European Child & Adolescent Psychiatry最新文献

This meta-analysis aims to identify intervention parameters (e.g., intensity, session time, frequency, and intervention duration) of targeted physical activity (PA) to improve inhibition control (IC) in children and adolescents with ADHD. The systematic search was conducted across PubMed, Web of Science, Embase, and Cochrane Library. In this meta-analysis we assessed the overall effect of PA interventions and then conducted subgroup meta-analyses and meta-regression to explore potential sources of heterogeneity. Finally, we checked publication biases and performed sensitivity analyses. Sixteen studies (591 participants aged 7-17 years) were included. The result showed that targeted PA interventions improved IC with high heterogeneity (SMD = 0.71, 95% CI [0.30, 1.11], I² = 83.11%). Long-term interventions improved IC (SMD = 0.84, 95% CI [0.36, 1.31], p < 0.01), whereas acute interventions did not. Although no statistically significant group difference in long-term interventions was found (p > 0.05), examination of individual studies suggested greater improvements with session time around 60 min (SMD = 1.43), 2-3 times/week (SMD = 1.04), and intervention duration of at least 8 weeks (≥8 weeks: SMD = 0.49; ≥12 weeks: SMD = 1.19). Meta-regression revealed an inverted U-shaped relationship between frequency and intervention effects (β_frequency = 2.15; β_{frequency*frequency} = -0.57). Targeted PA interventions could improve IC in children and adolescents with ADHD, particularly designed with a moderate frequency. Although session time and intervention duration in long-term interventions showed no statistical significance in this meta-analysis, examination of individual studies revealed their promising results. Further investigations are therefore recommended.

Suicide is a leading cause of death among adolescents, highlighting the importance of early intervention in school settings. Universal mental health awareness programs, aimed at improving mental health literacy and help-seeking behaviors, are a key preventive approach. This study examined whether changes in thwarted belongingness and perceived burdensomeness-two constructs from the Interpersonal Theory of Suicide (IPTS)-mediate the effects of school-based mental health interventions on suicidal ideation (SI). A total of 436 adolescents from central Israel (154 boys, 279 girls; M = 14.6, SD = 1.1) were randomly assigned to either a mental health awareness intervention (N = 256) or a minimal-intervention control group with attendance monitoring (N = 180). Belongingness, burdensomeness, and SI were assessed at baseline, 1-month, and 1-year post-intervention. Regression analyses showed that lower belongingness (β = -0.25, p < .001) and higher burdensomeness (β = 0.21, p < .01) predicted higher SI at 1-month, while only belongingness remained significant at 1-year (β = -0.19, p < .01). The mental health awareness intervention increased school-specific belongingness (β = 0.22, p < .001), whereas attendance monitoring intervention increased general belongingness (β = 0.18, p < .01). Mediation analysis indicated that the effects of the intervention type on SI were not significantly mediated by general and school belongingness. These findings suggest that promoting broader social connectedness beyond school environments may support reductions in adolescent suicide risk over time.

The objective of this study was to understand how socio-economic disadvantages relate to mental health problems (MHP) among children with mild intellectual disability or borderline intellectual functioning (MID-BIF) in outpatient care by extending beyond traditional economic measures, incorporating cumulative risks, and analyzing variations across clinical subgroups. Using a population-based case-control design, data from Statistics Netherlands and mental health records were analyzed for 1,742 children with MID-BIF receiving mental health care (M_age = 9.6, 33.1% girls) and 8,710 age- and sex-matched controls aged 0-17. Logistic regression revealed that children with MID-BIF and MHP were significantly more likely than controls to come from families facing socio-economic disadvantages, such as single parenthood, lower parental education, reliance on social benefits, low income, and subsidized housing. Socio-economic risks were more likely to cluster in the case group, with 15.3% of children exposed to five risk categories and 6.7% to all six, compared to 6.7% and 3.6% in controls, respectively. Children in the internalizing and externalizing symptom-based groups faced more pronounced socio-economic disadvantages than those in the developmental group. Additionally, more extensive care was unexpectedly linked to more favorable socio-economic conditions, suggesting a complex interplay between care needs and socio-economic conditions. Taken together, this study showed that children with MID-BIF receiving outpatient care for their MHP often face greater and more clustered socio-economic disadvantages. Simultaneously, children from socio-economically disadvantaged backgrounds received less specialized mental health care. This underscores the importance of addressing barriers in mental health care and promoting family- and community-based care.

War-related experiences in children often result in significant psychological stress, frequently requiring professional intervention. The Huggy-Puppy Intervention (HPI) has demonstrated effectiveness in alleviating stress symptoms, yet its delivery has thus far depended on healthcare professionals and the use of a single doll type. This study aimed to evaluate a parent-delivered adaptation of the intervention, and examine whether the type of doll moderates treatment efficacy. A total of 160 Israeli children aged 3-8 years (M = 5.1 ± 1.4; 57% girls) were randomized to receive one of five doll types as part of the HPI, delivered by parents during the 2023 Hamas-Israel war. Doll types included the original puppy doll, as well as monkey, teddy-bear, dog, and bunny dolls. Parents received instructional videos on how to implement the intervention. Stress symptoms were assessed using online parent-reports at baseline and three weeks post-intervention. Additional measures included child attachment to the doll, parental compliance, and satisfaction with the intervention. Linear mixed models yielded significant large reductions in stress symptoms from pre- to post-intervention across all doll types (Cohen's d = 0.94-0.97). Children exhibited lower attachment to the monkey dolls, and parents reported reduced satisfaction with these compared to other doll types. These findings support the efficacy of a parent-administered HPI in reducing war-related stress in children, with largely comparable outcomes across different doll types. This parent-delivered, adaptable approach enhances accessibility, offering a practical, cost-effective method for supporting children in crisis-affected areas where professional resources are limited.

Balancing autonomy and safety for youth with severe and enduring mental health problems (SEMHP) is a major challenge in (residential) child and adolescent psychiatry (CAP). While autonomy supports engagement and recovery, high-risk behaviors such as suicidality often necessitate safety measures that restrict autonomy. These conflicting priorities lead to clinical dilemmas and inconsistencies in care. To provide a nuanced understanding and enhance clinical support for youth with SEMHP, this study explores how autonomy and safety are understood and negotiated in residential CAP from the perspectives of youth, caregivers, and practitioners. In this qualitative study, we conducted two focus groups and eleven semi-structured interviews, involving youth with SEMHP (n = 7), practitioners (n = 8), and caregivers (n = 6). A reflexive thematic analysis was applied, and perspectives were compared. Autonomy and safety emerged as deeply interrelated concepts. Three main categories were deducted: (1) Foundation for safety and autonomy, (2) Regulation of safety and autonomy, and (3) Tensions and risks. Youth highlighted the need for relational proximity, trust, and shared decision-making, while practitioners emphasized boundaries and procedures. Caregivers expressed varied views, often evolving over time. These differences can lead to tensions, particularly in high-risk situations, where autonomy and safety are difficult to uphold simultaneously. Balancing autonomy and safety requires staying connected to support gradual growth within a predictable and supportive care environment. Particularly in high-risk situations, maintaining a relationship-centered approach, involving youth and caregivers in decisions, and creating space to slow down are key to fostering safety and autonomy in residential CAP.

Social support from family, friends, and teachers is critical in preventing adolescents' internalizing and externalizing problems. However, longitudinal research on how different combinations of social support influence these problems remains limited. To address this gap, this study employed Parallel Process Latent Class Growth Modeling (PP-LCGM) to examine the joint developmental trajectories of support from family, friends, and teachers, and their associations with the developmental trajectories of internalizing problems (i.e., depressive symptoms and non-suicidal self-injury) and externalizing problems (i.e., proactive and reactive aggression). A total of 1437 adolescents (56.9% male, M_age=13.48, SD = 0.70) participated in assessments conducted at three time points. The results identified one convergent trajectory of social support, represented by the high overall support class, along with four divergent trajectories, characterized as predominant family support, predominant friend support, predominant teacher support, and predominant family and friend support classes. Four trajectories of internalizing and externalizing problems were also identified: Congruent-increasing, congruent-decreasing, moderate with predominant depressive symptoms and reactive aggression, and congruent-low. Compared to those in the high overall support class, adolescents who benefited predominantly from family and/or friend support were more likely to fall into the moderate with predominant depressive symptoms and reactive aggression trajectory. Conversely, no significant differences were observed between four divergent support trajectories and the high overall support trajectory in terms of congruent-increasing or congruent-decreasing patterns of internalizing and externalizing problems. These findings suggest the key role of teacher support in protecting against depressive symptoms and reactive aggression, emphasizing the importance of equipping teachers to provide support to their students. Moreover, enhancing any single source of support, whether from family, friends, or teachers, can effectively curb the synchronous changes in internalizing and externalizing problems, offering valuable insights for resource-constrained interventions.

While sensory processing alterations in autism are well-documented, the neurophysiological correlates remain unclear. This meta-analysis examined differences in early event-related potentials (ERP) and event-related fields (ERF) between autistic and non-autistic individuals using electroencephalography and magnetoencephalography to identify neurophysiological alterations that may underlie variations in sensory perception, communication, and social interaction in autism. Following PRISMA guidelines, a database search was conducted for peer-reviewed studies published from January 1980 onwards. Random-effects meta-analyses were performed using the metafor package in R. Standardised mean-group differences in early ERP/ERF latencies and amplitudes were analysed with moderator analyses exploring demographic and methodological factors, including neurophysiological technique, sensory modality, age group, sex, and language impairment. 145 studies (3778 autistic, 3484 non-autistic participants) were included. Autistic individuals exhibited significantly longer latencies in P/M50 (SMD = 0.44; SE = 0.21; 95% CI 0.03-0.86; p = 0.04), P/M100 (SMD = 0.18; SE = 0.08; 95% CI 0.01-0.36; p = 0.03), N170 (SMD = 0.33; SE = 0.12; 95% CI 0.10-0.56; p = 0.01), and P/M200 (SMD = 0.30; SE = 0.09; 95% CI 0.12-0.48; p = 0.00) components. P/M50 showed the greatest latency alteration, with an effect-size nearing medium, especially in individuals with language impairment (Q_B(2) = 7.70, p = 0.02), followed by N170 most notable in autistic adolescents and adults (Q_B (3) = 12.30, p = 0.01). No significant amplitude alterations were found, and substantial heterogeneity was observed. Neurophysiological characteristics of sensory processing in autism implicate multiple mechanisms and stages given prolonged P/M50- and N170-latency (associated with sensory filtering challenges and social perception alterations, respectively). These component timings show potential as biomarkers, though heterogeneity and modest effect-sizes limit clinical application, highlighting the need for further research.

The mental health of children and adolescents is a critical concern, as a significant proportion of internalizing disorders emerge early in life, highlighting the importance of timely identification and intervention. However, recent data on the prevalence and comorbidity of these disorders among Spanish youth remain scarce. This study aims to examine the estimated rates and comorbidity patterns of internalizing symptoms -including depression, generalized (GAD) and social anxiety, somatic complaints, post-traumatic stress disorder (PTSD), obsessive-compulsive disorder (OCD), and eating behavior problems- in a nationwide sample of Spanish children and adolescents. A total of 5,450 participants aged 9 to 16 completed the Sistema de Evaluación de Niños y Adolescentes. Results show that 10.4% of children and 14% of adolescents exhibited clinically significant symptoms of at least one disorder. In children, the most common were depression (4.7%), social anxiety (3.6%), and GAD (3.4%); while in adolescents, OCD (4.5%), eating behavior problems (4.3%), and depression (4.0%) prevailed, indicating that, while the estimated rate of certain clinically significant symptoms has increased compared to pre-pandemic data, rates remain lower than what observed during COVID-19. However, some symptoms still require attention due to their potential impact on well-being. Comorbidity patterns reveal a strong presence of clinically significant depressive symptoms with other internalizing disorders, such as GAD, PTSD, and somatic complaints. Moreover, across several domains, the presence of clinically significant symptoms of one disorder increases the risk of also presenting another. These findings emphasize the need for strengthening mental health services, promoting early detection strategies and implementing targeted interventions within public health and educational settings.

The aim of this study was to investigate the impact of critical periods of maternal Generalized Anxiety Disorder (GAD) on mental health problems in preschoolers from a city in Southern Brazil. This cohort study included 328 pregnant adolescents and their children who were assessed in three stages (prepartum, postpartum, and at 4-5 years of age). The Mini International Neuropsychiatric Interview Plus (MINI PLUS) was used to assess maternal mental health, and the Strengths and Difficulties Questionnaire (SDQ) was used to assess child mental health. children of mothers with GAD only during pregnancy showed a higher risk of peer relationship problems (IRR: 3.57; p = 0.040) compared to children of mothers with no history of GAD. In turn, children of mothers with GAD only when the child was 4-5 years old had a higher risk of conduct problems (IRR: 2.77; p = 0.001), hyperactivity (IRR: 1.99; p < 0.028), and total problems (IRR: 3.26; p = 0.001) compared to children of mothers with no history of GAD. Maternal GAD at different periods was associated with different child mental health problems, highlighting the need for targeted preventive interventions.

To evaluate the feasibility and acceptability of a therapist-guided, mobile app-assisted behavioural treatment for children and adolescents with chronic tic disorders, compared to videoconference-delivered behaviour therapy for tics. Pilot, single-blind, two-arm randomised controlled trial (RCT). A specialist tic disorder clinic for children and adolescents in Denmark. 30 participants with Tourette syndrome or chronic tic disorder aged 9 to 17 years (inclusive) and their parents. Participants were randomised to 8 sessions of either mobile app-assisted behavioural therapy (n = 14) or videoconference-delivered behaviour therapy (n = 16) for tics. The primary outcomes were measures of feasibility, acceptability, adherence and safety. Secondary measures of tic severity (Yale Global Tic Severity Scale; YGTSS) were administered at baseline, post-treatment and 2-month follow-up. Both interventions were deemed feasible and acceptable by the families. Both groups experienced meaningful tic severity reductions on the Total Tic Severity Score of the YGTSS (app group: -9.25 (-13.10 to -5.41; Cohen d = 1.17); videoconference group: -7.43 (-10.93 to -3.93; Cohen d = 0.94). Participants in both groups experienced further tic severity improvements during the 2-month follow-up (app group: -5.75 (-9.16 to - 2.34; Cohen d = 0.96); videoconference group: -5.00 (-8.16 to -1.84; Cohen d = 0.64). A therapist-guided mobile app-assisted behavioural intervention was found to be acceptable and potentially efficacious in the treatment of tics in a naturalistic clinical setting. The findings are promising but preliminary, given the limited sample size. The efficacy should be evaluated in a larger RCT.