighted the association between abnormal parent-child bonding and mood and anxiety-related psychopathology in offspring, no systematic review or meta-analysis has assessed this relationship in adults. A literature search was conducted in five databases (MEDLINE, Embase, PsycINFO, CINAHL, Web of Science) on January 4th, 2021. Studies that assessed the relationship between parental bonding and the presence of a mood or anxiety disorder in adults were eligible for inclusion. Fifty-seven studies were included in the systematic review (n = 44 in the meta-analysis). Quantitative results indicated that individuals with major depression, panic disorder, or persistent depressive disorder reported lower parental care and higher overprotection compared to individuals without psychiatric diagnoses. Qualitative results indicated that individuals with diagnoses of mood or anxiety disorders tended to report higher parental abuse than controls. The measures of parental bonding used by the included studies are retrospective and subject to biases. All studies had a case-control design and thus, causal-relationships cannot be drawn from the results. Our findings suggest that poor-quality parental bonding early in life may place offspring at greater risk for mood and anxiety disorders during adulthood. Future research should extend these results by confirming the relationship between parental bonding and other psychiatric disorders, as well as identifying which factors mediate the relationship between abnormal parental bonding and psychiatric disorders. • Individuals with depression & PDD report lower parental care & higher protection. • Individuals with panic disorder report lower parental care & higher protection. • No differences in parental bonding were seen with PTSD or bipolar disorders. • A possible cultural difference exists in perceptions of parental protection. [ABSTRACT FROM AUTHOR]

Prominent models of adult social anxiety disorder emphasize the role of hyperreactivity and emotion regulation (ER) difficulties. However, it is unclear whether these factors are relevant in childhood, a critical period for the development of this disorder. We used ecological momentary assessment with mobile phones to assess daily-life emotional reactivity and use and effectiveness of ER strategies in children aged 10–13 years. We compared three groups: Social anxiety disorder (n = 29), clinical controls with mixed anxiety disorders (n = 27) and healthy controls (n = 31). We also investigated long-term effects of ER on trait social anxiety 12 months later. Hierarchical linear modelling revealed higher emotional reactivity and more use of suppression in children with social anxiety disorder compared to clinical and healthy controls. Contrary to our expectations, children with social anxiety disorder reported more use of avoidance and reappraisal compared to clinical, but not healthy, controls. The groups did not differ in subjective effectiveness of ER strategies. Use of suppression, avoidance, and rumination each predicted an increase in social anxiety 12 months later. Taken together, our results extend previous findings from lab and questionnaire studies and illustrate the role of maladaptive ER for child social anxiety disorder. • Little is known about maintaining factors of child social anxiety disorder (SAD). • High daily-life reactivity and use of suppression are specific to child SAD. • Maladaptive emotion regulation predicts trait social anxiety one year later. • Treatment should put more focus on reducing maladaptive emotion regulation. [ABSTRACT FROM AUTHOR]

Foster parents can be placed under significant demands when caring for foster children with extensive needs. Coming to terms with the challenges they have to face can be a daunting prospect. To examine foster parents' experiences is vital with a view to enhancing their resilience amid sustained demands and improving the professional support offered to them. This study explores foster parents' lived experience of caring for foster children with mental illness and attachment difficulties. Twenty-two foster parents, caring for foster children aged 2–17, were recruited from a mental health clinic providing assessment and treatment to children. In this qualitative study, in-depth interviews were conducted and analyzed using a descriptive phenomenological psychological approach. Our analysis revealed four interrelated constituents describing the foster parents' experiences: 1) Wanting to help a child, 2) Adjustments were harder than expected, 3) Sacrifices and suppression of needs, and 4) Commitment and love mixed with ambivalence. The findings highlight that being a foster parent for children with mental illness and attachment difficulties demands heightened patience, knowledge and understanding. It also involves a substantial emotional investment. This underscores the importance of addressing feelings of love, shame, and guilt in this context. Balancing the needs of the foster child with the well-being of the foster family can be challenging. Foster parents may need extensive support from professionals who are familiar with their unique circumstances to increase their feeling of self-efficacy and reduce ambivalent feelings regarding their role as caregivers. [ABSTRACT FROM AUTHOR]

Objective: Despite its clinical relevance to pediatric mental health, the relationship of irritability with anger and aggression remains unclear. We aimed to quantify the relationships between well-validated, commonly used measurements of these constructs and informant effects in a clinically relevant population.Method: A total of 195 children with primary diagnoses of attention-deficit/hyperactivity disorder, disruptive mood dysregulation disorder, or no major disorder and their parents rate irritability, anger, and aggression on measures of each construct. Construct and informant relationships were mapped via multi-trait, multi-method factor analysis.Results: Parent- and child-reported irritability and child-reported anger are highly associated (r = 0.89) but have some significant differences. Irritability overlaps with outward expression of anger but diverges from anger in anger suppression and control. Aggression has weaker associations with both irritability (r = 0.56) and anger (r = 0.49). Across measures, informant source explains a substantial portion of response variance.Conclusion: Irritability, albeit distinct from aggression, is highly associated with anger, with notable overlap in child-reported outward expression of anger, providing empirical support for formulations of clinical irritability as a proneness to express anger outwardly. Diagnostic and clinical intervention work on this facet of anger can likely translate to irritability. Further research on external validation of divergence of these constructs in anger suppression and control may guide future scale revisions. The proportion of response variance attributable to informant may be an under-recognized confound in clinical research and construct measurement. [ABSTRACT FROM AUTHOR]

Background Fetal exposure to unmetabolized folic acid (UMFA) during pregnancy may be associated with adverse neurodevelopment. Antiseizure medication (ASM) may interact with folate metabolism. Women with epilepsy using ASM are often recommended high-dose folic acid supplement use during pregnancy. Objectives The aim was to determine the association between UMFA concentrations in pregnant women with epilepsy using ASM and risk of autistic traits or language impairment in their children aged 1.5–8 y. Methods We included children of women with epilepsy using ASM and with plasma UMFA measurement enrolled in the Norwegian Mother, Father, and Child Cohort Study (MoBa). Data on ASM use, folic acid supplement use, autistic traits, and language impairment were obtained from parent-reported questionnaires during pregnancy and when the child was 1.5, 3, 5, and 8 y old. Plasma UMFA concentrations were measured during gestational weeks 17–19. Results A total of 227 ASM-exposed children of 203 women with epilepsy were included. Response rates at ages 1.5, 3, 5, and 8 y were 67% (n  = 151), 54% (n  = 122), 36% (n  = 82), and 37% (n  = 85), respectively. For 208 (94%) children, the mother reported intake of folic acid supplement. There was no association between UMFA concentrations and autistic traits score in the adjusted multiple regression analyses at age 3 y (unstandardized B: −0.01; 95% CI: −0.03, 0.004) or 8 y (unstandardized B: 0.01; 95% CI: −0.02, 0.03). Children exposed to UMFA had no increased risk of autistic traits at age 3 y [adjusted OR (aOR): 0.98; 95% CI: 0.2, 4.2] or 8 y (aOR: 0.1; 95% CI: 0.01, 1.4) compared with unexposed children. We found no association between UMFA concentrations and language impairment in children aged 1.5–8 y. Conclusions Our findings do not support any adverse neurodevelopmental effects of UMFA exposure in utero in children of women with epilepsy using ASM. [ABSTRACT FROM AUTHOR]

BACKGROUND AND OBJECTIVE: First-line, nonpharmacological therapy is recommended for many pediatric mental health (MH) conditions prior to initiating antipsychotic prescription therapies. Many children do not receive these recommended services, despite the known association between antipsychotic medications and metabolic dysfunction. The main objective of this study was to quantify the association among children's MH diagnosis categories, sociodemographic characteristics and receipt of first-line psychosocial care among children in Florida Medicaid METHODS: Florida Medicaid enrollment, healthcare and pharmacy claims were used for this multivariate analysis. Children were assigned to condition clusters wherein related diagnoses were grouped into clinically relevant categories. A total of 7704 children were included in the final analysis. RESULTS: Twenty-four percent of children in Florida Medicaid do not receive first-line, nonpharmacological psychosocial care. Age was significantly associated with not receiving psychosocial services, with older children less likely to receive. Non-Hispanic White children as well as those living in rural areas had lower odds of receiving behavioral intervention prior to initiating antipsychotics. Children with mood-disorders, behavior problems, anxiety and stress related disorders were more likely to receive first-line psychosocial care. CONCLUSIONS: This study provides an important understanding of the variability in receipt of first-line psychosocial care before antipsychotic medication initiation among children in Medicaid based on sociodemographic and MH health characteristics. These analyses can be used to develop quality improvement initiatives targeted toward children that are most vulnerable for not receiving recommended care. [ABSTRACT FROM AUTHOR]

Background: Current DSM and ICD classifications of Attention-Deficit/Hyperactivity Disorder (ADHD) exclude emotional dysregulation (ED) in their diagnostic criteria, despite ED symptoms frequently co-occurring in ADHD and likely sharing common neurobiological substrates. In this study, we examined whether consideration of ED symptoms could delineate more informative "ADHD+ED" subphenotypes.Method: 4106 children with ADHD were recruited. ED and inattentive (IA) and hyperactive/impulsive (HI) symptoms were profiled using latent class analyses (LCA). The derived latent class (LC) subphenotypes were evaluated and validated in relation to comorbidity patterns, executive functions, and functional impairments.Results: Five LC subphenotypes with ED symptoms were identified: IA/HI + ED profile (LC1); HI + ED profile (LC2); IA + ED profile (LC3); IA/HI profile (LC4); and IA profile (LC5). Cross-validation of the LCA model using support vector machine analysis confirmed 83% accuracy. ED positive (ED+ve) subphenotypes were associated with higher rates of oppositional defiant disorder, mood disorders, anxiety disorders, as well as more severe autistic traits and sluggish cognitive tempo symptoms. Higher rates of ecological executive functioning impairments (BRIEF ratings) were found among ED+ve subphenotypes (though no differences were detected by laboratory-based measures). Functional impairments were also more severe among participants with ED+ve subphenotypes.Limitations: The data for our LCA were cross-sectional and based primarily on parent ratings.Conclusion: Our classification model has parcellated IA, HI, and ED symptoms into novel informative subphenotypes. These classifications provide preliminary evidence that ED symptoms could serve as sentinel features to identify a potential "ADHD-complex" syndrome, which demarcates a more pervasive condition of greater severity, complexity, and impairment. [ABSTRACT FROM AUTHOR]

Background: Early difficult temperament and child mental health problems are consistently associated with impaired functioning in adulthood. We examined three potential pathways between difficult temperament in toddlerhood (age 2) and depressive symptoms (ages 21-23) and well-being (age 23): i) direct - early difficult temperament directly associates with these outcomes, ii) mediated - these direct effects are also mediated by a general psychopathology factor in late childhood/early adolescence (GPF; ages 7, 10,and 13), and iii) moderated-mediated - these mediated effects are also moderated by negative (age 42 months) and positive (age 33 months) parenting behaviors.Methods: The analytic sample included 1892 mother-child dyads (33.4% male children) from the Avon Longitudinal Study of Parents and Children (ALSPAC). Mothers reported on their child's difficult temperament, negative parenting, positive parenting, and child's mental health symptoms. In adulthood, participants reported their own depressive symptoms and well-being (i.e. mental well-being, life satisfaction, happiness).Results: First, early difficult temperament associated directly and positively with depressive symptoms, but negatively with well-being in adulthood. Second, the GPF in late childhood/early adolescence mediated these direct associations. Third, the mediated pathways were not moderated by negative or positive parenting.Limitations: i) low risk community sample, ii) early risks are based on maternal reports.Conclusions: Temperament is a risk factor for impaired psychosocial functioning in adulthood, manifested through increased susceptibility to psychopathology in childhood/adolescence. Although more research is needed to test their generalizability, these findings suggest that targeting early difficult temperament may alleviate the risk for later mental health difficulties and may increase general well-being. [ABSTRACT FROM AUTHOR]

Objective: Disruptive mood dysregulation disorder (DMDD) was introduced in DSM-5 to distinguish a subset of chronically irritable youth who may be incorrectly diagnosed and/or treated for pediatric bipolar disorder (BPD). This study characterized the rate of new treatment episodes and treated prevalence of BPD and DMDD from a longitudinal electronic health record database and examined the impact of DMDD on prescription trends.Method: A retrospective cohort study using 2008-2018 Optum electronic health record data was conducted. Youth aged 10 to < 18 years with ≥ 183 days of database enrollment before the study cohort entry were included. Annual new treatment episode rates per 1,000 patient-years and treated prevalence (%) were estimated. Prescriptions for medications, concomitant diagnoses, and acute mental health service use for 2016-2018 were evaluated.Results: There were 7,677 youths with DMDD and 6,480 youths with BPD identified. Mean age (13-15 years) and ethnicity were similar for both groups. A rise in new treatment episode rates (0.87-1.75 per 1,000 patient-years, p < .0001) and treated prevalence (0.08%-0.35%, p < .0001) of DMDD diagnoses (2016-2018) following diagnosis inception was paralleled by decreasing new treatment episode rates (1.22-1.14 per 1,000 patient-years, p < .01) and treated prevalence (0.42%-0.36%, p < .0001) of BPD diagnoses (2015-2018). More youth in the DMDD group were prescribed medications compared with the BPD group (81.9% vs 69.4%), including antipsychotics (58.9% vs 51.0%). Higher proportions of youth with DMDD vs youth with BPD had disruptive behavior disorders (eg, 35.9% vs 20.5% had oppositional defiant disorder), and required inpatient hospitalization related to their mental health disorder (45.0% vs 33.0%).Conclusion: Diagnosis of DMDD has had rapid uptake in clinical practice but is associated with increased antipsychotic and polypharmacy prescriptions and higher rates of comorbidity and inpatient hospitalization in youth with a DMDD diagnosis compared with a BPD diagnosis. [ABSTRACT FROM AUTHOR]

Objective: To describe adult outcome of people with attention-deficit/hyperactivity disorder (ADHD) diagnosed in childhood and its several key predictors via a review of 7 North American controlled prospective follow-up studies: Montreal, New York, Milwaukee, Pittsburgh, Massachusetts General Hospital (MGH), Berkeley, and 7-site Multimodal Treatment Study of Children With ADHD (MTA).Method: All studies were prospective and followed children with a diagnosis of ADHD and an age- and gender-matched control group at regular intervals from childhood (6-12 years of age) through adolescence into adulthood (20-40 years of age), evaluating symptom and syndrome persistence, functional outcomes, and predictors of these outcomes.Results: The rates of ADHD syndrome persistence ranged from 5.7% to 77%, likely owing to varying diagnostic criteria and the source of information (self-report vs informant report) across the studies. However, all studies observed high rates of symptomatic persistence ranging from 60% to 86%. The 7 studies were largely consistent in finding that relative to control groups, research participants with childhood-diagnosed ADHD had significant impairments in the areas of educational functioning, occupational functioning, mental health, and physical health as well as higher rates of substance misuse, antisocial behavior, and unsafe driving. The most consistently observed predictors of functional outcomes included ADHD persistence and comorbidity, especially with disruptive behavior disorders.Conclusion: Childhood ADHD has high rates of symptomatic persistence, which is associated with negative functional outcomes. Characteristics that predict these negative outcomes, such as comorbid disruptive behavior disorders, may be important targets for intervention. [ABSTRACT FROM AUTHOR]

Maternal distress experienced prenatally and in the child's first year of life has been associated consistently with offspring psychopathology. Less research has addressed whether it is also associated with variations in psychological traits. The present research used two samples from the Longitudinal Study of Australian Children to examine the association between maternal prenatal and postnatal distress and offspring temperament across childhood. Maternal distress experienced by mothers was associated with higher offspring reactivity and lower offspring persistence. These associations replicated across both types of maternal distress (prenatal/postnatal), across two different measures of temperament, and remained significant controlling for maternal distress concurrent with the temperament measures and controlling for maternal personality. There was less evidence that either type of maternal distress was associated with sociability and no evidence that it was associated with the trajectory of the three dimensions of temperament across childhood. Maternal distress is associated with traits that reflect dysregulation and may be one mechanism through which prenatal and early life factors contribute to individual differences in psychological function. [ABSTRACT FROM AUTHOR]

There is a growing appreciation that clinically impairing irritability is an important transdiagnostic symptom among children and adolescents with mental illness. Severe irritability, defined by frequent, developmentally inappropriate temper outbursts and low frustration tolerance, is one of the most common reasons that youths are referred for psychiatric evaluation and care.1 Although chronic irritability is the primary symptom in disruptive mood dysregulation disorder, the symptom is common in a diverse set of DSM-5 diagnoses, including major depressive disorder, autism spectrum disorder, oppositional defiant disorder, bipolar disorder, and generalized anxiety disorder.1 Given that clinically impairing irritability is often predictive of poor outcomes in childhood and worse clinical course in adulthood, a concerted effort is being made to refine the definition of this symptom and determine if severe irritability could be better understood and treated as an independent diagnosis.1 [ABSTRACT FROM AUTHOR]

• The collaborative outcome study on health and functioning during infection times (COH-FIT) is a global survey on COVID-19 impact to date, involving more than 230 researchers and 120 institutions across all continents. • COH-FIT is an online anonymous survey, cross-sectional at the individiual level, but longitudinal at the population level, and has a multi-wave structure. • COH-FIT is available in 30 languages, deliberately including linguistic and ethnic minorities. It collects information on health and functioning of adults, but also of children (from 6 years old) and adolescents, via self-report and parental rating questionnaire. • COH-FIT collects both representative sample via polling agencies, and non-representative samples via snowball/non-probability recruiting startegies. • COH-FIT has been collecting over 150,000 responses from over 150 countries, of which 13,000 minors from the six continents from april 26th, 2020 to june 2021. The COVID-19 pandemic has altered daily routines and family functioning, led to closing schools, and dramatically limited social interactions worldwide. Measuring its impact on mental health of vulnerable children and adolescents is crucial. The Collaborative Outcomes study on Health and Functioning during Infection Times (COH-FIT – www.coh-fit.com) is an on-line anonymous survey, available in 30 languages, involving >230 investigators from 49 countries supported by national/international professional associations. COH-FIT has thee waves (until the pandemic is declared over by the WHO, and 6–18 months plus 24–36 months after its end). In addition to adults, COH-FIT also includes adolescents (age 14–17 years), and children (age 6–13 years), recruited via non-probability/snowball and representative sampling and assessed via self-rating and parental rating. Non-modifiable/modifiable risk factors/treatment targets to inform prevention/intervention programs to promote health and prevent mental and physical illness in children and adolescents will be generated by COH-FIT. Co-primary outcomes are changes in well-being (WHO-5) and a composite psychopathology P-Score. Multiple behavioral, family, coping strategy and service utilization factors are also assessed, including functioning and quality of life. Up to June 2021, over 13,000 children and adolescents from 59 countries have participated in the COH-FIT project, with representative samples from eleven countries. Cross-sectional and anonymous design. Evidence generated by COH-FIT will provide an international estimate of the COVID-19 effect on children's, adolescents' and families', mental and physical health, well-being, functioning and quality of life, informing the formulation of present and future evidence-based interventions and policies to minimize adverse effects of the present and future pandemics on youth. [ABSTRACT FROM AUTHOR]

Objective: To test differential prospective prediction of growth in externalizing behavior, including oppositional defiant disorder, conduct disorder, and substance use disorders, by earlier hyperactive-impulsive (HI) vs inattentive (IN) symptoms of attention-deficit/hyperactivity disorder (ADHD).Method: Participants in the Longitudinal Assessment of Manic Symptoms (LAMS) Study (N = 685 at study entry), including 458 boys and 227 girls ages 6-12, completed full parent report and self-report assessments every year for 8 years on the Schedule for Affective Disorders and Schizophrenia for School-Age Children. Three sets of analyses were conducted. First, hierarchal regression (block entry) was used to test independent associations between HI symptoms and later externalizing outcomes, controlling for IN symptoms, and IN symptoms and later externalizing outcomes, controlling for HI symptoms. Second, logistic regression was used to test progression of DSM externalizing disorders. Third, tests of mediation were used to assess potentiation of externalizing progression through environmental risk mediators (eg, family environment, neighborhood violence).Results: Consistent with hypotheses derived from trait impulsivity theories of externalizing behavior, HI symptoms of ADHD were associated independently with long-term externalizing outcomes, whereas IN symptoms were not. Between months 48 and 96, ADHD-HI/combined symptom subtype diagnoses predicted later oppositional defiant disorder diagnoses, oppositional defiant disorder diagnoses predicted later conduct disorder diagnoses, and conduct disorder diagnoses predicted later substance use disorder diagnoses. Evidence for environmental risk mediation (eg, parental monitoring, neighborhood violence) was also found.Conclusion: Findings support trait impulsivity models of externalizing progression, whereby ADHD-HI/combined symptoms subtypes predispose to increasingly severe externalizing behaviors, which are magnified in contexts of environmental risk. [ABSTRACT FROM AUTHOR]

Objective: Behavioral interventions are well established treatments for children with attention-deficit/hyperactivity disorder (ADHD). However, insight into moderators of treatment outcome is limited.Method: We conducted an individual participant data meta-analysis (IPDMA), including data of randomized controlled behavioral intervention trials for individuals with ADHD <18 years of age. Outcomes were symptoms of ADHD, oppositional defiant disorder (ODD), and conduct disorder (CD) and impairment. Moderators investigated were symptoms and impairment severity, medication use, age, IQ, sex, socioeconomic status, and single parenthood.Results: For raters most proximal to treatment, small- to medium-sized effects of behavioral interventions were found for symptoms of ADHD, inattention, hyperactivity/impulsivity (HI), ODD and CD, and impairment. Blinded outcomes were available only for small preschool subsamples and limited measures. CD symptoms and/or diagnosis moderated outcome on ADHD, HI, ODD, and CD symptoms. Single parenthood moderated ODD outcome, and ADHD severity moderated impairment outcome. Higher baseline CD or ADHD symptoms, a CD diagnosis, and single parenthood were related to worsening of symptoms in the untreated but not in the treated group, indicating a protective rather than an ameliorative effect of behavioral interventions for these children.Conclusion: Behavioral treatments are effective for reducing ADHD symptoms, behavioral problems, and impairment as reported by raters most proximal to treatment. Those who have severe CD or ADHD symptoms, a CD diagnosis, or are single parents should be prioritized for treatment, as they may evidence worsening of symptoms in the absence of intervention. [ABSTRACT FROM AUTHOR]

Objective: To examine targeted, mechanism-based interventions is the next generation of treatment innovation. Biased threat labeling of ambiguous face emotions (interpretation bias) is a potential behavioral treatment target for anger, aggression, and irritability. Changing biases in face-emotion labeling may improve irritability-related outcomes. Here, we report the first randomized, double-blind, placebo-controlled targeted trial of interpretation bias training (IBT) in youths with chronic, severe irritability.Method: Patients with current disruptive mood dysregulation disorder (DMDD; N = 44) were randomly assigned to complete 4 sessions of active (n = 22) or sham (n = 22) computerized IBT training within a 1-week period. The first and last trainings were completed onsite, and 2 trainings were completed at home. We examined the effects of active IBT on labeling bias, primary outcome measures of irritability, and secondary outcome measures of anxiety, depression, and functional impairment. Follow-up assessments were completed immediately after the intervention as well as 1 and 2 weeks later.Results: We found that active IBT engaged the behavioral target in the active relative to the sham condition, as shown by a significant shift toward labeling ambiguous faces as happy. However, there was no consistent clinical improvement in active IBT relative to the sham condition either immediately after or 2 weeks after training in either the primary or secondary outcome measures.Conclusion: Although this randomized controlled trial of IBT in youths with DMDD engaged the proposed behavioral target, there was no statistically significant improvement on clinical outcome. Identifying and changing behavioral targets is a first step in novel treatment development; these results have broader implications for target-based intervention development.Clinical Trial Registration Information: Psychological Treatments for Youth With Severe Irritability; https://clinicaltrials.gov/; NCT02531893. [ABSTRACT FROM AUTHOR]

Although births below 28 completed weeks' of gestation contribute to less than 1% of all preterm births globally, the impact of extreme prematurity (EPT) on neurodevelopmental outcomes across the life-course is disproportionately large. Higher rates and increased severity of neurodevelopmental impairments (NDIs) are reported among extremely preterm infants (EPIs). Cognitive skills, motor skills (manifesting as cerebral palsy) and vision are most commonly affected, with effects pervasive throughout school, adolescence and early adulthood. In addition, poorer academic outcomes and higher rates of psychiatric morbidity are seen among EPTs. Consistent improvements in EPI survival in recent years has not been matched with improvements in neurodevelopmental outcomes, especially for those born at less than 25 gestational weeks. However, over the last 20 years, several national and cross-national cohort studies have helped advance our understanding of extreme prematurity's developmental and life-course consequences. Here we provide an overview of the key findings from 13 multi-centre cohorts measuring neurodevelopmental outcomes and discuss the theoretical and epidemiological perspectives of NDIs in the context of extreme prematurity to guide communication with families and shared care decision-making. [ABSTRACT FROM AUTHOR]

Objective: Irritability is a multifaceted construct in pediatric psychopathology. It has been conceptualized as having a phasic dimension and a tonic dimension. Disruptive mood dysregulation disorder is defined by the presence of both dimensions. Severe irritability, or disruptive mood dysregulation disorder, is highly comorbid with attention-deficit/hyperactivity disorder (ADHD). However, it is unknown whether the presence of ADHD modulates the expression of phasic and tonic irritability.Method: A data-driven, latent variable approach was used to examine irritability and ADHD symptoms in a transdiagnostic pediatric sample (N = 489) with primary disruptive mood dysregulation disorder, ADHD, subclinical irritability symptoms, or no diagnosis. Using latent profile analyses, we identified 4 classes: high levels of both irritability and ADHD symptoms, high levels of irritability and moderate levels of ADHD symptoms, moderate levels of irritability and high levels of ADHD symptoms, and low levels of both irritability and ADHD symptoms. Confirmatory factor analysis operationalized phasic irritability and tonic irritability.Results: As expected, the 2 latent classes characterized by high overall irritability exhibited the highest levels of both phasic and tonic irritability. However, between these 2 high irritability classes, highly comorbid ADHD symptoms were associated with significantly greater phasic irritability than were moderately comorbid ADHD symptoms. In contrast, the 2 high irritability groups did not differ on levels of tonic irritability.Conclusion: These findings suggest that phasic, but not tonic, irritability has a significant association with ADHD symptoms and that phasic and tonic might be distinct, though highly related, irritability dimensions. Future research should investigate potential mechanisms underlying this differential association. [ABSTRACT FROM AUTHOR]

Objective: We investigated the diagnostic progression to bipolar disorder (BD) among adolescents and young adults with attention-deficit/hyperactivity disorder (ADHD).Methods: Using the Taiwan National Health Insurance Research Database, we enrolled adolescents and young adults aged 10-29 years with ADHD between January 1, 2001, and December 31, 2010, who were followed up until December 31, 2011, to determine progression to BD. Cox regression analysis was used to examine candidate risk and protective factors.Results: At the 11-year follow-up, the progression rate from ADHD to BD was 5.12%. Of the participants who progressed, 62.16% (322/518) progressed within the first 3 years. Risk factors for progression were as follows: older age (hazard ratio [HR], 1.058; 95% confidence interval [CI], 1.033-1.084), comorbidity with autistic spectrum disorder (HR, 1.839; 95% CI, 1.415-2.391), disruptive behavior disorder (HR, 1.434; 95% CI, 1.132-1.816), intelligence disability (HR, 1.744; 95% CI, 1.399-2.176), depressive disorder (HR, 1.978; 95% CI, 1.577-2.482), alcohol use disorder (HR, 1.705; 95% CI, 1.057-2.751), cluster A (HR, 2.508; 95% CI, 1.167-5.391) or B (HR, 2.718; 95% CI, 1.974-3.741) personality disorder, and a family history of BD (HR, 2.618; 95% CI, 1.823-3.758) Identified protective factors were male sex (HR, 0.771; 95% CI, 0.630-0.943) and cluster C personality disorder (HR, 0.278; 95% CI, 0.086-0.898).Conclusion: The study demonstrated the specific risk and protective factors for BD progression among adolescents and young adults with ADHD. It is important for clinician and mental health care providers to recognize identified factors to focus on early detection and prompt intervention. [ABSTRACT FROM AUTHOR]

Objective: Callous-unemotional (CU) traits-characterized by low empathy, prosociality, and guilt-predict severe and persistent conduct problems. Although some interventions for conduct problems have been less effective in children with high levels of CU traits, studies have not examined whether CU traits interfere with treatment for other childhood disorders. Moreover, few treatments have demonstrated efficacy in decreasing CU traits themselves in early childhood. This study examined whether Parent-Child Interaction Therapy-Emotion Development (PCIT-ED), a novel PCIT adaptation that promotes emotional competence with demonstrated efficacy in treating preschool-onset major depressive disorder and oppositional defiant disorder, was also effective in treating these disorders in children displaying higher levels of CU traits. The study also examined whether PCIT-ED treatment produced significant and sustained decreases in CU traits.Method: This study examined 3- to 5-year-olds (N = 114) with preschool-onset major depressive disorder who completed the PCIT-ED trial. Children were randomly assigned to either immediate PCIT-ED treatment (n = 64) or a waitlist control condition (n = 50) in which they received the active treatment after 18 weeks. Psychiatric diagnoses and severity and CU traits in children were assessed at baseline, immediately after treatment, and 18 weeks after treatment completion.Results: Compared with the waitlist, PCIT-ED effectively reduced major depressive disorder and oppositional defiant disorder in preschoolers, regardless of initial levels of CU traits. Moreover, CU traits decreased from before to after treatment, and this treatment effect was sustained 18 weeks after treatment.Conclusion: Results support that novel interventions that enhance emotional development display significant promise in treating CU traits-behaviors that left untreated predict severe conduct problems, criminality, and substance use.Clinical Trial Registration Information: A Randomized Controlled Trial of PCIT-ED for Preschool Depression; https://clinicaltrials.gov; NCT02076425. [ABSTRACT FROM AUTHOR]

Objective: There have been inconsistent findings on the associations among prematurity, poor fetal growth, and depression. We examined the associations among gestational age, poor fetal growth, and depression in individuals aged 5 to 25 years.Method: We identified 37,682 case subjects based on International Classification of Diseases, Ninth Revision code 2961 and International Classification of Diseases, Tenth Revision codes F32.0-F32.9 and F33.0-F33.9 from the Care Register for Health Care, and 148,795 matched controls from the Finnish Central Population Register. Conditional logistic regression examined the associations between gestational age by each gestational week, poor fetal growth, and depression. The associations were adjusted for parental age and psychopathology, paternal immigrant status, maternal substance abuse, depression, number of previous births, marital status, socio-economic status, smoking during pregnancy, and the infant's birthplace.Results: In the adjusted models, increased risk of depression was found in children born ≤25 weeks (adjusted odds ratio [aOR] 1.89, 95% CI 1.08-3.31), at 26 weeks (aOR 2.62, 95% CI 1.49-4.61), at 27 weeks (aOR 1.93, 95% CI 1.05-3.53), and ≥42 weeks (aOR 1.11, 95% CI 1.05-1.19). In girls, extremely preterm birth was associated with depression diagnosed at 5 to 12 years (aOR 2.70, 95% CI 1.83-3.98) and 13 to 18 years (aOR 2.97, 95% CI 1.84-4.78). In boys, postterm birth (≥42 weeks) was associated with depression diagnosed at 19 to 25 years (aOR 1.28, 95% CI 1.07-1.54). Poor fetal growth was associated with an increased risk of depression in full-term infants (aOR 1.06, 95% CI 1.03-1.10) and postterm infants (aOR 1.24, 95% CI 1.08-1.43).Conclusion: Preterm birth before 28 weeks of gestation appeared to play a role in the development of childhood depression. Smaller effects were also seen in postterm births, especially in boys. [ABSTRACT FROM AUTHOR]

Limited prosocial emotions (LPE) are characterized by a lack of remorse or guilt, callousness/lack of empathy, being unconcerned about performance, and shallow/deficient affect. While previous research has largely focused on the presence or absence of LPE in youth, there is considerable evidence that symptom presence/absence and symptom impairment are separable dimensions, where impairment often is found to play a significant, unique role in assessing child psychopathology. The current study utilized a newly developed questionnaire with the purpose of exploring its psychometric properties and better understand the dual and potentially differential role LPE symptom presence and LPE-related impairment have in youth. Mothers (n = 265) of children (Mage = 8.04, SD = 2.07) completed questionnaires assessing LPE impairment, LPE symptoms, externalizing disorder symptoms, and functional impairment. Results demonstrated strong support for the psychometric properties of the newly developed measure of LPE impairment. Importantly, LPE-related impairment uniquely predicted all impairment domains above-and-beyond the effects of LPE symptoms, oppositional defiant disorder, and CD symptoms (as well as child age and sex covariates). Moreover, youth in the top 25th percentile on both LPE symptoms and LPE-related impairment (compared to youth only in the top 25th percentile in LPE symptoms) had greater mean externalizing symptoms and functional impairment. The preliminary evidence provided suggests researchers and clinicians may benefit from assessing both LPE symptoms and LPE-related impairment when attempting to identify youth with high levels of conduct problem symptoms and/or psychosocial impairment. Future research should aim to replicate and expand our findings to other clinical populations. [ABSTRACT FROM AUTHOR]

La cooccurrence de diagnostics (dx) en santé mentale réfère à la présence de deux ou plusieurs dx chez un même enfant et peut s'avérer synonyme d'une symptomatologie complexe et difficile à traiter. Afin d'identifier des leviers d'intervention dans le traitement de ces enfants, la présente étude examine si des facteurs familiaux, tels les symptômes dépressifs, le stress parental et la sensibilité chez les mères, sont associés à la cooccurrence de dx chez de jeunes enfants d'âge préscolaire. Pendant quatre ans, des parents et leurs enfants (1–5 ans) ont été sollicités à une clinique spécialisée de psychiatrie du Centre hospitalier universitaire Sainte-Justine de Montréal (Canada). Un protocole d'évaluation et d'observation a été proposé à un tiers des familles ayant pris part au projet. Notre étude porte sur les 54 enfants et parents ayant participé à ce protocole. La sensibilité maternelle a été observée via la procédure de la situation étrangère et les mères ont complété des questionnaires sur le stress et la dépression. Les dx des enfants ont été posés par les psychiatres. Les analyses montrent des difficultés cliniques sur le plan de la sensibilité (39 %), du stress (67 %) et de la dépression (43 %) chez de nombreuses mères. Le stress et la dépression ne sont pas associés à la présence de dx cooccurrents ; mais, les mères moins sensibles sont deux fois plus à risque que leur enfant présente plus d'un dx. L'étude souligne l'importance du parent dans les traitements des enfants avec une symptomatologie plus complexe. L'intervention dyadique améliorant la sensibilité parentale est discutée. Co-occurrence of mental health diagnoses (dx) refers to the presence of two or more dx in the same child and may imply a more complex profile of symptoms and be more difficult to treat. Treatments for children with co-occurring dx often appear successful for some of the symptoms, while other symptoms persist with clinical efforts. Although it is well documented that an early onset of disorders in the preschool period is associated with numerous adverse outcomes in the middle childhood or adolescence periods (e.g., antisocial behavior, peer rejection), little is known about risk and protective factors associated with the co-occurrence of psychopathological disorders in preschool children. To better identify intervention leverages for the treatment of these children, this study examines whether the quality of the family environment (maternal sensitivity, stress and depressive symptoms) is associated with the presence of co-occurring psychiatric dx among preschool age children. During four years, parents and children (1–5 years old) were approached at a specialized psychiatric clinic at the Sainte-Justine University Hospital Center in Montreal. An assessment and observation protocol was administered to a third of these families. Our study comprises the 54 children and their parents who participated to this protocol. In this sample, 37% of the children were diagnosed with an attention deficit hyperactivity disorder, 24% with a disruptive disorder, 39% with an oppositional defiant disorder and 46% with an anxiety disorder. Overall, 42 children (78%) were diagnosed with two or more dx. Maternal sensitivity was observed during the very well-validated Strange Situation Procedure. Mothers completed questionnaires on parental stress and their depressive symptoms. Children were diagnosed by the clinic's psychiatrists. Analyses showed clinical level difficulties of sensitivity (39%), stress (67%) and depression (43%) in a significant portion of the mothers. Parental stress and depression were not associated with co-occurring dx in children; however, less sensitive mothers were more likely to have children with more than one dx. Precisely, children of less sensitive mothers were more than twice as likely to present co-occurring disorders as children with more sensitive mothers. Parental sensitivity, i.e., the ability to observe, interpret correctly and respond in a timely and appropriate manner to the child needs, is more problematic in mothers of children with a more complex symptomatology. This study highlights the importance of parental involvement in the treatment of these preschool children. Parent–child dyadic interventions, such as the Attachment Video feedback Intervention (AVI), to optimize parental sensitivity are discussed. [ABSTRACT FROM AUTHOR]