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ABSTRACT This Virtual Issue of the International Journal of Eating Disorders honors the legacy of the late Dr. Michael Strober in the eating disorders and child psychiatry fields. Having served as Editor‐in‐Chief of the International Journal of Eating Disorders from 1983 to 2012, Dr. Strober elevated the quality of science conducted in the eating disorders field. His frank feedback and encouraging words inspired many junior researchers to sharpen their work and to think deeply about their results. An incisive thinker, eloquent writer, and gifted clinician, Dr. Strober was a role model for psychologists in clinical leadership positions and demonstrated that it is indeed possible to be a highly effective all‐rounder. In this issue, we present an annotated selection of Dr. Strober's publications in the journal over the past decades to illustrate the evolution of his thinking and the seeds of what have become major directions in the field, including fear conditioning and genetics. By presenting this collection of his work, we encourage all investigators to read broadly and deeply and to identify and acknowledge those incisive scholars who have built the foundation upon which our work today stands. [ABSTRACT FROM AUTHOR]

Social anxiety disorder (SAD) is a high-prevalence mental disorder among children and adolescents. The aim of this study is to compare and rank the effectiveness of several psychotherapies for SAD among children and adolescents. Only randomized controlled trials (RCTs) were utilized by searching PubMed, Embase, Cochrane Library, and Web of Science. We used network meta-analysis in the Bayesian framework to analyze the data. This study is registered with PROSPERO, number CRD42023476829. In total, 30 RCTs with 1547 individuals were included, and nine psychotherapies with three control conditions were compared and ranked in this study. The findings revealed that internet-delivered cognitive behavioural therapy (surface under the cumulative ranking curve [SUCRA: 71.2 %]), group cognitive behavioural therapy (SUCRA: 68.4 %), and individual cognitive behavioural therapy (SUCRA: 66.0 %) significantly reduced social anxiety symptoms; internet-delivered cognitive behavioural therapy also significantly decreased depression symptoms in these patients (SUCRA: 92.2 %). In addition, group cognitive behavioural therapy can enhance functioning in these patients (SUCRA: 89.6 %). These results suggest that internet-delivered cognitive behavioural therapy is the optimal type of psychotherapy for reducing social anxiety and depression symptoms in children and adolescents with SAD, internet-delivered parent-child interaction therapy and cognitive bias modification of interpretation have relatively poor treatment effects on social anxiety symptoms in children than other psychological interventions, and group cognitive behavioural therapy has better benefits in enhancing the functioning among children and adolescents with SAD. Further studies are needed to ascertain these results due to the limited number of included studies. • Network meta-analysis examines interventions for social anxiety disorder. • Internet-delivered CBT is an optimal psychotherapy for social anxiety disorder. • Group CBT has better benefits in enhancing the functioning. • Findings can provide recommendations for health care professionals and patients. [ABSTRACT FROM AUTHOR]

Summary Sleep difficulties are presumably a transdiagnostic factor in the complex aetiology of psychiatric disorders in youth. This study assessed the prevalence of sleep difficulties in children and adolescents seeking specialized psychiatric care, examined the relationships of internalizing and externalizing problems, and considered the moderating role of sex and age on these relationships. Parent‐reported data on difficulties initiating sleep, difficulties maintaining sleep, early morning awakenings and daytime fatigue from a large sample of children and adolescents referred for specialized psychiatric care (n = 4638; < 18 years) were used to estimate prevalence rates. To examine associations between these sleep difficulties and internalizing/externalizing problems, multiple linear regression analyses were conducted on available data (n = 3768) stratified in three age groups (1.5–5 years; 6–11 years; 12–18 years). Overall prevalence, i.e. at least one sleep difficulty was reported to be often or always present, was 65%. Difficulties initiating sleep occurred the most, closely followed by daytime fatigue. In all age groups, sleep difficulties were positively related to internalizing and externalizing problems. In young children and school‐age children, age moderated the interaction between sleep difficulties and internalizing problems. To conclude, prevalence rates of sleep difficulties in children with mental illness appear higher than it has been reported in the general youth population, especially difficulties initiating sleep and daytime fatigue. We observed that the associations between internalizing problems and sleep difficulties in young children and school‐age children seemed to be amplified with age, suggesting a negative, bidirectional, spiral in development. [ABSTRACT FROM AUTHOR]

A substantial portion of interventions designed to support autistic children are also designed to be delivered by caregivers (i.e. are ‘caregiver‐mediated’). Brown et al. (Journal of Child Psychology and Psychiatry, 2024) are one of the first groups to critically examine the baseline skills that caregivers bring as they prepare to learn a class of interventions called Naturalistic Developmental Behavioral Interventions (NDBIs), which are designed to support social communication growth in young autistic children. This commentary commends Brown and colleagues for their focus on caregivers, a linchpin within the increasingly prominent caregiver‐mediated process of intervention delivery. However, it is imperative that future research understand the potential adverse effects and supports that are needed to bolster caregivers in this crucial role. We present six recommendations for research on caregiver‐mediated interventions that build on Brown and colleagues' work and address these needs, which involve: caregiver supports, equitable samples, community settings, adaptive designs, general principles, and implications for NDBI dissemination. [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]

Background/Objectives: Attention-Deficit Hyperactivity Disorder (ADHD) is a prevalent neurodevelopmental disorder characterized by inattention, hyperactivity, and impulsivity. Traditional diagnostic methods, which depend on subjective assessments, often lack precision. This study evaluates the validity and reliability of a newly developed diagnostic tool, the Distractor-Embedded Auditory Continuous Performance Test (da-CPT), which integrates auditory stimuli with distractors to enhance the clinical utility of ADHD diagnosis. Methods: The study included 160 children aged 6–12 years, comprising 80 with a confirmed ADHD diagnosis and 80 controls. All participants completed the da-CPT, a web-based tool designed to assess inattention, hyperactivity, impulsivity, and timing via an auditory-based task. To validate the da-CPT, participants also completed the Conners' Parent Rating Scale—Revised Short Form (CPRS-R) and either the MOXO or IVA-2 tests. Data were analyzed using ROC curves and statistical correlations to assess sensitivity, specificity, and overall diagnostic accuracy. Results: The da-CPT demonstrated high diagnostic accuracy, with a sensitivity of 91.25% and specificity of 83.75%. ROC analysis indicated that the inattention index had the highest discriminatory power (AUC = 0.881), followed by timing, impulsivity, and hyperactivity (all p < 0.01). Furthermore, the da-CPT scores were strongly correlated with ADHD severity (p < 0.01). Conclusions: This study confirms that the da-CPT is a valid and reliable tool for diagnosing ADHD in children aged 6–12. By incorporating auditory stimuli and distractors, the tool offers a more ecologically valid assessment of ADHD symptoms in clinical settings, improving diagnostic precision and utility. [ABSTRACT FROM AUTHOR]

Aim: 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). Methods: 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. Results: 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. Conclusion: 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]

Le pédopsychiatre est de plus en plus sollicité dans notre contexte tunisien par les instances judiciaires pour l'examen des enfants et des adolescents. Cette augmentation de demandes serait en partie en rapport avec les progrès dans la législation de protection de la femme et l'enfant. Toutefois, plusieurs difficultés semblent toujours entraver le bon déroulement et suivi de ces examens. Ceci nous a motivé à mener ce travail dont l'objectif était de déterminer les caractéristiques épidémiologiques et cliniques des enfants examinés dans le cadre d'un examen médico-légal et de discuter les obstacles à l'origine de difficultés de gestion de ces demandes. Il s'agit d'une étude transversale descriptive et analytique qui a porté sur les dossiers de tous les consultants adressés à la consultation de pédopsychiatrie de Monastir dans le cadre d'un examen médico-légal, durant les années 2021–2022. Nous avons ainsi procédé au remplissage d'une fiche explorant les données sociodémographiques de l'enfant, ses antécédents ainsi que les caractéristiques de l'examen médico-légal. Notre étude a inclus 454 enfants et adolescents dont le sex-ratio M/F était égal à 1,03 et l'âge moyen de 11 ans. Il s'agit d'une population appartenant majoritairement à un milieu socioéconomique défavorisé et vivant dans une dynamique perturbée. La maltraitance (60,1 %) notamment sexuelle (53,5 %) était le motif le plus fréquent à l'origine de la demande d'examen médico-légal et les diagnostics retenus étaient dominés par les états de stress aigu et post-traumatique et les troubles de l'adaptation. Nous avons aussi noté un taux important de perte de vue pour ceux nécessitant un suivi ainsi que de peu d'informations disponibles sur les suites judiciaires pour les enfants ayant nécessité une prise en charge. Le présent travail a étudié un sujet crucial, dans lequel nous avons rapporté les caractéristiques sociodémographiques et cliniques des enfants examinés en pédopsychiatrie dans un cadre médico-légal. Une coopération entre tous les intervenants est ainsi nécessaire pour garantir une meilleure prise en charge et surtout une continuité dans les soins accordés à cette population particulière. Child and adolescent psychiatrists are increasingly being requested by judicial authorities to examine children and adolescents. This increase is in part attributable to progress in Tunisian legislation on the protection of women and children. Nevertheless, clinicians have encountered several difficulties in conducting these examinations. This study aims to analyse the epidemiological and clinical profiles of children examined in a medico-legal context and to discuss the difficulties in managing these examinations. This is a cross-sectional descriptive and analytical study that examined the records of all patients referred to the Child Psychiatry Department in Monastir as part of medico-legal examinations during the years 2021–2022. We therefore filled in a form to investigate the child's socio-demographic data, background and the specifics of the medical-legal examination. Our study included 454 children and adolescents with a M/F sex ratio equal to 103 and an average age of 11 years. The majority of the population was of low socioeconomic status and lived in a disrupted environment. Child abuse (60.1%), particularly of the sexual type (53.5%), was the most frequent reason for requesting a medico-legal examination, and the diagnoses retained were dominated by acute and post-traumatic stress disorders and adjustment disorders. We also observed a high rate of interruption in medical follow-up and limited availability of information regarding legal outcomes for children in need of psychiatric care. The current study delves into a significant matter by delineating the socio-demographic and clinical profiles of children undergoing examination in child psychiatry within a medico-legal framework. Collaboration among all stakeholders is thus imperative to ensure improved management and, most importantly, the continuity of care for this specific population. [ABSTRACT FROM AUTHOR]

Background: Influence of architectural features in child and adolescent psychiatric wards on coercive measure use has not been investigated so far. We aimed to assess the effect of altering the physical environment of an adolescent psychiatric inpatient unit on the proportion and frequency of adolescents experiencing mechanical coercive measures. Method: In a naturalistic observational design, coercive measures were compared before and after an architectural intervention facilitated by rebuilding a child and adolescent psychiatric department in October 2020. Age, gender, length of stay, main psychiatric diagnosis and indices of coercion in n = 782 admissions to inpatient child and adolescent psychiatry from April 2019 to April 2022 were extracted. Group comparisons were performed using chi‐squared tests for categorical and Mann–Whitney U‐tests for numerical variables. Results: After structural modernization which included amplifying space and with the newly introduced availability of seclusion rooms, significantly fewer patients were affected by mechanical restraint (8.1% vs. 13.7%, p =.013). Rate of seclusion increased to 5.0% (vs. 0%, p <.001). Rate of seclusion and/or restraint decreased from 13.7% to 11.8% (p =.425). The median cumulative duration of all coercive measures per affected case decreased significantly (2.8 vs. 5.4 h, p =.005), as well as its proportion to length of stay (0.8% vs. 2.8%, p =.006). Conclusions: Modernisation and restructuring of buildings hosting psychiatric departments can contribute to a reduction of coercive measures in child and adolescent psychiatric units. [ABSTRACT FROM AUTHOR]

Objective: Transgender youths are more likely than cisgender youths to need mental health care because of their high exposure to discrimination and victimization, including within health care systems. Accordingly, transgender youths have low care satisfaction and high rates of treatment dropout, further exacerbating existing mental health inequities. To reduce these inequities, mental health providers need knowledge and skills to enhance transgender youths' treatment engagement and benefits. However, a comprehensive set of practices addressing the needs of transgender youth patients and their providers does not exist. The authors developed gender-affirming psychotherapy (GAP), an evidence-informed set of skills and principles to augment mental health treatments for transgender youths. Methods: GAP was developed by using a human-centered design, a methodological approach for creating interventions that prioritize the needs of key stakeholders, which in this study included mental health providers and transgender youths and their parents (N=36). A scoping review of the literature and stakeholder focus groups were conducted to create GAP, which encompasses core principles and skills to enhance mental health services for transgender youths. Results: GAP encompasses 27 principles and 38 skills, organized within 10 domains. All principles and skills were designed to be relevant for various provider types (e.g., psychiatrists and social workers) and to be flexibly adapted to meet diverse patient needs. Conclusions: GAP offers a scalable and flexible approach to addressing the growing mental health care needs of transgender youths. The findings of this study suggest that a human-centered design is a feasible and efficient method for developing interventions to address health inequities. [ABSTRACT FROM AUTHOR]

Background: The precision child and youth mental health (PCYMH) paradigm has great potential to transform CYMH care and research, but there are numerous concerns about feasibility, sustainablity, and equity. Implementation science and evaluation methodology, particularly participatory logic models created with stakeholders, may help catalyze PCYMH-driven system transformation. This paper aims to: (1) report results of a PCYMH logic model scoping review; (2) present a case study illustrating creation of a participatory logic model for a PCYMH start-up; and (3) share the final model plus lessons learned. Methods: Phase 1: Preparation for the logic model comprised several steps to develop a preliminary draft: scoping review of PCYMH logic models; two literature reviews (PCYMH and implementation science research); an environmental scan of our organization's PCYMH research; a gap analysis of our technological capability to support PCYMH research; and 57 stakeholder interviews assessing PCYMH perspectives and readiness. Phase 2: Participatory creation of the logic model integrated Phase 1 information into a draft from which the final logic model was completed through iterative stakeholder co-creation. Results: Phase 1: The scoping review identified 0 documents. The PCYMH literature review informed our Problem and Impact Statements. Reviewing implementation and evaluation literature resulted in selection of the Reach, Effectiveness, Adoption, Implementation, Maintenance (RE-AIM) and Behavior Change Wheel (BCW) frameworks to guide model development. Only 1.2% (5/414) of the organization's research projects involved PCYMH. Three technological infrastructure gaps were identified as barriers to developing PCYMH research. Stakeholder readiness interviews identified three themes that were incorporated into the draft. Phase 2: Eight co-creation cycles with 36 stakeholders representing 13 groups and a consensus decision-making process were used to produce the final participatory logic model. Conclusions: This is the first study to report the development of a participatory logic model for a PCYMH program, detailing involvement of stakeholders from initial planning stages to the final consensus-based product. We learned that creating a participatory logic model is time- and labour-intensive and requires a multi-disciplinary team, but the process produced stakeholder-program relationships that enabled us to quickly build and implement the PCYMH startup. Our processes and final model can inform similar efforts at other sites. [ABSTRACT FROM AUTHOR]

The Child and Adolescent Mental Health Initiative (CAMHI) aims to enhance mental health care capacity for children and adolescents across Greece. Considering the need for evidence-based policy, the program developed an open-resource dataset for researching the field within the country. A comprehensive, mixed-method, community-based research was conducted in 2022/2023 assessing the current state, needs, barriers, and opportunities according to multiple viewpoints. We surveyed geographically distributed samples of 1,756 caregivers, 1,201 children/adolescents, 404 schoolteachers, and 475 health professionals using validated instruments to assess mental health symptoms, mental health needs, literacy and stigma, service use and access, professional practices, training background, and training needs and preferences. Fourteen focus groups were conducted with informants from diverse populations (including underrepresented minorities) to reach an in-depth understanding of those topics. A dataset with quantitative and qualitative findings is now available for researchers, policymakers, and society [https://osf.io/crz6h/ and https://rpubs.com/camhi/sdashboard]. This resource offers valuable data for assessing the needs and priorities for child and adolescent mental health care in Greece. It is now freely available to consult, and is expected to inform upcoming research and evidence-based professional training. This initiative may inspire similar ones in other countries, informing methodological strategies for researching mental health needs. [ABSTRACT FROM AUTHOR]

Evidence-based information is essential for effective mental health care, yet the extent and accessibility of the scientific literature are critical barriers for professionals and policymakers. To map the necessities and make validated resources accessible, we undertook a systematic review of scientific evidence on child and adolescent mental health in Greece encompassing three research topics: prevalence estimates, assessment instruments, and interventions. We searched Pubmed, Web of Science, PsycINFO, Google Scholar, and IATPOTEK from inception to December 16th, 2021. We included studies assessing the prevalence of conditions, reporting data on assessment tools, and experimental interventions. For each area, manuals informed data extraction and the methodological quality were ascertained using validated tools. This review was registered in protocols.io [68583]. We included 104 studies reporting 533 prevalence estimates, 223 studies informing data on 261 assessment instruments, and 34 intervention studies. We report the prevalence of conditions according to regions within the country. A repository of locally validated instruments and their psychometrics was compiled. An overview of interventions provided data on their effectiveness. The outcomes are made available in an interactive resource online [https://rpubs.com/camhi/sysrev%5ftable]. Scientific evidence on child and adolescent mental health in Greece has now been cataloged and appraised. This timely and accessible compendium of up-to-date evidence offers valuable resources for clinical practice and policymaking in Greece and may encourage similar assessments in other countries. [ABSTRACT FROM AUTHOR]

Objective: Knowing the prevalence of mental health difficulties in young children is critical for early identification and intervention. In the current study, we examine the agreement among three different data sources estimating the prevalence of diagnoses for attention deficit hyperactivity disorder (ADHD) and emotional disorders (i.e., anxiety or mood disorder) for children between birth and 9 years of age. Methods: Data from a prospective pregnancy cohort was linked with provincial administrative health data for children in Alberta, Canada. We report the positive agreement, negative agreement, and Cohen's Kappa of parent-reported child diagnoses provided by a health professional ("parent report"), exceeding a clinical cut-off on a standardized questionnaire completed by parents (the Behavior Assessment System for Children, 3rd edition ["BASC-3"]), and cumulative inpatient, outpatient, or physician claims diagnoses ("administrative data"). Results: Positive and negative agreement for administrative data and parent-reported ADHD diagnoses were 70.8% and 95.6%, respectively, and 30.5% and 94.9% for administrative data and the BASC-3, respectively. For emotional disorders, administrative data and parent-reported diagnoses had a positive agreement of 35.7% and negative agreement of 96.30%. Positive and negative agreement for emotional disorders using administrative data and the BASC-3 were 20.0% and 87.4%, respectively. Kappa coefficients were generally low, indicating poor chance-corrected agreement between these data sources. Conclusions: The data sources highlighted in this study provide disparate agreement for the prevalence of ADHD and emotional disorder diagnoses in young children. Low Kappa coefficients suggest that parent-reported diagnoses, clinically elevated symptoms using a standardized questionnaire, and diagnoses from administrative data serve different purposes and provide discrete estimates of mental health difficulties in early childhood. Plain Language Title: Prevalence of child mental health disorders according to different data sources in Canada Plain Language Summary: Knowing the prevalence of mental health difficulties in young children is critical for informing mental health policy and decision-making. Yet, different sources yield different estimates and we do not know how these estimates compare. In the current study, we examine the agreement among three different information sources estimating the prevalence of diagnoses for attention deficit hyperactivity disorder (ADHD) and emotional disorders (i.e., anxiety or mood disorder) for children between birth and 9 years of age. To estimate the prevalence of mental disorders, we asked parents if their child had ever been diagnosed, we asked parents to complete a questionnaire using clinical symptom cut-offs for diagnosis, and we looked at data collected in the health care system to see if a child was ever diagnosed by a healthcare provider. We found that for ADHD, parent report that their child had received a diagnosis and their child having received a diagnosis in the healthcare system were similar. There were larger differences between a parent report of elevated symptoms on a questionnaire and whether they had been diagnosed by a healthcare provider. For emotion disorders, there were larger differences between parent report that their child had received a diagnosis and whether one was documented in the health record. Overall, there was somewhat low agreement between these three sources of data. We conclude that the different sources of data used in this study provide different estimates of ADHD and emotional disorder diagnoses in children. Therefore, when trying to understand the burden of child mental health disorders in young children, it is important to consider multiple sources to obtain a comprehensive picture of the issue. [ABSTRACT FROM AUTHOR]

Le volet adolescents de l'enquête EPPOC (enquête flash en juillet 2020 dans les services ambulatoires et hospitaliers de pédopsychiatrie de secteur d'Occitanie) a permis de documenter la vision des adolescents suivis dans les services de pédopsychiatrie d'Occitanie sur leurs habitudes d'utilisation des écrans et l'impact du premier confinement sur ces habitudes. Quatre-vingt-quatre adolescents ont répondu (moy 14,05 ans, 42 garçons). Leurs réponses ont été segmentées en 2 groupes d'âges (parmi eux, 58,3 % sont d'âge collège, et 41,7 % d'âge lycée). Les adolescents sont équipés à 90,5 % de téléphones portables et à 88,1 % de 3 à 5 types d'écrans. La moitié (55,7 %) ont un écran dans leur chambre. L'usage intensif (> 4 h/j) concerne 32,5 % d'entre eux en semaine, 51,8 % le week-end, et pendant le confinement (PC), ces chiffres passent à 65,1 % aussi bien en semaine qu'en week-end. Ils utilisent leurs appareils en après-midi ou soirée pour trois quarts d'entre eux avant confinement (AC), alors qu'ils les utilisent davantage le matin et avant de s'endormir PC. L'utilisation de leurs appareils consiste surtout à regarder des vidéos ou écouter de la musique (91,2 % des lycéens). Les réseaux sociaux concernent surtout les lycéens (79,4 vs 45,8 % de collégiens). Un quart des adolescents reconnaissent des effets négatifs des écrans sur le sommeil et l'humeur, mais positifs sur les relations sociales. Un tiers (27,7 %) disent avoir été exposés à des contenus choquants. Ils pensent à 62,2 % arriver à gérer le temps passé sur leurs écrans (47,5 % PC) et 60,7 % pensent que leurs parents ne leur posent pas de limite d'accès. Ce qui semble déterminer un usage excessif des écrans est la possession d'un plus grand nombre d'écrans, la présence d'écrans dans la chambre et le manque de limitation parentale. Les profils d'association qui semblent se détacher de l'analyse multivariée sont « utilisation des réseaux sociaux/fille/ > 8 h d'utilisation par jour/lycée » et « pas de réseaux sociaux/ < 1 h/garçon/collège ». Dans les grandes tendances, les profils d'équipement des adolescents et l'utilisation qu'ils en font dans notre étude sont superposables aux résultats nationaux et internationaux. Cependant l'hétérogénéité des cadres conceptuels et des méthodes d'investigation ne permet pas de construire un véritable raisonnement comparatif. Seule, la donnée de plus de 4 h par jour d'utilisation pour définir un usage intensif semble faire consensus aujourd'hui, en raison des effets néfastes constatés sur les paramètres de santé physique et psychique. Des données sur l'utilisation des écrans par les enfants souffrant de différents troubles (troubles attentionnels, troubles du spectre de l'autisme, dépression...) commencent à être décrites dans la littérature internationale, et feraient utilement l'objet d'une prochaine étude qualitative. The adolescent part of the EPPOC survey (flash survey in July 2020 in outpatient and hospital child psychiatry state departments in Occitania) documents the point of view of adolescents followed in pedopsychiatric settings on their screen use, and the impact of the first lockdown (March to May 2020) on this variable. Eighty-four adolescents answered (mean age 14.05, 42 boys). Their answers were fractioned into two age groups (58.3% in middle school, and 41.7% in high school). In total, 90.5% of adolescents are equipped with mobile phones and 88.1% with 3 to 5 types of screens. Half of them (55.7%) have a screen in their bedroom. Intensive use (> 4 h/day) affects 32.5% of them on weekdays, 51.8% on weekends, and during lockdown (DL), these figures increase to 65.1% in both weekdays and weekends. Before lockdown (BL), three quarters of the adolescents use their devices in the afternoon or in the evening, while they use them more in the morning and before going to sleep DL. Using their devices, they mainly watch videos or listen to music (91.2% of high school students). Social networks mainly regards high school students (79.4 vs. 45.8% of middle school students). A quarter of the adolescents acknowledge the negative effects of screens on sleep and mood, and their positive effects on social relationships. About a third (27.7%) declare having been exposed to shocking content. 62.2% think they control the time they spend on their screens (47.5% DL), and 60.7% think that their parents do not set any screen time limitation. What seems to determine excessive screen use is the possession of a greater number of screens, the presence of screens in the bedroom and the lack of parental limitation. The statistic association profiles that seem to stand out from the multivariate analysis are "use of social networks/girl/ > 8 hours of use per day/high school" and "no social networks/ < 1 hour/boy/college". In the main trends, screen equipment and screen use in our adolescent population are comparable to national and international results. However, the heterogeneity of conceptual frameworks and investigation methods does not allow thorough comparative reasoning. Only the 4 hours screen use per day cut off to define "intensive use" seems to achieve consensus today, due to the harmful effects observed on physical and psychological health parameters on young populations. Data on screen use among children with various diagnoses (ADHD, ASD, depression, etc.) emerge in the international literature, and would usefully lay the foundations of a future qualitative study. [ABSTRACT FROM AUTHOR]

Objective: Non-suicidal self-injury (NSSI) is a significant mental health issue among depressed adolescents. This study aimed to investigate roles of psychological mindedness (PM) and self-compassion among depressed Turkish adolescents with NSSI. The mediating roles of PM and self-compassion between depression severity and NSSI were evaluated. Method: 119 depressed adolescents evaluated at a child psychiatry outpatient clinic in Turkey were categorised based on NSSI experience. Self-compassion and psychological mindedness scales (covering psychological interest, insight, help-seeking, and capacity for change subscales) were measured. Results: PM and self-compassion scores were lower in depressed adolescents with NSSI than adolescents without NSSI. Psychological interest (Odds Ratio (OR): 0.886, Confidence Interval (CI): 0.788–0.996), capacity for change (OR: 0.902, CI: 0.815–0.998), and self-compassion (OR: 0.937, CI: 0.879–0.999) emerged as protective factors against NSSI. Also, significant indirect effects of PM and self-compassion were observed between depression severity and NSSI. Seeking psychological help related to both intrapersonal and interpersonal functions, whereas psychological interest specifically related to interpersonal functions. Conclusions: PM and self-compassion appear as protective factors, with certain PM components linked to intrapersonal and interpersonal functions of NSSI. Thus, integrating interventions to boost PM and self-compassion into depression treatment strategies could be crucial. KEY POINTS: What is already known about this topic: It is known that the level of self-compassion and psychological mindedness (PM) is low in depressed individuals. Although NSSI is frequently associated with depressed adolescents, self-injury is not observed in all depressed cases. NSSI has intrapersonal and interpersonal functions, and the role of these functions varies with different psychopathology, including depression. What this topic adds: Depressed adolescents with higher PM and self-compassion scores are protected from NSSI. PM and self-compassion in depressed adolescents mediate the NSSI with no significant association with depression severity. Some components of PM are related to the intrapersonal and interpersonal functions of the NSSI. [ABSTRACT FROM AUTHOR]

Objective: The authors examined the initial implementation of the Indiana Adolescent Addiction Access (AAA) program, modeled on the widely disseminated Child Psychiatry Access Program framework. The AAA program developed a statewide consultation helpline to connect health care providers with adolescent addiction specialists. Methods: The AAA line was staffed by a coordinator, who fielded initial questions, and on-call clinical specialists (social workers, nurse practitioners, psychiatrists, and psychologists), who were paged to complete telephone consultations and provide care recommendations. When necessary, AAA providers offered urgent clinical assessments and initiated treatment. Descriptive analyses were performed for key variables over the first 21 months of AAA operations. Results: From July 2021 to March 2023, a total of 125 consultations were completed. Most callers were health care providers (71%) or parents (27%). Calls pertained to youths ages 10–18 years (mean±SD age=16.4±1.3; 62% of callers were male, 84% White, and 11% Black), with concerns around cannabis (63%), opioids (38%), and other substances. About 26% of calls related to an overdose, and 41% of cases were rated as severe. Recommendations included starting new medications (17%) or outpatient therapy (86%), and 17% of consultations resulted in urgent evaluations. Conclusions: The Indiana AAA program helps overcome key barriers to adolescent substance use treatment. Increasing the capacity to initiate medication for opioid use disorder and other treatment rapidly through consultation and direct care is a promising, scalable approach for preventing overdose deaths among youths. [ABSTRACT FROM AUTHOR]

Introduction: Attention deficit hyperactivity disorder (ADHD) is a childhood-onset neurodevelopmental condition characterised by inattention and/or hyperactivity--impulsivity. The ADHD symptoms are often evaluated and quantified using various assessment tools, such as the Conners' Continuous Performance Test II (CCPT-II), ADHD Rating Scale (ADHD-RS), Child Behaviour Checklist (CBCL), Clinical Global Assessment Scale (CGAS) and Clinical Global Impression Scale (CGIS). This study sought to compare CCPT-II with parent- and clinician-rated rating scales (ADHD-RS, CBCL, CGAS and CGIS) in measuring the core ADHD symptoms within the paediatric ADHD population. Methods: The data, gathered from a large-scale randomised controlled trial involving 172 children aged 6-12 years with ADHD, was pooled, and a Pearson correlation analysis was conducted. Results: No significant correlations were observed between CCPT-II and ADHD-RS, as well as the various subscales of CBCL, CGAS and CGIS. Conclusion: While CCPT-II may offer insights into ADHD symptomatology, its relationship with parent- and clinician-rated rating scales such as ADHD-RS, CBCL, CGAS and CGIS appears limited. Further research is warranted to elucidate the nuances of these assessment tools and their roles in evaluating ADHD. [ABSTRACT FROM AUTHOR]

Disruptive behavior disorders (DBDs) are comprised of conduct disorder and oppositional defiant disorder. Limited literature exists on the demographics of patients diagnosed with these conditions. Despite the clinical overlap of DBDs and attention-deficit hyperactivity disorder (ADHD), there is a stark divergence in the treatment and societal accommodation for these two diagnoses, amplifying the importance of this diagnostic challenge. Thus, potential diagnostic differences must be urgently and rigorously explored. Small, regional studies have reported potential "racial" disparities in the diagnosis of DBDs, especially when compared to the diagnosis of ADHD. Our study uses the National Inpatient Sample (NIS) database to provide the largest, most comprehensive investigation of "racial" disparities in the diagnosis of DBDs. Discharge data from 700,770 pediatric inpatients (mean age = 9.32 years) were included in this analysis. To explore potential disparities among children with symptoms in this area of clinical overlap, we assessed the relationship of "race" and the diagnosis of DBDs. Among the subgroup of pediatric inpatients diagnosed with ADHD or a DBD, Native American (OR = 2.18; 95% = 1.76, 2.70), Asian (OR = 1.88, 95% = 1.56, 2.26), Black (OR = 1.40; 95% = 1.32, 1.48), and Hispanic (OR = 1.20; 95% = 1.12, 1.28) "race" correlated with DBD diagnosis. By highlighting these diagnostic disparities, this study raises essential questions about race and the diagnosis of DBDs. [ABSTRACT FROM AUTHOR]

ObjectiveMethodsResultsDiscussionParents with borderline personality disorder (BPD) can present with negative parenting and parent–child dysfunctional interactions. This can adversely impact their children, leading to internalising and externalising problems. No reviews of psychological interventions for these children have been found. The present systematic review aims to identify and describe the characteristics, outcomes and evidence of psychological interventions for children of parent(s) with BPD.Five databases were searched in addition to unpublished clinical trials. Of the 2243 records screened, 24 records were identified, of which 19 were studies, reporting on 17 different psychological interventions.Most studies had low-moderate quality and were case studies/case series. More than half of the psychological interventions were multi-strategic, long-term, with mothers and their infants, and based on a psychodynamic model. Results revealed some improvements in parent, parent–child relationship and child outcomes. However, only one psychological intervention presented evidence of effectiveness.Psychological interventions for children of parent(s) with BPD are scarce and no conclusions can be made about them. To establish evidence-based psychological interventions for these children, future research should consider conducting effectiveness studies, namely large-scale randomised controlled trial studies, with strong quality, and including the fathers and older children. This systematic review could aid clinicians and researchers in treating and studying psychological interventions for this at-risk group. [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]

Background: Involving parents in mental health treatment services can empower parents to manage their child's illness. We conducted this study to develop a tool to assess parental care for children with mental illness. Materials and Methods: The present study was conducted in five phases that included in-depth interviews with parents in the outpatient department (OPD), focus group discussions (FGDs) with parents in an in-patient setting, and with a multidisciplinary team, item development, and the assessment of psychometric properties of the tool. Results: Parental care for children with mental illness (PCCMI) has 50 items derived from a thematic analysis of in-depth interviews of 31 parents and 2 FGDs with eight parents admitted at CPC and eight mental health professionals experienced in child and adolescent psychiatry. It is a 5-point Likert scale. The tool showed a high item-level Content Validity Index (I-CVI range: 0.8--1.0) and a high Scale Content Validity Index (S-CVI = 0.91). The test--retest method was used to calculate reliability. A total of 38 parents were included in the test--retest method. The mother and father's mean age and standard deviation (SD) scores were 39.7 ± 5.8 and 45.1 ± 4.9, respectively. Most parents' education level is above graduation (mothers: 86.8% and fathers: 86%). Around 63% of mothers were housewives and had normal pregnancies. The single measure two-way mixed absolute agreement intraclass correlation coefficient (ICC) value for 38 subjects was 0.96 with a 95% confidence interval (CI: 0.90--0.95), indicating high reliability. Conclusion: PCCMI has high I-CVI and S-CVI and good ICC test--retest reliability. This tool will help mental health professionals in the formal assessment of parental care for children with mental illness and provide the intervention to address issues related to the same. [ABSTRACT FROM AUTHOR]

SUMMARY: Diagnostic systems are not conducive to compassionate health-bringing psychiatric treatment. The systems were built around the fallacy that the politics of biomedicine could be reliably applied to the emergent properties of human psychological suffering and enable diagnosis-specific treatment packages. The resulting industrialised medicine, which reified people, failed to facilitate the compassion needed for healing. This article outlines an approach to psychiatric practice that involves understanding children's suffering and vulnerabilities in terms of their attachment strategies and adaptation to their context and takes a mindful approach to developing compassionate collaborative treatment goals (intelligent kindness). A shift towards mindful psychiatric medicine would encourage politicians to serve the people by addressing the contexts associated with human suffering and what makes people vulnerable, especially social inequalities. Healthy societies in which the psychiatric dis-ease of the population is adequately addressed will not be built with limited biomedical understanding of dis-ease. [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]

L'inceste au sein d'une fratrie est un sujet peu abordé malgré sa fréquence. L'objectif est d'explorer l'expérience subjective de la révélation d'un inceste entre un frère et une sœur par l'adolescent victime et ses parents dans le cadre d'une prise en charge pédopsychiatrique. Il s'agit d'une étude qualitative à partir d'entretiens semi-structurés menés auprès de trois adolescentes victimes suivies en pédopsychiatrie et ayant révélé l'inceste frère–sœur, et deux mères d'adolescentes victimes. L'analyse des données est réalisée selon la méthode de l'interprétative phenomenological analysis. Les résultats comprennent onze thèmes regroupés en trois méta-thèmes : (1) l'avant révélation : un état de mal-être qui amène aux soins ; (2) l'expérience de la révélation auprès d'un professionnel de santé ; (3) l'après révélation et ses conséquences. Chaque thème développe la perspective de l'adolescent, du parent et de la relation parent–enfant. Les différents thèmes font ressortir les spécificités du vécu de la révélation d'un inceste à l'adolescence et de ses conséquences variables sur l'adolescent, le parent et l'accompagnement médico-socio-judiciaire. L'étude met en évidence le processus graduel de la révélation à l'adolescence d'un inceste entre frère et sœur. La révélation doit être accompagnée sur la durée, d'autant plus qu'elle a des impacts variables, positifs mais aussi négatifs, sur l'adolescent et sa famille. Ces données amènent à repenser nos pratiques et à prendre en compte les approches familiales et transculturelles afin de proposer un accompagnement pluridisciplinaire à trois niveaux : individuel, parental et familial. Incest among siblings is a topic that is not often discussed despite its frequency. The objective of this study is to explore the subjective experience of the disclosure of brother/sister incest by the adolescent victim and their parents in the context of child psychiatric care. This is a qualitative study based on semi-structured interviews with three adolescent victims who were under child psychiatric care and who had revealed the brother/sister incest to their caregivers for the first time, as well as with two mothers of adolescent victims. The analysis of the data was conducted using the interpretative phenomenological analysis method. The results include eleven themes grouped into three meta-themes: (1) pre-disclosure: a state of unease that leads to the initiation of care; (2) the experience of disclosure to a health professional; (3) post-disclosure and its consequences. The different themes highlight the specificities of the experience of the disclosure of incest during the teenage years and the consequences for the parent–child relationship and also for the victim's relationship to the family depending on the adolescent's perspective, parental support, and the medical and legal support. The vulnerability of the adolescent population in a context of disclosure of intrafamilial sexual abuse between brothers and sisters makes it essential that we conceive of care in a specific way and take into account family and transcultural approaches. This study allows us to identify research perspectives in the field of child psychiatry as well as to formulate concrete clinical proposals, in particular a multidisciplinary support protocol on three different levels: individual, parental and familial. [ABSTRACT FROM AUTHOR]

Children with neurologic disorders face increased risks for mental health and neurodevelopmental conditions, with information often limited to parent report. To better understand mental health and neurodevelopmental needs in this population, a retrospective chart review of a convenience sample of children with neurologic disorders referred for a neuropsychological evaluation was conducted in the present study to explore interrater agreement between care team members (referring providers, parents, pediatric neuropsychologist). Qualitative and quantitative data were collected from the evaluation reports of 129 youth (9:0–17:11 years old; 51.2% of female sex) with neurologic disorders (i.e., 38.0% traumatic brain injury, 27.1% epilepsy, 14.7% premature birth, 7.8% pediatric cancer, 3.9% prenatal substance exposure, and 14.7% other) who completed an evaluation in 2019. Over half the youth were flagged for unmet neurodevelopmental and mental health concerns and analyses revealed low interrater agreement for mental health concerns (κ =.324), better agreement for neurodevelopmental concerns (κ =.511), and low sensitivity of referring providers (Se =.326) and parents (Se =.366). One-way analyses of variance uncovered important factors (e.g., symptom severity, adaptive skills) that may account for missed concerns. Findings guide recommendations to strengthen methods for understanding mental health and/or neurodevelopmental concerns in children with neurologic disorders. [ABSTRACT FROM AUTHOR]

The diagnosis of childhood schizophrenia was widely employed in the U.S. from the 1930s to the late 1970s. In this paper I will provide a history of the diagnosis. Some of the earliest publications on childhood schizophrenia outlined the notion that childhood schizophrenia had different types. I will outline the development of these types, outlining differing symptoms and causes associated with various types. I outline how different types of childhood schizophrenia were demarcated from one another primarily on age of onset and the type of psychosis which was believed to be present. I will outline how various child psychiatrists viewed the types of childhood schizophrenia posited by other child psychiatrists. I will outline the process of abandoning childhood schizophrenia. I use my history to challenge what I believe are misconceptions about childhood schizophrenia. Also, I will use my history to draw lessons for thinking about modern notions of autism. It shows potential problems around formulating psychiatric diagnoses around causes and how compromises might be needed to prevent those problems. Additionally, childhood schizophrenia shows that psychiatrists could formulate subtypes that are not based upon functioning levels and that we can conceive of subtypes as dynamic whereby someone can change which subtype they exhibit over time. [ABSTRACT FROM AUTHOR]

Background. Children with cancer often undergo prolonged and recurrent hospitalization, which leads to an increased incidence of sleep disruptions and psychiatric disorders. This study aimed to objectively quantify the prevalence of sleep disruptions in hospitalized pediatric oncology patients and to determine the effects of psychiatric disorders, treatment regimens, and hospital conditions on sleep patterns. Method. This cross-sectional study included 39 children who were undergoing treatment and monitoring in the pediatric oncology inpatient service. Parents completed questionnaires providing information about their child’s sleep patterns, quality of life, and hospital conditions. The children were monitored for five days using actigraphy to record sleep parameters. They were evaluated with a semi-structured interview form (Schedule for Affective Disorders and Schizophrenia for School-Age Children-Present and Lifetime Version-DSM 5-Turkish Adaptation) for psychiatric diagnoses. Results. Sleep disruptions were identified in 27 (69.2%) children with cancer. In addition to adjustment disorder and anxiety disorder psychiatric diagnoses, behavioral problems and emotional symptoms were more common in the group with sleep disruptions. Actigraphy measurements indicated that poor sleep was associated with younger age, recent cancer diagnosis, specific phobias, depression, daytime napping, and frequent vital sign assessments. Conclusion. Sleep problems in hospitalized children with cancer are linked to psychiatric comorbidities, treatment routines, and hospital conditions. By recognizing psychiatric symptoms and optimizing hospital conditions that affect sleep, healthcare providers can enhance the quality of sleep for these children. [ABSTRACT FROM AUTHOR]

Objective: This systematic review used established rating criteria to describe the level of evidence for interventions aimed at preventing or reducing bullying perpetration and victimization in schools, synthesized the evidence for students from racially and ethnically diverse backgrounds, and reviewed the literature for available information to conduct an economic analysis of the interventions. Methods: Major databases, gray literature, and evidence-base registries were searched to identify studies published from 2008 through 2022. The authors rated antibullying intervention models as having high, moderate, or low evidence depending on the number and rigor of studies with positive findings. Results: Overall, 80 articles reporting on 71 original research studies describing a total of 48 antibullying interventions met the inclusion criteria for this review. Two schoolwide interventions received a high-evidence rating: the KiVa (Kiusaamista Vastaan) Antibullying Program and the Friendly Schools program. Multilevel interventions with components at the levels of school, classroom, and individual student most consistently showed strong evidence for reducing bullying behavior in elementary and middle school grades. Four interventions yielded positive effects in reducing bullying and victimization among diverse samples of students. Conclusions: Antibullying interventions can reduce bullying in schools. Some interventions show effectiveness with students from racially and ethnically diverse backgrounds. The gains relative to per-student costs were in the range that is considered cost-effective. Most implementation costs are spent on staff training and support. Research on successful implementation of whole-school interventions and additional synthesis of evidence pertaining to program structures would further advance the antibullying evidence base. [ABSTRACT FROM AUTHOR]

Schools are an important component in the mental health system of care for youths. Teachers and other school staff have unique opportunities to promote emotional wellness and prevent mental health conditions. Although numerous programs are available, identifying evidence-based and effective options is a significant challenge. This introduction lays out the rationale and methodology of the Assessing the Evidence Base (AEB) series, a collection of systematic reviews of school-based mental health promotion and prevention approaches recommended by the National Academies of Sciences, Engineering, and Medicine for students in kindergarten through grade 12. Authors of the current AEB series used the rating criteria derived from the 2014 AEB series, which provided systematic reviews of a wide spectrum of interventions for mental and substance use disorders. Like its predecessor, the current series upholds a high standard of scientific rigor while ensuring that the information is easily accessible to various stakeholders in education, behavioral health, and communities. It describes the universal features included in each systematic review, such as a rating of the level of evidence for interventions, intervention program components, identification of interventions that have yielded positive outcomes for students from underserved populations, and a review of cost data. The AEB systematic reviews will serve as an important tool for decision makers involved in managing limited resources for various programs in school-based mental health services by synthesizing large bodies of research for use by leaders in education and behavioral health. [ABSTRACT FROM AUTHOR]

Objective: Many parents struggle to find mental health care for their children, and many mental health clinicians do not accept insurance payments. The authors aimed to estimate the frequency and cost of self-pay psychotherapy and psychotropic medication management visits for youths and to determine how service use varies by family income. Methods: A descriptive cross-sectional analysis was performed among youths ages 5–17 years in the 2018–2020 Medical Expenditure Panel Survey. Specialist visits included those with psychiatrists, psychologists, social workers, and mental health counselors or family therapists. Results: Approximately one in five of 13,639 outpatient mental health specialist visits were self-pay, with psychologists (23% of visits) and social workers (24% of visits) most likely to see youths on a self-pay basis. Use of self-pay care was strongly associated with higher income, but even families earning <$28,000 per year utilized some self-pay care, at a median cost of $95 per visit. Self-pay visits were associated with slightly lower clinical need than insurance-covered visits, although this measure varied by income. Conclusions: The self-pay market for child mental health care potentially exacerbates inequities in access to care by burdening low-income families with high costs. Incentivizing mental health providers to participate in insurance for larger portions of their patient panels, for example, by increasing reimbursement rates and reducing paperwork, may help improve equitable access to mental health care. To the extent that reimbursement rates drive insurance acceptance, the frequency of self-pay mental health visits suggests that mental health services are underreimbursed relative to their benefit to patients and families. [ABSTRACT FROM AUTHOR]

Rationale: Information is limited about the association between obstructive sleep apnea (OSA) and mental health disorders in children. Objectives: In children, 1) to evaluate the association between OSA and new mental healthcare encounters; and 2) to compare mental healthcare encounters 2 years after to 2 years before OSA treatment initiation. Methods: We conducted a retrospective longitudinal cohort study using Ontario health administrative data (Canada). Children (0–18 yr) who underwent diagnostic polysomnography (PSG) 2009–2016 and met criteria for definition of moderate-severe OSA (PSG-OSA) were propensity score weighted by baseline characteristics and compared with children who underwent PSG in the same period but did not meet the OSA definition (PSG-No-OSA). Children were followed until March 2021. Weighted cause-specific Cox proportional hazards and modified Poisson regression models were used to compare time from PSG to first mental healthcare encounter and frequency of new mental healthcare encounters per person time, respectively. Among those who underwent adenotonsillectomy (AT) or were prescribed and claimed positive airway pressure therapy (PAP), we used age-adjusted conditional logistic regression models to compare 2 years post-treatment to pretreatment odds of mental healthcare encounters. Results: Of 32,791 children analyzed, 7,724 (23.6%) children met criteria for moderate-severe OSA. In the PSG-OSA group, 7,080 (91.7%) were treated (AT or PAP). Compared with PSG-No-OSA, the PSG-OSA group had a shorter time from PSG to first mental healthcare encounter (hazard ratio, 1.08; 95% confidence interval [CI], 1.05–1.12) but less frequent mental healthcare encounters in follow-up (rate ratio, 0.92; 95% CI, 0.87–0.97). OSA treatment (AT or PAP) was associated with lower odds of mental healthcare encounters 2 years after treatment initiation compared with 2 years before (odds ratio, 0.69; 95% CI, 0.65–0.74). Conclusions: In this large, population-based study of children who underwent PSG for sleep disorder assessment, OSA diagnosis/treatment was associated with an improvement in some mental health indicators, such as fewer new mental healthcare encounters compared with no OSA and lower odds of mental healthcare encounters compared with before OSA treatment. [ABSTRACT FROM AUTHOR]

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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

Bowlby developed the theory of attachment, describing it as a lasting emotional bond between human beings, manifested by seeking proximity to caregivers, especially in times of distress. Children adjust their behavior to prevent separation from their primary attachment figure – someone who provides support, protection and care. Attachment theory provides a favorable framework for understanding our two cases and their developmental paths. We report two cases of female individuals, both of whom had a family history of psychiatric disease and experienced early parental separation with the grandparents playing significant roles in their upbringing. The two cases had radically different outcomes: one was diagnosed with schizophrenia and the other with generalized anxiety-depressive disorder. We attempt to analyze the reasons for the disparate outcomes of these two cases through the framework of numerous published studies that highlight protective and risk factors for psychiatric disease, studies that highlight the impact of traumatic events in childhood on a child’s biological, psychological and social development, as well as through the lens of psychodynamic and attachment theories. Throughout the analysis, the importance of early intervention is made clear: both through various treatment modalities and preventive measures, as well as by providing successful mental health programs directed towards the destigmatization of children with mental health problems.

The World Psychiatry Exchange Program offers opportunities overseas for early career psychiatrists (ECPs), fostering immersion in clinical and cultural contexts. In this article, we present the experiences of two Tunisian ECPs in India. Activities included observing interviews, and attending courses and webinars. Challenges and opportunities in perinatal psychiatry and in child psychiatry were observed, emphasising cross-cultural nuances. Language barriers were overcome through translation. Notably, collaboration and proximity between departments countered mental illness stigma among medical professionals. This exchange underscores the importance of cultural awareness, collaboration and contextual adaptation in psychiatry. Lessons from this cross-cultural experience offer insights for enhanced care and research in diverse settings. This exchange also allowed for a rich scientific and cultural experience and brought to light many commonalities between India and Tunisia.

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]

Introduction: Psychotherapy delivered via videoconferencing (teletherapy) was a well-accepted treatment option for children and adolescents during the early phases of the COVID-19 pandemic. Information on the long-term satisfaction with teletherapy in routine clinical practice is missing. Methods: Caregivers (parents) and psychotherapists of n = 228 patients (4–20 years) treated in a university outpatient clinic completed a follow-up survey on satisfaction with videoconference-delivered cognitive-behavioral treatment (CBT). The follow-up survey (T2) was conducted about 1 year after initial assessment of treatment satisfaction in 2020 (T1). Results: At follow up, therapists reported that 79% of families had received teletherapy as part of a blended treatment approach including in-person and videoconference delivery of CBT. Wilcoxon tests revealed that satisfaction with teletherapy was stable over time. In addition, parent ratings of the impact of teletherapy on treatment satisfaction and the therapeutic relationship did not change over time. Therapists' ratings of the impact of teletherapy on the therapeutic relationship with the caregiver were more negative at T2 compared to T1. Satisfaction with teletherapy was higher for patients with less pandemic-related stress, less externalizing behavior problems, and older age (all r <.35). Conclusion: The high level of satisfaction with teletherapy for children and adolescents treated in routine clinical practice reported in 2020 was maintained after social distancing regulations were eased in 2021. Teletherapy provided as part of a blended treatment approach is a well-accepted method of treatment delivery for youths with mental health problems. The study was registered in the German Clinical Trials Register (DRKS00028639). [ABSTRACT FROM AUTHOR]

Background: Parents of children with Autism Spectrum Disorder (ASD) may face several challenges. Implementation of the Stepping Stone Triple P (SSTP) for parents proved to have an effect on reducing parents’ negative emotions and children’s disruptive behavior. However, some studies state otherwise. Objective: This study aims to assess the impact of the SSTP on parents’ negative emotions and disruptive behavior in children with ASD. Methods: Independent searching from databases conducted using a pre-registration search strategy until November 2023. The ROB 2.0 tool was used to assess the risk of bias in the results of the studies. The results were analyzed with vote counting and meta analysis. The quality of evidence was analyzed using GRADE and publication bias was checked using forest plots. Results: Vote-counting analysis from 11 studies (939 populations) show that SSTP has a positive impact. Meta-analysis was found that SSTP can reduce the level of negative emotions [MD 1.14 (95% CI -1.73 to -0.55) and I2 = 0%] and children's disruptive behavior [MD 6.31 (95% CI -7.84 to -4.78) and I2 = 68 %] and still consistent after subgroup analysis resulting in 8 study arms. The quality of the evidence was moderate and publication bias was not detected. Conclusion: Most research supports that SSTP has an impact on reducing negative emotions and disruptive behavior in children with ASD. Further research with alternative parameters is still needed. To reduce bias, a randomization method according to the protocol must be applied. Latar Belakang: Orang tua anak dengan Autism Spectrum Disorder (ASD) mungkin menghadapi beberapa tantangan. Penerapan Stepping Stone Triple P (SSTP) pada orang tua terbukti memberikan pengaruh dalam mengurangi emosi negatif orang tua dan perilaku disruptif anak. Namun, beberapa penelitian menyatakan sebaliknya. Tujuan: Penelitian ini bertujuan untuk menilai dampak SSTP terhadap emosi negatif orang tua dan perilaku disruptif anak penderita ASD. Metode: Peninjau secara independen mencari studi dari database menggunakan strategi pencarian pra-pendaftaran hingga November 2023. ROB 2.0 digunakan untuk menilai risiko bias hasil penelitian. Hasilnya dianalisis dengan vote counting dan meta analisis. Kualitas bukti dianalisis menggunakan GRADE dan bias publikasi diperiksa menggunakan Forest Plot. Hasil: Analisis penghitungan suara dari 11 penelitian (939 populasi) menunjukkan bahwa SSTP cenderung mengurangi emosi negatif pada orang tua yang memiliki anak ASD, perilaku mengganggu pada anak, dan disfungsi pengasuhan. Meta-analisis menemukan bahwa SSTP dapat menurunkan tingkat emosi negatif [MD 1.14 (95% CI -1.73 hingga -0.55) dan I2 = 0%], dan perilaku mengganggu anak [MD 6.31 (95% CI -7.84 hingga -4.78) dan I2 = 68 %] dan masih konsisten setelah analisis sub kelompok menghasilkan 8 kelompok penelitian. Kualitas buktinya moderat dan bias publikasi tidak terdeteksi. Kesimpulan: Sebagian besar penelitian mendukung bahwa SSTP berdampak pada pengurangan emosi negatif dan perilaku mengganggu pada anak ASD. Penelitian lebih lanjut dengan parameter alternatif masih diperlukan. Untuk mengurangi bias, metode pengacakan sesuai protokol harus diterapkan.

Bowlby remained attached to his psychoanalytic roots and conceptualised treatment in terms of one-to-one relationships, albeit acknowledging the need for a family formulation. Bowlby's five therapeutic tasks were never adapted to the current understanding of working with the relationships fostering the development and maintenance of children's attachment strategies. This paper goes through each of Bowlby's five tasks and adapts them to our current understanding of development, with consequences for prioritising family approaches, rather than a secure base alone with a therapist. In doing so I will review the process of achieving security, seeing it as more similar to an allostatic process than a state of homeostasis.

ObjectiveMethodsResultsConclusionsAttention Deficit Hyperactivity Disorder (ADHD) is one of the most common mental disorders in children. Evidence regarding the impact of probiotics supplementation in ADHD children is limited and controversial. Thus, this study aimed to assess the effect of probiotics as an adjunctive therapy with Ritalin among ADHD children and adolescents.This study was a triple-blind, randomized controlled trial of 60 Iranian ADHD patients aged four to sixteen. The participants were randomly assigned to receive probiotics supplements containing both Lactobacillus plantarum PTCC 1896™ (A7) and Bifidobacterium animalis subsp. Lactis (BB-12®) (n = 30) or placebo (n = 30) for 8 weeks. ADHD symptoms were assessed using Conners’ Parent Rating Scale (CPRS) and Integrated Visual and Auditory Continuous Performance Test (IVA/CPT) at baseline and during the study.This study showed a significant decrease in the CPRS total score after 4 weeks of intervention in the probiotic group (baseline: 43.96 ± 21.52; fourth week: 37.22 ± 23.01; p = 0.01). However, no significant finding was found for the total score of the CPRS after 8 weeks. Moreover, at the end of the study, a significant increase was observed in score of auditory response control in the probiotic versus the placebo group (probiotic: 91.55 ± 16.69; placebo: 80.55 ± 17.43; p = 0.02).Probiotics supplementation with Ritalin may have some beneficial effects among ADHD children and adolescents, such as improving auditory response control and total score of CPRS. However, further clinical trials are required to clarify the impact of probiotics on ADHD. [ABSTRACT FROM AUTHOR]

Background: Mental illnesses are common among children and negatively impact wellbeing during childhood as well as later in life. However, many children with these conditions are not able to access needed mental health care. The Wisconsin Child Psychiatry Consultation Program (WI CPCP) was created to reduce gaps in access to care by providing primary care providers with referral resources, access to behavioral health consultations, and training on mental health topics. Objectives: The purpose of this study was 1) to assess the effectiveness of the WI CPCP in Milwaukee County, providing specific insights into provider's ability to care for child mental health, and 2) identify challenges Milwaukee PCPs faced in providing mental health care to child patients and contextualize these challenges in a conceptual framework of access to health care. Methods: A cross-sectional mixed-methods secondary data analysis was conducted using data collected from online baseline and nine-month follow-up surveys completed by providers participating in the program practicing in Milwaukee County from 2014 to 2022. Provider confidence and skill in providing mental health care was analyzed quantitatively using Two-sample Wilcoxon rank-sum (Mann–Whitney) tests (baseline vs. follow-up survey responses) and descriptive statistics (follow-up survey only). Provider challenges to providing mental health care were analyzed qualitatively using a thematic analysis research approach. Results: Results from quantitative analyses showed that provider confidence and skill in treating childhood anxiety and depression improved from baseline to follow-up. Results from qualitative analyses were categorized by factors within and beyond the scope of WI CPCP. Within the scope of WI CPCP, providers reported a lack of knowledge of referral options and a lack of training in mental health care as well as a lack of knowledge in assessing and treating mental disorders. Still, many barriers to mental healthcare access persist that are beyond the scope of WI CPCP, such as long wait times and a lack of insurance coverage. Conclusions: This study supports the effectiveness of the program to improve access to care for children. However, there is a need for additional solutions such as better reimbursement for mental health professionals and expanded insurance coverage. [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]

Youth with developmental and pre-existing mental health conditions have been particularly vulnerable to declines in psychological functioning during the COVID-19 pandemic. This study aimed to first, analyze service usage within an outpatient child and adolescent psychiatry clinic in the months preceding and during the COVID-19 pandemic, and second, to examine associations with potential protective factors against mental health concerns in a treatmentengaged sample. Service usage was examined using clinic billing data, and reports on protective factors were gathered via parent survey of 81 children ages 6--17 years who received mental health treatment in an outpatient psychiatry clinic during the pandemic. Protective factors were assessed at the individual, family, and community levels, and included children's use of coping strategies, parental resilience, and parents' perceived social supports. Study outcomes, including mental health concerns, mental health emergencies, pandemic-related distress, and social impact of the pandemic, were analyzed via Pearson correlations and simultaneous multiple linear regressions. Findings suggest increased service usage and child coping, parental resilience, and social connectedness as factors associated with fewer mental health concerns in youth with psychiatric concerns during the pandemic. This study lends support for expanding psychiatric services with continued use of telemedicine platforms. Further, findings suggest a mental health benefit to optimizing individual, parental, and community-based resources to enhance children's psychological functioning, particularly for youth with pre-existing mental health conditions. [ABSTRACT FROM AUTHOR]

Bowlby remained attached to his psychoanalytic roots and conceptualised treatment in terms of one-to-one relationships, albeit acknowledging the need for a family formulation. Bowlby's five therapeutic tasks were never adapted to the current understanding of working with the relationships fostering the development and maintenance of children's attachment strategies. This paper goes through each of Bowlby's five tasks and adapts them to our current understanding of development, with consequences for prioritising family approaches, rather than a secure base alone with a therapist. In doing so I will review the process of achieving security, seeing it as more similar to an allostatic process than a state of homeostasis. [ABSTRACT FROM AUTHOR]

Psychoactive medications are increasingly used to treat children and youth with mental health conditions, but individual variations in response highlight the need for precision medicine. Pharmacogenetic (PGx) testing is a key component of precision medicine. The number of commercial pharmacogenetic testing companies promoting PGx, with the promise of achieving individualized and effective treatment of mental health conditions, has grown exponentially in recent years. Scientific evidence supporting the use of PGx to manage mental health conditions is limited, especially for paediatric populations. This practice point outlines steps guiding the use and interpretation of PGx testing for psychoactive medications in clinical settings, along with key supportive resources. Practice guidelines have been developed for variants in pharmacogenes encoding cytochrome P450 drug-metabolizing enzymes (e.g. CYP2C19 , CYP2D6 , CYP2C9) as one determinant of drug concentrations in blood, which can support both drug choice and dosing strategy for certain anti-psychotics, anti-depressants, and anti-epileptics. Adverse drug reactions to some anti-epileptic drugs (e.g. carbamazepine and phenytoin) have been associated with certain human leukocyte antigen types and variants in DNA polymerase gamma (POLG ; valproic acid). Evidence remains limited for genetic variants of drug target proteins, making it challenging to identify patients with altered treatment responses at a therapeutic blood concentration. [ABSTRACT FROM AUTHOR]

Catatonia is a neuropsychiatric disorder associated with changes in behavior and affect. In adults, catatonia can respond rapidly to treatment with benzodiazepines as part of the "lorazepam challenge test." The acute effectiveness of benzodiazepine treatment in pediatric catatonia, however, has received less study. This study reports catatonia severity as measured by the Bush Francis Catatonia Rating Scale (BFCRS) in pediatric patients before and after treatment with lorazepam. Multicenter retrospective cohort study from 1/1/2018 to 6/1/2023 of patients aged 18 and younger with a clinical diagnosis of catatonia and assessment using the BFCRS before and after treatment with lorazepam. Among 54 patients, median age was 16, and 26 (48.1 %) were female. Neurodevelopmental disabilities were present in 24 (44.4 %) of patients. Prior to treatment, patients had a mean BFCRS score of 16.6 ± 6.1, which significantly reduced to 9.5 ± 5.3 following treatment with lorazepam (mean paired difference 7.1; t = 9.0, df = 53, p < 0.001), representing a large effect size (Hedges's g = 1.20; 95 % CI: 0.85 to 1.55). No significant association was found between lorazepam dose or route of administration and clinical response, nor were age, sex, study site, the presence of a neurodevelopmental disorder, the presence of hyperactive catatonic features, or the time between treatment and reassessment associated with post-treatment BFCRS. Lorazepam resulted in a rapid improvement in BFCRS score in pediatric patients, with a large effect size. Further research is needed into optimal dosing and route of administration of the lorazepam challenge test in pediatric patients. [ABSTRACT FROM AUTHOR]