European Child & Adolescent Psychiatry最新文献

The COVID-19 pandemic brought unprecedented global challenges. Amid the crisis, the potential impact of COVID-19 exposure on the neurodevelopment of offspring born to infected mothers emerged as a critical concern. This is a prospective cohort study of pregnant women and their offspring enrolled in the Signature project at Hospital Universitario Virgen del Rocio in Seville, Spain, between 01/01/2024 and 08/31/2022. Participants were subsequently classified into SARS-CoV-2 exposed (mild or severe COVID-19) and non-exposed groups. Maternal stress was assessed through the Perceived Stress Scale; offspring neurodevelopment was screened through Ages & Stages Questionnaire, 3rd Edition (ASQ-3) at 6 months and 12 months. Association between COVID-19 severity and neurodevelopmental outcomes were analyzed with univariate and multivariate analysis. The cohort included 689 women categorized into three distinct groups based on COVID-19 severity: non-infected mothers (N = 277), mothers with mild COVID-19 (N = 358), and mothers with severe COVID-19 (N = 54). The reference category for the odds ratio (OR) analyses was the non-infected group. In utero exposure to mild or severe COVID-19, as well as maternal stress, was not significantly associated with risk of developmental concern in any ASQ-3 subdomain at 12-month follow-up. This study highlights the need for further research with longer follow-up periods to better understand the potential long-term impact of prenatal COVID-19 exposure on offspring neurodevelopment.

Research on complex posttraumatic stress disorder (CPTSD) among individuals with refugee backgrounds is limited, and its validity within this group remains underexplored. This study aimed to assess the prevalence and discriminant validity of posttraumatic stress disorder (PTSD) and CPTSD, as well as the risk factors for CPTSD, in a community sample of adolescents with refugee backgrounds residing in Sweden. This study involved 296 adolescents. Probable diagnoses were evaluated according to DSM-5 and ICD-11 criteria. Latent class analysis was employed to examine the discriminant validity of PTSD and CPTSD, while logistic regression analysis was used to explore risk factors for CPTSD. The findings indicated that 24.1% had a probable diagnosis of PTSD according to the DSM-5. For ICD-11, the equivalent proportions were 7.1% for PTSD and 10.8% for CPTSD. Latent class analysis identified three distinct classes: Low symptoms (46.9%), PTSD (29.6%), and CPTSD (23.6%). Compared to the PTSD class, membership in the CPTSD class was predicted by exposure to more types of violence and child maltreatment. It was also associated with higher posttraumatic stress symptoms, worse general functioning, poorer mental well-being, increased suicidal thoughts, more treatment-seeking behavior, and greater comorbidity. This study found a high prevalence of PTSD and CPTSD among adolescents with refugee backgrounds living in Sweden. Distinct classes aligned with the ICD-11 formulation of PTSD and CPTSD were identified, with exposure to violence and child maltreatment emerging as key risk factors for CPTSD. Results underscore the importance of identifying and addressing posttraumatic stress in adolescents with refugee backgrounds. Future research should aim to further validate the CPTSD diagnosis in larger samples of adolescents with refugee backgrounds.

The use of online pornography is widely prevalent among adolescents. This study presents a systematic review and meta-analysis to explore the relationship between online pornography use and psychopathological symptoms in this population. The study was conducted in accordance with the guidelines outlined in the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). A comprehensive literature search was conducted in PubMed, Scopus and Web of Science for studies published between 2005 and 2024. Eligible studies included quantitative research examining the association between online pornography use and psychopathological symptoms as defined by the DSM-5-TR, with samples comprising adolescents aged 10-19 years. Fourteen studies were included in the systematic review, and twelve were incorporated into the meta-analysis. The meta-analyses revealed a moderate positive correlation between online pornography use and psychopathological symptoms among adolescents. Subgroup analyses indicated no significant differences based on gender. The findings suggest that, in its most problematic manifestations, online pornography use among adolescents may serve as a maladaptive coping strategy for managing underlying distress. An empathetic approach with adolescents displaying problematic online pornography use has the potential to improve the outcomes of therapeutic interventions. These interventions might enhance adolescents' personal and relational resources, thus facilitating the discovery of healthier alternatives that effectively address their psychological needs.

Low parental education has been suggested as a risk factor for attention-deficit hyperactivity disorder (ADHD), but the associations may differ by gender and age, as boys are diagnosed more often and earlier than girls. Parental education might also not predict offspring ADHD diagnosis similarly if parents themselves have ADHD. We examined how maternal and paternal education level predicts offspring ADHD diagnosis at ages 4-17 and whether these associations are modified by gender, age (4-12 vs. 13-17), and family history of ADHD (biological parent and/or full sibling vs. none). We used data on 419,152 individuals born in Finland between 1994 and 2003, identified ADHD diagnosis from national registers with first clinical diagnosis or ADHD medication purchase, and estimated incidence rate ratios (IRR) in Poisson regression. Compared to tertiary education, basic parental education predicted a higher than twofold likelihood of ADHD diagnosis in offspring (maternal IRR 2.17, 95% confidence interval 2.07-2.28; paternal 2.36, 2.26-2.48). The likelihood was about threefold in childhood and twofold or less in adolescence, and mostly similar for boys and girls. Among those with family history of ADHD, the associations were weaker in childhood (highest IRR 1.85, 1.30-2.64) and negligible in adolescence. These findings suggest that low parental education is more strongly associated with an increased likelihood of offspring ADHD diagnosis in childhood than adolescence and in families without an identified history of ADHD. Improving diagnostic processes may help ensure appropriate access to diagnosis and care at any age, irrespective of parental education level and family history of ADHD.

The COVID-19 pandemic significantly worsened mental health (MH) challenges among young people. We aimed to assess changes in mental health-related outpatient care before and after the onset of the pandemic. In this nationwide cross-sectional study, we retrieved visits to general practitioners (GP) resulting in the coding of a MH disorder and/or the prescribing of any psychotropic medication for children aged 6 to 17 years, from January 1, 2016 to May 31, 2022 in France. Interrupted time series analysis of monthly rates of MH-related outpatient visits (per 100,000) was conducted to assess changes in trends overall and by age and sex group (girls/boys- 6 to 11 years; girls/boys- 12 to 17 years). Rate ratios (RR) were also calculated to compare estimated rates after the pandemic onset with expected rates. In total, 5,271,958 MH-related outpatient visits were analyzed. We noted an immediate decrease of the outpatient visit rate by 30.8% in the initial pandemic period (March-May 2020). Hereafter, visit rates increased by 0.4% per month, eventually exceeding expected levels by 6% overall. Notably, outpatient visit rates for adolescent girls (12-17 years) rose 20% above expected levels, while rates for younger girls (6-11 years) declined by 6%. Trends remained stable for other age-sex groups. These findings indicate a persistent increase in outpatient mental healthcare use in children, especially adolescent girls, more than two years after the pandemic onset. Future research should explore the factors contributing to the increased mental health burden in adolescent girls and the potential resilience observed in boys.

Psychostimulants have been recommended as first-line therapy for attention-deficit/hyperactivity disorder (ADHD), and safety concerns related to cardiovascular events in psychostimulant users have attracted increasing attention. However, evidence remains limited regarding the cardiovascular risks associated with methylphenidate use in children and adolescents who have heart disease or a family history of cardiovascular conditions. We conducted a self-controlled case series (SCCS) study using Taiwan's nationwide insurance database (2004-2021), which links data from births registered in the National Health Insurance system. A total of 2,493 individuals with ADHD, at least one methylphenidate prescription, and incident cardiovascular disease (CVD) were enrolled. A stratified Cox regression model adjusted for time-varying confounders was used to estimate the relative risks (RRs) of arrhythmias, ischaemic heart disease, and cerebrovascular disease during methylphenidate exposure compared with those during unexposed periods. Effect modification by congenital heart disease and family history of CVD was also assessed. We found a significantly increased risk of arrhythmias during both the exposed period (RR: 1.41, 95% CI (Confidence Interval): 1.21-1.63) and the pre-exposed period (RR: 1.50, 95% CI: 1.15-1.96). No significant association was observed between methylphenidate use and the risk of ischaemic heart disease (RR: 0.86, 95% CI: 0.49-1.50) or cerebrovascular disease (RR: 0.79, 95% CI: 0.45-1.39). A family history of CVD did not affect cardiovascular risk. However, individuals with congenital heart diseases had an elevated risk of arrhythmias during the pre-exposed period (RR: 3.19, 95% CI: 1.47-6.94) but not during the exposed period. These findings suggest that methylphenidate use is not significantly associated with ischaemic heart disease or cerebrovascular events in ADHD youth, even those with a family history of CVD or congenital heart diseases. The relationship between methylphenidate and the increased risk of arrhythmias during both the exposed and pre-exposed periods needs further investigation.

A number of indicators point to a decline in youth mental health globally over the past 15 years. Access to medical treatment and assistance is becoming increasingly difficult as the social divide is widening due to an imbalance between supply and demand. Hospitalization remains a critical yet costly component of child and adolescent mental health care, reserved for the most severe cases. While necessary in some situations, inpatient treatment carries substantial drawbacks, including family separation and social disruption. This paper discusses if increasing hospital beds across Europe can be the solution to the youth mental health crises by examining differences in the availability of child and adolescent psychiatric hospital beds across Europe. International comparisons reveal striking heterogeneity in hospital beds availability, which does not correlate with improved mental health and behavioral outcomes in young people at the population level. Furthermore, the data does not suggest that this heterogeneity reflects the need to address different levels of psychopathology. Besides the limitations of the currently available data, evidence suggest that effective outpatient and home-based interventions can reduce hospital dependence without compromising treatment efficacy. The COVID-19 pandemic highlighted both the vulnerability of traditional services and the growing role of digital mental health support, which adolescents increasingly access via online platforms. Emerging stepped-care and community-based models, including lay-provider interventions, demonstrate potential to expand reach while conserving specialized resources. Given scarce capacity, European-wide recommendations are needed to ensure equitable access to acute care, while integrating innovative, digitally supported, low-threshold services into youth mental health systems.

Background: Recently, extended reality technologies have been increasingly utilized in therapeutic and educational interventions for individuals with autism spectrum disorder (ASD). This systematic review and meta-analysis evaluated the effectiveness of extended reality interventions in addressing core deficits and enhancing functional performance among individuals with ASD.

Methods: A systematic literature search was conducted across six databases-namely, PubMed, Embase, Cochrane Library, PsycINFO, CINHAL, and ERIC-from their inception to August 29, 2024, with no language restrictions. Studies were included if they (1) examined participants diagnosed with ASD; (2) employed an intervention utilizing virtual reality, augmented reality, or mixed reality; (3) used outcome measures related to social functioning, behavior, emotion, cognition, and anxiety; and (4) were published in a peer-review journal. The standardized mean difference (SMD) was employed as the primary effect size indicator, while heterogeneity was assessed using the I² statistic. Additionally, the quality of the included studies was systematically analyzed.

Results: A meta-analysis of 11 randomized controlled and 20 non-randomized trials was conducted using a random-effects model. The extended reality intervention resulted in significant improvements in social skills (SMD: 0.59, p = 0.04), behavior (SMD: 0.61, p = 0.004), emotion recognition ability (SMD: 0.86, p = 0.0005), and cognitive ability (SMD: 0.92, p < 0.00001) among individuals with ASD.

Conclusion: This study's findings substantiate the effectiveness of extended reality interventions for addressing core deficits and enhancing functional performance among individuals with ASD. Therefore, the utilization of extended reality in therapeutic and educational interventions for individuals with ASD is both feasible and promising.

Most youth do not experience a coordinated and planned transition out of child and youth mental health services, which often results in discontinuity in mental health care. This gap in care has led to the development and uptake of novel interventions, such as the transition navigation model, to facilitate mental health care transitions. The transition navigation model is a research-informed intervention that aims to assess and improve youth's transition readiness, identify their transition needs and goals, and support the transfer of care to adult or community mental health services. To evaluate the ongoing implementation of this model, we conducted a pre-post mixed-methods study involving youth participants accessing transition navigation services at two hospitals. Participants (n = 43) completed self-report measures on transition readiness, daily functioning, and mental health service use at baseline and 6-month follow-up. Twenty participants also completed qualitative interviews focused on understanding their experiences and satisfaction with the navigation service. Results indicate a significant increase in participants' mean transition readiness score and a decrease in the number of emergency department visits from baseline to the 6-month follow-up. However, there were no significant changes in mean functioning scores or self-reported mental health symptoms. The quantitative and qualitative findings converged, indicating overall high satisfaction with the navigation service, with the primary gap in the service being the lack of communication maintained with youth while in the program.

A 10-week randomised controlled trial (RCT) showed efficacy of micronutrients in improving symptoms associated with Attention-Deficit/Hyperactivity Disorder (ADHD). This study investigated duration effects of micronutrient treatment through the open label (OL) phase and document the micronutrient effect on those initially allocated to placebo. Children aged 7-12 years randomized to micronutrients or placebo for 10 weeks (RCT), then received 10 weeks OL, creating two groups: placebo first then micronutrients (P-M) or micronutrients in both phases (M-M). Assessments included measures of ADHD, emotional dysregulation and Clinical-Global-Impression-Improvement (CGI-I). Of the 93 children enrolled in RCT, 78 (83.9%) completed OL; 37 in P-M and 41 in M-M. For those initially assigned to placebo, CGI-I responders significantly increased from 32.4% in the RCT to 64.9% in OL (p = .002); those who took micronutrients for 20 weeks increased from 46.3% (end-of-RCT) to 63.4% responders (end-of-OL) but this was not significant (p = .065). Over half of children were treatment responders at end-of-OL, based on 30% reduction in ADHD symptoms from baseline, both from parent (61.5%) and clinician (53.8%) report. Pre-post effect sizes within both groups were significant and very large for all measures, with no significant group differences at end of OL. There were no differences in side effects. Both groups showed significant increases in height over time. This study supports micronutrients as a viable treatment option for ADHD with acute changes maintained and improved over a further 10-week period, with the placebo group catching up to those exposed to micronutrients for full trial duration.