The Brown University Child and Adolescent Behavior Letter最新文献

Dialectical behavior therapy (DBT) and its adaptation for adolescents (DBT-A) provide evidence-based tools for individuals with chronic emotion dysregulation and their families (Linehan, 2015; Miller et al., 2007). Teens with emotion dysregulation struggle to understand, label, and accept their emotions; they are frequently unable to modulate the intensity of their emotions to match the goals of the present context. No matter how much emotionally-dysregulated teens and their families may wish it were so, emotion regulation does not include getting rid of emotions. Why not? We need emotions for survival, as emotions serve essential functions: to motivate us for action and to communicate to ourselves and others. Rather than eliminating emotions, emotion regulation aims to help individuals understand their own emotions, decrease emotional vulnerability and suffering, and change unwanted emotions. This article presents “Check the Facts,” a DBT skill for helping individuals with emotion dysregulation effectively change unwanted emotions. We share a handout that we adapted from DBT with step-by-step tips based on our experience treating adolescents with chronic emotion dysregulation co-occurring with obsessive-compulsive disorder (OCD)/anxiety disorders.

Preventing child maltreatment can result in a reduction in suicide and mental disorders, research has found. The link between childhood maltreatment and adult depression has been known for some time, but the first study published has shown that this maltreatment causes mental disorders and suicide. The study took into account genetic and environmental confounding. For the study, maltreatment was defined as physical abuse, sexual abuse, emotional, or neglect before at 18.

Post traumatic stress disorder (PTSD) is a condition characterized by reexperiencing symptoms, persistent avoidance, negative alterations in cognition and mood, and changes in arousal and reactivity in response to a traumatic event (American Psychiatric Association, 2013). The pathophysiology of PTSD is not fully understood but likely related to dysregulation of fear-processing. Currently, the gold standard of treatment is trauma-focused cognitive behavioral therapy (TF-CBT). SSRIs are the only FDA-approved pharmacologic treatments for PTSD in adults and there are no FDA approved medications to treat pediatric PTSD. Unlike studies in adults, double-blinded randomized control trials (RCTs) did not show any efficacy for SSRIs in pediatric patients diagnosed with PTSD (Hudson et al., 2021). While estimates of pediatric PTSD prevalence varies, the prevalence of PTSD at age 18 is 7.8% (Rolling et al., 2023). Sleep disturbances such as insomnia, night-time awakenings, and nightmares often persist despite treatment with TF-CBT or SSRIs. Left untreated, sleep disturbances are predictive of PTSD persistence and comorbid psychiatric complications (Rolling et al., 2023). There is evidence supporting the use of the medication prazosin in alleviating pediatric PTSD sleep disturbances including nightmares and insomnia. Anywhere from 20–80% of children with PTSD report nightmares compared to a prevalence of 10–20% in the general pediatric population (Kovachy et al., 2013). There is a growing need for pharmacologic therapy given the paucity of providers trained in TF-CBT and a need for symptomatic management. In this review, we will examine sleep disturbances in pediatric PTSD patients and discuss the feasibility of prazosin as an adjunct treatment option.

Below is a handout created by the authors of the top lead in this issue. You can use this with your patients, after reading the article.

Siblings are frequently overlooked as an essential focus in family-based interventions with children. And yet, 80–85% of children worldwide have at least one sibling (Campion Barr & Killeron, 2015). Some have suggested that sibling relationships are a prototype for peer relationships in childhood and adulthood. This makes intuitive sense when one considers the arena within which siblings grow and mature together, with the dynamics involving strong attachments, cooperation, and rivalry and conflict. For instance, a positive sibling relationship can provide emotional support and a sense of security, while a negative relationship can lead to increased stress and anxiety.

Extreme irritability is a challenging quality for children and adolescents and those that live with them; one that often brings them into treatment due to the impact on others. Further, it also leads to a cycle of interpersonal rejection from others based on the unpleasantness of interaction with such an individual. For these reasons, both anger and irritability have received increasing attention from researchers and clinicians in recent years, yet conceptualization is still murky, as is measurement. Is it temperament? Is it a sign of pathology? Specific to mood disorders or a cross-sectional symptom? Stable and enduring, or not?

When I was in adult psychiatry residency, I was shocked by the frequency of which young adult female patients would request evaluation for potential ADHD. Many of these young women presented as well with mood and anxiety symptoms, and it was imperative to determine whether the predominant impairment was secondary to untreated ADHD or other psychiatric conditions. In full disclosure, I was unfortunately primed to be skeptical of these college-aged students who were seeking a diagnosis of ADHD, and I naively felt that their presenting concerns of inattentiveness, difficulty with concentration, and reduced motivation was more likely attributed to untreated depression in this population rather than an undetected ADHD. After all, I wondered, how would ADHD have gone unnoticed for all of their childhood and only now manifest in young adulthood? Oddly enough, I encountered very few young adult males with signs concerning for untreated ADHD; if anything, I saw more males on stimulants for ADHD than women, despite encountering more young women reporting concerns for untreated ADHD.

According to the federal National Health Interview Survey and National Health Interview Survey–Teen, there's a big gap between the emotional support parents think their adolescent children are getting, and the support the teens say they're getting. In 2021–2022, 58.5% of teenagers reported always or usually receiving the social and emotional support they needed. Differences were seen by several demographic characteristics including sex, race and Hispanic origin, sexual or gender minority status, highest parental education level, and family income level. Teenagers who always or usually received support were less likely to report poor or fair health, anxiety or depression symptoms, very low life satisfaction, and poor sleep quality. Parents consistently reported higher perceived levels of their teenager's social and emotional support compared with the teenager's self-report.

There are widespread concerns about the influence of social media on the mental health of adolescents, but the backdrop to this is that most research has not looked at clinical groups, but only the general population. For this study, research reviewed the literature to look at the association between social media use and internalizing symptoms — anxiety and depression. They found that clinical, as against community, samples show an increased risk of internalizing symptoms related to social media use, and that this is correlated with the amount of time spent on social media.