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The article presents two workshops related to the clinical practice of child and adolescent psychiatry. The first workshop addresses the medical-legal aspects in clinical decision-making, such as parental authority and shared custody. The second workshop focuses on the increasing complexity of mental health in the child and adolescent population and the transition to adulthood. It also mentions assistance programs, a specific care program for individuals with early psychotic disorder, and an intervention model from the Guideline Team. In addition, several presentations related to care and research in child and adolescent psychiatry are presented, including parenting-based interventions for children with autism spectrum disorder, intensive intervention in a Day Hospital for adolescents with ASD, care for patients with ASD in adulthood, and recommendations for conducting research in child and adolescent psychiatry. It also addresses specialized healthcare training in child and adolescent psychiatry, the organization of multiprofessional mental health teaching units, and the impact of the internet on the mental health of young people. [Extracted from the article]

Une société en désolation et de déliaison attaque d'abord les sciences humaines et sociales et fait encourir le risque de rupture du lien intersubjectif et de solidarité. Le renoncement à celui-ci est à l'origine de la perte du sens et du retour de la peur de la folie. Les soignants subissent l'impact de ce monde nouveau et saisis par l'urgence, agissent sur le présent, plus que n'élaborent des prospectives d'avenir tenant compte de l'histoire, et médicalisent puis psychiatrisent des problématiques humaines de vie et de mort. La rationalisation des démarches diagnostiques et thérapeutiques dictée plus par l'économisme d'aujourd'hui, qui n'est pas une science humaine et sociale mais une idéologie, menace de balayer les acquis de le Pédopsychiatrie institutionnelle, et de l'indispensable éthique de la rencontre interhumaine au cœur du soin. A society where desolation and delirium reigns attacks first and foremost the human and social sciences, and runs the risk of breaking the bonds of intersubjectivity and solidarity. The renunciation of the latter is at the root of the collective loss of meaning and the return of fear of madness. Mental health caregivers feel the impact of this new world and, seized by the urgency of the situation, act in the present rather than looking to the future, taking history into account, medicalizing and then subjecting human problems of life and death to psychiatric analysis and treatment. The rationalization of diagnostic and therapeutic approaches dictated more by today's economism, which is not a human and social science but an ideology, threatens to sweep away the achievements of institutional child psychiatry, and the indispensable ethic of inter-human encounter that lies at the heart of care. [ABSTRACT FROM AUTHOR]

La négligence est la plus fréquente des maltraitances et la plus grave pour le développement de l'enfant. Elle est sous-repérée aujourd'hui. Le terme de négligence n'est pas un terme juridique ni médical. Il est pourtant employé par les médecins et travailleurs sociaux, avec une définition en creux, comme l'absence de soins adaptés pour le développement de l'enfant. La négligence est multifactorielle. Ses effets sont précoces, dépendant de l'âge de l'enfant. La mortalité et la morbidité ont augmenté, de même que les séquelles développementales sont décrites. La négligence a plus d'impact sur le développement que la violence physique. Le pédopsychiatre peut mener différentes actions au bénéfice de l'enfant négligé. D'abord le repérage de la négligence et l'alerte à donner. Le repérage implique de rechercher des indicateurs de négligence et une clinique particulière variant selon l'âge et nécessitant d'explorer les différentes lignes de développement. Le pédopsychiatre cherchera à éliminer une cause sensorielle ou neurodéveloppementale avec parfois recours à des avis spécialisés. Il observera le comportement de l'enfant seul et avec ses parents, les relations parents–enfants et considérera l'enfant au-delà du microsystème familial dans une approche écosystémique. Il pourra s'aider d'outils disponibles et normés en langue française. Il pourra être amené à signaler la situation de l'enfant aux autorités administrative et judiciaire. Ensuite, les soins apportés à l'enfant négligé se feront dans son écosystème. Les interventions devront être précoces, participatives et partenariales avec les services sociaux, les éducateurs, le personnel du lieu de placement. La prise en charge cherchera à compenser les effets négatifs développementaux de la négligence pour redresser la trajectoire développementale. Elle devra tenir compte de la psychopathologie des enfants. La psychothérapie, dont le cadre sera à adapter, aidera l'enfant à s'approprier son histoire. La dernière action à développer par le pédopsychiatre formé est préventive. Il est important que le pédopsychiatre soit informé et formé à la prise en charge de la négligence et de ses effets. Les enfants négligés d'aujourd'hui seront les adultes de demain qui auront le plus de troubles psychiatriques. Neglect is the most common form of child abuse. It can also have the most serious impact on a child's development, with an increased and accompanying risk of the emergence of psychiatric disorders from adolescence to adulthood. Child neglect is under-recognized today, due to a lack of training for professionals, the orientation of child psychiatry, and difficulties in understanding what this vague concept refers to. After proposing definitions of neglect, its characteristics, and its effects, we present the possible actions of the child psychiatrist in the ecosystem of the neglected child. Neglect is neither a legal nor a medical term. It is, however, used by doctors and social workers, with a loose definition as the absence of appropriate care for a child's development. Neglect is multifactorial. The French consensus approach to the basic needs of the child has highlighted a meta-need for security, emphasizing attachment and the particular qualities of the caregiver. In light of this report, we understand that affective or emotional neglect is the most problematic form of neglect. The effects of neglect are early, depending on the child's age. They can manifest as developmental delays, sleep disorders, tonus disorders in infants, intellectual disorders, and various internalized and externalized disorders in adolescence. Mortality and morbidity are increased in cases of neglect, and developmental sequelae have been described. Neglect has a greater impact on development than physical abuse. The child psychiatrist can take three types of action to treat the neglected child. Firstly, he or she must identify neglect and alert the appropriate instances so as to protect the child. Identification involves being aware of indicators of neglect and a particular clinical pattern that varies according to age, requiring the exploration of the different lines of development. Three clinical patterns seem to be linked to extreme neglect: anaclitic depression, post-traumatic stress disorder, particularly complex developmental trauma, and attachment disorders. When faced with symptoms suggestive of neglect, the child psychiatrist should try to rule out a sensory or neurodevelopmental cause, sometimes seeking the advice of a specialist. He or she will observe the child's behavior alone and with his or her parents, as well as parent-child relationships, and will consider the child outside the family microsystem in an ecosystemic approach. The child psychiatrist can use available standardized tools that explore the various dimensions of neglect. This multi-consultation assessment should not delay the child psychiatrist's initial actions, given the narrow developmental windows. In particular, the child psychiatrist may be required to report the child's situation to the administrative and judicial authorities. The care provided to the neglected child will then take place within the child's own ecosystem. Interventions must be early, participative and in partnership with social services, educators, and staff at the placement site. Care will seek to compensate for the negative developmental effects of neglect, in order to correct the child's developmental trajectory. It must take into account the child's psychopathology. Psychotherapy, the framework of which will need to be adapted, will help the child to assume ownership of his or her history. Child psychiatrists can also take part in innovative initiatives to help children at risk, such as mobile teams. The final action to be developed by the trained child psychiatrist is preventative. It is important that child psychiatrists be informed and trained to deal with neglect and its effects. Today's neglected children will be tomorrow's adults with the most psychiatric disorders. [ABSTRACT FROM AUTHOR]

Key Points: Question: Is age stratification relevant for estimating the prevalence and burden associated with mental disorders and substance use disorders in the period from childhood to early adulthood? Findings: In this cross-sectional study using data from the 2019 Global Burden of Disease study, there was a high prevalence of mental disorders affecting children and youths, indicating that more than 1 of 10 (or 293 million) individuals aged 5 to 24 years globally live with a diagnosable mental disorder—in terms of burden, around one-fifth of all disease-related disability (considering all causes) was attributable to mental disorders among this population. Additionally, this age period encompasses about one-fourth of the mental disorder burden across the entire life course. Meaning: Given the implications of the early onset and lifetime burden of mental and substance use disorders for policy making, age-disaggregated data are essential for a more accurate understanding of vulnerability and more effective prevention and intervention initiatives. This cross-sectional study estimates the global prevalence and years lived with disability associated with mental disorders and substance use disorders across 4 age groups (age 5 to 9, 10 to 14, 15 to 19, and 20 to 24 years) using data from the 2019 Global Burden of Disease. Importance: The period from childhood to early adulthood involves increased susceptibility to the onset of mental disorders, with implications for policy making that may be better appreciated by disaggregated analyses of narrow age groups. Objective: To estimate the global prevalence and years lived with disability (YLDs) associated with mental disorders and substance use disorders (SUDs) across 4 age groups using data from the 2019 Global Burden of Disease (GBD) study. Design, Setting, and Participants: Data from the 2019 GBD study were used for analysis of mental disorders and SUDs. Results were stratified by age group (age 5 to 9, 10 to 14, 15 to 19, and 20 to 24 years) and sex. Data for the 2019 GBD study were collected up to 2018, and data were analyzed for this article from April 2022 to September 2023. Exposure: Age 5 to 9 years, 10 to 14 years, 15 to 19 years, and 20 to 24 years. Main Outcomes and Measures: Prevalence rates with 95% uncertainty intervals (95% UIs) and number of YLDs. Results: Globally in 2019, 293 million of 2516 million individuals aged 5 to 24 years had at least 1 mental disorder, and 31 million had an SUD. The mean prevalence was 11.63% for mental disorders and 1.22% for SUDs. For the narrower age groups, the prevalence of mental disorders was 6.80% (95% UI, 5.58-8.03) for those aged 5 to 9 years, 12.40% (95% UI, 10.62-14.59) for those aged 10 to 14 years, 13.96% (95% UI, 12.36-15.78) for those aged 15 to 19 years, and 13.63% (95% UI, 11.90-15.53) for those aged 20 to 24 years. The prevalence of each individual disorder also varied by age groups; sex-specific patterns varied to some extent by age. Mental disorders accounted for 31.14 million of 153.59 million YLDs (20.27% of YLDs from all causes). SUDs accounted for 4.30 million YLDs (2.80% of YLDs from all causes). Over the entire life course, 24.85% of all YLDs attributable to mental disorders were recorded before age 25 years. Conclusions and Relevance: An analytical framework that relies on stratified age groups should be adopted for examination of mental disorders and SUDs from childhood to early adulthood. Given the implications of the early onset and lifetime burden of mental disorders and SUDs, age-disaggregated data are essential for the understanding of vulnerability and effective prevention and intervention initiatives. [ABSTRACT FROM AUTHOR]

BACKGROUND: Internet gaming disorder (IGD) leads to social disturbances and isolation, neglect of daily responsibilities, behavioral disorders, and physical impairments. OBJECTIVE: This study aimed to investigate the effect of IGD on spine biomechanics, range of motion in the neck and low back, and lung functions and respiratory muscle strength in children and adolescents. METHODS: Sixty-four children and adolescents with IGD (Group I) and 41 healthy controls (Group II) were included in the study. The outcomes were assessed with the Visual Analogue Scale (VAS), Internet Addiction Scale, active range of motion (AROM) in the neck and lumbar spine, posture and spinal alignment, lung function tests, and respiratory muscle strength. RESULTS: There is a significant difference in pain intensity at rest, during activity, and daily sitting time between groups (p < 0.05). Craniovertebral angle, shoulder asymmetry, thoracic kyphosis angle, cervical extension and rotation, and right lumbar rotation significantly decreased in Group I than in Group II (p < 0.05). Besides, the PEF, FEF 25–75%, and respiratory muscle strength were lower in Group I than in Group II (p < 0.05). With a multiple linear regression model, MEP, FEV1, and weekly time spent playing online games were significant predictors of internet addiction intensity (R2 = 0.28; p = 0.02, p = 0.01, and p < 0.001, respectively). CONCLUSION: Postural misalignment and increased sedentary time cause physical health deterioration and negatively affect lung functions in children and adolescents with IGD. Consequently, considering both psychological and physical health is necessary to assess the problematic nature of internet gaming. A comprehensive assessment and multidisciplinary team approach is essential to managing the IGD. [ABSTRACT FROM AUTHOR]

Clinical guidelines recommend periodic monitoring for adverse metabolic effects associated with second-generation antipsychotic medications. The authors sought to evaluate adherence to the guideline-recommended metabolic monitoring schedule for children and adolescents prescribed second-generation antipsychotics. The authors used a national electronic medical records database for a retrospective study of children and adolescents ages 1–17 years (N=9,620) who were prescribed second-generation antipsychotics in January 2010–December 2018. Adherence to guideline-recommended monitoring of body mass index (BMI), blood glucose, and cholesterol was categorized as full, partial, and no monitoring. Full monitoring of patients was defined as strict metabolic monitoring, following the guideline-recommended schedule. Patients who received any monitoring, but not meeting the full monitoring criteria, were considered partially monitored. Three multinomial logistic regression models were fitted for each metabolic parameter to identify predictors associated with monitoring status. BMI was the metabolic parameter with the highest adherence to guideline-recommended monitoring (full monitoring, 4.7% of patients; partial monitoring, 44.8%), followed by blood glucose (full monitoring, 6.5%; partial monitoring, 29.4%) and cholesterol (full monitoring, 0.8%; partial monitoring, 22.4%). Being Black (vs. non-Black), having a comorbid mood disorder (vs. none), receiving olanzapine as the index second-generation antipsychotic (vs. aripiprazole), and receiving an antidepressant as a concurrent medication (vs. none) were associated with a higher likelihood of receiving both full and partial monitoring of all three metabolic parameters. Both full and partial adherence to guideline-recommended monitoring of children and adolescents prescribed second-generation antipsychotics were poor. However, children and adolescents at increased metabolic risk tended to be more closely monitored. [ABSTRACT FROM AUTHOR]

Introduction: This paper describes the process of implementing a family focused model, The Family Model, in child and adolescent and adult mental health services in Sweden. Additionally, it describes a service development project carried out in both services within a defined geographical area of Region Stockholm. The Family Model is a communication tool designed to assist clinicians in both services to have family focused conversations with their patients and relatives. Internationally, the needs of individuals experiencing mental health challenges (parents, children and young people) and their close relatives are now well recognized, but barriers to family focused practice nevertheless persist. The aim of this study was to better understand clinicians' experiences in implementing The Family Model in both services. Methods: Three preplanned focus group interviews were carried out with 14 clinicians and managers across both services and the data were analyzed in accordance with methods of Naturalistic inquiry. Result: Findings suggest that The Family Model has utility in both services. The Naturalistic inquiry analyses revealed three main themes: individual, relational and organizational aspects with a total of 10 sub-themes of how the models influence the participants. Furthermore, analyses on a meta understanding level explored that participants underwent a developmental journey in learning about and using The Family Model in practice which was expressed through three themes: "Useful for burdened families", "Influencing prevention", and "To integrate this would be fantastic". Conclusions: The Family Model, when adapted for the Swedish context, is a useful tool for assisting experienced clinicians to engage in family focused practice in both child and adolescent and adult mental health services. The Family Model highlights different aspects in everyday clinical services that were of special interest for clinicians, families, and the system. Future research could explore families' perspectives of the utility of the model. [ABSTRACT FROM AUTHOR]

Effective methods to assess mental disorders in children are necessary for accurate prevalence estimates and to monitor prevalence over time. This study assessed updates of the tic disorder and attention-deficit/hyperactivity disorder (ADHD) modules of the Diagnostic Interview Schedule for Children, Version 5 (DISC-5) that reflect changes in diagnostic criteria in the Diagnostic and Statistical Manual of Mental Disorders (Fifth edition, DSM-5). The DISC-5 tic disorder and ADHD parent- and child-report modules were compared to expert clinical assessment for 100 children aged 6–17 years (40 with tic disorder alone, 17 with tic disorder and ADHD, 9 with ADHD alone, and 34 with neither) for validation. For the tic disorder module, parent-report had high (>90%) sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy, while the youth-report had high specificity and PPV, moderate accuracy (81.4%), and lower sensitivity (69.8%) and NPV (67.3%). The ADHD module performed less well: parent-report had high NPV (91.4%), moderate sensitivity (80.8%), and lower specificity (71.6%), PPV (50.0%), and accuracy (74.0%); youth-report had moderate specificity (82.8%) and NPV (88.3%), and lower sensitivity (65.0%), PPV (54.2%), and accuracy (78.6%). Adding teacher-report of ADHD symptoms to DISC-5 parent-report of ADHD increased sensitivity (94.7%) and NPV (97.1%), but decreased specificity (64.2%), PPV (48.7%), and accuracy (72.2%). These findings support the use of the parent-report tic disorder module alone or in combination with the child report module in future research and epidemiologic studies; additional validation studies are warranted for the ADHD module. [ABSTRACT FROM AUTHOR]

Background: Confidentiality is a crucial ethical principle in therapy, particularly for children and adolescents, yet their perception of it remains understudied. We aimed to explore minors' perspectives and attributions on confidentiality in psychological and medical treatment. Methods: We interviewed 11 pediatric patients aged 7 to 15 and used reflexive thematic analysis to analyze their responses. Results: Four main themes were extracted from the data: (1) confidentiality and uncertainty regarding what information will be shared with clinicians and parents; (2) consequences of breaching confidentiality, encompassing breaches of confidentiality in the past and their negative effects on interactions with parents and health professionals; (3) exceptions to confidentiality, including understanding the limits of confidentiality; and (4) autonomy and self-determination, reflecting the desire for involvement in medical decisions. Conclusions: Explanations about confidentiality rules and limits, especially with younger children, are crucial. This is particularly important because it is fundamental to promote children's development and self-determination through increasing autonomy, as well as to provide a sense of security and respect through transparent rules. A single educational session on confidentiality at the outset of therapy is insufficient; ongoing conversations are needed to reinforce understanding and promote autonomy. [ABSTRACT FROM AUTHOR]

Alterations in brain-derived neurotrophic factor (BDNF) expression have been suggested to mediate the influence of environmental factors on the emergence of depression through epigenetic modifications. However, research on this subject in the developmental population is lacking and the pathophysiology of adolescent depression remains unclear. We aimed to investigate the alterations in BDNF expression and global DNA methylation in depression among adolescent girls. Thirty female inpatients with the initial diagnosis of depression were assessed before and after the period of antidepressant treatment and compared with thirty age-matched healthy controls. The assessment involved BDNF and proBDNF serum levels, the BDNF gene exon IV promoter methylation, and global DNA methylation. The methylation level in the BDNF gene exon IV promoter was significantly lower in the studied group compared with the control and correlated negatively with the severity of depression. The test distinguished the studied group from the controls with a sensitivity of 37% and specificity of 90%. The differences were no longer present after the period of antidepressant treatment. No differences in the global DNA methylation, BDNF, and proBDNF levels were found. We concluded that decreased methylation in the BDNF exon IV promoter could be considered as a biomarker of a depression state among adolescent girls. [ABSTRACT FROM AUTHOR]

Objective: To draw implications for training of therapist responsiveness from a sequential mixed-methods study on challenging clinical situations. Method: Study 1: online survey mapping frequency and perceived difficulty of 15 clinical situations in a representative sample of psychologists. Study 2: online survey mapping frequency and perceived difficulty of 19 clinical situations among therapists in child and adolescent psychiatry. Study 3: focus group study exploring the situations identified through study 1 and 2. Results: Study 1 and 2 showed that ratings of each situation varied between individuals and context. Study 3 showed that the degree to which a situation was challenging was described as depending on the characteristics of the therapist and the context. Experientially, challenging situations were characterized by lacking access to necessary information, falling short, and disturbing arousal. Perceiving therapeutic opportunities despite the challenging nature of the situation, collegial support, self-knowledge, and engagement were important resources. Conclusion: Six implications of the results from the three studies for training of responsiveness are discussed: (1) building self-awareness and conceptualization skills; (2) personalizing training; (3) transforming disturbing arousal into engagement; (4) being exposed to a broad range of clinical situations; (5) training on commonly encountered situations; and (6) building tolerance for uncertainty and capacity to seek support. [ABSTRACT FROM AUTHOR]

• Anxiety and depression account for up to 50% of annual mental health costs. • The transferability of evidence-based interventions into practice is required. • Super Skills for Life is effective in children with diagnosed emotional disorders. Super Skills for Life (SSL) is a CBT-transdiagnostic group intervention currently being translated and validated in multiple countries. In Spanish children, it has shown a positive impact on anxious and depressive symptoms, as well as other variables such as self-concept, prosocial behaviors, or behavioral problems. However, the effectiveness of the program to treat internalizing symptoms in children with a mental disorder in a clinical setting has not been examined so far. The aim of this study was to evaluate the effectiveness of SSL in a Spanish sample of children with a major internalizing disorder. Participants aged 8–12 years (71.6% boys) were randomly allocated to the SSL group (n = 43) or the waiting list control (WLC) group (n = 43). All children and their parents completed a series of measures before the first session and after the last session or at about the same time in the WLC group. The effectiveness of the intervention was assessed using generalized estimating equations. Significant reductions from pretest to posttest across multiple outcomes were found in children who participated in SSL group compared to those in the WLC group, including anxiety symptoms (SCAS, p =.02), anxiety interference (CALIS, p =.002), depressive symptoms (CDI, p =.033) and remission from diagnosis (K-SADS, p <.001). This study provides initial support for SSL as an effective treatment for children with emotional disorders in clinical settings. Future studies are needed to analyze long-term effects and broader benefits of the program in clinical contexts. [ABSTRACT FROM AUTHOR]

Objectives: Identification of clinically significant irritability in preschool age is important to implement effective interventions. However, varying informant and measurement methods display distinct patterns. These patterns are associated with concurrent and future mental health concerns. Patterns across multi‐informant methods in early‐childhood irritability may have clinical utility, identifying risk for impaired psychosocial functioning. Methods: Using data from the Multidimensional Assessment of Preschoolers Study (N = 425), latent profile analysis identified irritability patterns through the parent‐reported Multidimensional Assessment Profile Scales–Temper Loss (MAPS‐TL), parent‐reported interviewer‐rated Preschool Age Psychiatric Assessment (PAPA), and observer‐rated Disruptive Behavior Diagnostic Observation Schedule (DB‐DOS). These profiles were characterized on protective factors, global functioning, and mental health syndromes, concurrently and at early school age and preadolescent follow‐up. Results: Fit indices favored a five‐class model: Low All, High Observation with Examiner (high DB‐DOS Examiner Context), High All, High Parent Report (high MAPS‐TL/PAPA), and Very High Parent Report (very high MAPS‐TL/PAPA). Whereas Low All and High Observation with Examiner exhibited strong psychosocial functioning, remaining profiles showed impaired psychosocial functioning, with the Very High Parent Report group showing higher impairment at follow‐ups, ds = 0.37–1.25. Conclusions: Multi‐informant measurements of irritability may have utility for clinical prediction, and future studies should test utility for diagnostic precision. [ABSTRACT FROM AUTHOR]

Objectives: Anticipatory anxiety and heightened responses to uncertainty are central features of anxiety disorders (ADs) that contribute to clinical impairment. Anxiety symptoms typically emerge during childhood, and even subthreshold‐AD symptoms are associated with distress and risk for future psychopathology. This study compared facial emotional response to threat and uncertainty between preadolescent girls with ADs, girls with subthreshold‐AD symptoms, and controls. Methods: Facial emotional responding was characterized in preadolescent girls (age 8–11) with a range of anxiety symptoms: no/low anxiety (controls, n = 41), subthreshold‐AD (n = 73), and DSM‐5 diagnoses of separation, social, and/or generalized ADs (n = 45). A threat anticipation paradigm examined how image valence (negative/neutral) and image anticipation (uncertain/certain timing) impacted activity of the corrugator supercilii, a forehead muscle implicated in the "frown" response that is modulated by emotional stimuli (negative > neutral). Corrugator magnitude and corrugator timecourse were compared between groups. Results: Findings demonstrate greater corrugator activity during anticipation and viewing of negative stimuli, as well as increased corrugator reactivity in subthreshold‐AD and AD girls. Timecourse analyses of negative versus neutral stimuli revealed that AD and subthreshold‐AD girls had greater uncertainty‐related increases in corrugator activity compared to controls. Conclusion: Results extend the physiological characterization of childhood pathological anxiety, highlighting the impact of subthreshold‐AD symptoms. [ABSTRACT FROM AUTHOR]

Background: Knowledge of the association between parental personality disorders and mental disorders in children is limited. To examine the association between parental personality disorders and the risk of mental disorders in offspring. Methods: We linked Danish health registers to create a cohort of children born from January 1, 1995, to December 31, 2016. Children were followed until their 18th birthday, diagnosis set, emigration, death, or December 31, 2016. Parental personality disorders according to the International Classification of Diseases (ICD) Eighth or 10th Revision. Poisson regression analyses were used to estimate the incidence risk ratio (IRR) and cumulative incidence of ICD 10th mental disorders in offspring (age 0–17). Results: The study cohort included 1,406,965 children. For girls, maternal or paternal personality disorder (MPD/PPD) was associated with mental disorders: MPD girls (IRR, 2.74; 95% CI, 2.59–2.89) and PPD girls (IRR, 2.10; 95% CI, 1.94–2.27). Likewise, the risk was increased for both MPD boys (IRR, 2.44; 95% CI, 2.33–2.56) and PPD boys (IRR, 2.04; 95% CI, 1.91–2.18). For girls and boys combined, exposure to two parents with a personality disorder was associated with the highest risk (IRR, 3.69; 95% CI, 3.15–4.33). At age 18, the cumulative incidence of any mental disorder in children of one or two parents with a personality disorder was 34.1% (95% CI, 33.0–35.1), which was twice the cumulative incidence of mental disorders in nonexposed children (15.2% [95% CI, 15.1–15.3]). Conclusion: Children of parents with a personality disorder were at a 2 to 3.5 times higher risk of mental disorders compared with nonexposed offspring. Possible mechanisms of transmission of mental disorders from parent to child involve genetic, environmental, and gene–environment pathways. More research into these mechanisms and research into preventive interventions is warranted. [ABSTRACT FROM AUTHOR]

In 1957, the British-Indian child psychiatrist Dr Elwyn James Anthony travelled to the Zurich International Congress of Psychiatry to show a film featuring 70 children with such complex symptomatology and behaviour that they betrayed the certainty of contemporary theories of developmental psychology and psychoanalysis. This article examines the significance of Anthony's film to the creation of new scientific models in international developmental psychology and psychiatric epidemiology. It marked a significant change in the use of filmed evidence that sought to create a truly global and universalist approach to atypical child development based purely on scientific observations. This new observational work was important in shaping new internationally ratified models to study the epidemiology of children's psychiatric conditions. [ABSTRACT FROM AUTHOR]

Perinatal mental health conditions are the most common complications of childbirth and have well-established enduring negative effects. Obstetric (Ob) clinicians care for patients with perinatal mental health conditions across a spectrum of acuity, severity, and complexity. Ob and psychiatric clinicians can collaborate to create a cohesive continuum of psychopharmacologic care for perinatal patients. This chapter provides an overall framework for Ob-psychiatric clinician collaboration with examples of innovation in care delivery. [ABSTRACT FROM AUTHOR]

La notion de développement est utilisée de manière courante dans la nosographie pédopsychiatrique depuis les années 1980 et le DSM-III. Or, depuis le DSM-5 en 2013, son usage s'est considérablement répandu à travers toute la psychiatrie dans son ensemble. Nous soutenons la thèse d'un prisme à travers lequel la clinique est regardée et la psychopathologie conçue. Nous proposons d'étudier cette évolution de la pensée médicale qui figure à notre sens l'influence théorique de la psychiatrie de l'enfant sur la psychiatrie de l'adulte. Initialement, les troubles du développement concernent, d'une part, les troubles sévères de la vie relationnelle dits envahissants et incluant l'autisme, et d'autre part, les troubles spécifiques qui affectent les apprentissages. L'essor d'un abord développemental de la pathologie correspond aux États-Unis avec la création en 1975 d'une loi qui défend le droit de ces patients, le Developmental Disabilities Act. Le DSM-5 associe le développement aux neurosciences et englobe l'ensemble des troubles pédopsychiatriques au sein d'un vaste ensemble neurodéveloppemental. Enfin, une approche dite vie entière inspire toute la psychiatrie de l'adulte. Philosophie et histoire de la psychiatrie permettent de tracer ce fil d'Ariane et in fine l'influence inattendue de la psychiatrie de l'enfant, alors que ses assises théoriques et institutionnelles sont régulièrement remises en cause. Vitalité étonnante que cette évolution conceptuelle que nous nommons développementalisme, terme créé avec un tout autre sens par le pédiatre américain Arnold Gesell au lendemain de la Seconde Guerre mondiale. The notion of development has been commonly used in child psychiatry for diagnosing since the 1980s and the DSM-III classification. Yet, since DSM 5 in 2013, its use has spread considerably throughout psychiatry as a whole and has increasingly become a prism through which general psychiatry looks mainly at clinical matters and psychopathology. We propose to consider this evolution in medical thinking in psychiatry since the 1980s and the specific links between child and general psychiatry in nosography through the lens of development. We aim to evaluate the influence of child psychiatry by studying the history of international nosography from DSM-III to DSM-5. Developmental disorders concern initially severe child disorders (pervasive developmental disorders including infantile autism) and also specific disorders affecting learning. In the United States, this increasing significance of the developmental perspective has been translated into political action in the Developmental Disabilities Act of 1975, which defends the rights of these patients. DSM-5 combines development with neuroscience and encompasses all child psychiatric disorders within a vast neurodevelopmental framework. Ultimately, a "whole life" approach inspires all adult psychiatry. Philosophy and the history of psychiatry allow us to address the increasing and unexpected influence of child psychiatry on psychiatry. We argue that this conceptual evolution that we call developmentalism, a term coined with an all-together different meaning by the American pediatrician Arnold Gesell in the aftermath of the Second World War, has an astonishing vitality. [ABSTRACT FROM AUTHOR]

Dans cet article, l'auteure retrace les premiers moments de l'introduction de la psychanalyse en pédopsychiatrie et le contexte de leur émergence dans les années 1920 et 1930 en France. Ils sont contemporains de la difficile introduction de la psychanalyse dans l'univers médical. La psychanalyse de l'enfant apparaît alors comme une prophylaxie des troubles névrotiques et suscite l'intérêt des psychopédagogues et des éducateurs. L'auteure retrace les travaux pionniers de la psychanalyste Sophie Morgenstern au sein de la consultation de psychiatrie infantile de Georges Heuyer, et ceux de Pierre Mâle dans sa consultation de psychiatrie infantile à Henri Rousselle. Celui-ci deviendra, à la Libération, le spécialiste de la psychothérapie de l'adolescent. Cependant, l'héritage de Morgenstern va être oublié ou renié par ceux qui vont lui succéder, et elle s'interroge sur les raisons de ce phénomène. Ces travaux pionniers, qui dessinent un nouveau visage de l'enfance normale et anormale, vont connaître une forte expansion après la Seconde Guerre mondiale. In this paper, the author describes the first moments of the introduction of psychoanalysis in child psychiatry and the context of their emergence in the 1920s and 1930s in France. They are contemporaneous with the difficult introduction of psychoanalysis into the medical world. Child psychoanalysis then appeared as a prophylaxis of neurotic disorders, and aroused the interest of educational psychologists and educators. It traces the pioneering work of psychoanalyst Sophie Morgenstern in Georges Heuyer's child psychiatry consultation, and that of Pierre Mâle in Henri Rousselle's child psychiatry consultation. After the Liberation, he became the recognized specialist in adolescent psychotherapy. On the other hand, Morgenstern's legacy will be forgotten or disowned by those who will succeed her, and the author wonders about the reasons for this phenomenon. This pioneering work, which drew a new face of normal and abnormal childhood, was to be greatly expanded after the Second World War. [ABSTRACT FROM AUTHOR]

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Background: The current literature lacks scientific research on child and adolescent psychiatrists' (CAPPS) perspectives on dental and oral health. This study aims to investigate the opinions and approaches of child and adolescent psychiatrists and their patients regarding oral and dental health. Methods: A questionnaire-based cross-sectional study was conducted among members of the Professional Association for Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy in Germany. Results: Out of the association members, 10.9% (n = 109) participated, with 5.2% (n = 52; 38f/14m) completing the questionnaire. Dental and oral health topics were discussed with one-fifth of the patients (19.2%), while 11.5% reported that they were "never" a part of their therapy. Patient-related concerns about dental and oral health were primarily brought into the context of child and adolescent psychiatric work. Dental treatment anxieties were prominent. Only 3.8% of the participants regularly assigned diagnoses related to dental status. The CAPPS employ a bio-psycho-social model for the genesis of oral health-related conditions in Children and Adolescents with Special Needs. Conclusions: CAPPS have a foundation in relationship-based work for assessing oral and dental healthcare and providing recommendations for further dental care. Regional networking and science must be further developed. [ABSTRACT FROM AUTHOR]

Objective: To provide an overview of Joe Biederman's contributions to child and adolescent psychiatry. Method: Nine colleagues described his contributions to: psychopharmacology, comorbidity and genetics, pediatric bipolar disorder, autism spectrum disorders, Tourette's and tic disorders, clinical and neuro biomarkers for pediatric mood disorders, executive functioning, and adult ADHD. Results: Joe Biederman left us with many concrete indicators of his contributions to child and adolescent psychiatry. He set up the world's first pediatric psychopharmacology clinic and clinical research program in child adolescent psychiatry. As a young faculty member he began a research program that led to many awards and eventual promotion to full professor at Harvard Medical School. He was for many years the most highly cited researcher in ADHD. He achieved this while maintaining a full clinical load and was widely respected for his clinical acumen. Conclusion: The world is a better place because Joe Biederman was here. [ABSTRACT FROM AUTHOR]

Objective: We leveraged common genetic variation underlying ADHD, educational attainment (EA) and cognition (COG) to understand the nature of the Behavior Rating Inventory for Executive Functions (BRIEF) and its relationship to academic functioning. Method: Participants were 991 youth, ages 7 to 17, consecutively referred for neuropsychiatric evaluation. Polygenic scores (PGS) for ADHD, EA, and COG were related to the BRIEF using regression analyses. Structural equation models were used to examine the associations between the PGS, BRIEF and academic outcomes (math, reading, and special education services [EDPLAN]). Results: After modeling the PGS together, only the EA and ADHD PGS significantly associated with the BRIEF. The BRIEF partially mediated the relationships between EA PGS with math and EDPLAN and fully mediated the relationship between ADHD PGS and EDPLAN. Conclusion: Genetic data extend evidence that the BRIEF measures a construct relevant to educational success that differs from what is indexed by cognitive testing. [ABSTRACT FROM AUTHOR]

The environment influences the way we act, react and adapt to our surroundings whether it is consciously or unconsciously. Though it is widely accepted that multiple interacting systems influence human behaviour and development across the life span, the reality of teasing these factors apart is difficult and challenging. In this brief commentary on Czernine and colleagues' important and timely paper, ‘Can a modernised psychiatric unit space reduce the use of coercive measures in child and adolescent psychiatry?’, I evaluate and build on the evidence presented by making constructive suggestions on ways of improving the status quo healthcare and treatment conditions for children and adolescents today. The underlying assumption is that by furthering this complex yet important area of research in the field of psychiatry and adjacent disciplines, we can improve existing healthcare systems and processes that are aligned with meeting child and adolescent needs. [ABSTRACT FROM AUTHOR]

Recently, more effort has been devoted to ensuring that scientific knowledge can be mobilised to make a positive impact on individuals and society. Scientists are encouraged, and even required, to communicate their findings beyond academic circles – to inform interested groups. However, there can be challenges with language use and communicating concepts; interpreting results; and from time pressure to communicate results rapidly. Here, we discuss intended and unintended consequences of science communication. We emphasise the importance of training to achieve these communication skills and working with non‐academic partners – to mitigate potential harm from misinterpreted results and to ensure that science communication is maximally beneficial. [ABSTRACT FROM AUTHOR]

Mobile crisis response (MCR) is a community-based intervention designed to provide de-escalation and relief to individuals experiencing a behavioral health or substance use–related crisis wherever they are, including at home, at work, at school, or in the community. Often it is the first, or only, option for youth who experience barriers to accessing traditional mental health care in the community. Elevated rates of mental health needs and suicidality among children and adolescents in the United States make availability of quality MCR increasingly important. Studies suggest that an estimated 70% to 80% of children with mental health disorders do not receive care, and minoritized children are even less likely to access community-based behavioral health care services.1 MCR can act as a bridge for securing treatment for children in acute distress. However, until recently, few studies have demonstrated the outcomes of MCR services for children and adolescents or more specifically for minoritized youth. [ABSTRACT FROM AUTHOR]

The article offers information on the third Residential Course on Child and Adolescent Psychiatry, held from September 27th to 30th, 2023, in Catania, Italy.

Aim: Children with autism spectrum disorder (ASD) are especially vulnerable to the pandemic due to their need for routine and difficulty in adapting to change. The aim of this study was to evaluate the psychosocial impact of the Coronavirus disease-2019 (COVID-19) pandemic on children diagnosed with ASD and their families and the challenges they faced during this period. Materials and Methods: We surveyed 85 parents of children with ASD aged 3-18 years, who were followed up in our clinic between the years of 2020 and 2021. We assessed ASD families’ pandemic impact with the “Child and Adolescent Reactions to Stressful Situations-Autism Family Adaptation and Resilience” items. Parents answered the questionnaire online or by phone. Results: The mean age of the children was 10.3±4.1 years, 65 were boys and 20 were girls. 10.6% of the families had a medical emergency during the pandemic. The most common behavioral problems were anger, difficulty in concentrating, and hyperactivity. 37.6% of the children could not receive educational support, 74.1% could not receive treatment, 31.1% had difficulty in reaching a doctor, and 7.8% had difficulty in affording treatment. Furthermore, 33% of the children spent more than 4 hours a day on screens. 61.2% of parents rated the pandemic quarantine process as more difficult than before. Conclusion: The pandemic disrupted the daily routines, special education, rehabilitation, and health care services of children with ASD. It also increased their behavioral problems. Therefore, recognizing and addressing the psychological needs of children with special needs, such as ASD, will be an important part of the response to future disasters.

Since the beginning of the COVID-19 pandemic, the prevalence of mental disorders in children and adolescents has increased significantly. Evidence shows that childhood mental disorders can have serious consequences on psychosocial, cognitive, and physical development. Approaches from Positive Education go further than the urgently needed prevention of mental disorders by aiming directly at promoting subjective, psychological, and social wellbeing. The present study describes the implementation of a brief program to promote wellbeing in 15 elementary schools. For this purpose, in a regular university seminar, students of teaching and educational science were instructed to give 11 "happiness lessons" for fourth graders in a team of two and in the presence of the class teacher over the course of 3 months. Quantitative data were collected from children and parents in the treatment group classes and in the parallel classes serving as the waiting control group at four measurement points (pre, post, 1- and 2-month follow-up). We assessed psychological wellbeing, negative emotions and moods, parent support and home life, perception of the school environment, and self-esteem of the children with established instruments with versions for children and their parents and the frequency of positive and negative emotions of the children in self-report only. Additionally, we applied ad hoc items on subjective perception of the project and open questions in the treatment group. Data were analyzed with EectLiteR using multigroup structural equation models. Results showed a small significant eect for negative emotions with the children's data and a medium eect for psychological wellbeing in the perception of the parents at the 1-month follow-up. Interaction eects suggest that lower baseline levels in parent support and home life and self-esteem would increase the treatment eect for these constructs. The need for more grounded framework in positive education and the inclusion of more qualitative methods as well as suggestions to improve the program in the sense of a whole school approach are discus [ABSTRACT FROM AUTHOR]

Background: Systemic therapy (ST) is a psychotherapeutic intervention in complex human systems (both psychological and interpersonal). Cognitive behavioural therapy (CBT) is an established treatment for children and adolescents with mental disorders. As methodologically rigorous systematic reviews on ST in this population are lacking, we conducted a systematic review and meta-analysis to compare the benefit and harm of ST (and ST as an add-on to CBT) with CBT in children and adolescents with mental disorders. Methods: We searched MEDLINE, Embase, PsycINFO and other sources for randomised controlled trials in 14 mental disorder classes for the above comparisons in respect of effects on patient-relevant outcomes (search date: 7/2022). Where possible, meta-analyses were performed and results were graded into 3 different evidence categories: "proof", "indication", or "hint" (or none of these categories). PRISMA standards were followed. Results: Fifteen studies in 5 mental disorder classes with usable data were identified. 2079 patients (mean age: 10 to 19 years) were analysed. 12/15 studies and 29/30 outcomes showed a high risk of bias. In 2 classes, statistically significant and clinically relevant effects in favour of ST were found, supporting the conclusion of a hint of greater benefit of ST for mental and behavioural disorders due to psychoactive substance use and of ST as an add-on to CBT for obsessive-compulsive disorders. In 2 other classes (eating disorders; hyperkinetic disorders), there was no evidence of greater benefit or harm of ST. For affective disorders, a statistically significant effect to the disadvantage of ST was found for 1 outcome, supporting the conclusion of a hint of lesser benefit of ST. Conclusions: Our results show a hint of greater benefit of ST (or ST as an add-on to CBT) compared with CBT for 2 mental disorder classes in children and adolescents (mental and behavioural disorders due to psychoactive substance use, obsessive compulsive disorders). Given the importance of CBT as a control intervention, ST can therefore be considered a beneficial treatment option for children and adolescents with certain mental disorders. Limitations include an overall high risk of bias of studies and outcomes and a lack of data for several disorders. [ABSTRACT FROM AUTHOR]

Background: During the COVID 19 pandemic, there were social restrictions with severe mental stress for a long time. Most studies on mental health consequences of the pandemic focused primarily on the beginning of the pandemic. The present study on families of patients or study participants of a child and adolescent psychiatry aimed to examine long-term profiles of emotions and worries in adults with and without mental health condition (mhc) during the first 1.5 years of the COVID-19 pandemic. Methods: We surveyed emotions and worries of 128 adults with (n = 32) and without (n = 96) pre-pandemic mhc over a 1.5-year study period from spring 2020 until summer/autumn 2021. Emotions and worries were captured at four time points: [i] pre-pandemic, [ii] spring 2020 (first lockdown was implemented), [iii] December 2020 (hard lockdown at Christmas time) and [iv] summer/autumn 2021 (considerable ease of regulations); [i] pre-pandemic and [iii] December 2020 were measured retrospectively). First, we run non-parametric tests to compare emotions and worries between adults with and without pre-pandemic mhc at the four time points. Next, we conducted latent profile analysis to identify subgroups from the total sample who share similar trajectories of emotions and worries. Finally, a logistic regression analysis was run to examine whether socio-demographic and psycho-social factors were related to identified trajectories of emotions and worries. Results: Adults without pre-pandemic mhc reported a strong worsening of emotions and worries at the beginning of the pandemic and a lower worsening during the course, while adults with pre-pandemic mhc reported a constant worsening of emotions and worries. The latent profile analysis revealed three profiles of adults who show either i) an adaption, ii) no adaption or iii) a continuous high condition. With increasing age, higher perceived stress and pre-pandemic mhc, the likelihood of an adaption was increased. Conclusion: The results of the present study suggested that adults (both with and without pre-pandemic mhc) coped the crisis with different strategies and that most of them returned to their initial, pre-pandemic levels of emotions and worries when social restrictions were considerably eased or stopped. [ABSTRACT FROM AUTHOR]

Psychiatric and neurodevelopmental conditions in children are common, often co-occur, and can be highly impairing. Moreover, psychiatric disorders that typically do not fully manifest until adulthood, such as schizophrenia, have their roots in early development, with atypical brain and behavioral patterns arising well before a clinical diagnosis is made. The relevance of brain development to improving outcomes of psychiatric and neurodevelopmental conditions underscores the need to cultivate a pipeline of investigators with the necessary training to conduct rigorous, developmentally focused research. [ABSTRACT FROM AUTHOR]

Objectives: Eating disorders are serious psychiatric conditions that affect people of all ages. Many psychiatry trainees' first and only experience with eating disorders during training is their Child and Adolescent Psychiatry (CAP) rotation. This study aimed to explore the learning experience of psychiatry trainees working within an Eating Disorder Program (EDP) during their CAP rotation. Methods: Fifteen trainees who participated in the EDP were recruited to complete an online survey and focus groups; a thematic analysis design was used to identify themes emerging from their responses. Results: Themes emerged from the trainee learning experience of working in the EDP around what they found they learnt, what aided that process, what was difficult, and recommendations for future improvement. Conclusions: This study provided insight into the trainee experience in an EDP as one example of how trainees can learn about eating disorders and one way that could inform future workforce and training initiatives. [ABSTRACT FROM AUTHOR]

The efficacy and tolerability of psychotropic medications can vary significantly among children and adolescents, and some of this variability relates to pharmacogenetic factors. Pharmacogenetics (PGx) in child and adolescent psychiatry can potentially improve treatment outcomes and minimize adverse drug reactions. This article reviews key pharmacokinetic and pharmacodynamic genes and principles of pharmacogenetic testing and discusses the evidence base for clinical decision-making concerning PGx testing. This article reviews current guidelines from the United States Food and Drug Administration (FDA), the Clinical Pharmacogenetics Implementation Consortium (CPIC), and the Dutch Pharmacogenetics Working Group (DPWG) and explores potential future directions. This review discusses key clinical considerations for clinicians prescribing psychotropic medications in children and adolescents, focusing on antidepressants, antipsychotics, stimulants, norepinephrine reuptake inhibitors, and alpha-2 agonists. Finally, this review synthesizes the practical use of pharmacogenetic testing and clinical decision support systems. [ABSTRACT FROM AUTHOR]

Background: Maternal psychological stress during pregnancy and postnatally has been shown to be associated with offspring atopic diseases (asthma, atopic dermatitis and allergic rhinitis). The aim of this study was to assess whether this association may be attributable to the child's own mental health disorders. Method: The study population included 15,092 twin children born 2002–2010 in Sweden. Questionnaire data at age 9 years was linked to national patient‐ and prescription registers. Maternal mental health during pregnancy and 3 years postnatally were identified from diagnosis and medication data (depression, anxiety and stress disorders). Atopic diseases in children were identified from questionnaires, diagnosis and medication data. Child mental health status (depression and anxiety) was identified from questionnaires. Three‐way decomposition methods tested for mediation or interaction by child mental health disorders. Results: Maternal mental health disorders were associated with most child atopic diseases including asthma aRR1.36 (95% CI 1.12, 1.60), and child mental health disorders, aRR1.73 (95% CI 1.56, 1.92). Children with mental health disorders were comorbid for atopic diseases with only asthma reaching statistical significance, aRR1.29 (95% CI 1.14, 1.47). Three‐way decomposition found that mediation or interaction by child mental health disorders did not account for the mother mental health and child atopy associations except in parent‐report asthma, where child mental health disorders mediated 13.4% (95% CI 2.1, 24.7) of the effect, but not for objectively defined (diagnosis and medication) asthma. Conclusion: The associations between maternal mental health and child asthma and allergic diseases do not appear to be attributable to child mental health disorders. [ABSTRACT FROM AUTHOR]

Introduction: Mental disorders in children can present with non specific behavioural issues, like irritability and procrastination. These issues are often neglected, which can negatively affect academic performance and overall development. Teachers hold a unique position to promote mental health and facilitate early identification of mental disorders, leading to timely referrals for early intervention. Aim: To examine the knowledge and attitude of school teachers towards mental disorders in school-going children. Materials and Methods: A cross-sectional study was conducted in Karwar city over a period of two months (July and August 2019) at the Karwar Institute of Medical Sciences, Karnataka, India. A total of 121 primary and high school teachers from 11 schools participated in the study. Purposive sampling was used, as all schools in Karwar city were approached for the study. A self-designed questionnaire consisting of 20 questions (10 questions on knowledge and 10 questions on attitude towards children with mental disorders) was used. Descriptive statistics, such as percentages, were used for data analysis. Results: The study revealed that teachers had moderate knowledge about child mental disorders. However, there was a lack of awareness about the treatment and care of such children. Sixty-three (52.07%) teachers believed that mental disorders result from incorrect thinking. Seventy-nine (65.29%) teachers were of the opinion that sleeping pills are not the only available treatment. Attitude towards children with mental disorders were both positive and negative. 82 (67.77%) teachers believed such children to be less intelligent, while 76 (62.81%) teachers did not believe mentally ill children indulge in violence. Many teachers were aware that these children can be vulnerable to bullying and discrimination by their peers. Conclusion: The study concluded that there is moderate knowledge and mixed attitude among school teachers regarding mental disorders in school-going children. This highlights the need for proper training programs that can aid in early identification, timely referrals for mental health evaluation, and the promotion of child mental health. [ABSTRACT FROM AUTHOR]

Attention-deficit/hyperactivity disorder (ADHD) is among the most common mental disorders in children and adolescents. While most studies in this field have focused on the genetic and neurobiological underpinnings of the disorder, research focusing on the family environment as a critical context contributing toward the manifestation and maintenance of child ADHD symptoms is still less extensive. Therefore, the aim of this study was to examine longitudinal and bidirectional associations between child hyperactivity, mother–child negativity, and sibling dyad negativity. Data were analyzed of up to 4,429 children from the Avon Longitudinal Study of Parents and Children, a nationally representative prospective birth cohort study in the United Kingdom, at three time points (T1–T3, children aged 4, 7, and 8 years). At baseline (T1, n = 4,063), the child sample (98.8% White ethnic background) composed of 51.6% males. Child hyperactivity symptoms, mother–child negativity, and sibling dyad negativity were examined based on maternal reports. The random intercepts cross-lagged panel model was adopted to parcel out between-family differences from within-family fluctuations and test bidirectional associations. On the between-family level, families with higher child hyperactivity reported higher mother–child and sibling dyad negativity. On the within-family level, unidirectional spillover processes between sibling dyad negativity and mother–child negativity as well as between mother–child negativity and child hyperactivity emerged. Future work in the area of child hyperactivity should implement a transactional family systems approach incorporating both parent–child and sibling subsystems. Interventions to reduce negative interactions between parents and hyperactive children may offer promising improvements in child symptoms and thus alleviate family burden. [ABSTRACT FROM AUTHOR]

In the context of ongoing workforce shortages, rising symptom severity, and increased rates of psychotropic prescribing, the 2021 declaration of a national emergency in child and adolescent psychiatry (CAP) has highlighted the need for innovative strategies to address access to quality care. As valued members of the interdisciplinary team, Board‐Certified Psychiatric Pharmacists (BCPPs) in CAP are well‐positioned to address these needs as they are integrated across various settings (e.g., ambulatory clinics, and psychiatric hospitals) and have expertise in psychiatric and neurodevelopmental disorders. As educators and advocates for evidence‐based psychotropic medication management, BCPPs in CAP decrease polypharmacy, increase medication adherence and knowledge, and enhance patient outcomes. Given the need for interdisciplinary collaboration among BCPPs, CAP, and primary care providers, it is crucial for pharmacy administrators to respond and recognize the necessity of integrating pharmacy services into CAP and integrating BCPPs into pharmacy departments. [ABSTRACT FROM AUTHOR]

In 2019, the University of California at San Francisco (UCSF) launched the Child and Adolescent Psychiatry Portal (CAPP), a pediatric mental health care access (PMHCA) program providing remote mental health consultation services to pediatric primary care providers (PCPs) throughout Northern and Central California. The development and implementation of CAPP was guided by Human-Centered Design (HCD), an iterative, rapid-paced innovation process focusing on stakeholders' needs and experiences, which shaped the development of CAPP's programs. The resulting key programmatic elements are designed for pediatric workforce development: (1) PCP consultation with a child and adolescent psychiatrist via a telephone warmline; and (2) training and education for providers. CAPP has grown rapidly since its launch, having enrolled 1,714 providers from 257 practices spread across 36 counties and provided 3,288 consults on 2,703 unique lives as of August 2023. Preliminary evaluation findings indicate high PCP satisfaction with CAPP's services, despite continued challenges of integrating behavioral health into primary care. Throughout the HCD and implementation process, multidisciplinary partnerships have proven critical in providing end-user input to inform and improve program design. This growing network of partnerships, developed through the cultivation of personal relationships and trust over time, has also proven essential for CAPP's rapid growth and sustainability. Overall, this Community Case Study highlights the critical role of partnerships and the importance of taking a people-centered approach, as captured in CAPP's motto, "Connecting for Care. [ABSTRACT FROM AUTHOR]

Today, child psychiatry appears as a field of opposition between different scientific rationalisms. Added to this is a growing distrust of clinicians' subjectivity and, more broadly, of their "semiological tools", i.e. the whole edifice of institutions, practices and thinking surrounding them. Historically, this questioning of medical reasoning dates back to an ancient debate that has run through the entire practice of Medicine since the Age of Enlightenment. In order to address this, child psychiatry, aware of the complexity of its object of interest – mental phenomena, development, the human person, society – has constructed a "semiological tool" able to apprehend this complexity. It combines multidisciplinary eclecticism, a dynamic understanding of bio-psycho-social trajectories and an awareness of the importance of the clinical encounter. We will consider these elements in relation to three principles used to describe complex objects. [ABSTRACT FROM AUTHOR]

Introduction: Resilience and quality of life (QOL) can involve a positive approach in group interventions for parents of children with autism spectrum disorders (ASD). This study aims to evaluate resilience and family QOL at the start of a psychoeducational group. Methods: Cross-sectional assessment of resilience and family QOL used the Family Quality of Life Scale (ECVF) and 14-item Resilience Scale (RS-14). Results: The study group showed high levels of resilience. Parents considered the resources/support domain crucial, although satisfaction in this area was comparatively lower. Concerns about low satisfaction with available resources and support were notable. Gender differences were observed but not statistically significant. Discussion: The study's findings support prior research on parental resilience in families of children with ASD. The literature on the QOL for these families presents mixed findings. The importance of parental involvement in service planning is highlighted. Conclusions: This study emphasizes the importance of resilience in parents of children with ASD, suggesting it as a potential therapeutic target. The findings underscore the need to address the perceived low quality of available resources and support. Further investigation is needed. [ABSTRACT FROM AUTHOR]

Changes in parental roles have renewed the focus on a father's involvement in an offspring's psychological development. However, fathers are still under-represented in family research. There are only a few structured father-centered intervention programs in child and adolescent psychiatry. In a German population sample, a pilot father-centered family intervention program with n = 16 participants, conducted in person (n = 8) and online (n = 8), in a child and adolescent psychiatry inpatient/day clinic setting was evaluated by comparing paternal stress, PSE, and child-rated paternal competence in a pre–post design. Participating fathers showed significant decreases in child-related parenting stress (presence: p = 0.042, online: p = 0.047) and significant increases in PSE (p = 0.006/0.012). Parent-related stress and child-rated paternal competence were unaffected (p = 0.108/0.171; p = 0.167/0.101), while small-to-medium effect size measures pointed in the direction of our hypothesis (d = 0.48/0.36; d = 0.37/0.50). Participant satisfaction was higher in person than online (p = 0.008). As social and biological fathers have important influences on child and adolescent well-being and development, they should be included more frequently in prevention and intervention programs. Fathers seem to benefit from gender-specific intervention programs with regard to stress reduction, as well as experiencing competence- and PSE-increasing effects. [ABSTRACT FROM AUTHOR]

Background: There is limited data on gastric emptying in dyspeptic children. We aimed to determine solid and liquid emptying rates in dyspeptic children and correlate with clinical characteristics. Methods: Charts of dyspeptic children undergoing 4‐hour dual‐phase gastric scintigraphy were reviewed for demographics, symptoms, and comorbidities. Key Results: In 1078 dyspeptic patients (65% females, median age 13 years) vomiting (55%), nausea (53%), and abdominal pain (52%) were the most common symptoms. The most common comorbidities were mental health (32%), neurologic (27%), and hypermobility spectrum disorders (20%). Solid and liquid emptying rates were aligned in 61.23%. Delayed solid with normal liquid emptying were noted in 2.5%, compared to delayed liquid with normal solid emptying in 26.16%. Abdominal pain had a trend for association with delayed or normal solid emptying (p = 0.06). Nausea was mostly reported with normal solid emptying (p < 0.0001) and underreported in patients <12 years with vomiting (29%). Abnormal solid emptying (rapid and delayed) was noted more frequently in children with mental health disorders (p = 0.027). Rapid liquid emptying was more common in children with genetic disorders (p = 0.032). Conclusion and Inferences: Over half of children with dyspepsia had delayed liquid gastric emptying, and one quarter had delayed liquid with normal solid emptying. Dual‐phase gastric emptying studies may help target therapy in dyspeptic children. Nausea is not a reliable symptom for dyspepsia in younger children. Given the significant association of abnormal gastric emptying in children with mental health disorders, we recommend screening and treating children with dyspepsia. [ABSTRACT FROM AUTHOR]

Recently, there has been an increase in telemedicine applied to child neuropsychiatry, such as the use of online platforms to collect remotely case histories and demographic and behavioral information. In the present proof-of-concept study, we aimed to understand to what extent information parents and teachers provide through online questionnaires overlaps with clinicians' diagnostic conclusions on attention-deficit/hyperactivity disorder (ADHD). Moreover, we intended to explore a possible role that autism spectrum disorders (ASD) symptoms played in this process. We examined parent- and teacher-rated questionnaires collected remotely and an on-site evaluation of intelligence quotients from 342 subjects (18% females), aged 3–16 years, and referred for suspected ADHD. An easily interpretable machine learning model—decision tree (DT)—was built to simulate the clinical process of classifying ADHD/non-ADHD based on collected data. Then, we tested the DT model's predictive accuracy through a cross-validation approach. The DT classifier's performance was compared with those that other machine learning models achieved, such as random forest and support vector machines. Differences in ASD symptoms in the DT-identified classes were tested to address their role in performing a diagnostic error using the DT model. The DT identified the decision rules clinicians adopt to classify an ADHD diagnosis with an 82% accuracy rate. Regarding the cross-validation experiment, our DT model reached a predictive accuracy of 74% that was similar to those of other classification algorithms. The caregiver-reported ADHD core symptom severity proved the most discriminative information for clinicians during the diagnostic decision process. However, ASD symptoms were a confounding factor when ADHD severity had to be established. Telehealth procedures proved effective in obtaining an automated output regarding a diagnostic risk, reducing the time delay between symptom detection and diagnosis. However, this should not be considered an alternative to on-site procedures but rather as automated support for clinical practice, enabling clinicians to allocate further resources to the most complex cases. [ABSTRACT FROM AUTHOR]

This study examines parents' experiences of support, investigation and treatment from child healthcare/psychiatry and habilitation in children with ESSENCE symptoms (neurodevelopmental symptoms). Data were collected through focus interviews, with 13 parents. A conventional qualitative analysis revealed four main categories: confidence, information, competence and collaboration, affecting parents. While waiting for an investigation parents experience anxiety, frustration, lack of information and confidence and doubts about their parenting ability, which also affects the child. The categories were interpreted using Bronfenbrenner's bioecological model to illustrate the effects on the family's interaction with the context. Parents demand a greater insight and participation in the ongoing process and improved collaboration between the various professionals Trial registration: Retrospectively registered clinical Trials 2021, PLUSS identifier, NCT04815889. [ABSTRACT FROM AUTHOR]

Peu d'études ont recherché de manière systématique des antécédents de violences sexuelles chez des adolescents présentant des troubles psychiatriques sévères et hospitalisés en pédopsychiatrie. Nous présentons ici les résultats d'une étude rétrospective menée sur les dossiers de l'ensemble des adolescents hospitalisés dans un service de pédopsychiatrie du département de la Seine Saint-Denis entre 2017 et 2021. L'objectif de l'étude était de rechercher la fréquence des Antécédents d'Agression Sexuelle (AAS) chez les adolescents hospitalisés en service de pédopsychiatrie et de tenter de décrire des liens chronologiques et symptomatologiques entre ces antécédents et l'hospitalisation en pédopsychiatrie, dans le but de proposer d'éventuelles recommandations de dépistage et de prise en charge. Nous avons réalisé une étude rétrospective basée sur l'analyse des dossiers médicaux des 141 adolescents hospitalisés dans un service de pédopsychiatrie entre 2017 et 2021. En rappelant l'épidémiologie des agressions sexuelles dans l'enfance et l'adolescence (fréquente, concernant garçons et filles, dans un tiers des cas intrafamiliale, et dans environ la moitié des situations non crue et non-accompagnée) notre étude souligne l'importance de leur dépistage par les médecins et les soignants. La prévalence significativement plus importante des tentatives de suicide et des automutilations doit particulièrement attirer l'attention sur le risque d'antécédents d'agression sexuelle, car ces symptômes sont fortement associés dans notre étude. La prévalence significativement plus importante des dépressions et des troubles de personnalité limite peut permettre d'aller vers une meilleure compréhension des répercussions des agressions sexuelles à l'adolescence. Le délai court entre l'agression sexuelle et sa révélation dans notre observation et les révélations d'agressions sexuelles intra familiales majoritairement faites durant l'hospitalisation soulignent l'intérêt d'une hospitalisation systématique des adolescents, notamment après une tentative de suicide. Le cadre rassurant d'une hospitalisation peut favoriser une révélation d'agression sexuelle plus rapide et ainsi en diminuer les effets psychiques dévastateurs à l'adolescence. Une faiblesse potentielle de notre étude est que, même dans un service spécialisé, de tels antécédents sont encore probablement sous-évalués et insuffisamment notés dans les dossiers médicaux. Une attention accrue est certainement nécessaire lors des entretiens pédopsychiatriques sur d'éventuels antécédent d'agressions sexuelles. Néanmoins, la rareté des études systématiques sur le sujet fait que cette étude ouvre la voie à la réalisation d'études prospectives. Des recommandations peuvent être proposées, également pour des situations moins graves, sans troubles psychiatriques avérés, mais suite à une tentative de suicide. L'hospitalisation peut alors se dérouler en service de pédiatrie avec un accompagnement psychologique adapté et non en service de pédopsychiatrie. Quel que soit le lieu de prise en charge psychologique des adolescents ayant fait une tentative de suicide, l'attention sur les antécédents d'agression sexuelle doit être améliorée afin de les repérer au plus tôt, d'effectuer une prévention secondaire et d'éviter une dégradation psychique du processus adolescent qui s'en trouve fragilisé. Few studies have systematically searched for a history of sexual violence in adolescents with severe psychiatric disorders hospitalized in departments of child psychiatry. Here, we present the results of a retrospective study conducted on the records of all adolescents hospitalized in a child psychiatry department in the Seine Saint-Denis department between 2017 and 2021. The aim of the study was to investigate the frequency of Antecedents of Sexual Aggression (AAS) in adolescents hospitalized in child psychiatry departments and to attempt to describe chronological and symptomatological links between these antecedents and hospitalization in child psychiatry, with the aim of proposing possible screening and management recommendations. We conducted a retrospective study based on analysis of the medical records of 141 adolescents hospitalized in a child psychiatry department between 2017 and 2021. By recalling the epidemiology of sexual aggression in childhood and adolescence (frequent, involving both boys and girls, in a third of cases intrafamilial, and in about half of the situations uncrushed and unaccompanied) our study underlines the importance of their detection by physicians and caregivers. The significantly higher prevalence of suicide attempts and self-harm should draw particular attention to the risk of a history of sexual assault, as these symptoms are strongly associated in our study. The significantly higher prevalence of depression and borderline personality disorder may provide a better understanding of the repercussions of sexual assault in adolescence. The short delay between the sexual assault and its disclosure in our observation, and the fact that most disclosures of intra-family sexual assaults were made during hospitalization, underline the value of systematic hospitalization of adolescents, particularly after a suicide attempt. The reassuring environment of hospitalization may encourage a more rapid disclosure of sexual assault, and thus lessen its devastating psychic effects during adolescence. A potential weakness of our study is that, even in a specialized service, such antecedents are probably still undervalued and insufficiently noted in medical records. More attention should certainly be paid during child psychiatric interviews to any history of sexual assault. Nevertheless, given the scarcity of systematic studies on the subject, this study paves the way for prospective studies. Recommendations can also be made for less serious situations, with no proven psychiatric disorders, but following a suicide attempt. In such cases, the patient could be hospitalized in a pediatric ward, with appropriate psychological support, rather than in a child psychiatry ward. Regardless of where adolescents who have attempted suicide are psychologically cared for, greater attention needs to be paid to any history of sexual aggression, so as to identify it as early as possible, provide secondary prevention and avoid the psychic deterioration of the adolescent process which would be weakened as a result. [ABSTRACT FROM AUTHOR]

Les violences sexuelles sur les mineurs ont des répercussions psychologiques importantes tout au long de la vie. Chez les adolescents, elles peuvent notamment se traduire par des mises en danger comme des tentatives de suicide. Leur repérage par les professionnels de santé est donc un enjeu important afin de proposer à ces jeunes une prise en charge médicale et sociale adaptée. Des recommandations professionnelles émergent quant au repérage des violences sexuelles chez les mineurs, mais malgré cela elles restent souvent sous-diagnostiquées. Au sein du centre hospitalier Robert-Ballanger (Aulnay-sous-Bois, Seine-St-Denis), un protocole spécifique permet l'hospitalisation en pédiatrie de tous les adolescents suicidants. Nous avons réalisé une étude afin de mettre à profit ce temps d'hospitalisation pour un meilleur repérage des antécédents d'agressions sexuelles chez les adolescents. Nous avons réalisé une étude rétrospective basée sur l'analyse des dossiers médicaux de 138 adolescents hospitalisés dans le service de pédiatrie et suivis par l'équipe de liaison de pédopsychiatrie au centre hospitalier Robert-Ballanger en 2021. Nous retrouvions significativement plus d'adolescents agressés sexuellement parmi les adolescents hospitalisés pour des gestes ou des idées suicidaires (12 sur 54; 22 %) que parmi les adolescents hospitalisés pour d'autres motifs pédopsychiatriques (5 sur 84; 6 %). Les situations d'agressions sexuelles décrites par les adolescents concernés étaient concordantes avec les données des études épidémiologiques françaises : elles concernaient majoritairement les filles (14 sur 17), étaient des agressions répétées dans les trois quarts des cas, et il s'agissait d'agressions intrafamiliales dans un tiers des cas. La révélation des faits était souvent faite à un soignant (pour 5 adolescents sur 17). Les adolescents avec un antécédent d'agression sexuelle étaient davantage concernés par des faits de violences intrafamiliales, mais aussi de harcèlement scolaire. Nous retrouvions un nombre significativement plus élevé de tentatives de suicide chez les adolescents agressés sexuellement, ainsi qu'un nombre plus élevé de tentatives de suicide ayant nécessité une hospitalisation en réanimation. L'hospitalisation en pédiatrie des adolescents suite à une tentative de suicide apparaît comme un outil intéressant pour le repérage des antécédents d'agression sexuelle chez ces jeunes. Notre étude met en évidence une sur-représentation des adolescents agressés sexuellement parmi ceux pris en charge pour des idées suicidaires ou des tentatives de suicide, ainsi que des points de vigilance spécifiques. Un cadre rassurant, la sensibilisation des professionnels et une attention particulière pourraient permettre un meilleur repérage et, de fait, une meilleure protection et un suivi thérapeutique adapté. Sexual violence against minors has important psychological repercussions throughout life. In adolescents, it can result in endangerment or self-aggressive behaviour such as suicide attempts. Its detection by health professionals is therefore an important issue in order to provide these young people with appropriate medical and social care. Professional recommendations call for systematic hospitalization of adolescents who have attempted suicide, but these recommendations have not yet been widely applied. At the Robert-Ballanger hospital (Aulnay-sous-Bois, Seine-St-Denis, France), a specific protocol has been established between paediatrics and child psychiatry departments, allowing all suicidal adolescents to be hospitalized in paediatrics. We conducted a study to take advantage of this hospitalization time to better identify sexual violence in adolescents. We conducted a retrospective study based on the analysis of the medical records of 138 adolescents hospitalized in the paediatric ward and followed by the child psychiatry liaison team at the centre hospitalier Robert-Ballanger (Aulnay-sous-Bois) in 2021. We found significantly more sexually assaulted adolescents among those hospitalized for suicidal gestures or ideas (12 out of 54; 22%) than among those hospitalized for other reasons (5 out of 84; 6%). The sexual assaults described by the adolescents concerned were consistent with data from epidemiological studies and French victimization surveys : they mainly concerned girls (14 out of 17), were repeated assaults in three quarters of cases, and were intrafamilial assaults in one third of cases. The disclosure was often made to a caregiver (for 5 of 17 adolescents). Adolescents with a history of sexual assault were more concerned with intrafamilial violence but also with school harassment. We found a significantly higher number of suicide attempts among sexually assaulted adolescents, as well as a higher number of suicide attempts requiring hospitalization in intensive care. Paediatric hospitalization of adolescents attempting suicide appears to be an interesting tool for identifying a history of sexual assault in these young people. Our study highlights an over-representation of sexually assaulted adolescents among those treated for suicidal thoughts or suicide attempts, as well as specific factors that should be vigilantly monitored. A reassuring environment, awareness-raising among professionals, and special attention to detail could all help to improve detection and hence protection and appropriate therapeutic follow-up. [ABSTRACT FROM AUTHOR]