The Brown University Child and Adolescent Behavior Letter最新文献

Avery is a patient I worked with earlier on in my clinical career (name and details have been altered for confidentiality). She identified as cisgender, bisexual, white adolescent female. Avery was referred to home-based services following an inpatient admission due to suicidal ideation, an active eating disorder, anxiety symptoms, and substance use. She was experiencing an increase in depressive and anxiety symptoms prior to admission due to family stress after disclosing sexual abuse with DCYF [Department of Children, Youth, and Families] becoming involved. Avery reported a history of experiencing negative comments made about her sexuality and feeling othered by peers at school. On top of this, she was in the refeeding stage (the process of increasing caloric intake to achieve weight goal) of her eating disorder treatment and trying to learn to navigate a new family environment. Aivery was not unique in turning to substances as a coping strategy.

An article in Psychiatric News published in January summed up mounting evidence linking the use of cannabis by young people to depression and suicide. Quoting experts from the annual meeting of the American Academy of Child and Adolescent Psychiatry (AACAP), the article looks at the expanded types of products, increasing potency, and legalization are contributing to “unprecedented exposure to young people during a critical period of brain development,” said Jesse D. Hinckley, M.D., associate clinical professor of psychiatry and co-founder of the addiction biology laboratory at the University of Colorado School of Medicine, at the meeting. “Cannabis prevention and early intervention are suicide prevention,” Hinckley said. “There's an even greater need for these programs in states that have passed recreational or medical cannabis laws, where youth cannabis use is more prevalent.”

It wasn't what they were meant to do originally, but recently, the East Boston Neighborhood Health Center has found new work in helping people who need it. Nancy Slamet, Director of the East Boston Alliance for Support, Treatment, Intervention and Education (EASTIE) Coalition, works with the center on outreach for community members and promoting health equity, because 60–70% of the population is from Latin America.

Many people know the hallmark signs of post-traumatic stress disorder, including nightmares, flashbacks, avoidance of reminders, etc. But trauma also often brings mindset shifts: “Something is wrong with me — I deserved what happened. The world isn't safe, and evil is always lurking. I can't trust anybody but myself.” Some people also experience intense emotions like anger and sadness, while others may find it hard to feel anything at all.

A $10-million grant from the Substance Abuse and Mental Health Services Administration to the American Academy of Pediatrics (AAP) funded a program which has a free portal that families can use to get real information about social media. A presentation on this program, the AAP's Center for Excellence on Youth Social Media and Mental Health” at the annual CADCA (Community Anti-Drug Coalitions of America) leadership conference in Washington in February, focused on empowering parents.

In physics, the “observer effect” describes how the act of measuring something subtly alters that something. Werner Heisenberg and colleagues found this (also called the “uncertainty principle”) as they measured atomic particles, finding their method precisely read a particle's position, but interfered with its motion — making the two dimensions (position and motion) impossible to accurately measure simultaneously. Or as one Wikipedia author noted, checking the pressure in a tire causes air to escape, thereby changing the amount of pressure.

Contingency management (CM) — paying patients in treatment for addiction for negative drug tests — is the best method for treating stimulant use disorders, according to the National Institute on Drug Abuse and researchers. Because there is no other effective treatment for stimulant use disorders, CM is particularly important. However, the federal government has required that these payments be very low (no more than $75 a year) in order to avoid “kickbacks.” The idea that treatment providers would use the payments as incentives to get patients kept this effective protocol from being included in treatment or even in research. However, finally the federal government has upped the amount. The Substance Abuse and Mental Health Services Administration (SAMHSA) announced that its grant programs which authorize CM can now provide values of up to $750 a year per patient.

Researchers have found both positive and negative associations between mental symptom severity and general cognition. Prior studies showed mixed findings. But this study, by noting that the associations were nonlinear, reconciled those prior studies, which assumed that symptom severity tracked with cognitive ability. In fact, the association between cognition and symptoms may be the opposite in low vs. high symptom severity samples. The study shows that it's necessary to use clinical information in studies of cognitive impairment. Because mental illnesses are a leading cause of disability, and cognitive impairments often play a role across psychiatric disorders. The researchers wanted to determine if the association between general cognition and mental health symptoms diverges at different symptom severities in children. For the study, researchers used the ongoing Adolescent Brain and Cognitive Development (ABCD) study to assess 5175 children at ages 9 to 11 years. They evaluated aggregate cognitive test scores (general cognition) in relation to total and subscale-specific symptoms reported from the Child Behavioral Checklist. Linear models showed differing associations between general cognition and mental health symptoms, depending on the range of symptom severities queried. Nonlinear models confirm that internalizing symptoms were significantly positively associated with cognition at low symptom burdens and significantly negatively associated with cognition at more severe symptoms. [Pines, A., Tozzi, L., Bertrand, C., et al. (2024, Dec). Psychiatric symptoms, cognition, and symptom severity in children. JAMA Psychiatry, 81(12), 1236–1245. https://doi.org/10.1001/jamapsychiatry.2024.2399.]

Pediatric anxiety is among the most common mental health diagnoses for American youth, yet few youths diagnosed with anxiety/obsessive-compulsive disorder (OCD) receive treatment. The majority of parents nationwide report at least some difficulty accessing mental health care for their child. Within the state of Rhode Island, where 12.7% of youth experienced anxiety concerns during 2021, 59% of caregivers reported difficulty accessing mental health care of any kind (Child and Adolescent Health Measurement Initiative, 2021-2022). Access to exposure-based CBT (exposure therapy), despite strong evidence as a frontline treatment for anxiety/OCD, is especially limited.

Greetings to you, readers, from me, taking over editorial duties of the CABL. Many thanks to Dr. Anne Walters for her years of professional mentorship as well as support during this transition. There are many topics I'm anticipating over the coming year of CABL publication. But, as this is my inaugural column, I thought I would start with a brief reflection on the very process of looking forward.