Child Psychiatry & Human Development最新文献

There is a high prevalence of untreated depression in adults and youth observed at the population level in the United States, and many who would benefit from treatment do not receive it. One proposed effort to increase access to care is the use of measurement-based care (MBC; repeated use of symptom measures for screening and treatment guidance) by primary care physicians to treat non-complex cases of depression. MBC has been shown to improve patient outcomes compared to care as usual, but there are barriers that need to be addressed at the health system level for effective implementation to occur. Herein we provide an overview of MBC and detail benefits and barriers of MBC implementation. Relevant considerations and guidance for implementing MBC are presented, and a case example of a health system implementing MBC is included. Though issues of reimbursement, limited human and technological resources, and resistance to systemic change are barriers to implementing MBC, effective strategies exist to overcome these barriers. In addition to helping health systems align with changes to value-based care models, effective implementation of MBC can likely improve patient outcomes and result in net financial benefits.

Despite the significant increase in adolescent mental health challenges in recent years, structural barriers continue to limit access to and engagement in mental health services. As such, opportunities to learn directly from adolescents and their families on how to best structure and deliver services are paramount. The current study assumes a multi-informant approach and reports on adolescents' and caregivers' (N = 33) experiences in an adapted telehealth/hybrid Dialectical Behavior Therapy for Adolescents (DBT-A) program. Focus groups were conducted across two cohorts of families who participated in DBT-A skills groups, to collect family-centered data on the acceptability of program modifications, engagement in the adapted telehealth/hybrid DBT-A, and recommendations for improvement. Participants were predominately Latine White and were from a broad range of socioeconomic backgrounds. Additionally, 45.5% of the adolescents identified as LGBTQ + . Focus group findings emphasized how the telehealth platform was both convenient and disengaging, and how in-person sessions offered improved group connection and content engagement. Participants underscored the importance of balancing multi-family group sessions with adolescent- and caregiver-only group sessions in the program, and adolescents emphasized a need for the DBT-A program to better center adolescents' unique experiences and voices throughout sessions. Both adolescents and caregivers suggested modifications to synthesize the content and improve generalizability of the DBT-A skills to their real lives. Overall, these findings add to a new and evolving branch of DBT-A qualitative inquiry, as well as the growing body of work that recommends incorporating the voices of people with lived experiences into the development and modification of psychological services.

Correctly assessing children's theory of mind (TOM) is essential to clinical practice. Yet, most tasks heavily rely on language, which is an obstacle for several populations. Langdon and Coltheart's (Cognition 71(1):43-71, 1999) Picture Sequencing Task (PST), developed for research purposes, avoids this limitation through a minimally-verbal procedure. We thus developed a tablet adaptation of this task for individual application, engaging children's motivation and allowing response times collection. To assess this tablet-PST, we first tested a large sample of neurotypical children (6-11 years-old, N = 248), whose results confirmed the task's structural and content validity, and permitted the construction of three standardized clinical indices. In a second experiment, we applied those to previously diagnosed autistic children (N = 23), who were expected to show atypical TOM performance. Children's outcomes were consistent with what was hypothesized and confirmed the task's external validity and moderate clinical sensitivity. The tablet-PST thus appears as a suitable tool, providing detailed profiles to inform clinical decisions.

Despite the growing support for the multiple developmental pathways to phenotypic callous-unemotional (CU) traits (i.e., primary, and secondary CU variants), there remains limited research on childhood manifestations of CU variants in non-Western, community samples. Using a latent profile analysis with data sourced from the longitudinal, nationwide Korean sample (N = 1597, 48.7% girls), we discerned heterogeneous groups of children, based on externalizing problems, CU traits, and emotional reactivity level. The optimal five-profile solution identified distinct subgroups: low-risk, primary CU (characterized by low emotional reactivity and externalizing problem), reactive (low CU/moderate emotion reactivity and externalizing problem), and two secondary CU groups (i.e., secondary-high CU and secondary-moderate CU; both high in emotional reactivity and externalizing problems). The two secondary CU variants demonstrated differences from the primary CU variants, in that both are high in preschool externalizing problems (age 6) and school-age conduct problems (age 11). However, the secondary-moderate CU group displayed greater levels of anxiety at age 11 compared to secondary-high CU, indicating divergent developmental trajectories of secondary CU variants. These findings expand our understanding of CU variants among Korean preschoolers and highlight the role of emotional reactivity in distinguishing such subtypes and identifying their developmental outcomes across time.

Few studies have reported long-term follow-up data on selective preventive interventions for adolescents. No follow-up selective preventive transdiagnostic studies for adolescents at-risk for emotional disorders, such as anxiety and depression, have been reported. To fill this gap, this study aims to provide the first follow-up assessment of a randomized controlled trial (RCT) studying selective transdiagnostic prevention in at-risk adolescents. A 12-month follow-up assessment was conducted with subjects who originally received either PROCARE (Preventive transdiagnostic intervention for Adolescents at Risk for Emotional disorders), PROCARE+, which includes the PROCARE protocol along with personalized add-on modules or an active control condition (ACC) based on emotional psychoeducation, and their respective booster session for each experimental condition. 80 subjects (47.5% girls) aged between 12 and 18 years (M = 14.62; SD 1.43) who completed these treatment conditions were available for the 12-month follow-up. The results demonstrate the superior long-term efficacy of the PROCARE+ intervention in mitigating emotional symptoms and obsessive-compulsive symptomatology compared to the PROCARE and ACC conditions, with effect sizes notably exceeding those commonly observed in preventive programs. While the three treatments demonstrated beneficial impacts, the pronounced results associated with PROCARE+ at the 12-month follow-up emphasized the importance of personalized treatment modules and the sustained benefits of booster sessions in the realm of preventive psychological interventions. The findings also highlight the potential role of add-on modules in enhancing the effects of the PROCARE+ condition.

This study analyzes suicide rates, causes, methods, and age- and gender-specific trends among children and adolescents in Turkey (2004-2023) using Turkish Statistical Institute data. Utilizing data from the Turkish Statistical Institute, suicide deaths across two age groups (< 15 years and 15-19 years) were examined. During this period, 8,954 suicides were recorded, with 52.6% involving males. Hanging (41.3%) and firearms (30.2%) were the most frequently used methods, showing significant gender differences (p < 0.01). Family discord emerged as the leading cause of suicide among females, while illness was predominant among males. The findings underscore the urgent need for culturally tailored, evidence-based suicide prevention strategies. Key measures include restricting access to means of suicide, enhancing family-based interventions, and improving mental health services with a focus on early detection. Adoption of the WHO's "LIVE LIFE Initiative for Suicide Prevention" could provide a robust framework to reduce youth suicide rates in Turkey.

Integration of measurement-based care (MBC) into clinical practice has shown promise in improving treatment outcomes for depression. Yet, without a gold standard measure of MBC, assessing fidelity to the MBC model across various clinical settings is difficult. A central goal of the Texas Youth Depression and Suicide Research Network (TX-YDSRN) was to characterize MBC across the state of Texas through the development of a standardized tool to assess the use of MBC strategies when assessing depression, anxiety, side effects, and treatment adherence. A chart review of clinical visits indicated standardized depression measures (71.2%) and anxiety measures (64%) were being utilized across sites. The use of standardized measures to assess medication adherence and side effects was limited to less than six percent for both, with the majority utilizing clinical interviews to assess adherence and side effects; yet medication was changed in nearly half. Rates of utilization of standardized measures for participants with multiple MBC forms were similar to those who only provided one form.

Deficits in effortful control (EC) contribute to patterns of maladaptation across development; however, little is known about how specific subfactors of EC differentially predict children's externalizing psychopathology. Using a longitudinal sample of 206 children (47.8% female, 42.6% Caucasian), the current study employed a bi-factor structural equation modeling approach to examine the concurrent and longitudinal associations between EC and its subfactors (i.e., attentional focusing, low-intensity pleasure, perceptual sensitivity, inhibitory control) and conduct problems, attention deficit disordered behaviors (ADD), and callous-unemotional (CU) traits at 36 and 84 months, respectively. Results indicated that increased general EC at 36 months predicted reduced CU traits and ADD at 84 months. Attentional focusing was the only subfactor to uniquely predict later CU traits, suggesting that strong attentional abilities attenuate risk for CU trait development. The implications for research and practice are discussed.

This study examines whether gestational age, birth weight, and early term birth is associated with childhood mental disorders in 342 pregnant women recruited at less than 20 weeks gestation and were then followed up until 4 years postpartum, including 93 children born at early term. Women were assessed at recruitment using the Structured Clinical Interview for DSM. At 4 years of age their children were assessed using the Preschool Age Psychiatric Assessment (PAPA) and the Child Behavior Checklist (CBCL). This study found earlier birth predicted an increased risk for anxiety disorders and demonstrated a significant interaction between gestational age and lower birthweight. The risk for ADHD increased with lower gestational age independent of birthweight. In contrast, gestational age was not associated with Oppositional Defiant Disorder, Conduct Disorder, internalizing or externalizing symptoms. These findings highlight the important differences in the association of early term birth and vulnerability for specific mental disorders.

Although extant cross-sectional data suggest that parents have experienced numerous challenges (e.g., homeschooling, caregiver burden) and mental health consequences during the COVID-19 pandemic, longitudinal data are needed to confirm mental health changes relative to pre-pandemic levels and identify which specific pandemic-related changes most highly predict mental health during the pandemic. In two longitudinal subsamples (N = 299 and N = 175), we assessed change in anxiety, depression, and stress before and during the pandemic and whether the accumulation of pandemic-related changes predicted observed mental health changes. On average, parents reported increased depression and anxiety, but no significant changes in reported stress. Moreover, increased interpersonal conflict, difficulty managing work and caregiving responsibilities, and increased economic challenges were the types of pandemic-related changes that most strongly predicted worse mental health, highlighting that juggling caregiving responsibilities and economic concerns, along with the pandemic's impact on interpersonal family relationships are key predictors of worsening parental mental illness symptoms.