Journal of the American Academy of Child and Adolescent Psychiatry最新文献

Through the eyes of a child, owning a Betta fish is a magical experience filled with valuable lessons. From the moment the colorful fish swims into its new home, children learn about responsibility and care. They quickly understand that, just like people, fish have needs-they require clean water, proper food, and a comfortable, enriching environment of SpongeBob SquarePants decor. Beyond practical lessons, children also experience empathy, developing a bond with their fish. This is how my children feel about the newest member of our family, Sparkles. A beautiful, shiny hue of electric blue, Sparkles was an unexpected gift provided in lieu of a goody bag at a 5-year-old birthday party. My initial shock (built on a foundation of dread) transformed into the most pleasant surprise as I watched all 3 of my children cooperate, collaborate, and problem solve to keep Sparkles alive. Each child developed their specific role and purpose in Sparkles' care, from handling the tank cleaning and rearranging of aquarium plants, to providing nurturing support through whispering frequent "I love you's" and never missing a feeding. My children became little caregivers beaming with pride, ingesting the parenting Kool-Aid with reckless abandon. Witnessing this transformation was not only sweet, but wildly amusing, especially when matter-of-fact explanations of fish behavior were provided by elementary school humans.

Evidence-based medicine (EBM) is the established, albeit at times conceptual, standard of care, and understanding its ongoing operational evolution is critical to JAACAP readers. At the center of operationalizing the concept of EBM are the accurate tools for screening, diagnosis, and outcome measurement. Historically, these instruments relied on trained raters assessing the patient's signs and symptoms.

Objectives: Emotional dysregulation is a common and debilitating problem for autistic children and their families. However, we know little about early-onset patterns of dysregulation, associated risk factors, and child and family outcomes. We aimed to characterize trajectories of emotional dysregulation in an inception cohort of autistic preschoolers.

Method: Caregivers reported on the emotional dysregulation of 396 autistic children using the Aberrant Behavior Checklist (ABC) irritability and hyperactivity scales at 6 timepoints from shortly after ASD diagnosis (ages 2-4 years) to pre-adolescence (10-11 years). Covariance pattern mixture modeling was used to characterize the number and shape of latent dysregulation trajectories that best fit underlying data. Child and family correlates were measured at baseline and ages 10-11 years to characterize early risk factors and pre-adolescent profiles associated with distinct latent trajectories.

Results: Three distinct trajectory classes best fit the data: persistently self-regulated (18% of sample); moderate and declining (54%), and persistently dysregulated (28%). Children classified in the persistently dysregulated trajectory lived with more depressed caregivers and in families reporting greater relationship problems and lower household incomes compared to lower-risk trajectories. Few associations were found with baseline child characteristics. Persistent dysregulation problems were associated with significantly worse child mental health and functional outcomes during pre-adolescent years.

Conclusion: Risk of persistent severe emotional dysregulation may be identifiable at time of early autism diagnosis. Diagnostic assessments should include contextual risk factors and links to evidence-based family supports and interventions.

Objective: Adolescents with disrupted rest-activity rhythms (RAR) including shorter sleep duration, later sleep timing and low physical activity levels are at a greater risk for mental and behavioral problems. However, it remains unclear whether the same associations can be observed for within-subject changes in RAR.

Method: Our longitudinal investigation on RAR used Fitbit data from the Adolescent Brain Cognitive Development (ABCD) Study at the 2-year (FL2: aged 10-13 years) and 4-year follow-up (FL4: aged 13-16 years). 963 youths had good-quality Fitbit data at both time points. In this study we examined changes in RAR from FL2 to FL4, their environmental and demographic contributors as well as brain and behavioral correlates.

Results: From FL2 to FL4, adolescents showed decreases in sleep duration and physical activity as well as delayed sleep timing (Cohen's d .44-.75). The contributions of environmental and demographic factors to RAR changes were greatest for sleep timing (explained 10% variance) and least for sleep duration (explained 1% variance). Delays in sleep timing had stronger correlations with behavioral problems including impulsivity and poor academic performance than reductions in sleep duration or physical activity. Additionally, the various brain measures differed in their sensitivity to RAR changes. Reductions in sleep duration were associated with decreased functional connectivity between subcortical regions and sensorimotor and cingulo-opercular networks and with enhanced functional connectivity between sensorimotor, visual and auditory networks. Delays in sleep timing were mainly associated with grey matter changes in subcortical regions.

Conclusion: The current findings corroborate the importance of sleep and physical activity in adolescents' brain neurodevelopment and behavioral problems. RAR might serve as biomarkers for monitoring behavioral problems and be potential therapeutic targets for mental disorders in adolescents.

Objective: Although many factors predict adolescent depression, risks that operate as necessary conditions (i.e., the absence of the factor conveys the absence of the outcome) have been largely unexplored. This study aimed to evaluate which psychosocial risk factors might serve as necessary conditions for future onset of depression across adolescence.

Method: At baseline we assessed cognitive and personality risks, symptom severity, stressful events, and past depression history among 382 adolescents (225 girls; age M = 12.6), who were then followed over 2 years with repeated diagnostic interviews to ascertain depression onset. We applied an innovative statistical approach in mental health research, namely Necessary Condition Analysis (NCA).

Results: Results showed that baseline rumination (d = .50), stressful events (d = .37), depressive symptoms (d = .23), and self-criticism (d = .35) all emerged as significant necessary conditions for adolescents to be diagnosed with depressive disorder(s) over subsequent 24 months. Overall, 13.5% of the sample did not show all the necessary conditions (i.e., they lacked one or more conditions) and were therefore virtually immune from experiencing one or more major depressive episodes (MDEs) over the follow-up, and 65.5% did not meet all those conditions for experiencing three or more MDEs (i.e., recurrent depression).

Conclusion: The findings can inform future theory building and testing as well as clinical applications via screening of necessary risk to future pediatric depression so that youth who may most benefit from effective interventions can be identified.

Study preregistration information: The Necessary Conditions for Depressive Symptomsand Major Depressionin Adolescence; https://osf.io; b5ced.

Diversity & inclusion statement: We worked to ensure race, ethnic, and/or other types of diversity in the recruitment of human participants. We worked to ensure sex and gender balance in the recruitment of human participants. One or more of the authors of this paper self-identifies as a member of one or more historically underrepresented sexual and/or gender groups in science.

Objective: The aim of this study was to assess the promotive and protective effects of parental and peer racial-ethnic socialization (RES) on adolescents' psychological well-being in the context of racial-ethnic discrimination. We hypothesized that RES would buffer the pernicious effects of discrimination on well-being by promoting more proactive coping (problem-solving, seeking social support) and less avoidant coping responses.

Method: Participants were a nationally representative sample of 371 ethnoracially minoritized adolescents who were recruited through a research survey panel (51.75% assigned female sex at birth; 46.90% Black, 24.80% Latine, 20.22% Asian/Asian American; M_age= 14.47 years, SD_age= 1.46, age-range= 10-19 years). Participants completed daily surveys of exposure to racial-ethnic discrimination, RES, coping, and psychological well-being across 30 days.

Results: Results indicated parental cultural socialization promoted more positive next-day well-being via increased problem-solving coping (B=0.01, SE=0.01, p<.05). The same pattern of findings emerged when examining cultural socialization messages from peers (B=0.02, SE=0.01, p<.01) and preparation for bias messages from parents (B=0.02, SE=0.01, p<.01). RES significantly moderated the effects of racial-ethnic discrimination on avoidance coping.

Conclusion: Findings suggest that RES from parents and peers may promote more positive psychological well-being in adolescents by facilitating proactive coping processes on days when they experience racial-ethnic discrimination. Overall, the study points to the need for continued efforts to develop, test, and disseminate evidence-based approaches to strengthening RES competency, as doing so may be a critical avenue for cultivating resilience among ethnoracially minoritized youth.

The study by Vivanti et al.¹ represents a significant contribution to research on autism screening. This cluster-randomized controlled trial (RCT) sought to determine whether the implementation of the Modified Checklist for Autism in Toddlers, Revised with Follow-Up (M-CHAT-R/F)² during routine well-child check-ups could improve the early identification and referral rates for autism spectrum disorder (ASD). The trial included a diverse sample of pediatric practices, randomly assigned to either an experimental group, in which the M-CHAT-R/F was systematically implemented with high fidelity, or a control group that continued with usual care practices.