Child Psychiatry & Human Development最新文献

Children and young people living in the Occupied Palestinian Territory (OTP) are repeatedly exposed to potentially traumatic events that can challenge their mental health and school functioning. This study aimed to develop a practical checklist of conflict-related potentially traumatic events of relevance in the school context throughout the OPT. Post-traumatic stress reactions (PTSR) and school functioning assessed the predictive validity of the checklist. Furthermore, we sought to explore the frequency of exposure, PTSR and school functioning between the areas in the OTP and explore how frequency and severity of exposure was associated to PTSR and school functioning. The study was conducted using a mixed method approach between January-June 2019. A qualitative approach with focus group workshops in Gaza city and Ramallah in the West Bank defined the checklist. Quantitative data and statistical analysis validated the checklist and explored the further objectives. The checklist was administered to pupils aged 12-16 (N = 789) recruited from 17 schools in East-Jerusalem, the West Bank and the Gaza Strip, which reported a mean of 5.06 (SD = 2.48) conflict-related potentially traumatic events within the past three months, regardless of where they came from. The predictive validity of the checklist was found to be significant (p < .01), and exposure predicted PTSR and school functioning. Since the checklist consists of only 12 items, it is practical to use for screening and monitoring in a school context. The extent to which the checklist can serve as a multipurpose checklist remains to be tested through practical use, followed by evaluations and further research.

Research indicates that remission rates for social anxiety disorder are significantly lower (35%) than for any other anxiety disorder (54%) following cognitive behavioral therapy (CBT). Nevertheless, CBT remains the recommended treatment for adolescents with social anxiety disorder. The literature shows limited knowledge regarding which adolescents with primary social anxiety disorder respond better or worse to group-based cognitive-behavioral therapy (CBT). The current study aimed to identify baseline predictors of change in treatment response from group-based CBT for 90 adolescents aged 12-17 years with a primary diagnosis of social anxiety disorder. Treatment response was evaluated as changes from baseline to three-month follow-up in self-reported social anxiety symptoms and clinician-rated social anxiety diagnosis. The examined predictors were as follows: Demographic predictors included age, gender, and parents' education level. Clinical predictors included social anxiety symptoms, anxiety symptoms, interference in daily life, depressive symptoms, parents' overall anxiety, depression, and stress level. Theory-derived predictors were based on theoretically maintaining factors of social anxiety disorder and included safety behaviors, self-focused attention, post-event processing, and distorted cognitions. Mixed linear models were applied to analyze the predictor's effect on each outcome variable over time. Results indicated that higher severity of safety behaviors and social anxiety symptoms at baseline predicted larger improvement in self-reported social anxiety symptoms. Moreover, higher severity of social anxiety symptoms and anxiety symptoms predicted less likelihood of being free of social anxiety diagnosis. None of the other variables predicted significant change in either self-reported social anxiety symptoms or clinician-rated social anxiety diagnosis. In conclusion, the findings indicate that adolescents with a high degree of safety behaviors and social anxiety symptoms improved the most from group-based CBT, but also, that high baseline symptom severity remains elevated and have an increased risk of a social anxiety diagnosis at three-month follow-up. However, replication of these findings is needed in more sufficient powered trials.

Transgender and gender diverse (TGD) adolescents experience disproportionately higher rates of mental health concerns compared to cisgender adolescents. This paper compares the clinical and psychosocial risk profiles of TGD and cisgender adolescents seeking treatment for mental health concerns. Data was obtained from adolescents waiting for psychiatric care (age 12-17; N = 1362). Severity of mental disorder symptoms, substance use, self-harm, suicidal ideation, trauma experiences, and daily functioning were compared. TGD adolescents experienced significantly more symptoms of depression, anxiety and ADHD, self-harm, suicidal ideation and attempts and trauma experiences than cisgender peers. This data replicates previous findings that TGD adolescents experience greater psychopathology and psychosocial stressors than cisgender peers adding findings from a treatment seeking sample.

Developmental pathways to callous-unemotional (CU) traits are heterogeneous, with early social experiences and stress physiology, such as hypothalamic-pituitary-adrenal (HPA) axis functioning, likely playing key roles. However, few studies have examined how adversity and HPA axis functioning in early childhood relate to later CU traits. Using Latent Basis Growth Mixture Modeling with a longitudinal sample (N = 1,292), we examined relations between trajectories of salivary basal cortisol in early childhood (6, 15, 24, and 48 months), adversity at 6 months, and CU traits at preadolescence (M_age = 13.22, SD = 0.62 years, range = 12.52-15.68 years). Results revealed a low-stable basal cortisol class (class 1, ~ 95%) and an unstable class (class 2, ~ 5%) transitioning from high to low cortisol. Class 2 had significantly higher levels of CU traits at preadolescence than class 1. Early adversity at 6 months predicted CU traits in class 2. These findings identify a specific physiological pattern under which early adversity relates to later CU traits.

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.