Child Psychiatry & Human Development最新文献

Weight gain is instrumental in recovery from anorexia nervosa (AN)/atypical AN, yet the effect of premorbid weight status on treatment-related weight gain is unclear. In 71 medically hospitalized adolescents with AN/atypical AN, relative weight gain, measured via change in BMI z-scores, was assessed over 12-months of outpatient treatment following hospitalization and compared for premorbid weight status. Patients with premorbid overweight/obesity had a longer illness duration (p = .03) and more weight loss (p < .001) than patients with premorbid normal weight, and less weight gain at 3-, 6-, 9-, and 12-months post-discharge (all p's ≤ .01). Premorbid weight status was not associated with treatment dropout, medical readmissions, psychiatric hospitalizations, or psychotropic medication use (all p's > .05). Findings tentatively suggest that inpatients with AN/atypical AN and premorbid overweight/obesity gain less weight in the 12-months post hospitalization, despite similar illness severity indicators. Rigorous prospective studies are needed to solidify factors underlying these trends.

This study is an evaluation of group-based acceptance and commitment therapy (ACT)-a transdiagnostic therapeutic approach-in adolescents with anxiety and/or depressive psychiatric disorders in a community hospital outpatient setting. The objective was to evaluate treatment effects on 1) symptom reduction and 2) psychological flexibility measured by underlying ACT processes (avoidance, fusion, mindfulness, valued action) and evaluate whether improvements represent reliable and clinically significant change. Measures were completed by 99 outpatients aged 13 to 18 pre- and post-treatment and at 3-month follow-up. Generalized estimating equation analysis and pairwise comparisons were used to identify changes in symptoms and ACT processes over time. Results showed decreases in anxiety symptoms (pre to post d = -.50; post to 3-month follow-up d = -.41); 2) depression symptoms (d = -.51; d = -.46); 3) and avoidance/fusion (d = -.60; d = -.49), increased mindfulness (d = -.70; d = -.34); and enhanced commitment to values-based action from post-treatment to 3-month follow-up (d = .25). About half of participants reporting clinically elevated symptoms before treatment showed reliable and clinically significant improvement 3-months after treatment ended. Results support the utility of group-based ACT with adolescents. This is the first evaluation conducted in Canadian adolescents seeking community hospital outpatient services for wide ranging and complex mental health difficulties. Future research should continue to take a transdiagnostic perspective and include a control or comparison group and adolescents from different settings.

Children victimized by their peers and those with sleep disturbances are at risk for developing an array of difficulties and disorders. While there is some evidence suggesting that sleep impacts peer victimization and peer victimization results in sleep disturbance, the longitudinal bidirectional associations between peer victimization and sleep disturbance have been understudied, particularly in late childhood. Further, gender differences in these associations are largely unknown. To further understand these links, 175 children (ages 8-11, M = 9.30, 51.4% girls) in grades 3-5 completed measures of peer victimization and sleep disturbance. Physical victimization at Time 1 significantly predicted sleep disturbance 6 months later at Time 2, while sleep disturbance at Time 1 showed a marginally statistically significant association with later physical victimization 6 months later, suggesting a potential bidirectional relationship. Relational victimization was not longitudinally related to sleep or vice versa. Results also suggest similar effects for boys and girls. Implications of these findings are offered.

The School Anxiety Scale - Teacher Report (SAS-TR) assesses children's anxiety from the teacher's perspective. Originally developed in English and subsequently validated in Spanish and Iranian populations, a validated Italian version is still lacking. The current study aimed to translate, adapt and validate the SAS-TR into Italian. The SAS-TR was translated from English into Italian following 5 stages of cross-cultural adaptation and was assessed for face and content validity by five primary school teachers. A sample of 66 teachers completed the SAS-TR in a community sample of 201 children aged 6-11 years. Exploratory and confirmatory factor analysis were performed. To investigate the concurrent validity, teachers also completed the Strengths and Difficulties Questionnaire-Teacher (SDQ-T). After four weeks, the teachers re-provided ratings on the SAS-TR to assess test-retest reliability. SAS-TR ratings for the same children provided by permanent teachers (who have ≥ 10 teaching hours in classroom) and specialist teachers (who have < 10 teaching hours in classroom) were compared. Exploratory and confirmatory factor analysis confirmed the two-factor structure and the goodness fit of the scale, excluding item 12. The Italian SAS-TR exhibited strong face and content validity (mean = 3.71 ± 0.57), excellent internal consistency (α = 0.902) and almost perfect test-retest reliability over 4-weeks (ICC = 0.829). Additionally, moderate and statistically significant correlations between SAS-TR and SDQ-T "Emotional symptoms" subscale (ρ_s = 0.62) supported concurrent validity. Finally, permanent teachers reported higher levels of anxiety symptoms compared to specialist teachers (p < 0.05). Overall, the Italian version of SAS-TR demonstrates adequate psychometric properties, suggesting its suitability for assessing anxiety symptoms in children aged 6-11 by teachers.

Suicide ideation and attempts account for over half of emergency department visits among adolescents in the United States. Social connectedness has been identified as a protective factor, yet little is known about its role in the moments during a suicidal crisis. We examined adolescents' retrospective anticipation of others' emotional reactions to their prospective death by suicide as an indicator of perceived social (dis)connectedness during a suicidal crisis. Qualitative responses from a clinical sample of 104 adolescents (79 female), ages 12-19, with recent suicide ideation or attempt were analyzed using reflexive thematic analysis. Three superordinate themes were developed: (1) living for others: social bonds as protective anchors, (2) social disconnection and emotional disengagement, and (3) navigating dynamic social connections: protective or risk amplifying. These findings suggest that suicide-related interventions should address adolescents' perceptions of social (dis)connectedness and target both interpersonal and intrapersonal factors during moments of crisis to improve clinical outcomes.

This study uses diagnostic classification models (DCMs) to improve how emotional and behavioral disorders (EBD) are assessed in children and adolescents in Iran. Data from 1,437 Iranian students aged 6-18 were analyzed using the DSM-oriented Child Behavior Checklist, focusing on six symptom areas: depression, anxiety, somatic complaints, attention-deficit/hyperactivity, oppositional defiant behavior, and conduct problems. Instead of relying on total scores, DCMs examine patterns of symptoms across multiple domains at the item level. A theory-based Q-matrix aligned with DSM criteria was developed, validated by experts, and evaluated using modern model-fit tools, including lens plots and RMSD indices. Results showed that simpler (reduced) models fit the data better than the fully saturated model. Strong links were observed between anxiety and depression, as well as between oppositional defiant and conduct problems. Some symptom areas (such as anxiety and oppositional defiant problems) showed greater uncertainty in classification, while others (such as somatic and conduct problems) were more stable. Importantly, children with the same total symptom scores often had very different symptom profiles, highlighting the limits of traditional scoring methods. Overall, the findings suggest that DCMs can provide a more precise and informative view of children's mental health symptoms, especially in culturally specific contexts. Further research is needed to confirm how well these classifications relate to real-world functioning and clinical outcomes.

The global rise in youth mental ill-health is exacerbated by a shortage of clinicians trained in evidence-based care, making it difficult to translate research into effective practice - especially for body dysmorphic disorder (BDD), an adolescent-onset condition that often goes undetected and untreated. This study aimed to explore clinicians' experiences of participation in an online educational programme focused on the assessment and treatment of BDD in youth. We also aimed to investigate their use of newly learned skills after completing the programme. Semi-structured interviews were conducted with 12 clinicians who had completed the online education. Conventional content analysis was used, identifying three main categories. The online format - personal and flexible included reports on building personal connection within online education, flexibility allowing for individualised and integrated learning, and on-demand online supervision facilitating participation. Educational content - motivated learning and facilitated application concerned diverse perceptions of test value, challenge and impact, varying content presentation making the education effective and credible, interactive and practical content for real-world application, and personalised and supportive learning through detailed feedback. Learning outcomes - increased knowledge and changed working practices included descriptions of enhanced proficiency in assessment and treatment of BDD, transdiagnostic value and use, and spreading knowledge and improving clinical routines. Participants reported generally positive experiences of the training and changes in working practices following training. Limitations were also noted, such as insufficient applied skills training and peer support. Future improvements should focus on enhancing practical skills training and providing additional implementation support at both clinician and organisational level.

Persistent tic disorders (PTD), including Tourette Syndrome (TS), impact individuals' lives well beyond motor and vocal tics, affecting self-beliefs, relationships, and daily functioning. This qualitative study examined stigma and discrimination experienced by youth and adults with TS, their caregivers, and healthcare providers through in-depth interviews with 35 participants. Thematic analysis revealed four major themes: limited resources and funding, widespread misconceptions and stereotypes, negative experiences shaping self-perceptions and behaviors, and the importance of supportive environments in fostering resilience. Participants reported that widespread misunderstanding and exclusion led to significant psychosocial challenges, which were often more disruptive than the tics themselves. The findings highlight the need for clinical and behavioral interventions that address broader psychosocial issues, not just symptom management. Future research should explore resilience and protective factors that may help buffer against adverse experiences and improve psychosocial outcomes. This study was pre-registered at ClinicalTrials.gov (NCT05696769) and the Open Science Framework https://doi.org/10.17605/OSF.IO/EX52G .

Early maternal life experiences, such as childhood maltreatment (CM), particularly emotional neglect may disrupt her recall of parental bonding experiences and the development of a healthy mother-infant relationship. This pilot study of thirty-eight postpartum Latina mothers examined preliminary intergenerational associations of maternal retrospective self-reported history of CM, particularly emotional and physical neglect (Childhood Trauma Questionnaire-CTQ), perception of parental bonding (PBI) and postpartum bonding PBQ with her infant. Nonparametric correlations showed that higher emotional neglect, more consistent than physical neglect, was associated with a lower perceived maternal and paternal care, and higher paternal overprotection. Furthermore, hierarchical regression analyses demonstrated preliminary evidence that emotional neglect was the most consistent predictor of postpartum bonding difficulties, including general bonding impairment, rejection/anger, and infant-focused anxiety. Higher maternal gestational age emerged as a possible protective factor across model, associated with more favorable bonding outcomes. These preliminary findings suggest that emotional neglect may exert lasting intergenerational effects on perceived parental bonding and maternal bonding capacities in the postpartum period. These results highlight the need for trauma-informed perinatal care and early screening of adverse childhood experiences (ACEs) to prevent child maltreatment in Hispanic populations.

This study examined associations of parents' subjective perceptions of disaster-related harm from the Great East Japan Earthquake (GEJE) with their mental health and with emotional and behavioral problems in their children born post-disaster. Participants included 218 parents (207 mothers, 11 fathers) and 219 children born post-GEJE, residing in affected areas. Parents served as proxy reporters, completing measures assessing their disaster-related experiences, psychological distress, depressive symptoms, post-traumatic stress symptoms, and their children's emotional and behavioral problems. Structural equation modeling was conducted to evaluate pathways among variables. Higher disaster-impact scores were significantly associated with poorer parental mental health (β = 0.15, p = .048), which was associated with more emotional and behavioral problems in children (β = 0.43, p < .001). The relationship between disaster impact and children's outcomes was mediated through parental mental health rather than through a direct pathway. Children's psychological adjustment following large-scale disasters may be influenced by their caregivers' mental health, even without direct trauma exposure. Family-centered mental health interventions are essential components of comprehensive disaster-recovery strategies.