European Child & Adolescent Psychiatry最新文献

When studying therapeutic alliance, researchers typically use data with a 'one-with-many' (OWM) nested structure in which each therapist ('one') treats several clients ('many'). The OWM structure offers the opportunity to assess the interdependence in dyadic therapeutic alliance data by disentangling three components: (1) the client's tendency to generally rate the alliance with his therapists ('client perceiver' component); (2) the client's rating of the unique alliance with his therapist ('client relationship' component); and (3) the therapist's characteristics that elicit a consistent alliance rating in his clients ('therapist partner' component). Similarly, three such components can be distinguished for the therapists' alliance ratings. We used the reciprocal OWM design to distinguish these alliance components, pertaining to the first therapeutic session of two hundred and three youths aged 13 to 23 years who entered a youth mental health and youth addiction treatment facility. We found that most of the alliance variance pertained to the relationship component (client-rated alliance: 99.2%; therapist-rated alliance: 56.0%), with virtually no evidence of therapist's characteristics that elicited a consistent (high or low) alliance rating in his clients. Clients who reported a uniquely strong alliance with their therapist were more likely to have a favorable 4-months treatment outcome (Odds ratio 1.10; p < 0.001). None of the other (client/therapist) alliance components were related to treatment outcome, nor did we find evidence of dyadic reciprocity, which would occur when a therapist would report a particularly strong alliance with the client if that client reported a particularly strong alliance with the therapist, and vice versa.

Objective: The Youth Act, implemented by the Dutch government in 2015, aimed to provide more efficient, coherent, and cost-effective care tailored to the specific needs of children, while also reducing medicalization. Between 2003 and 2013, there was a four-fold increase in methylphenidate prescriptions among Dutch children aged 4 to 18 years. However, the impact of the Youth Act on the ADHD medication dispensing remains unassessed. This study investigated changes in ADHD medication dispensing patterns among Dutch youth following the implementation of the Youth Act.

Method: A before-after retrospective cohort study was conducted using data from the Dutch community pharmacy-based IADB.nl database among 137,684 youths aged 0-19 years using ADHD medication between 2010 and 2022.

Results: A significant decrease in overall ADHD medication dispensing prevalence rates per thousand youths was observed in 2022 compared to 2015 (35.2 vs. 45.7, p < 0.001). Methylphenidate accounted for approximately 87% of all ADHD medication dispensing. Incidence rates decreased significantly among children aged 7-12 from 2015 to 2022 (9 vs. 7.3, p < 0.001), while incidence rates increased significantly in adolescent youths (4 vs. 4.8, p = 0.008), particularly among adolescent females (3.5 vs. 5.3, p < 0.001). Females had lower prevalence rates and shorter durations of ADHD medication use compared to males, with no difference in daily dose observed.

Conclusion: ADHD medication dispensing among Dutch youth declined following the 2015 implementation of the Youth Act. However, other factors such as the DSM-5 revision, COVID-19, and medication shortages likely contributed to this decrease, suggesting a multifactorial explanation for the observed changes in ADHD medication dispensing.

Preliminary empirical evidence supports the efficacy of digital parent management training (d-PMT) in the treatment of externalizing behavior problems in children. This study investigated the efficacy of a mobile-based self-directed d-PMT for parents of children aged 4-11 years with attention-deficit/hyperactivity disorder (ADHD) with or without oppositional defiant disorder (ODD), and without pharmacological and/or behavioral therapy. Participants were randomized 1:1 to d-PMT (hiToco^®) plus treatment as usual (TAU) or TAU only for 16 weeks. The primary outcome was a reduction of parent-rated externalizing problem behavior including symptoms of ADHD and ODD. Secondary outcomes included parent-rated ADHD symptoms only, ODD symptoms only, and functional impairment of the child as well as parenting behavior and family strain. Sixty-five participants were randomized to the dPMT + TAU group (n = 34) or the TAU group (n = 31). All children had a clinical diagnosis of ADHD; clinically diagnosed ODD was reported in 9 children (26.5%) in the d-PMT + TAU group and 13 children (42%) in the TAU group. The mean ± SD age of the children was 8.4 ± 1.7 years (69.2% boys). On average, participants used the program for 8 h in total. Regarding the primary outcome, significant treatment effects favoring the d-PMT + TAU group compared to the TAU group were observed at week 12 (W12) and W16 (Cohen's d at W12: 0.74; at W16: 0.48). Post-hoc analyses showed that 50% of the children in the d-PMT + TAU group compared to 30% in the TAU group were reliably recovered or improved. Significant treatment effects in favor of the d-PMT + TAU group were also observed for all secondary variables. Our findings suggest that a mobile-based self-directed d-PMT for parents may play an important role in the multimodal treatment of children with ADHD in future clinical routine practice.

Although underexplored, the literature has suggested that children with motor difficulties experience sensory processing alterations, limiting their participation in daily activities. In that sense, investigating sensory processing in children with neurodevelopmental challenges, such as Developmental Coordination Disorder (DCD), can yield valuable insights into the characteristics of this population and support decision-making by health and education professionals regarding assessment and intervention. This study compared sensory processing patterns between children with Developmental Coordination Disorder (DCD), possible DCD (pDCD), and typical development; and (2) examined associations between motor outcome measures and sensory processing. Caregivers of 694 children (mean age = 8.03 ± 1.43; 50.8% girls) completed the Short Sensory Profile 2 (which provides information on four sensory processing patterns: seeker, sensor, avoider, and bystander), DCD Questionnaire, and a sociodemographic questionnaire. Children's motor outcomes were assessed using the Movement Assessment Battery for Children - 2. Motor outcomes and other Diagnostic and Statistical Manual of Mental Disorders criteria for DCD classified children into three groups: (i) with DCD, (ii) pDCD, and (iii) typically developed. Results reveal significant differences (p < 0.001) between the groups across the four sensory processing patterns: children with DCD presented increased bystander patterns (34.6%). The sensor and bystander patterns showed a negative correlation with motor outcomes. The bystander emerged as a predictor of motor outcomes (B: -0.166 to -0.411; p < 0.001). These findings suggest that bystander sensory processing patterns may contribute to the motor difficulties observed in children with DCD, particularly in their reduced ability to perceive sensory input compared to their peers.

Persistent motor and vocal tic disorders (PMTD/PVTD) are distinct diagnoses from Tourette syndrome (TS). In both, the threshold for the diagnosis is up to age 18, whereas tics infrequently manifest after age 12. In our cohort of youth with tic disorders from Calgary, Canada, we aimed to determine whether the clinical features and comorbidity profile of PMTD/PVTD differ from those of TS, and assess whether chronic tic disorders with adolescent-onset (age ≥ 12) are different from disorders with childhood-onset (< 12 yr). A total of 341 children and adolescents with primary chronic tic disorders were included (90.0% with TS, 7.0% with PMTD, 1.8% with PVTD). Regarding age at tic onset, participants with adolescent-onset tics (6.7%) were diagnosed with attention-deficit/hyperactivity disorder (ADHD) more often than those with childhood-onset (p = 0.02); there were no differences in sex ratio, tic severity and impairment. Regarding tic disorder diagnosis, participants with PMTD/PVTD had a later age at tic onset than those with TS (p = 0.01) and had less psychiatric comorbidity (p = 0.01), specifically ADHD and obsessive-compulsive disorder; there were no differences in tic severity or impairment. Given that the major difference between TS and PMTD/PVTD lies in psychiatric comorbidities, which are not part of the diagnostic criteria, we suggest creating a single category for primary persistent tic disorders. Tic onset in adolescence is uncommon, and coupled with the lack of any major difference in clinical features, should lead us to question whether the age limit in the diagnostic criteria might not be more relevant as a supportive criterion.

Background: Chronic Tic disorders (CTD) including Tourette Syndrome (TS), are associated with psychopathological comorbidities. Attention deficit/hyperactivity disorder (ADHD), autism spectrum disorder (ASD) and other comorbidities have been linked to delays in early developmental milestones. Few studies have investigated the relationship between early developmental milestones, tic severity, and related comorbidities.

Methods: 383 participants aged 3-16 years (76.8%, n = 294 boys) with CTD from the baseline assessment of the European Multicenter Tics in Children Study (EMTICS), were evaluated for: retrospective early developmental milestones (sitting, walking, first words, complete a sentence, bladder and bowel control), tic severity, tic-related functional impairment, obsessive-compulsive disorder (OCD), ADHD, oppositional defiant disorder (ODD) and suspected ASD. Data was collected using gold-standard self and clinician reporting instruments. Analyses included Pearson correlations and logistic regressions.

Results: Correlations between the acquisition of developmental milestones and tic severity or impairment were significant with small effect sizes (severity of motor tics and tic impairment were correlated with walking (r = .11), while vocal tics were correlated with first words (r = .12)). Logistic regression revealed that delayed acquisition of first words was significantly associated with ADHD, ODD and suspected ASD (Odds Ratio (ROR): 1-1.13, 1.04-1.22, 1.05-1.21, respectively), while delayed walking acquisition was associated with OCD (ROR: 1.01-1.27).

Discussion: This study highlights the association between early developmental milestones and later psychopathological comorbidities in CTD patients. These findings emphasize the need for further research to distinguish between children with only tics and those with tics and psychopathological comorbidities, to improve early detection of individuals at risk.

Adolescent internalising and externalising behaviours arise from a complex interplay of genetic and environmental factors. Understanding how parents' genes affect risk for psychopathology in offspring-whether through direct genetic transmission or environmentally mediated genetic nurture-is crucial for identifying causal mechanisms and intervention targets. However, few studies have examined this interplay rigorously in relation to adolescent psychopathology, and findings to date have remained mixed. To tackle this gap in research, we examined both genetic transmission and genetic nurture pathways using polygenic risk for psychopathology on adolescent internalising and externalising behaviours.The sample comprised 762 genotyped parent-offspring trios from the TRacking Adolescents' Individual Lives Survey (TRAILS). Parent and offspring polygenic scores for genetic liability to general psychopathology (p-PGS) were computed and jointly modelled to estimate genetically transmitted and genetic nurture contributions to parental reports of offspring internalising and externalising behaviours at age 11.Our findings indicate that parental polygenic risk for genetic liability to general psychopathology (captured as parental p-PGS) was associated with adolescent internalising-but not externalising-behaviours. Primarily this association was via environmental rather than direct genetic pathways, providing support for genetic nurture (b = 0.13, 95% CI = 0.05/0.22, q-value = 0.004). However, we found no association between parental p-PGS and adolescent-reported parenting behaviours, limiting our ability to assess whether genetic nurture effects for internalising problems were mediated by adolescent perspectives of parenting.The study highlights the importance of genetic nurture's influence on internalising behaviours, and encourages the consideration of genetic influences on perceptions of environmental influences that may be key.

Background: Attention deficit/hyperactivity disorder (ADHD) and autism are both neurodevelopmental disorders associated with functional impairment in social, academic, and occupational domains.

Methods: This longitudinal study, a follow-up to the CHARGE Study (ReCHARGE), evaluated diagnosis of ADHD and its presentation type (Inattentive, Combined-Hyperactive/Impulsive), in a cohort of 8 to 20 year-olds from four developmental categories recruited at ages 2-5 years: Autism, developmental delay without autism (DD), other early concerns (OEC) or typical development (TD, controls from the general population) (n = 645). ADHD diagnosis was based on parent clinical interviews (DISC or MINI), observational methods and multiple rating scales. Multivariate Poisson log regression models were fit to estimate associations of early childhood neurodevelopment with later ADHD diagnoses. Adjusted confounding variables included child's age, sex, parental ADHD, socioeconomic indicators, and maternal prenatal conditions.

Results: Of 645 participants, 213 (33.0%) met criteria for ADHD. Early childhood diagnosis was the strongest predictor. For Hyperactive/Impulsive or Combined presentation, relative risks (RRs [95% CI]) were 5.4 [3.0, 9.4] for autism, 4.4 [2.3, 8.4] for DD, and 3.1 [1.5, 6.1] for OEC. For Inattentive presentation, RRs were 2.6 [1.6, 4.2] for autism, 1.4 [0.7, 2.9] for DD, and 2.6 [1.4, 4.2] for OEC. For any ADHD presentation, RRs were 3.1 [2.2, 4.4] for autism, 2.4 [1.6, 3.6] for DD, and 2.4 [1.6, 3.6] for OEC.

Conclusions: This study reinforces the need for evaluation of ADHD and its presentation type in autistic children and other developmental delays, as these youth are at high risk for ADHD. Clinicians should assess the presence of ADHD-related challenges across development and service needs in individuals with autism and/or DD due to their high ADHD risk.

This study investigates parental factors as predictors of the outcome of an internet-based and telephone-assisted parent training intervention targeting child disruptive behavior, when it was implemented nationwide in Finland. 2,900 families with children who met screening criteria at their 4-year-old health checkup received the 11-week intervention. Potential predictors included parents' age and educational attainment, family structure, enrollment year, parenting skills, and parental mental health. The outcome was the Child Behavior Checklist 1.5-5 externalizing score, collected at baseline, 6-, 12-, and 24-month follow-ups. Hierarchical linear models were used to examine changes in the outcome over time. At 6 months, parents of children whose mothers had a college or university degree reported smaller reductions in child externalizing problems compared to those with lower maternal education (β= 0.87, 95% CI [0.28, 1.45], p= .004). At 24 months, greater reductions in externalizing problems were observed in children whose parents had a high parental over-reactivity score at baseline (β= -1.23, 95% CI [-1.97, -0.49], p= .001), as well as a medium or high baseline parental Depression, Anxiety and Stress Scale total score (Medium: β= -1.01, 95% CI [-1.65, -0.36], p= .002; High: β= -1.05, 95% CI [-1.82, -0.28], p= .007). There were greater changes in the outcome over time among disadvantaged populations, particularly families with lower education, poorer parenting skills, or more severe parental mental health problems. Future research is needed to examine the consistency of these effects across diverse sociodemographic groups and settings.