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Approaching the 30th anniversary of the discovery of resting state functional magnetic resonance imaging (rsfMRI) functional connectivity, we reflect on the impact of this neuroimaging breakthrough on the field of child and adolescent psychiatry. The study of intrinsic functional brain architecture that rsfMRI affords across a wide range of ages and abilities has yielded numerous key insights. For example, we now know that many neurodevelopmental conditions are associated with more widespread circuit alterations across multiple large-scale brain networks than previously suspected. The emergence of population neuroscience and effective data-sharing initiatives have made large rsfMRI datasets publicly available, providing sufficient power to begin to identify brain-based subtypes within heterogeneous clinical conditions. Nevertheless, several methodological and theoretical challenges must still be addressed to fulfill the promises of personalized child and adolescent psychiatry. In particular, incomplete understanding of the physiological mechanisms driving developmental changes in intrinsic functional connectivity remains an obstacle to further progress. Future directions include cross-species and multimodal neuroimaging investigations to illuminate such mechanisms. Data collection and harmonization efforts that span multiple countries and diverse cohorts are urgently needed. Finally, incorporating naturalistic fMRI paradigms such as movie watching should be a priority for future research efforts., (© 2024. The Author(s).)

The clinical and diagnostic debate circulating pediatric bipolar disorder (PBD) has been highlighted as one of the most controversial themes in child psychiatry. With atypical symptomatic expression, constituting its predominant diagnostic discrepancy, PBD is manifested through prolonged manic episodes and affective storms, lacking the symptomatic cycling and episodic nature presented in adult BD. Apart from its unique clinical presentation, the substantial symptomatic overlap with attention deficit hyperactivity disorder (ADHD) indicate an important diagnostic challenge in PBD. Specifically, both disorders share core characteristics such as irritability, hyperactivity, excessive talking and distractibility. Against this background of findings on the overlapping symptomatology between PBD and ADHD, current research guidelines highlight the need of exploring non-symptomatic markers as potential clinical phenotypes. Especially in disorders with distinctive biologic underpinnings, both clinicians and researchers have shown increased interest in establishing neuropsychological profiles. Recent neuropsychological studies indicated the distinct nature of neurocognitive deficits in PBD, describing impairments in various cognitive skills during acute episodes phases, while this severe deterioration of cognitive deficits appears to persist even during euthymic states. Regarding neuropsychological assessment in AHD, recent findings suggested dysfunctions in the domains of working memory, verbal memory and response inhibition. Furthermore, neuroimaging studies are fast becoming a key instrument to establish distinct neuropsychological profiles for PBD and ADHD. A large number of neuroimaging studies have indicated abnormalities in limbic, cortical and subcortical brain systems, while meta-analytic findings of voxel based morphometric studies highlight abnormalities in dorsolateral and lateral orbitofrontal-temporal areas in PBD. In recent neuroimaging findings with focus on neurocognitive performance during an emotional Stroop task, patients diagnosed with ADHD indicated activation on higher cortical centres associated with processing speed and significantly decreased role of sustained attention. Furthermore, these findings suggest emotional regulation and inhibitory control are moderately intercorrelated, adding more complexity to the theme of neurocognitive deficits in ADHD. These observations on the neurobiological mechanisms of cognitive impairments in PBD appear to provide robust evidence on a potential specific neuropsychological profile of PBD, the relationship between mood states and neuropsychological functioning, and the link between emotion generation and regulation in children with PBD.

Purpose: Self-harm is common among adolescents, and is even more frequent among psychiatric populations. The aim of this study was to increase knowledge and understanding of different aspects of life for adults who, when adolescents, had engaged in severe self-harm during inpatient stays. Material and methods: Individual semi-structured interviews were held with seven former inpatients with a history of severe self-harm during inpatient stay in their adolescence. The interviews were analysed using a qualitative method, and the results were described in the form of categories and sub-categories. Results: Five categories, with 16 sub-categories, were found to be related to the former patients' experiences of their lives. At the time of the interviews, the subjects were in their early thirties and had no ongoing self-harm. In childhood they had experienced a dysfunctional relationship with one or both of their parents, and self-harm was one of several destructive behaviours. Friendships outside the unit were difficult during adolescence. Soon after admission to the psychiatric inpatient unit, relationships with other patients became important and contributed to them wanting to stay at the unit. Meaningful relationships and being part of a social context with healthy expectations were seen as important factors for stopping self-harm at a later stage. The subjects' experiences of their life today ranged from not enjoying it to accepting their current situation. Conclusion: These findings are based on a small sample, but they indicate the importance of relationships and the social context in contributing to and then ending self-harm.

Background: Recently, the number of epidemiological studies of child psychiatry has increased, but most of these studies focus on children living in city centres. Unfortunately, one-third of the global population lives in rural areas, and various habitations exist in cities, including city centres and slums. Moreover, despite having a high risk for psychopathology development, individuals who have symptoms but fall outside the limits specified for diagnoses due to having fewer symptoms than those mentioned in diagnostic systems and individuals who do not fulfil the impairment criteria listed in diagnostic systems are not addressed in these studies. Aim: The purpose of this study was to understand the prevalence of DSM-IV childhood psychiatric disorders and subthreshold psychiatric problems from middle-class city centres, city centres in slums, towns and village areas of Turkey with a nationally representative sample using a state-of-the-art methodology. Methods: In total, 1080 children were randomly selected from second and third grades for the study's sample. A structured diagnostic interview was applied. Results: The overall prevalence of psychiatric disorders was 8.4% ( n  = 91); 7.2% ( n  = 78) of the children were subthreshold cases. The general prevalence of psychiatric disorders was higher among children living in villages with respect to all the other human settlement areas included in the study. Conclusions: Although global urbanisation foregrounds the mental health of children living in cities, children in rural areas may have a greater risk of developing a mental disorder. This study confirmed that an equal amount of children fell outside of the diagnosing limits.

Music is a significant part of daily life for most youth, affording clinical opportunities to cultivate positive emotions, engagement, relationships, meaning, and accomplishment. Clinical inquiry into what types of music elicit different emotions, how music fits into daily life routines, how music connects one to others, and how music anchors life events can improve the clinician-patient alliance and patient well-being practices. Music may be useful in home and school settings to help youth manage diverse moods. Practicing an instrument effectively accelerates accomplishment and pleasure, which applies to other life activities., (Copyright © 2018 Elsevier Inc. All rights reserved.)

Training and practice within child psychiatry has focused predominantly on mental illness rather than mental health. A growing body of evidence, however, is demonstrating the importance for clinicians also to be able to focus directly on enhancing positive traits and emotions and increasing well-being and health promotion in their patients. This complementary aspect of mental health care has been called well-being and positive psychiatry, among other terms. Being able to apply these principles to standard practice requires new knowledge, skills, and attitudes that are not part of traditional psychiatric training., (Copyright © 2018 Elsevier Inc. All rights reserved.)

50 years specialty for child and adolescent psychiatry in Germany. History, current situation, and future perspectives Abstract. Abstracts: Method: Review of the historical background and implementation of an independent medical specialty "child and adolescent psychiatry" (CAP) in Germany. Results: The implementation of an independent specialty for CAP in 1968 was crucial for the progressive further development of the discipline. The Enquête Commission "Psychiatry" of the Federal Government, followed by the Model Program "Psychiatry", the Staff Regulations for Psychiatry, the Agreement on the Social Psychiatry and the Psychotherapy Act have had significant impact on the care for psychiatrically ill children and adolescents and their families. This led to an institutional anchoring of new structures, covering three of the four leading principles of the Model Program, namely integration into medicine, community-based and appropriate care. Equality of psychiatric patients with other patient groups has, nevertheless, not yet been achieved and is still to be claimed. Current and future challenges are: (1) The realistic evaluation of new research methods and epochal trends and elimination of opposites, (2) the establishment of future-oriented research initiatives, (3) the intensive promotion of clinical and scientific staff members, and (4) a renewed attention for the subjective perspective of the illness. Conclusions: The implementation of an independent specialty "child and adolescent psychiatry" was an important stimulus for the further development of the discipline. Essential demands for the future will be: the integration of CAP into the curriculum for medical students and the promotion of young researchers within the scope of regional and supra-regional projects.

The legal framework of mother-baby care has evolved over the last thirty years driven by innovative programmes put in place by hospital health professionals. Liaison in perinatal care lies at the crossroads of different temporalities and treatment objectives, and requires constant dialogue between the liaison caregivers and those in maternity. The aim is to form a holding environment facilitating the establishment of an adapted response to the complexity of the clinical situations encountered., (Copyright © 2018 Elsevier Masson SAS. All rights reserved.)

Competing Interests: Competing interests: None declared.

Purpose of Review: Improving child and adolescent mental health (CAMH) is a priority worldwide. The majority of children with psychiatric conditions in low-middle-income countries (LMIC), like Ghana, receive no treatment due largely to limited resources and few CAMH training opportunities. The Komfo Anokye Teaching Hospital (KATH) and University of Michigan (UM) established a partnership to expand CAMH training for general psychiatrists in Ghana. Lessons learned from the early stages of the collaboration can serve as an adaptable roadmap for similar efforts to expand CAMH training in LMIC., Recent Findings: Previous articles have discussed global academic partnership, training, and capacity building programs; however, early challenges, opportunities, and preparatory stages involved in creating a mutually beneficial collaboration aimed at improving child psychiatry expertise in a LMIC are under explored in the global mental health literature. This article seeks to fill that gap by using examples to highlight unique considerations for institutions in the initial stages of establishing their global partnership. The early stages of a global partnership can impact the success of the collaboration. Collaborations should be bi-directional, sensitive to local culture, and flexible and establish achievable sustainable goals.

Transitional and Adolescent Psychiatry in Austria: A Pilot Study on the Attitudes of Experts Abstract., Objective: This pilot study establishes baseline data on the current situation of transitional processes in Austrian psychiatry. We sought to gather information on the specific problems and needs occurring during the transition of mentally ill adolescents from child and adolescent to adult psychiatry., Method: Professionals (psychiatrists, psychologists, psychotherapists) working in child and adolescent psychiatry and adult psychiatry (N = 86) were assessed by means of an online survey concerning their experience with the transition of young adults., Results: Almost all of the subjects queried (98.8 %) considered the current system inappropriate, and the majority (70.9 %) thought that patients would not tolerate transition from youth to adult psychiatric institutions very well. Only 16.3 % reported having a structured transition protocol at their workplace. Further 83.7 % expressed the need to improve collaboration between adolescent and adult psychiatry., Conclusions: This sample of Austrian healthcare professionals describes large deficits regarding transitional issues in psychiatry. There is an urgent need to establish structured protocols for transition, especially since experiences occurring during this vulnerable period are crucial to the mental health of young people later in life.

Background: A parental mental illness affects all family members and should warrant a need for support., Aim: To investigate the extent to which psychiatric patients with underage children are the recipients of child-focused interventions and involved in interagency collaboration., Methods: Data were retrieved from a psychiatric services medical record database consisting of data regarding 29,972 individuals in southern Sweden and indicating the patients' main diagnoses, comorbidity, children below the age of 18, and child-focused interventions., Results: Among the patients surveyed, 12.9% had registered underage children. One-fourth of the patients received child-focused interventions from adult psychiatry, and out of these 30.7% were involved in interagency collaboration as compared to 7.7% without child-focused interventions. Overall, collaboration with child and adolescent psychiatric services was low for all main diagnoses. If a patient received child-focused interventions from psychiatric services, the likelihood of being involved in interagency collaboration was five times greater as compared to patients receiving no child-focused intervention when controlled for gender, main diagnosis, and inpatient care., Conclusions: Psychiatric services play a significant role in identifying the need for and initiating child-focused interventions in families with a parental mental illness, and need to develop and support strategies to enhance interagency collaboration with other welfare services.

The medical speciality "Child and Adolescent Psychiatry" exists since 2007. 2015 a new training regulation defined an increment to "Child and Adolescent Psychiatry and Psychotherapeutic Medicine". To document the achievements in research within the last 10 years for the first time, all papers listed in Pubmed and all books published by the member of the ÖGKJP were summarized. Additionally, the clinical/scientific key aspects of all large teaching centres were documented.All members of the ÖGKJP are scientifically active in various areas of child psychiatry. Most of the 284 publications (n = 115; 41%) were published on 5 topics: eating disorders, forensic psychiatry, neuropediatrics, psychoses and prodromal states, suicidality. Thirteen of the papers have already been awared prices because of their high quality. All departments define clinical/scientific key areas - beside a time-consuming clinical work load - and offer specialized care. Further development of research competence should take place and should also have high priority in health politics.

We discuss the comprehensive work for the development of child and adolescent psychiatry in Austria, summarize the current status of care in various settings and focus on further developments. Intramural care offers about 50% of the places needed and is heterogeneously distributed over the country, extramural care offers already around one quarter of care in need. We calculated a fully developed extramural care system from about 2033. Further development of the Austrian care system in child and adolescent psychiatry needs collaborative efforts of all responsible players.

The child- and adolescent psychiatry has emancipated itself 10 years ago from an additional specialist physician's area to a separate specialist medical domain with a specific curriculum. Associated with this is an irreconcilable interlacing with the psychotherapy of childhood and adolescence. Even if childhood and juvenile psychiatry is always settled within the framework of a biopsychosocial model, psychotherapy is of particular importance. In the following, the psychotherapeutic requirements and ethical issues of the human being are to be formulated according to a view on the new morbidity and the Zeitgeist in which we are working. A scientific legitimation leads to the demarcation of esoteric endeavors and the view into practice leads us from nosology to functionality in the consideration of mental disorders in children and adolescents.

Anniversaries are turningpoints for reflexions of the past and planing for the future. In conclusion of all papers in this actual issue one can say tha CAP has reached a respected place in the medical landscape. Also internationally, the work of Austrian child and adolescent psychiatrist is recognised and respected. CAP is cooperating as an respected discipline with adjacent specialties as pediatrics and psychiatry as well as with external partners as Kinder- und Jugendhilfe (social child welfare).Anyway, the actual situation shows several deficits concerning patient care on all levels of the health system as well as in education and training of sufficient numbers of child and adolescent psychiatrists.

Objectives: First, to outline the paradigm change of the past 20 years that has transformed the theory and practice of child and adolescent psychodynamic psychotherapy; second, to update aspects of the current Practice Parameters for Psychodynamic Psychotherapy with Children to align with the paradigm change driven by the principles of regulation theory, relational trauma and repair, and the critical need for clinicians' self-care in trauma informed psychotherapy., Conclusion: The emerging neuroscience-driven paradigm of psychotherapy poses challenges for the child and adolescent psychotherapist: to embrace the new conceptual reference points as organising principles leads to an urgent need to rethink traditional diagnostic formulations and time-honoured techniques for intervention. Our child patients and their families are entitled to benefit from the translation of the new research evidence from attachment regulation theory to clinical psychotherapy. Our clinical psychotherapy should sustain the 'best-interest-of-the-child' standards for well-being while also heeding Frances Tustin's warning for therapists to avoid the 'perpetuation of an error' by overlooking recent developments from allied fields in developmental psychology and the neurosciences.

A family can be viewed as a system respecting the principle of homeostasis and therefore considered as a system in equilibrium or out of equilibrium, or even both simultaneously or consecutively. Within a family system, there are oscillatory phenomena and synchronization of the emotional, behavioral and relational rhythms of each member of the family system as well as synchronization of this system with others. A disruption of family synchronies, consisting of successive desynchronizations and resynchronizations, can take place in order for a change to occur. We created a mobile team for preadolescents and adolescents with psychological difficulties and their families; this mobile team enables to trigger a change by acting on the family synchronies like a 'social zeitgeber', i.e. an external factor synchronizing social and biological rhythms. The mobile team acts by disrupting the synchronies of the family system and this disruption is facilitated by a state of crisis experienced by the family. More specifically, the mobile team intervention provokes changes in the family representations associated with changes in the family emotional climate, measured by expressed emotion, due to disruptions in the synchronization of certain rhythms (desynchronization and then resynchronization of these rhythms), and could therefore be considered as a 'social zeitgeber'. It creates an experience that becomes part of the individual's and family's history and could be reactivated in the future if necessary. Finally, it allows the family and the adolescent with difficulties to reach new perspectives and representations which participates to the process of change, but also to benefit at the same time from a secure basis and frame created by the (re)synchronization of family emotions through the intervention of the mobile team following a ritualized procedure., (Copyright © 2017. Published by Elsevier Ltd.)

The German Psychiatry Personnel Act, which went into effect in 1990, has led to a decrease in the number of child and adolescent psychiatry inpatient beds, to a decrease in the length of stay, and to an increase in inpatient psychotherapy. Today, this act is outdated~ for a number of reasons, such as changes in the morbidity of the population, the rising number of emergencies, and new professional standards such as documentation. In addition, new legal provisions and conventions (like the UN Convention on the Rights of the Child) necessitate a complete reevaluation. Child and adolescent psychiatry needs a normative act to enable the necessary implementation. Many different rationales are available to support the debate.

Objectives: Health sciences suffer from insomnia: experts too often concentrate their efforts on the wake state. Fortunately enough, some of them have taken the road towards the "Dark Third of Life": sleep. This article gives an historical account of the development of the first Canadian sleep disorders laboratory and clinic specifically and selectively designed for children and adolescents with a psychiatric diagnosis. It then stresses the importance of sleep in children bearing a psychiatric diagnosis and summarizes therapeutic strategies., Methods: Data-on-file and selective review of literature., Results: An innovative scheme matching sleep psychologists and psychiatrists with expertise in neurodevelopmental disorders led to the creation of a sleep research laboratory on mental health disorders. The initial research projects on the sleep and dreams of patients with schizophrenia and persons with autism are summarized. The Sleep Disorders Clinic for Children and Adolescents was then created at the Hôpital Rivière-des-Prairies, leading to much needed activities focused on youth. Indeed, sleep disorders show a high prevalence in children with a psychiatric diagnosis and the literature shows that these children have an increased sensitivity for diurnal effects of poor sleep. The main sleep-relevant issues at stake are reviewed, including the high frequency of sleep disorders in pedopsychiatric patients. Clinical challenges are described and the operating mode of the Sleep Disorders Clinic is illustrated., Conclusion: Sleep disorders and their effects on daytime functioning need to be assessed in children with a psychiatric diagnosis in order to generate a full clinical picture. Appropriate tools and know-how are readily available in order to achieve this goal.

Psychosomatic health complaints (PHC) can significantly impair psychosocial development of children and adolescents and are therefore of considerable interest in health sciences and public health surveillance. Questions addressed the type of function that describes individual trajectories best, potential differences between these, and corresponding predictors from the perspective of both children and their parents. Based on the German population-based and representative BELLA cohort sample, 2,857 children and adolescents between 7 and 17 years of age at baseline were analysed over a period of 3 years with yearly follow-ups using mixed growth curve analyses. PHC were measured in accordance with the health behaviour in school-aged children-symptom checklist. The mean level of PHC was rather low, slightly lower for the parent report than for the self-report and significantly different between subjects. Concerning the parent report, the 2-year course is best described by a slowly increasing linear trend that decelerates somewhat over time. The increasing linear trend was more pronounced in the self-report from 11 to 17 years of age, but was significantly different for each subject and correlated with baseline scores. Trajectories could be explained by known predictors, most importantly by mental health problems of the child or adolescent. The results confirm the findings of previous studies and provide representative data about the individual short-term development of PHC in children and adolescents in Germany.

Contemporary child and adolescent psychoanalytic technique has evolved and changed a great deal in the last thirty years. This paper will describe the analysis of an adolescent girl from early in the author's career to demonstrate the ways in which technique has changed. The clinical material presented highlights six areas in which contemporary child and adolescent analysts practice and/or understand material and the clinical process differently than they did thirty years ago: (1) the contemporary perspective on mutative action, (2) the contemporary emphasis on mental organization, (3) the developmental lag in integrating the structural model, (4) the child analyst's multiple functions, (5) the child analyst's use of countertransference, and (6) the child analyst's work with parents. The author discusses how he would work differently with the patient now using his contemporary perspective. But he also wonders what might have been lost by not working in a more traditional manner, in particular the opportunity to analyze the patient's hypersensitivity to feeling hurt and mistreated so directly in the transference.