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BackgroundMethodsResultsDiscussionPsychotic Like Experiences (PLEs), suicidal ideation, and depressive symptoms are related and common symptoms in adolescents treated in psychiatric services. However, more granular analysis of the associations between the two types of symptoms is sparse. This study aims to investigate the associations between self-reported PLEs and depressive symptoms on a sub-scale and item level, among adolescents attending secondary level psychiatric care.The sample included 328 adolescents (aged 13–18 years) attending adolescent psychiatry outpatient units of the Helsinki University Hospital. Depressive symptoms were assessed using the BDI-1A (total score and separate Suicidal Ideation item score). PLEs were assessed with the PQ-B and analysed as sum scores for the sub-scales Sensory Distortion, Grandiosity, Disorganised Speech, Paranoia, and Unusual Thoughts.High scores on PQ-B subscales Paranoia and Unusual Thoughts were both independently associated with more depression and suicidality. Item analysis showed that the associations between PLEs and depression were driven by two PQ-B Paranoia subscale items, and one Unusual Thoughts subscale item.The findings suggest that the association between PLEs and depressive symptoms is driven by paranoid experiences and unusual thought content. Professionals in psychiatric care should expect this type of co-occurrence. [ABSTRACT FROM AUTHOR]

Technology-facilitated sexual violence (TFSV) is a ubiquitous societal problem with negative health consequences. Child and Adolescent Psychiatric (CAP) patients are burdened with more violence exposure than other groups, but more work is needed to chart their exposure to TFSV specifically and to understand how it relates to their mental health. In this study, we aimed to investigate the occurrence of unwanted online sexual solicitation (UOSS) in a young Swedish psychiatric sample. We also aimed to measure the associations between psychiatric symptoms and exposure to UOSS, offline sexual harassment, cyberbullying, and offline bullying. We also aimed to analyze possible differences between boys and girls. Our results show a high occurrence of UOSS (48.61%), which is higher than in the general population. UOSS was significantly higher among girls (57.31%) than boys (20.59%), but boys in the CAP group were burdened with more UOSS victimization than boys in general. Co-occurrence of UOSS with other types of offline and online harassment was substantial. UOSS, together with age and offline sexual harassment, predicted anxiety and depressive symptoms among both girls and boys. UOSS also showed a significant interaction effect with gender, suggesting that boys exposed to UOSS suffer higher levels of anxiety and depressive symptoms than girls exposed to UOSS. Preventing and treating mental health difficulties needs to consider contextual circumstances such as exposure to sexual violence online. [ABSTRACT FROM AUTHOR]

Introduction: Religion and spirituality (R/S) serve as sources of meaning-making and coping for many individuals and families. While research on the relationship between R/S and mental health has been ongoing, their role in pediatric mental health is poorly understood. The objective of this study is to assess research trends and predominant themes of R/S in child and adolescent psychiatric research in articles published in the Journal of the American Association of Child and Adolescent Psychiatry (JAACAP). This provides a rough measure of the relative importance of these topics to academic psychiatrists and researchers in the field and identifies gaps for future research. Methods: All research and review articles published in JAACAP between 2000- 2023 with a focus on R/S themes were retrieved, screened, and appraised for content and extent of focus on R/S (major, minor, incidental). Included articles were assessed for R/S variables and predominant themes. Results: Thirty-two (32) research articles published between 2000-2023 contained sufficient R/S content for inclusion in our study. Only 4 articles had R/S as their major focus. Our analysis suggested a decline in publications with R/S content over the last 24 years. The R/S variables and measurement tools were heterogenous, with religious attendance and religious affiliation being the most frequently measured variables. The predominant themes include the relationships between R/S and psychopathology, suicide, utilization of services, conceptualization of illness, trauma, identity, and coping. Discussion: Despite the significance attributed to R/S by many youths and families and the increasing academic interest in the intersection between R/S and health, a significant gap exists in our understanding of R/S vis-à-vis child and adolescent mental health. This gap may be further compounded by the limited attention offered to R/S factors and variables in academic psychiatric activities. JAACAP, a global leading academic platform, may advance this discourse by inviting and encouraging publications addressing R/S variables. This may inform diagnostic, preventive, and interventive clinical work with children and their families. [ABSTRACT FROM AUTHOR]

Objective: This quasi-experimental study aimed to describe the outcome of a social skills intervention for adolescents with depression followed up at an outpatient Child and Adolescent Psychiatry Unit. Twenty adolescents with depression attending a tertiary care facility in Colombo, Sri Lanka were recruited, who participated in two social skills training programmes (6 months apart), in addition to pharmacological treatment. Outcome of the programme was measured by a self-administered questionnaire that assessed perceived changes in social skills, before and after the intervention. Wilcoxon Signed Rank test was used to determine the statistical significance of improvement in social skills. Results: The sample consisted of 80% (n = 16) female adolescents. Median scores (inter-quartile range) for social skills before and after the first social skills programme were 31.5 (21.0–36.0) and 33.0 (28.25–40.25) respectively, indicating a significant improvement in social skills following intervention (p = 0.011, r = 0.57). A similar improvement was observed after the second programme (n = 10), reporting higher median scores for social skills after intervention (29.5 vs. 37.5, p = 0.005, r = 0.89). A significant improvement was also observed in perceived ability to cope with depressive thoughts after intervention (p = 0.032), indicating that social skills training can be a useful adjunct to pharmacological interventions, in the management of depression in adolescents. [ABSTRACT FROM AUTHOR]

Background: The COVID-19 pandemic was associated with an increase in child and adolescent mental health disorders, with subsequent worsening of patient access to specialist mental health care. Clinicians working in the community were faced with increased demands to diagnose and manage pediatric mental health disorders, without always having the confidence and knowledge to do so. We therefore developed COnnecting Mental-health PAediatric Specialists and community Services (COMPASS)—a collaborative model designed to upskill community clinicians in child and adolescent mental health care and provide them with better access to child and adolescent psychiatry expertise. COMPASS comprises (1) an online Community of Practice (CoP) with fortnightly one-hour sessions covering: anxiety; aggression and challenging behaviours; depression; self-harm and suicidality; eating disorders; and autism spectrum disorder/complex cases and (2) primary and secondary consultations for general practitioners and paediatricians with an experienced child psychiatrist. We aimed to assess the impact of COMPASS on community clinician self-reported confidence in: managing common child and adolescent mental health disorders (Objective 1, primary outcome); navigating the mental health care system (i.e. knowing how services are organised, accessed, and how to refer patients, Objective 2); diagnosing conditions (Objective 3); prescribing psychotropic medications (Objective 4) as well as the impact on, clinician practice and wellbeing (Objective 5) and outcomes of patients referred by COMPASS clinicians to the child psychiatrist (Objective 6). Methods: We evaluated COMPASS in its first year, with COMPASS running from March to July 2021. Participating clinicians completed pre-post surveys evaluating change in Objectives 1 to 4 above, using study-designed measures. A purposive sample of clinicians was then invited to a semi-structured interview to understand their experience of COMPASS and its impacts on practice and wellbeing (Objective 5). We adopted an inductive approach to the qualitative analysis using the Framework Method. This involved selecting five random transcripts which were double coded and categorized, to generate an initial framework against which all subsequent transcripts were analysed. Themes and subthemes were generated from the data set, by reviewing the matrix and making connections within and between clinicians, codes and categories One child psychiatrist completed a 2-week logbook of the nature and outcomes of primary and secondary consultations (Objective 6). Findings: 51 (86%) clinicians attended CoP sessions and completed pre-post surveys, with 92% recommending COMPASS to peers. Clinicians reported increased confidence in the pharmacological and non-pharmacological management of all conditions, most notably for management of self-harm. They also reported increased knowledge of how to navigate the mental health system and prescribe medications. Qualitative analysis (n = 27 interviews) found that COMPASS increased clinician wellbeing and reduced feelings of professional isolation and burnout. Over the 2-week snapshot, the child psychiatrist consulted on 22 patients and referred all back to the community clinician. Conclusions: COMPASS is associated with improved clinician confidence to manage child and adolescent mental health concerns, navigate the mental health system, improved clinician wellbeing, and reduced need for ongoing mental health care by specialists. [ABSTRACT FROM AUTHOR]

Background: While Tourette syndrome (TS) and attention-deficit/hyperactivity disorder (ADHD) often co-occur, the nature of the relationship between their symptoms is not well understood. Network analysis of psychopathology allow for detailed examinations of symptom interactions, providing an effective approach to explore the patterns of comorbidity between TS and ADHD symptoms. Methods: This study included 3,958 participants (male/female = 3,004/954, age mean ± SD = 8.60 ± 2.25 years). We collected data on TS symptoms using the Motor Tic, Obsessions and Compulsions, Vocal Tic Evaluation Survey (MOVES), and ADHD symptoms using the Swanson, Nolan, and Pelham Rating Scale-IV (SNAP-IV). Network analysis was employed to construct a combined network of TS and ADHD symptoms at the symptom level. We utilized the expected influence (EI) and bridge EI metrics to explore the core and bridge symptoms within the network. Results: The network structure demonstrated a moderate number of non-zero connections between TS and ADHD symptoms, constituting 23.06% of all potential connections. Core symptoms in the comorbidity network included "Often has difficulty sustaining attention in tasks or play activities," "Certain bad words or thoughts keep going through my mind," and "Words come out that I can't stop or control." Bridging symptoms identified were "Words come out that I can't stop or control," "I do certain things like jumping or clapping over and over," "I can't control all my movements," and "Often talks excessively." Conclusion: The core and bridging symptoms identified in this study serve as potential therapeutic targets for the treatment of TS and ADHD comorbidity in clinical children and adolescents. [ABSTRACT FROM AUTHOR]

Background: In 2019, the world faced a pandemic brought about by a severe acute respiratory infection caused by SARS-CoV-2 virus. The spread of this virus has profoundly affected societies, particularly in terms of their economic, human and social dimensions, as well as their healthcare systems. Several restrictive measures (reduced social interaction, periodic school closures,...) had to be taken to contain the spread of the virus. These measures have had an impact on the psychological well-being of both adults and children. The aim of this study was to assess the changes in psychotropic drugs prescriptions for children and adolescents living in Limousin, a French region, over the period 2018 to 2021. Methods: The consumption of psychotropic drugs was studied using a national database of drug reimbursement. These data were extracted and supplied from the nationwide French reimbursement healthcare system database (SNDS). The following therapeutic classes were studied: N05A (antipsychotics), N05B (anxiolytics), N05C (hypnotics and sedatives), N06A (antidepressants) and N06B (psychostimulants). Data were collected for insured persons under the age of 18 who received at least one reimbursement for a psychotropic drug between 2018 and 2021. Results: Over a 4-year period, 7949 patients under the age of 18 were included with an average age of 12.1 years and a sex ratio of 0.97 M/F. The number of patients increased from 2018 to 2021, as did the number of reimbursements. We observed a statistically significant difference of means of patients reimbursed per week for on five therapeutic classes, with the greatest difference in 2021 (p < 0.0001). An increase in the number of patients of between + 20.7% and + 689% was observed, depending on the drug classes studied. Comparisons between the COVID-19 and pre-COVID-19 periods showed a significantly higher COVID average for psychotropic drugs reimbursements in general and individually for all classes except psychostimulants. Conclusion: The results show a significant increase in the consumption of psychotropic drugs among youth. The increase in psychotropic drug use was continuous and progressive throughout the pandemic. All five classes were increased, but particularly anxiolytics and antidepressants. The COVID-19 context may have been at the origin of a deterioration in the mental health of children and adolescents, or of a heightened awareness of psychiatric care among young people. [ABSTRACT FROM AUTHOR]

Background: Despite efforts to promote guideline use, guideline adoption is often suboptimal due to failure to identify and address relevant barriers. Barriers vary not only between guidelines but also between settings, intended users, and targeted patients. Multi-professional guidelines are often used in child and adolescent mental health services (CAMHS), making the implementation process more difficult. Despite this, there is a lack of knowledge about which barriers to consider or if barriers vary by profession. The aim of this study was to address these gaps by examining barriers to adopting a multi-professional depression guideline in the context of a nationwide implementation study. Methods: 440 CAMHS clinicians across Sweden (52%) completed the Barriers and Facilitators Assessment Instrument (BFAI) ahead of an implementation endeavour. BFAI is a widely used and validated measure of guideline implementation on four scales: Innovation, Provider, Context, and Patient. Barriers were calculated at scale and at item levels. ANOVA and chi-square tests were used to analyse differences by profession and effect sizes were calculated. Results: Overall, clinicians were optimistic about guideline uptake, particularly about guideline characteristics and their own adoption ability. Barriers were related to the patient and the context domains, as well as to individual clinician knowledge and training. Perceptions differed across professions; psychiatrists were most, and counsellors were least positive about guideline embeddedness. Conclusion: This large-scale quantitative study suggests that CAMHS clinicians have an overall favourable attitude towards guideline adoption but highlights the need for adaptations to certain patient groups. Strategies to improve guideline use should primarily address these patient issues while securing proper support to the implementation. Implementation efforts, particularly those targeting staff knowledge, training, and involvement, may benefit from being tailored to different professional needs. These findings may inform implementation projects in CAMHS and future research. [ABSTRACT FROM AUTHOR]

Aim Methods Results Conclusion Evidence suggests an association between maternal hypothyroidism and risk of attention‐deficit/hyperactivity disorder (ADHD) or autism spectrum disorder (ASD) in offspring. We examined the risk of ASD and ADHD in individuals with congenital hypothyroidism (CHT).A nationwide population‐based cohort study enrolled a total of 1260 children younger than 12 years with a confirmed diagnosis of CHT and no prior diagnosis of any neurodevelopmental disorders, selected from the National Health Insurance Research Database of Taiwan between 1998 to 2013. In addition, 12,600 controls matched for sex, age, and residence were selected. Cox proportional hazards analysis was used to investigate the association among CHT, ASD, and ADHD.Children with CHT were associated with a higher incidence of ASD (7.1‰ vs 1.3‰, P < 0.001) and ADHD (39.7‰ vs 18.7‰, P < 0.001) than the control group. Cox regression analyses demonstrated that children with CHT were associated with elevated risks of ASD (hazard ratio [HR], 4.72 [95% confidence interval (CI), 2.08–10.70]) and ADHD (HR, 2.03 [95% CI, 1.49–2.77]), after adjusting for demographic data and family history of major psychiatric disorders, compared with the control group.Children with CHT were associated with approximately a two‐fold increased risk of ADHD and a four‐fold increased risk of ASD than the control group. Our study highlights the need for future research to elucidate the potential pathophysiology among CHD, ASD, and ADHD. [ABSTRACT FROM AUTHOR]

Background: India's landscape of sub/super-specialization courses is expanding rapidly. Numerous courses spanning various domains of psychiatry exist, and this trend is poised to continue its upward trajectory. We aimed to assess the need for sub/super-specialization courses in psychiatry in India and explore the structural components of the courses. Methods: This was a cross-sectional study. A total of 142 psychiatrists/psychiatry residents from India were surveyed using an online questionnaire after approval from the Institutional Ethics Committee. Results: "Good" and "intense" need for specialization courses was reported to be highest for child and adolescent psychiatry (68.3%), followed by addiction psychiatry (56.4%) and psychotherapy (55.6%). A 1-year post-doctoral fellowship was reported to be the most preferred course format. Practical examination was suggested to be the preferred summative assessment method for different course formats. Conclusion: The availability of sub/super-specialization courses presents an opportunity to enhance psychiatrists' training in specific areas of interest. Offering a variety of course options enables psychiatrists to select the most suitable program based on their individual requirements and career goals. [ABSTRACT FROM AUTHOR]

Early maladaptive schemas (EMSs) have scarcely been studied in adolescents. The present study investigates EMSs in two clinical samples of 12–22-year-olds recruited from patients entering a specialized adolescent psychiatry clinic [n = 190] or a pediatric clinic [n = 119] in Finland. The endorsement of EMSs was compared between these samples, and the association of EMSs with perceived parental bonding was assessed. EMSs were assessed with the Young Schema Questionnaire-Short Form 2-Extended and particularly affectionless control parenting style with the Parental Bonding Instrument. The main analyses were conducted using general linear modeling. Significant differences existed between the two samples, with most EMSs and EMS domains being stronger in the adolescent psychiatry sample. The Disconnection and Rejection domain was associated with maternal affectionless control in the adolescent psychiatry sample and paternal affectionless control in the pediatric sample. The results provide novel findings of EMSs in adolescents and their links to parenting. [ABSTRACT FROM AUTHOR]

Kahramanmaraş earthquakes occurred on 6 February 2023, and many people died and were trapped under the rubble. The objective of this research was to investigate child victims of the quake, who were most dramatically affected, required intensive care and were trapped under debris/rubble/wreckage in terms of psychiatric status and the disaster-related or personal determinants of psychopathologies. Pediatric patients (n=77) who were hospitalized in intensive care units and inpatient wards within the first month after the earthquake and were consulted to the Child Psychiatry, were examined in terms of psychiatric symptoms, use of psychotropics, duration under debris, loss of relatives, loss of limbs, and intensive care requirement. Anhedonia, loss of appetite, psychosomatic and dissociative symptoms, as well as psychotropic need/use were significantly higher in patients who required intensive care. Dissociative and psychosomatic symptoms were linked with longer durations under debris. The current findings highlight prominent and predominated psychiatric symptoms in child victims of quakes, hospitalized in intensive care units and being prolonged trapped under debris. Prolonged entrapment correlated with increased dissociative and psychosomatic symptoms, emphasizing the need for targeted psychiatric support for vulnerable earthquake survivors. [ABSTRACT FROM AUTHOR]

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Background: Mental health in adolescence is critical in its own right and a predictor of later symptoms of anxiety and depression. To address these mental health challenges, it is crucial to understand the variables linked to anxiety and depression in adolescence. Methods: Here, we analyzed data of 278 adolescents that were collected in a nation-wide survey provided via a smartphone-based application during the COVID-19 pandemic. We used an elastic net regression machine-learning approach to classify individuals with clinically relevant self-reported symptoms of depression or anxiety. We then identified the most important variables with a combination of permutation feature importance calculation and sequential logistic regressions. Results: 40.30% of participants reported clinically relevant anxiety symptoms, and 37.69% reported depressive symptoms. Both machine-learning models performed well in classifying participants with depressive (AUROC = 0.77) or anxiety (AUROC = 0.83) symptoms and were significantly better than the no-information rate. Feature importance analyses revealed that anxiety and depression in adolescence are commonly related to sleep disturbances (anxiety OR = 2.12, depression OR = 1.80). Differentiating between symptoms, self-reported depression increased with decreasing life satisfaction (OR = 0.43), whereas self-reported anxiety was related to worries about the health of family and friends (OR = 1.98) as well as impulsivity (OR = 2.01). Conclusion: Our results show that app-based self-reports provide information that can classify symptoms of anxiety and depression in adolescence and thus offer new insights into symptom patterns related to adolescent mental health issues. These findings underscore the potentials of health apps in reaching large cohorts of adolescence and optimize diagnostic and treatment. [ABSTRACT FROM AUTHOR]

Aims Methods Results Conclusion Estimates of the occurrence of bipolar disorder among adolescents vary from country to country and from time to time. Long delays from first symptoms to diagnosis of bipolar disorder have been suggested. Studies among adults suggest increased mortality, particularly due to suicide and cardiovascular diseases. We set out to study the prognosis of adolescent onset bipolar disorder in terms of rehospitalizations, diagnostic stability, and mortality.The study comprised a register‐based follow‐up of all adolescents admitted to psychiatric inpatient care for the first time in their lives at age 13–17 during the period 1980–2010. They were followed up in the National Care Register for Health Care and Causes of death registers until 31 December 2014.Incidence of bipolar disorder among 13‐ to 17‐year‐old adolescents over the whole study period was 2.8 per 100, 000 same aged adolescents, and across decades, the incidence increased six‐fold. Patients with bipolar disorder during their first‐ever inpatient treatment were rehospitalized more often than those treated for other reasons. Conversion from bipolar disorder to other diagnoses was far more common than the opposite. Mortality did not differ between those firstdiagnosed with bipolar disorder and those treated for other reasons.The incidence of adolescent onset bipolar disorder has increased across decades. The present study does not call for attention to delayed diagnosis of bipolar disorder. Adolescent onset bipolar disorders are severe disorders that often require rehospitalization, but diagnostic stability is modest. Mortality is comparable to that in other equally serious disorders. [ABSTRACT FROM AUTHOR]

To reduce coercion in acute inpatient child and adolescent psychiatric units, a better understanding of individuals at risk for seclusion and/or restraint (S/R) is needed. We report data on the proportion of patients secluded/restrained and factors associated with higher risk of S/R. Identifying preventative mechanisms through risk stratification upon inpatient admission can aid the training of mental health professionals, and support shaping specific workflows for at-risk populations for example by joint crisis plans or post-coercion review sessions. Methods: A case-control study included all admissions (n = 782) to a department of child and adolescent psychiatry within 36 months between 2019 and 2022. Data on age, sex, out of home care, primary and comorbid ICD-10 diagnoses, length of stay, prior/multiple admissions were compared between admissions with and without S/R using chi square tests for categorical and t-tests for continuous variables. Uni- and multivariate binary logistic regression models were computed. Results: The overall proportion of S/R was 12.8% (n = 100). Females (p = 0.001), patients in out of home care (p < 0.001), with prior admission (p < 0.001), Post-traumatic stress disorder (PTSD; p < 0.001) and Borderline personality disorder (BPD; p < 0.001) were at a significantly higher risk of S/R. Length of stay in days (OR 1.01), out of home care (OR 3.85), PTSD (OR 6.20), BPD (OR 15.17), Attention deficit hyperactivity disorder (ADHD)/conduct disorder (OR 4.29), and manic episode/bipolar disorder (OR 36.41) were significantly associated with S/R in multivariate regression. Conclusions: Child and adolescent psychiatric staff should consider risk factors when using coercive measures. Patients with PTSD and/or BPD are the most vulnerable subgroups. Training of professionals and clinical practice need to be adapted in order to prevent the use of S/R and its potential hazards. [ABSTRACT FROM AUTHOR]

This article discusses the relationship between developmental trauma and violence, arguing that trauma is often overlooked in discussions about violence and mental illness. The authors conducted a literature review and found that early exposure to trauma is a significant risk factor for psychiatric disorders and violence. They propose the reintroduction of developmental trauma disorder (DTD) to better understand the unique implications of childhood trauma. The article emphasizes the need for trauma-informed care and the development of tailored service models for at-risk individuals. It also highlights the potential misdiagnosis of developmental trauma as other conditions and the long-lasting effects it can have on children. The article suggests trauma-informed care, peer support, and digital mental health interventions as potential treatment practices. It concludes by emphasizing the importance of accurate diagnosis and individualized treatment strategies for developmental trauma. [Extracted from the article]

Introduction: Obsessions are recurrent ego-dystonic thoughts, images, or urges followed by compulsion to reduce them. The phenomenology of obsessive–compulsive disorder (OCD) along with comorbidities is essential for understanding treatment response. This study aimed to assess phenomenology, impairment, and psychiatric co-morbidity associated with OCD in children and adolescents. Methodology: A cross-sectional study was done among 36 patients suffering from OCD. Socio-demographic and clinical details were collected with the application of Children's Yale-Brown Obsessive Compulsive Scale for severity of illness, Children's Global Assessment Scale for impairment assessment, and Kiddie-Sads-Present and Lifetime Version for comorbidity. Result: Thirty-six patients, comprising 20 male and 16 female subjects, with a mean age ± SD of 11 ± 3.4 years and a mean duration of illness of 12.30 months, were included in the study. A positive family history was noted in 30.6% of subjects. Mean C-YBOCS score was 24.44 (moderate to severe OCD) and the mean C-GAS score was 47.86, with 55.6% of subjects suffering from other comorbidities. Fear of contamination with washing and cleaning was among the most common themes in the population. Data was analyzed and presented as mean ± SD, frequencies, and percentages. Conclusion: Considering the increased prevalence of OCD in children and adolescent populations, a thorough symptom evaluation and any co-morbidities related to OCD should be considered by clinicians. [ABSTRACT FROM AUTHOR]

Objective: During the COVID-19 pandemic, the prevalence of depression and anxiety among children and adolescents significantly increased, along with the number of visits to emergency departments due to suicidality and/or suicide attempts. Relatedly, health care workers experienced significant burnout and symptoms of anxiety, depression, and posttraumatic stress disorder during this time. However, the corresponding impact on psychiatric inpatient treatment has not yet been researched. We hypothesized that during the pandemic, adolescents hospitalized in an acute care psychiatric inpatient unit had increased incidents of suicide attempts and nonsuicidal self-injurious behaviors and of aggressive behaviors toward others, resulting in greater use of constant observation and restraints. Method: This study was a retrospective chart review based on electronic medical record data examining use of restraints and constant observation one year before the pandemic (March 2019 to February 2020) and 1 year following the onset of the pandemic (March 2020 to February 2021) in an acute-care adolescent (12 to 17 years old) psychiatric inpatient unit. Results: There were 571 admissions during the year before the pandemic and 500 admissions during the pandemic. The number of patients who were restrained (χ2 = 7.86, p = 0.005), number of patients who were placed on constant observation (χ2 = 13.41, p < 0.001), and number of constant observation orders per patient (χ2 = 91.90, p < 0.001) were all significantly greater during the pandemic. Conclusion: Psychiatrically hospitalized adolescents during the pandemic received more intensive interventions such as restraints and constant observation. Severe patient psychopathology and staff shortages, as well as limitations of and decreases to the dialectical behavior therapy program, may have been the contributing factor. [ABSTRACT FROM AUTHOR]

Nonsuicidal self-injury typically involves deliberate harm without suicidal intent; however, rare cases exist where self-injury occurs unintentionally, without conscious awareness. This report presents the case of a 16-year-old boy who exhibited unintentional self-harm during sleep, associated with severe academic stress and perfectionism. Despite psychological and medical interventions, the behavior persisted until academic stress was alleviated. This case highlights the need for a differentiated clinical approach to managing unintentional self-harm, emphasizing the importance of stress management and psychological support in adolescents to address the underlying emotional and behavioral triggers.

Abstract Background In 2019, the world faced a pandemic brought about by a severe acute respiratory infection caused by SARS-CoV-2 virus. The spread of this virus has profoundly affected societies, particularly in terms of their economic, human and social dimensions, as well as their healthcare systems. Several restrictive measures (reduced social interaction, periodic school closures,…) had to be taken to contain the spread of the virus. These measures have had an impact on the psychological well-being of both adults and children. The aim of this study was to assess the changes in psychotropic drugs prescriptions for children and adolescents living in Limousin, a French region, over the period 2018 to 2021. Methods The consumption of psychotropic drugs was studied using a national database of drug reimbursement. These data were extracted and supplied from the nationwide French reimbursement healthcare system database (SNDS). The following therapeutic classes were studied: N05A (antipsychotics), N05B (anxiolytics), N05C (hypnotics and sedatives), N06A (antidepressants) and N06B (psychostimulants). Data were collected for insured persons under the age of 18 who received at least one reimbursement for a psychotropic drug between 2018 and 2021. Results Over a 4-year period, 7949 patients under the age of 18 were included with an average age of 12.1 years and a sex ratio of 0.97 M/F. The number of patients increased from 2018 to 2021, as did the number of reimbursements. We observed a statistically significant difference of means of patients reimbursed per week for on five therapeutic classes, with the greatest difference in 2021 (p

Abstract Background Psychiatric medications are not efficacious for treating borderline personality disorder (BPD), yet many patients with BPD are prescribed multiple psychiatric medications. This study aimed to (1) characterize psychiatric medication prescribing practices in adolescents with BPD and (2) assess whether demographic features are associated with prescribing practices. Method This sample was N = 2950 pediatric patients with BPD (ages 10–19) across the U.S. Data came from the NeuroBlu database, which includes data from 30 U.S. healthcare systems and hundreds of hospitals. Poisson regressions and chi-squared tests determined whether gender, race, and ethnicity were associated with (1) number of unique psychiatric medications prescribed and (2) number of unique medication classes prescribed. Results Roughly two-thirds (64.85%) of youth were prescribed any medications. Of these youth, 79.40% were prescribed ≥ 2 unique medications and 72.66% were prescribed ≥ 2 unique medications classes. The mean number of unique medications was 3.50 (SD = 2.50). The mean number of unique medication classes was 2.35 (SD = 1.15). The most commonly prescribed medication classes were antidepressants and antipsychotics, which were often prescribed in combination. Poisson regressions showed that boys were prescribed more unique medications (M = 3.67) than girls (M = 3.47). Non-Latinx youth were prescribed significantly more unique medications (M = 44.12) than Latinx youth (M = 3.60, p = .01). Conclusions Results characterize psychiatric medication prescribing practices in youth with BPD. Prescribing practices vary by demographics, such that boys and non-Latinx youth are prescribed more medications than girls and Latinx youth, respectively. These demographic differences suggest that prescribers may treat BPD differently based on patient demographic characteristics.

Abstract Introduction Obsessions are recurrent ego-dystonic thoughts, images, or urges followed by compulsion to reduce them. The phenomenology of obsessive–compulsive disorder (OCD) along with comorbidities is essential for understanding treatment response. This study aimed to assess phenomenology, impairment, and psychiatric co-morbidity associated with OCD in children and adolescents. Methodology A cross-sectional study was done among 36 patients suffering from OCD. Socio-demographic and clinical details were collected with the application of Children’s Yale-Brown Obsessive Compulsive Scale for severity of illness, Children’s Global Assessment Scale for impairment assessment, and Kiddie-Sads-Present and Lifetime Version for comorbidity. Result Thirty-six patients, comprising 20 male and 16 female subjects, with a mean age ± SD of 11 ± 3.4 years and a mean duration of illness of 12.30 months, were included in the study. A positive family history was noted in 30.6% of subjects. Mean C-YBOCS score was 24.44 (moderate to severe OCD) and the mean C-GAS score was 47.86, with 55.6% of subjects suffering from other comorbidities. Fear of contamination with washing and cleaning was among the most common themes in the population. Data was analyzed and presented as mean ± SD, frequencies, and percentages. Conclusion Considering the increased prevalence of OCD in children and adolescent populations, a thorough symptom evaluation and any co-morbidities related to OCD should be considered by clinicians.

Gender differences in mental health emerge as early as in childhood and adolescence, highlighting the potential need for gender-specific child and adolescent mental health care. However, it is unclear how gender-specific child and adolescent mental health care is implemented and whether its' approaches are useful. Therefore, this study reviews gender-specific interventions and their effectiveness for child and adolescent mental health. Five databases were searched for articles published between 2000 and 2021. In total, 43 studies were included. Most interventions were conducted in school (n = 15) or community settings (n = 8). Substance-related disorders (n = 13) and eating disorders (n = 12) were addressed most frequently. Most interventions targeted girls (n = 31). Various gender-specific aspects were considered, including gender-specific risk and protective factors (n = 35) and needs (n = 35). Although most interventions yielded significant improvements in mental health outcomes (n = 32), only few studies reported medium or large effect sizes (n = 13). Additionally, there was a lack of strong causal evidence derived from randomized controlled trials, calling for more rigorous trials in the research field. Nevertheless, our findings indicate that gender-specific mental health care can be a promising approach to meet gender-specific mental health needs. [ABSTRACT FROM AUTHOR]

SUMMARY: Multiaxial classification system development (organising important and relevant clinical factors under multiple headings or 'axes') has a long history stretching back to the 1940s. The World Health Organization supported the development of a multiaxial system of classification for children from the 1960s and in the 1990s produced a comprehensive multiaxial system which could be used with ICD-10. Using the multiaxial approach provides for an atheoretical framework that can integrate factors from within the child and the environmental influences on the child. This article presents a variety of ways in which the ICD-10 multiaxial framework can be extended from its classic usage to provide clinicians with valuable tools to assist in a biopsychosocial clinical assessment. Using the multiaxial system in an extended format allows a more comprehensive diagnosis and planning of treatments and is helpful in the training and teaching of juniors. It is also useful in evaluating responses to medication when it is combined with a chronological analysis and can provide other useful ways of integrating information relevant to understanding clinical cases. [ABSTRACT FROM AUTHOR]

Background: Early exposure to neighborhood social fragmentation has been shown to be associated with schizophrenia. The impact of social fragmentation and friendships on distressing psychotic-like experiences (PLE) remains unknown. We investigate the relationships between neighborhood social fragmentation, number of friends, and distressing PLE among early adolescents. Methods: Data were collected from the Adolescent Brain Cognitive Development Study. Generalized linear mixed models tested associations between social fragmentation and distressing PLE, as well as the moderating role of the number of total and close friends. Results: Participants included 11 133 adolescents aged 9 to 10, with 52.3% being males. Greater neighborhood social fragmentation was associated with higher levels of distressing PLE (adjusted β = 0.05; 95% CI: 0.01–0.09). The number of close but not total friends significantly interacted with social fragmentation to predict distressing PLE (adjusted β = −0.02; 95% CI: −0.04 to <−0.01). Among those with fewer close friends, the association between neighborhood social fragmentation and distressing PLE was significant (adjusted β = 0.07; 95% CI: 0.03–0.11). However, among those with more close friends, the association was non-significant (adjusted β = 0.03; 95% CI: −0.01 to 0.07). Conclusions: Greater neighborhood social fragmentation is associated with higher levels of distressing PLE, particularly among those with fewer close friends. Further research is needed to disentangle aspects of the interaction between neighborhood characteristics and the quality of social interactions that may contribute to psychosis, which would have implications for developing effective interventions at the individual and community levels. [ABSTRACT FROM AUTHOR]

Neurodevelopmental disorders (NDDs) are a group of conditions characterized by impairments of brain processes that impact cognition, communication, motor abilities, and/or behavior during development. These conditions typically have significant effects across the life span and impact personal, social, academic, or occupational functioning. The US Centers for Disease Control and report that 1 in 6 children has a developmental disability, making it highly likely for child and adolescent psychiatrists to encounter children with NDDs in daily practice.1 While the etiologies of NDDs are broad, genetic syndromes are a common cause of NDDs. The diagnostic yield of thorough genetic testing for NDDs as a group is about 40% based on meta-analysis, including 30% to 50% yield in patients with global developmental delay (GDD) or intellectual disability (ID) and 15% to 20% yield in patients with in autism spectrum disorder.1-3 The findings are extremely heterogeneous, including chromosomal copy number variants (CNVs) and more than 2,000 known monogenic disorders associated with NDDs.3 Diagnostic yields will increase over time with advances in technology and disease gene discovery.3 [ABSTRACT FROM AUTHOR]

A group of youth with severe and enduring mental health problems (SEMHP) falls between the cracks of the child-and-adolescent psychiatry (CAP) system. An insufficient understanding of these youth's mental health problems results in a failure to accurately identify and provide support to these youth. To gain a deeper understanding, the aim of this study is to explore characteristics of youth with SEMHP in clinical practice based on the experiences of youth and clinicians in CAP. This qualitative study consisted of 20 semi-structured interviews with 10 youth with lived experience and 10 specialized clinicians in CAP. Both a thematic and content analysis was conducted to identify, assess, and report themes associated with youth with SEMHP. Themes were individual characteristics such as trauma, masking, self-destructive behavior, interpersonal distrust as well as environmental and systematic characteristics including parental stressors, social isolation and societal stressors, which go beyond the existing classifications. These characteristics profoundly impact youth's daily functioning across various life domains, creating an interactive process, ultimately leading to elusive mental health problems and overwhelming feelings of hopelessness. The authors recommend proper assessment of characteristics in all life domains affected and their perpetuating effect on SEMHP during diagnostics in CAP. Engaging in a dialogue with youth themselves is crucial due to the nature of youth's characteristics, which frequently transcend traditional classifications and may not be immediately discernible. It also requires an integrated care approach, entailing collaborations between educational institutions and mental healthcare providers, and attention to potential indicators of deficits in the healthcare system and society. [ABSTRACT FROM AUTHOR]

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Introduction: The Mental Welfare Commission for Scotland published a report into the death of a young person, with recommendations for the Royal College of Psychiatry in Scotland Child and Adolescent Faculty; to explore if there were barriers to the use of Clozapine in young people in Scotland. Methods: A mixed-methods study was performed using a cross-sectional survey of clinicians working in child and adolescent psychiatry across Scotland, to determine attitudes towards clozapine use and the perceived barriers and facilitators to clozapine treatment. Results: Results suggest that there may be a lack of clearly defined pathways within and between services, as well as a lack of resources provided for the necessary monitoring of a young person started on clozapine. Multiple respondents felt unskilled in clozapine initiation and had not accessed formal training. The most frequently mentioned themes for improving facilitation of clozapine prescription were that of increased resources and training. Discussion: National policymakers including the Mental Welfare Commission, NHS Education for Scotland, and NHS Scotland should consider these findings to address the potential underutilisation of clozapine for people aged under 18 in services across Scotland. A review of current service provision should take place, with consideration of whether the facilitators to clozapine prescription which our study has highlighted could be implemented more effectively. This may help reduce identified barriers and increase clozapine prescription to those who would benefit from it, potentially improving outcomes for young people with treatment-resistant psychosis. [ABSTRACT FROM AUTHOR]

Background: The decision to allocate hospitals for the initial reception of hostages abducted on the October 7th Hamas attack introduced an array of unprecedented challenges. These challenges stemmed from a paucity of existing literature and protocols, lack of information regarding captivity conditions, and variability in hostage characteristics and circumstances. Objective: To describe the rapid development, implementation and evaluation of the Hostage-ReSPOND protocol, a comprehensive trauma-informed procedure for the care of hostages, including young children, their caregivers and families, immediately following their release from prolonged captivity. Methods: A multidisciplinary expert focus group conducted a comprehensive literature review to develop the ReSPOND protocol, consisting of: Readiness of teams via multifaceted trainings, utilizing live simulations and video debriefings; Specialized professional teams experienced in providing holistic trauma-informed care; Personalized care tailored to individualized and developmentally-informed needs; Optimal safety rooted in creating a secure environment and trauma-informed response to young children, adolescents, caregivers and families; and Navigating Discharge, through coordination with community-based care systems. Results: A designated facility at the Children's hospital was carefully prepared for receiving 29 hostages, aged 3.9–80 years, 28% under the age of 18. Implementation of the ReSPOND protocol, which prioritized holistic psychosocial interventions above urgent medical care, proved feasible and effective in managing the diverse and complex needs of returnees as per provider report. Finally, systemic assessment of returnee's immediate and long-term mental health needs proved highly challenging. Conclusions: There is currently no literature addressing the response to released hostages, especially those involving infants, young children and families within a children's hospital facility. This study has the potential to fill a crucial gap in knowledge by introducing a novel protocol which could offer valuable insights for public health organizations tasked with providing acute care to diverse individuals and families experiencing extreme, multi-layered mass traumatization. [ABSTRACT FROM AUTHOR]

An editorial discusses forensic child and adolescent psychiatry, highlighting its recent emergence as a specialized field within psychiatry. It outlines challenges, such as high cooperation with the legal system, and mentions collaborative efforts, including the European Association for Forensic Child and Adolescent Psychiatry (EFCAP), to advance research and education in this area.

The coronavirus disease 2019 pandemic has presented tremendous challenges to the United States health care system, as well as to individual physicians, communities, and families. Throughout the pandemic, the American Academy of Pediatrics (AAP) has striven to elevate the needs of infants, children, and adolescents, as well as the pediatricians who care for this population. Historically, these communities have often been overlooked and deprioritized in health care systems, and these deficits persisted into the pandemic. To fill this gap, the AAP took on an essential role in leading the national response for pediatrics. This article details the AAP pandemic response and includes the perspectives of multiple AAP leaders involved in the response and details on Academy advocacy with high-level staff and officials at federal agencies and the executive branch. The AAP provided initial guidance to pediatricians that predated the World Health Organization's declaration of a public health emergency. The Academy then developed entirely new approaches to meet the unprecedented needs of its practicing members and families by providing timely, rigorous information endorsed by pediatric experts. When coronavirus disease 2019 vaccines were developed, the AAP strongly advised the inclusion of those younger than 18 years in vaccine trials and advocated for equitable distribution plans. The AAP provided its members with strategies for combating misinformation. The Academy was at the forefront of advocating for the safe return to in-person schooling, recognizing that social isolation was contributing to the growing mental health crisis among youth. In 2021, the AAP, the American Academy of Child and Adolescent Psychiatry, and the Children's Hospital Association declared a national emergency in child and adolescent mental health. In addition, the AAP implemented educational and training opportunities for clinicians and developed resources for youth and their families. After the end of the public health emergency, AAP members continue to use innovations and efficiencies developed as part of their pandemic response. The successes of the AAP pandemic response, alongside lessons learned, help define an important model for responding to future pandemics and public health emergencies in ways that support children, families, and the pediatric workforce. [ABSTRACT FROM AUTHOR]

The article explores the evolving landscape of gender dysphoria treatment in children and adolescents, focusing on social, legal, and medical transitions. It highlights the historical rarity of gender dysphoria and the recent surge in referrals, particularly among post-pubertal individuals assigned female at birth. It includes the introduction of puberty blockers and hormonal treatments, influenced by Dutch protocols and subsequent guidelines.

Hoarding behavior is prevalent in children and adolescents, yet clinicians do not routinely inquire about it and youth may not spontaneously report it due to stigma. It is unknown whether hoarding behavior, over and above obsessive-compulsive symptoms (OCS), is associated with major clinical factors in a general youth population. This observational study included N = 7054 youth who were not seeking help for mental health problems (ages 11–21, 54% female) and completed a structured interview that included evaluation of hoarding behavior and OCS, as a part of the Philadelphia Neurodevelopmental Cohort between November 2009 and December 2011. We employed regression models with hoarding behavior and OCS (any/none) as independent variables, and continuous (linear regression) or binary (logistic regression) mental health measures as dependent variables. All models covaried for age, sex, race, and socioeconomic status. A total of 374 participants endorsed HB (5.3%), most of which reported additional OCS (n = 317). When accounting for OCS presence, hoarding behavior was associated with greater dimensional psychopathology burden (i.e., higher P-factor) (β = 0.19, p <.001), and with poorer functioning (i.e., lower score on the child global assessment scale) (β = − 0.07, p <.001). The results were consistent when modeling psychopathology using binary variables. The results remained significant in sensitivity analyses accounting for count of endorsed OCS and excluding participants who met criteria for obsessive-compulsive disorder (n = 210). These results suggest that hoarding behavior among youth is associated with poorer mental health and functioning, independent of OCS. Brief hoarding-behavior assessments in clinical settings may prove useful given hoarding behavior's stigma and detrimental health associations. [ABSTRACT FROM AUTHOR]

A small group of youth and emerging adults deals with severe and enduring mental health problems (SEMHP). Current mental health care struggles to recognize and treat this group timely and adequately, leaving these youth between the cracks of the system. A first step to improve care for this group is to gain a deeper understanding of the characteristics of youth with SEMHP. Therefore, this study aimed at reviewing current literature about this target group and what is known so far about their characteristics. We included 39 studies with a focus on youth aged 12–25 years with SEMHP. After critical appraisal, a content analysis and in-depth thematic analysis were conducted. According to the included studies, youth with SEMHP were characterized by severe distress and recurrent comorbid mental health problems, with pervasive suicidality. Further, underlying trauma, family conflicts, peer rejection, deep feelings of hopelessness, and psychosocial malfunctioning characterized SEMHP. It was described that for youth with SEMHP a pervasive pattern of dysfunction in multiple domains is present leading to a detrimental impact. Subsequently, this pattern exerts a reciprocal influence on the mental health problems, causing a vicious circle further worsening SEMHP. Our findings emphasize the need for a holistic approach and to look beyond the traditional classification system in order to meet the needs of these youth with wide-ranging comorbid mental health problems. [ABSTRACT FROM AUTHOR]

Adolescents seeking gender-affirming medical care (GAMC) face numerous barriers that may delay or inhibit their access to these services. Such obstacles include mental health professional (MHP) assessment requirements prior to initiating GAMC.MHP letters ultimately carry little benefit for patients. Their formulaic nature discourages nuance, reduces likelihood of capturing gender embodiment goals (beyond a narrow definition of gender dysphoria), and may cause clinicians to overlook presenting mental health concerns. MHP assessment requirements also reinforce the conception of gender dysphoria as a mental health disorder. Moreover, studies have not shown that requiring MHP assessment letters effectively reduces regret among patients. Fortunately, primary clinicians who provide GAMC are most often capable of assessing patients without additional input from an MHP. In this article, we provide an ethical framework for clinicians that prioritizes patient autonomy through an informed assent approach. We discuss Appelbaum's criteria and its application, and contexts in which MHP consultation is appropriate. We also address common questions about informed assent among clinicians, patients, and families. Finally, we advocate for bolstering multidisciplinary support teams involved in GAMC to facilitate the informed assent process. This approach upholds patient autonomy, expands access to GAMC, and utilizes the mental health workforce more effectively. [ABSTRACT FROM AUTHOR]

This study investigates the impact of the Neurosequential Model of Therapeutics (NMT) in child and adolescent psychiatric care, addressing a gap in current clinical methodologies that tend to focus on single problems rather than the interconnected nature of many real-life mental health issues. The study was conducted in a residential setting over an extended period, including children aged 7–13, to observe the effects of implementing NMT. The children presented with complex symptoms and multiple diagnoses. The methods incorporated the NMT approach, emphasizing individualized treatment plans based on each child's unique brain development, and aimed at addressing multiple, interconnected problems simultaneously. Results from multilevel model analyses of behavioral difficulties, measured using the Child Behavior Checklist (CBCL), revealed substantial improvements in treatment effectiveness post-NMT implementation. Despite the limitations, such as a non-randomized participant selection and limited sample size, the findings strongly suggest that NMT enhances care effectiveness in real-world clinical settings, particularly for children with complex mental health issues. The study concludes that relationally oriented milieu therapy, and specifically the NMT approach, holds great promise for advancing pediatric psychiatric care, advocating for its broader application and further research to refine and substantiate its efficacy. [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]

SUMMARY: John Bowlby's 'Attachment and Loss' trilogy set the scene for half a century of attachment research and theorising. This article picks out the key themes of his work – the attachment dynamic, the impact of trauma and life events, defensive exclusion, loss and bereavement, and internal working models – and points to their continuing relevance. [ABSTRACT FROM AUTHOR]

Conducting a new patient evaluation is a core skill in the practice of child and adolescent psychiatry. For residents, the psychiatric evaluation of a child is a stressful transition point moving from general to a child psychiatric specialty requiring new knowledge and skills. [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]

Objective: Qualitative research methods are based on the analysis of words rather than numbers; they encourage self-reflection on the investigator's part; they are attuned to social interaction and nuance; and they incorporate their subjects' thoughts and feelings as primary sources. Despite appearing well suited for research in child and adolescent psychiatry (CAP), qualitative methods have had relatively minor uptake in the discipline. We conducted a qualitative study of CAPs involved in qualitative research to learn about these investigators' lived experiences, and to identify modifiable factors to promote qualitative methods within the field of youth mental health. Methods: We conducted individual, semi-structured 1-h long interviews through Zoom. Using purposive sample, we selected 23 participants drawn from the US (n = 12) and from France (n = 11), and equally divided in each country across seniority level. All participants were current or aspiring CAPs and had published at least one peer-reviewed qualitative article. Ten participants were women (44%). We recorded all interviews digitally and transcribed them for analysis. We coded the transcripts according to the principles of thematic analysis and approached data analysis, interpretation, and conceptualization informed by an interpersonal phenomenological analysis (IPA) framework. Results: Through iterative thematic analysis we developed a conceptual model consisting of three domains: (1) Becoming a qualitativist: embracing a different way of knowing (in turn divided into the three themes of priming factors/personal fit; discovering qualitative research; and transitioning in); (2) Being a qualitativist: immersing oneself in a different kind of research (in turn divided into quality: doing qualitative research well; and community: mentors, mentees, and teams); and (3) Nurturing: toward a higher quality future in CAP (in turn divided into current state of qualitative methods in CAP; and advocating for qualitative methods in CAP). For each domain, we go on to propose specific strategies to enhance entry into qualitative careers and research in CAP: (1) Becoming: personalizing the investigator's research focus; balancing inward and outward views; and leveraging practical advantages; (2) Being: seeking epistemological flexibility; moving beyond bibliometrics; and the potential and risks of mixing methods; and (3) Nurturing: invigorating a quality pipeline; and building communities. Conclusions: We have identified factors that can support or impede entry into qualitative research among CAPs. Based on these modifiable findings, we propose possible solutions to enhance entry into qualitative methods in CAP (pathways), and to foster longer-term commitment to this type of research (identity). [ABSTRACT FROM AUTHOR]

Background: Research shows that only around half of all survivors of child sexual abuse (CSA) disclose the abuse during childhood and adolescence. This is worrying, as CSA is related to substantial suffering later in life. The proportion of children and adolescents who have been exposed to CSA is significantly higher in Child and Adolescent Psychiatry (CAP) than in the general population. Healthcare professionals report that uncovering CSA is a complex and challenging task. However, we know little about how they proceed when uncovering CSA. More knowledge of healthcare personnel's experience is therefore necessary to facilitate and increase CSA disclosure. The study aims to explore how CAP healthcare professionals in Norway proceed when assessing and detecting CSA, how they experience this work, and what hinders or facilitates their efforts. Methods: The study employed a mixed method approach. Data was collected through an anonymous online survey, generating both quantitative and qualitative data. The sample consisted of 111 healthcare professionals in CAP, of whom 84% were women, with a mean age of 40.7 years (range 24–72; sd = 10.8). Mean years of CAP clinical experience were 8.3 years (range 0–41; sd = 7.5). The quantitative data was analysed using descriptive statistics, correlations, and independent sample t-tests, while the qualitative data was analysed using a team-based qualitative content analysis. Results: The results showed that detection of CSA was viewed as an important, but complex task in CAP, and the existing procedures were deemed to be insufficient. The therapists mostly felt confident about how to proceed when they suspected or detected CSA, yet they seldom detected CSA. In their initial assessment they applied standardised procedures, but if their suspicion of possible CSA persisted, they seemed to rely more on clinical judgement. Specific challenges and facilitators for CSA detection were identified, both in the individual and in the organisation. Conclusions: The study highlights the challenges and complexities healthcare professionals and the CAP system face when assessing CSA, which may account for the low detection rate. The results show that healthcare professionals believe room for clinical autonomy and targeted competence development may improve CSA detection. Additionally, the findings suggest a need for CAP to define roles and responsibilities within and between agencies. [ABSTRACT FROM AUTHOR]

Over half of youth with attention-deficit/hyperactivity disorder (ADHD) have co-occurring psychiatric or medical conditions that present treatment challenges. Stimulants are the most effective pharmacologic treatment of ADHD for preschoolers to adults but questions about safety with co-occurring conditions frequently arise. In addition, stigma surrounding diagnosis and treatment can negatively impact care. This manuscript presents evidence-based practice pearls to guide treatment decisions for youth with ADHD and common coexisting psychiatric and medical conditions. Recommendations address specific stimulant adverse effects (i.e., anxiety, cardiac, growth, mania, psychosis) along with management strategies. Pearls were developed for the most common clinical questions, controversial topics, or therapeutic issues that may not be widely known. The goals of this manuscript are to: 1) provide a detailed resource for interprofessional teams regarding stimulant use in youth with ADHD, 2) improve therapeutic outcomes for youth with ADHD and co-occurring psychiatric and/or medical conditions through evidence-based recommendations, and 3) decrease stigma associated with stimulant use through education. [ABSTRACT FROM AUTHOR]