European Child & Adolescent Psychiatry最新文献

Inpatient treatment is widely used for children and adolescents in psychiatric crisis but may disrupt family life and routines. Home treatment offers a less restrictive alternative. This systematic review and meta-analysis compared both approaches regarding psychopathology, family functioning, psychosocial functioning, and readmissions, considering post-treatment vs. follow-up effects and sequential vs. stand-alone models. Following PRISMA 2020, systematic searches were conducted in Medline, Cochrane Library, Embase, PsycInfo, and trial registries. Two reviewers independently screened articles, extracted data, and assessed risk of bias. Random-effects meta-analyses were conducted where feasible, and certainty of evidence was rated using Grading of Recommendations Assessment, Development and Evaluation (GRADE). The protocol was registered in PROSPERO (CRD42023458888). Fifteen studies (N = 617 participants) were included, with eleven contributing to meta-analyses. No significant differences were found between HT and IT for psychopathology, psychosocial functioning, or readmissions. A significant subgroup difference between post-treatment and follow-up was observed for psychosocial functioning (p = 0.0058), with inpatient treatment showing short-term advantages and HT more favorable outcomes at follow-up. Effects on psychopathology were small and non-significant, and readmission rates did not differ (risk ratio (RR) = 1.27, 95% CI [0.93-1.74]). Evidence on sequential models and family functioning was limited and showed no clear superiority of either approach. HT appears comparable to IT and may offer more sustained improvements in psychosocial functioning. Due to the limited quality of the included studies, these results should be interpreted with caution.

Care-experienced children are known to have histories of adverse childhood experiences (ACEs). Exposure to adversity is a well known risk factor for negative outcomes across the lifespan. However, very little is known about the adversity histories of young children in care, and how this may affect their emotional, behavioural, and attachment disorder outcomes over time. Data from 378 young children in foster care, aged 0-5 years old, as part of the Best Services Trial (BeST^?) were used. Adversity experiences were identified and coded by reviewers from social care records. Age at entry to care was also recorded. Outcome variables used in this study included emotional and behavioural difficulties and attachment disorder symptoms measured at two timepoints (a few weeks after entering care, and 2.5 years later). The number of ACEs in this sample was high, with around two thirds of children having experienced 4 or more. The older the age at which a child entered foster care was strongly related to higher number of ACEs, and increased severity of maltreatment, experienced. An increase in emotional and behavioural difficulties after 2.5 years in care was significantly uniquely predicted by the number of pre-care ACEs a child experienced. Attachment disorder symptoms were significantly lower at 2.5 years in care as compared to levels at entry to care. These findings indicate that prevention and early identification of risk in vulnerable families is paramount. Additionally, tailored interventions for the emotional and behavioural wellbeing of young children in care is essential.

Introduction: Autism Spectrum Disorder (ASD) and Attention Deficit Hyperactivity Disorder (ADHD) have a complex etiology involving both genetic and environmental factors, with mechanisms still unclear. In this review, we investigated the association between maternal 25-hydroxyvitamin D status during pregnancy and the risk of diagnosis and symptoms of ASD and ADHD in offspring in developmental age.

Methods: We searched online databases up to February 13, 2026. We conducted a quantitative meta-analysis by comparing the exposure categories and using a dose-response approach across the entire exposure range.

Results: We included 15 eligible studies: 8 related to ASD and ASD symptoms, 5 related to ADHD and ADHD symptoms, and 2 to both. Comparing high versus low maternal vitamin D status, we found an inverse association with both lower ASD risk (RR = 0.91; 95% CI 0.87-0.96) and ADHD risk (RR = 0.90; 95% CI 0.82-0.99). In the dose-response pooled analysis, ASD risk linearly decreased by 9% for every 10 nmol/L increase in maternal serum vitamin D levels. Higher vitamin D levels were also inversely associated with ADHD symptoms, though estimates were statistically imprecise due to the limited number of studies.

Conclusions: Higher vitamin D status during pregnancy appears to be linearly associated with a reduced risk of ASD and ADHD diagnoses and symptoms in offspring, with no evidence of thresholds across the investigated exposure range. These findings suggest the opportunity to assess vitamin D levels during pregnancy, and to consider its supplementation in deficiency cases, to support fetal brain development and promote neuroprotection.