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

ABSTRACT This review aims to consolidate and appraise evidence exploring the caregiver burden of parents of children with mental disorders. A mixed‐studies review structure was adopted and six electronic databases (PubMed, CINAHL, PsycINFO, Embase, Scopus and ProQuest Dissertations and Theses Global) were searched from each database's inception date until September 2023. Thomas & Harden's thematic analysis framework was utilised for data analysis. Twenty‐three studies were included in this review. The results‐based convergent integration method identified an overarching theme titled ‘hiding behind the walls on fire, engulfed in chaos: dark and alone’, three main themes named ‘Invisible scars’: role of psychological factors on caregiver burden, navigating through social and economic influences on caregiving burden, and influence of illness‐related variables and nine subthemes. This review highlighted that the parents perceived insufficient support from healthcare providers and a lack of insight regarding their children's medical condition as the primary contributors to the burden experienced. It is imperative for healthcare professionals to collaboratively engage with parental caregivers, offering accessible treatment options for their children with mental disorders and providing comprehensive educational resources to facilitate a profound understanding of their children's mental health conditions. In addition to addressing caregivers' informational needs, the establishment of an integrated support system is advocated, one involving active participation from healthcare professionals, healthcare institutions, community resources, social services and policymakers. This holistic approach could better meet the multifaceted needs of caregivers, encompassing psychosocial, emotional and financial aspects.Trial Registration: International Prospective Register of Systematic Reviews: PROSPERO ID: CRD42022363420 [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]

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]

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: 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]

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]

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]

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]

Accessible Summary: What is known on the subject: Restraining and secluding health consumers for safety reasons continue to be used in psychiatric inpatient facilities even though they have no therapeutic value and have negative effects on consumers, families and staff.Six Core Strategies (6CS) for reducing seclusion and restraint have been developed to address this problem but there are very few effectiveness studies in inpatient adolescent psychiatric facilities. What the paper adds to existing knowledge: We used a mixed methods approach to evaluate the implementation of 6CS in an adolescent psychiatric facility. The implementation was successful. It eliminated the use of seclusion, substantially reduced the use of restraints and significantly reduced staff absenteeism.Using thematic analysis on feedback surveys, we identified five dominant themes that described consumers' and carers' experiences during their stay at the facility: communication, service delivery, flexibility, consistency and internal feeling states. What are the implications for practice: This study provides support for the feasibility of a comprehensive and broad‐based intervention program such as 6CS to reduce seclusion and restraint practices in inpatient mental health facilities.This study also demonstrates the value of using surveys to gather consumer and carer feedback and improve outcomes for service users. Introduction: Seclusion and restraint practices are routinely used in psychiatric facilities but are controversial for ethical, legal and safety reasons, and can cause significant harm to consumers, staff and organisations. Six Core Strategies (6CS) for reducing seclusion and restraint were developed to address this problem but very few studies have examined their effectiveness in adolescent settings. Aim/Question: To evaluate the implementation of 6CS in an adolescent inpatient psychiatric facility. Method: We retrieved archival data from an acute adolescent psychiatric ward that implemented the 6CS. Using a mixed methods approach, we evaluated outcomes on the use of seclusion and restraint, nursing staff sick leave and feedback surveys. Results: Findings showed an elimination of seclusion, and a significant reduction in restraint use and staff absenteeism in the 12 months after project implementation. Thematic analysis of feedback survey responses identified communication, service delivery, flexibility, consistency and internal feeling states as dominant themes in consumers' and carers' experience on the unit. Discussion: The 6CS is feasible and may be effective in reducing seclusion and restraint, which in turn may have a positive impact on staff wellbeing. Implications for Practice: Implementation of the 6CS with executive support, combined with staff and programmatic changes at a local level is recommended. [ABSTRACT FROM AUTHOR]

Copyright of Turkish Journal of Child & Adolescent Mental Health / Çocuk ve Gençlik Ruh Sagligi Dergisi is the property of Galenos Yayinevi Tic. LTD. STI and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

In the context of the current youth mental health crisis, it is prudent to reconsider how resources are allocated to facilitate the delivery of effective and comprehensive supports and services to children and adolescents. Schools are the main delivery sites for youth mental health services. Many districts have adopted comprehensive school mental health systems (CSMHS) to provide a multitiered approach comprising mental health promotion, prevention, and intervention to students via partnerships between school and community health and behavioral health providers. COVID-19 relief funding and other new federal and state investments in school mental health have led to expansions of school mental health programming in most states. An impending federal funding cliff necessitates an examination of how to wisely invest now to achieve the greatest positive future impact on youth mental health. To capitalize on opportunities to sustain effective school mental health and maximize return on investment, states may consider four strategies: leverage cross-sector partnerships to advance school mental health policies and funding, strengthen and expand Medicaid coverage of CSMHS, establish and enhance data systems, and create state technical assistance and professional development support for CSMHS implementation through local education agencies. [ABSTRACT FROM AUTHOR]

Copyright of Revista Foco (Interdisciplinary Studies Journal) is the property of Revista Foco and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Neuromodulatory interventions are relatively novel and approaches to studying harms and tolerability have varied. Using a checklist based on guidelines from Good Clinical Practice and the Harms Extension of the CONSORT (Consolidated Standards of Reporting Trials) Statement, we identified how adverse events are measured, assessed, and reported in studies evaluating neuromodulation for the treatment of mental and neurodevelopmental disorders among children and adolescents. A systematic literature review identified 56 experimental and quasi-experimental studies evaluating transcranial magnetic stimulation (TMS), transcranial alternating (tACS) or direct (tDCS) current stimulation, transcranial pulse stimulation (TPS), and vagus or trigeminal nerve stimulation (VNS or TNS). For 22 studies (39%), the types of adverse events to be monitored were identified, and for 31 studies (55%), methods for collecting adverse event data were described. Methods for assessing adverse events were less commonly described with 23 studies (41%) having details on assessing event severity, and 11 studies (20%) having details on assessing event causality. Among 31 studies with reported results, headache, skin irritation, and general pain or discomfort were the most reported across studies. Seizure, untoward medical occurrences, and intracranial bleeding, edema, or other intracranial pathology were considered serious events, but these events were not reported as occurring in any results-based papers. Taken together, the findings from this review indicate that most studies of pediatric neuromodulatory interventions did not include descriptions of adverse event monitoring and evaluation. Comprehensive event monitoring and reporting across studies can significantly augment the current knowledge base. [ABSTRACT FROM AUTHOR]

This study examines the reliability of parental concern (PC) as an indicator for mental disorders in preschool-aged children in a clinical setting, aiming to establish sensitivity and specificity, evaluate PC's predictive value for specific diagnoses, and explore the influence of child age on predictions. The sample comprises 574 children referred to child psychiatry services (mean age 47 months, 73% boys). Analyses of sensitivity and specificity for five distinct PC were conducted, while logistic regressions explored the predictive value of PC for corresponding diagnoses, accounting for child age. Language-related concerns emerged as the most frequent and accurate. Sensitivity ranged from 7% to 72%, while specificity ranged from 57% to 97%. PC demonstrated predictive validity for their corresponding diagnoses, except for motor disorders. Child age did not substantially influence these predictions. Findings suggest that systematically incorporating PC into the assessment process for preschool-aged children consulting in child psychiatry is warranted. [ABSTRACT FROM AUTHOR]

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

Background: Mental health diagnoses can co-occur with complex medical illness in pediatric patients. Pediatricians may not feel comfortable with managing psychopharmacology for patients and access to child psychiatrists can be limited. Palliative care (PC) providers follow patients with serious illness longitudinally to address burdensome symptoms that affect quality of life and may be responsible for evaluation and treatment of mental health concerns; however, education in managing psychologic distress for pediatric palliative care (PPC) providers is limited. Objective: This study seeks to describe the antidepressant prescribing practices of PPC providers and describe their level of training and comfort in assessing for anxiety and depression and prescribing psychotropic medications. Methods: An electronic survey approved by the American Academy of Hospice and Palliative Medicine was distributed nationally to PPC providers. Results: A total of 58 providers responded to the survey (response rate 12.3%). Most reported prescribing a variety of antidepressants (79%). Very few used formal assessment tools to screen for depression (7%) or anxiety (16%). Less than a third of providers consulted child psychiatry before prescribing antidepressants (29%). More than half of providers (54.5%) had no formal training in assessment and treatment of anxiety and depression in pediatric patients. Despite this, many providers (70%) reported feeling comfortable in prescribing antidepressants while also endorsing interest in more training for behavioral health evaluation and treatment (82.5%). Conclusions: Limited training in assessing mental health concerns, prescribing, and managing psychopharmacology suggests an opportunity for more targeted education for pediatric PC providers regarding antidepressant prescribing practices. [ABSTRACT FROM AUTHOR]

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

Objective: The authors sought to examine trends in stimulant initiation and follow-up care for attention-deficit hyperactivity disorder (ADHD) via telemedicine. Methods: This retrospective longitudinal study used national, deidentified commercial health insurance outpatient claims among children (ages 2–17 years; N=535,629) and adults (ages 18–64 years; N=2,116,160) from January 2019 through April 2022. Regression analyses were used to examine risk for stimulant initiation, whether initiation occurred via telemedicine or in-person care, and receipt of a follow-up visit. Results: The mean monthly adjusted number of stimulant initiations per 100,000 enrollees was similar for children before and during the COVID-19 pandemic (prepandemic, 57 initiations; during pandemic, 56 initiations) but increased for adults (prepandemic, 27 initiations; during pandemic, 33 initiations). Initiations via telemedicine peaked at 53%–57% in April 2020 and dropped to about 14% among children and 28% among adults in April 2022. Telemedicine initiations were significantly more common among psychiatrists than among other prescribers (OR=3.70, 95% CI=3.38–4.06 [children]; OR=3.02, 95% CI=2.87–3.17 [adults]) and less common for rural residents (OR=0.57, 95% CI=0.40–0.82 [children]; OR=0.75, 95% CI=0.61–0.92 [adults]). Follow-up care was significantly more common among individuals whose care was initiated via telemedicine than among those receiving in-person care (OR=1.09, 95% CI=1.00–1.19 [children]; OR=1.61, 95% CI=1.53–1.69 [adults]). Conclusions: Many stimulant treatments were initiated via telemedicine. Proposed rules to prohibit controlled substance prescribing without an in-person evaluation would require significant changes in current practice, potentially limiting access to stimulant medications for ADHD. [ABSTRACT FROM AUTHOR]

Background: The rising percentage of children and adolescents experiencing mental disorders brought attention to the emerging opportunities for proactive oral health interventions in this population. Currently, existing guidelines focus mainly on oral health in general practice and on adults residing in care homes. This report aims to provide a broad overview of the effectiveness of oral health interventions for children and adolescents with mental disorders. Method: This review followed the PRISMA (Preferred Reporting Items for Systematic Review and Meta‐Analyses 2020) statement. The initial electronic search yielded a total of 3710 articles. The search identified 2354 potential papers after removing duplicates and 2301 articles were excluded by title and abstract. The full texts of the remaining 53 articles and nine articles from the citation searching were screened and 15 articles matched the inclusion criteria. The Mixed‐Method Appraisal Tool (MMAT) was used for quality appraisal. Results: The thematic analysis resulted in four main themes which were educational intervention, physical intervention, clinical intervention, and a combination of both educational and clinical intervention. Conclusion: We presented the findings in a narrative synthesis with the primary outcomes which served as answers to our main research question that prompted this systematic review. [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.

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]

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]

Background: The mental health of children conceived using Assisted Reproductive Technologies (ARTs) such as In-Vitro-Fertilization (IVF) is a subject of significant controversy. Existing studies suggest children conceived through ART meet physical and cognitive developmental milestones at similar rates to their spontaneously conceived peers, however, a significant number of studies have connected ART conception with mental health conditions, particularly depression and attention-deficit hyperactivity disorder (ADHD) in adolescence. This study, therefore, aimed to determine whether maternal use of ARTs to achieve pregnancy is associated with an increased risk of mental disorders in these children, and whether these effects are sex-dependent or confounded by known covariates in the ART population. Methods: Secondary data analysis was performed using Growing Up in Australia: The Longitudinal Study of Australian Children (LSAC) data; a nationally representative population-based cross-sequential cohort study. Multivariate logistic regression models examined the impact of ART (including IVF and other fertility drugs, from LSAC wave-1 and wave-2 conducted in 2004 and 2006, respectively) on mental health outcomes (i.e., autism, ADHD, anxiety and/or depression, from LSAC waves 8 conducted in 2018) in Australian adolescents aged 18–19 years in 2018 (n = 1735). Known sociological and obstetric covariates including maternal age, birth weight, smoking and drinking alcohol during pregnancy, maternal gestational diabetes, postnatal depression, hypertension, and socioeconomic status were considered to generate an adjusted logistic model. Variables with a p-value of <0.05 in the regression models were considered statistically significant. Results: Of the 1735 mother-child dyads analysed, the maternal mean age was 35.6 years (Standard deviation = ±4.75), approximately 5% of mothers (n = 89) used ART to become pregnant, and 22% of adolescents (n = 384) had a mental disorder. Longitudinal analysis revealed no relationship between ART and children developing a mental disorder in the LSAC population. Conclusion: These results should reassure parents considering ART that there is no increased risk of psychological or neurodevelopmental problems in their ART conceived offspring. [ABSTRACT FROM AUTHOR]

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

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

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

Cet article rend compte des résultats d'une recherche menée conjointement par les professionnels d'une équipe de centre médico-psychologique et de sociologues. Il interroge les effets du premier confinement (printemps 2020) sur les situations des enfants suivis au CMP et leur famille, mais également sur les pratiques des soignants. L'étude a été mise en œuvre à partir de mai 2020, avec deux modalités de réflexion proposées à dix professionnels (psychologues, pédopsychiatres, orthophonistes, psychomotriciens, assistante sociale) du CMP : soit écrire un texte de quelques pages, soit participer à un entretien avec l'un des quatre sociologues. Dans les deux cas, la consigne était de partir de situations cliniques en détaillant les différents aspects sociaux et psychiques et de formuler des idées sur les effets du confinement, en s'appuyant sur des exemples cliniques tout en préservant l'anonymat des patients. Après ce premier temps d'élaboration commune, plusieurs rencontres entre soignants et sociologues ont eu lieu pour réfléchir ensemble au contenu de ces textes et élaborer une réflexion plus générale dont cet article est l'aboutissement. Cette recherche a permis de documenter l'effet de la crise sanitaire sur les enfants et les familles (renforcement des inégalités sociales) telles que perçues par les professionnels, ainsi que les adaptations des pratiques de soin (consultations à distance) et les questionnements des professionnels durant cette période. Concernant les situations des enfants et des familles, les données recueillies révèlent des inégalités sociales exacerbées par le contexte de crise sanitaire mais soulignent également l'existence de certains facteurs (type de logement, configurations familiales, rapport aux normes scolaires et sanitaires) qui ont pu créer des différences entre personnes pourtant issues de catégories socioprofessionnelles semblables. Concernant les pratiques et réflexions des professionnels, le souci de garantir la continuité du lien a été essentiel pour les professionnels, ce qui a donné lieu à des pratiques possiblement éloignées du cadre habituel, avec la limitation des rendez-vous en présence et l'usage du téléphone pour les consultations. Les professionnels se sont interrogés sur les effets et enjeux de ces suivis à distance et ont été contraints de se repositionner sur les plans clinique et thérapeutique. Cette expérience de recherche invite à renouveler ce type d'étude, pour la richesse des résultats obtenus grâce au croisement des regards des soignants et des sociologues, mais aussi pour son intérêt du point de vue de la réflexivité de l'équipe soignante. In this article, we present the results of a research project conducted jointly by professionals from a child and adolescent mental health center (CMP) and sociologists. We explore how the first confinement (in the spring of 2020) affected the situation of the child patients at the CMP and their families, as well as the care practices of the professionals. The study was implemented in May 2020. Nine mental health professionals (psychologists, child psychiatrists, speech therapists, psychomotor therapists, social worker) were invited either to write a text reflecting on their experience, or to participate in an interview with one of the four sociologists. In both cases, the suggestion was to describe clinical situations, focusing both on social and psychological aspects, and to formulate ideas on the effects of confinement based on these clinical examples, while preserving the anonymity of the patients. Following this phase, the mental health team and the sociologists met several times to collectively discuss the content of these texts and to elaborate a reflection at a more general level that resulted in this article. This research illustrates some effects of the Covid-19 crisis on children and families, notably the reinforcement of social inequalities, as witnessed by mental health care professionals. It also documents the adaptations of care practices (e.g. remote consultations) during this period, as well as the multiple questions that professionals had to address. Regarding the situations of the children and their families, the data collected reveal that social inequalities have been exacerbated by the context of the pandemic, but it also underscores how certain factors (type of housing, family configurations, individuals' relationships with academic and public health norms) may have contributed to differences between families from similar socio-professional categories. Regarding mental health care, it appears that guaranteeing the continuity of the relationship with the child and/or the family was a crucial concern for the professionals. As face-to-face appointments were limited, practices arose that were not seen as options in the usual work environment and habits, such as phone consultations. Professionals questioned the effects and stakes of these remote encounters and were forced to reposition themselves clinically and therapeutically. This research experience encourages us to renew this type of study, because of the richness of the results produced by an analysis associating professionals and sociologists, but also because of its contribution to the mental health team's capacity to reflect critically on its own practices. [ABSTRACT FROM AUTHOR]

Transgender and gender diverse (TGD) youth, individuals whose gender identity is different from the sex that was assigned at birth, report higher rates of mental health and emotional challenges and are approximately twice as likely to access psychiatric inpatient services compared with cisgender peers. 1 Existing research has suggested that the minority stress that TGD youth face from having to navigate transphobic cultural contexts and systems (eg, unsupportive parents/caregivers, school staff, peers) may play a key factor in mental health disparities, such as increased risk of depression, anxiety, suicidal ideation, suicide attempts, and nonsuicidal self-harm. 1,2 These higher rates of mental health challenges among TGD youth offer an explanation as to why these youth access inpatient services significantly more frequently than cisgender peers. Research has found that TGD youth often experience discrimination during psychiatric inpatient admissions (eg, being misgendered during admission intake, facing stigmatization for an evolving gender identity, and receiving care from staff who have not been trained to provide gender-affirming care), 3 despite professional organizations, such as the American Academy of Child and Adolescent Psychiatry, underscoring the importance of TGD youth receiving psychiatric care that is inclusive and affirming. 4 Given that the inpatient setting offers a unique opportunity to facilitate positive and affirming changes for TGD youth, it is essential for providers to have a strong understanding of what affirmative care looks like within this context to best support this vulnerable patient population and reduce experiences of discrimination. [ABSTRACT FROM AUTHOR]

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

Practicing newly acquired skills in different contexts is considered a crucial aspect of Cognitive Behavioral Therapy (CBT) for anxiety disorders (Peris et al. J Am Acad Child Adolesc Psychiatry 56:1043–1052, 2017; Stewart et al. Prof Psychol Res Pract 47:303–311, 2016). Learning to cope with feared stimuli in different situations allows for generalization of learned skills, and experiencing non-occurrence of the feared outcome helps in developing non-catastrophic associations that may enhance treatment outcomes (Bandarian-Balooch et al. J Behav Ther Exp Psychiatry 47:138–144, 2015; Cammin-Nowak et al. J Clin Psychol 69:616–629, 2013; Kendall et al. Cogn Behav Pract 12:136–148, 2005; Tiwari et al. J Clin Child Adolesc Psychol 42:34–43, 2013). To optimize treatment outcome, homework is often integrated into CBT protocols for childhood anxiety disorders during and following treatment. Nevertheless, practicing at home can be challenging, with low motivation, lack of time, and insufficient self-guidance often listed as reasons for low adherence (Tang and Kreindler, JMIR Mental Health 4:e20, 2017). This conceptual review provides an overview of (1) how existing CBT childhood programs incorporate homework, and empirical evidence for the importance of homework practice, (2) evidence-based key elements of practice, and (3) how mHealth apps could potentially enhance practice at home, including an example of the development and application of such an app. This review therefore sets the stage for new directions in developing more effective and engaging CBT-based homework programs for childhood anxiety disorders. [ABSTRACT FROM AUTHOR]

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

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

After decades of controversy, the concept of childhood depression now seems to be part of standard medical knowledge. Yet the form and content of this nosological entity, like many psychiatric diseases, is continuously shaped by the scientific, clinical, and political communities involved in child psychiatry. In this qualitative study, we explored how the concept of childhood depression is constructed in early twenty-first century child psychiatry. We conducted a series of 18 interviews with practising child psychiatrists, international experts in the field, and interpreted them with thematic analysis informed by discourse analysis. We identified five overarching discourse themes across interviews, relating to the definition of depression, the diagnostic process, the causes of this condition, the therapeutic strategy, and the scientific role of child psychiatry. Most participants agreed that childhood depression was a mental disorder where irritability prevailed, heavily influenced by psychosocial factors, and for which psychotherapy was the ideal treatment. However, subtle points of dissent also surfaced: whether depression is primarily a mood state or psychological suffering, whether categories or dimensions are more suitable to make the diagnosis, and whether there is a genetic predisposition were some of the most controversial topics. Theoretical considerations regarding childhood depression may have significant scientific, moral, and socio-political implications beyond child psychiatry and should be addressed appropriately. [ABSTRACT FROM AUTHOR]

Introduction: Autism Spectrum Disorder (ASD) is a complex and variable neurodevelopmental condition that affects how individuals perceive and interact with the world around them. Characterized by significant difficulties in social communication and the presence of restrictive and repetitive behaviors, ASD is a disorder that can influence all aspects of a person's life. Purpose: The purpose of this paper is to identify the influence that risk factors can have on the pathogenesis of autism spectrum disorder, through the description of a clinical case. Material and methods: We present the clinical case of a 7-year-old patient admitted to the Pediatric Psychiatry Department at the Clinic of Pediatric Neurology and Psychiatry in Timișoara, exhibiting clinical symptoms indicative of autism spectrum disorder. Results: Given the increasing frequency of this condition and its multiple implications on familial, social, educational, and professional aspects, this article will report on a clinical case diagnosed with autism spectrum disorder, highlighting the implications of risk factors. The patient underwent clinical and paraclinical investigations, psychiatric and psychological evaluations, and received specialized treatment, showing slow but favorable progress over time. Discussions: Understanding the risk factors associated with the pathogenesis of autism spectrum disorder is crucial for early diagnosis and intervention. Risk factors for ASD are diverse, encompassing both genetic and environmental components that impact the clinical presentation and long-term outcomes. Conclusions: Autism Spectrum Disorder (ASD) is a complex and multifactorial condition that requires a comprehensive understanding of the numerous risk factors involved in its pathogenesis. From genetic and hereditary components to prenatal, perinatal, environmental, and biological influences, each of these factors plays a crucial role in determining an individual's susceptibility to ASD. [ABSTRACT FROM AUTHOR]

Family navigation (FN) and phone-based care coordination may improve linkages from primary care to community-based mental health referrals, but research on their differential impact is limited. This mixed-methods study compared FN and phone-based care coordination in connecting families to mental health services from primary care. Families of children (56.3% male, mean age = 10.4 years, 85.4% Black) were sequentially assigned to either receive FN through a family-run organization or phone-based coordination via the child psychiatry access program (CPAP). Caregiver-reported children's mental health improved in both groups and both groups were satisfied with services. More families in the CPAP group had appointments made or completed (87%) than families in the FN group (71%) though the difference was not statistically significant. Future research with a larger sample that matches family needs and preferences (e.g., level and type of support) with navigation services would be beneficial. [ABSTRACT FROM AUTHOR]

Virtual Reality (VR) technology allows the design and application of realistic but adaptive learning environments in medical education. In particular, virtual patient systems have logistical and methodological advantages compared to noncomputerized interventions. However, evidence for their effectiveness is fragmented as any educational domain introduces its requirements regarding learning goals, measurements of learning outcomes, and application design. In this context, we present preliminary results of evaluating a VR training application for conducting a clinical interview to diagnose mental disorders in children and adolescents using virtual patients. The evaluation focuses on design elements related to the virtual patient’s appearance and natural language capabilities. Our results indicate that our virtual patient design is highly believable and that our dialog system is satisfying. However, conversational flow requires optimization. We discuss design directions and potential enhancements for learner-virtual patient interactions in VR and address future operations to evaluate the effectiveness of our approach. [ABSTRACT FROM AUTHOR]

Background: Few studies have assessed the burden of mental disorders among children and adolescents considering the impact of co-morbidities and suicide on disability adjusted life years (DALYs). Methods: This was a multicenter cross-sectional study. Our survey data in Liaoning Province (LN) were used to estimate the burden of six mental disorders, supplemented with data from other investigative studies conducted in China to assess four other disorders. DALYs were derived from the sum of years lived with a disability (YLDs) adjusted for co-morbidities, and the years of life lost (YLLs) adjusted for suicide. The changes in DALYs, YLDs, and YLLs were compared with and without adjustment for co-morbidities and suicide. Results: The DALYs rate of mental disorders among children and adolescents in LN decreased from 1579.6/105 to 1391.4/105, after adjusting for both co-morbidities and suicide (-11.9%). The DALYs rate for major depression, anxiety disorder, and conduct disorder (-80.8/105, -75.0/105 and -30.2/105, respectively) were the top three contributors to the DALYs reduction (-188.2/105). The YLDs decreased from 72724.8 to 62478.5 after co-morbidity adjustment (-17.8%), mainly due to the reduction by major depression (-35.3%) and attention deficit/hyperactivity disorder [ADHD] (-34.2%). The YLLs increased from 130 to 1697.8 after adjusting for suicides (+ 56.9% of all suicide YLLs), mainly due to the contribution of major depression (+ 32.4%) and anxiety disorder (+ 10.4%). Compared to GBD 2010, the estimated DALY rate for mental disorders in LN was to be about 80%, with the proportion of DALYs and DALY rates explained by major depressive disorder accounted for only approximately one-third (14.6% vs. 41.9% and 202.6 vs. 759.9, respectively). But the proportion and absolute level of DALY rates explained by anxiety disorders were approximately 2-fold higher (39.7% vs. 19.6% and 552.2 vs. 323.3, respectively). Conclusions: The DALYs of mental disorders among Chinese children and adolescents were approximately 80% of the global level, with anxiety disorders imposing about 2 times the global level. Co-morbidity and suicide must be adjusted when calculating DALYs. [ABSTRACT FROM AUTHOR]

Background: It was aimed to examine the sociodemographic and clinical characteristics of 638 children who applied to Şanlıurfa Training and Research Hospital for Special Needs Report for Children (SNRC) and to contribute to new studies in the field of mental health with the results obtained. Materials and Methods: In our study, children and young people who applied to Şanlıurfa Training and Research Hospital for the purpose of a special needs report for children in the 6-month period between 01.10.2023 and 31.03.2024 were included. Participants' information was scanned retrospectively through the hospital information system. Results: The gender distribution of the cases was 261 (40.9%) females and 377 (59.1%) males with a male/female ratio of 1.44. The median age of the patients was 94.5 months (IQR 25/75: 51/134 months). When the distribution of the diagnoses of the cases was analyzed, it was observed that the problems in the cognitive domain were in the first place. In the cognitive domain, the most frequently reported condition was mental capacity at a level requiring an HSN (has special needs) rate. Speech sound disorder and ASD (autism spectrum disorder) were found to be statistically significantly higher in males. The level of need for HSN was found to be more frequent in males. In the diagnoses of delayed milestone, delayed development of receptive or expressive language, and speech disorder (all diagnoses within speech sound disorder within the scope of SNRC), it was found that the group with a statistically significant diagnosis had a lower average age than those without a diagnosis. In the diagnoses of childhood-onset speech fluency disorder and specific learning disability, the mean age of individuals with a diagnosis was statistically significantly higher than that of individuals without a diagnosis. Conclusions: Child and adolescent mental health and illness specialists and all health professionals who care for children should have the necessary knowledge to make appropriate referrals to ensure the educational and social rights of children and young people with special needs. In this context, it is important that physicians working with children and adolescents in our country have sufficient knowledge about SNRC and that their awareness on this issue is increased. [ABSTRACT FROM AUTHOR]

In this commentary, I argue that including and operationalizing allostatic processes will become increasingly important in future research on parent–child biobehavioral coregulation. In particular, the conceptualization and modeling of dyadic oscillatory rhythms that align in expected ways with the child's developmental stage and that distinguish typical and atypical development will be useful in future work. Despite the inherent asymmetry characteristic of parent–child relationships, we should not forget to consider the child's effects on the parent within and across time, the additional environmental demands upon parents that shape parent–child coregulation, and variations in parent–child asymmetry by parental risk factors. Studying risk factors that are dyadic in nature, such as child maltreatment, may be particularly informative in gaining a deeper understanding of how parent–child coregulation interfaces with developmental psychopathology. To best model parent–child coregulation as a dynamic system, it will be critical to employ more nonlinear analytic models and better represent the multiple hierarchical domains of coregulation and their interactions, including affect, cognition, behavior, and biology. Finally, in future research, a deeper application of existing dyadic and dynamic theories, as well as the generation of new dyadic developmental theories, will aid us in obtaining a stronger understanding of the developmental function and intervention implications of parent–child biobehavioral coregulation. [ABSTRACT FROM AUTHOR]