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

Objective: Previous research suggests that adult survivors of Ebola Virus Disease (EVD) experience mental health problems following their infection. This study examines long-term mental health consequences of EVD for child survivors, and those affected by EVD but not themselves infected, compared to controls. This study also examines the mediating effects of caregiver mental health on children's mental health outcomes.

Method: Using a case-control study design, we recruited 663 children (aged 10-17) and their caregivers at two time points, from six geographically diverse districts in Sierra Leone. Our analytic sample included n=217 EVD-infected children, n=206 EVD-affected children (i.e. children who were not themselves infected but someone in their household was infected), n=230 control children, and one caregiver per child (N=653). Using a Structural Equation Model, we examined the mediating effects of caregiver anxiety and depression at Time 1 on the relationship between study condition and children's prosocial behaviors and behavioral difficulties at Time 2, controlling for child's age, gender, household wealth, urban vs. rural, and district.

Results: EVD-infected and -affected children were more likely to demonstrate behavioral difficulties compared to controls. Caregiver depression mediated the relationship between being affected by EVD and children's behavioral problems. Caregiver anxiety mediated the relationship between being EVD-affected and children's prosocial behaviors.

Conclusion: The mental health consequences of EVD are long-lasting for EVD child survivors and those affected, as well as caregivers. Policy and programmatic responses need to account for the heightened vulnerability introduced not just to survivors after an infectious disease outbreak, but to their families and household members.

As the most common provider of child mental health services,¹ schools are well positioned to be the most powerful lever for improving the prevention and treatment of mental health disorders in children and adolescents. As one component of a comprehensive school-based mental health program (ie, also referred to as Multi-Tiered Systems of Support [MTSS]),² universal mental health screening can play several critical roles: identifying students in urgent need of attention, identifying at-risk students, monitoring the effects of school-wide interventions, as well as providing valuable psychoeducation to caregivers.³.

We thank Dr. Øien for his comments on the relevance and implications of our cluster randomized controlled trial (RCT) in his editorial, "Editorial: The Critical Examination of Autism Screening Tools: A Call for Addressing False Negatives."¹.

Autism spectrum disorder (ASD) presents a unique challenge in psychiatry, characterized by its complexity of individual cases.¹ The rising prevalence of complex ASD cases prioritizes effective diagnosis, individualized intervention, and support strategies.² Traditional tools such as the Autism Diagnostic Observation Schedule (ADOS) are valuable for diagnostics, but they struggle to capture the subtle changes in social communication skills. This can make it challenging to design individualized interventions.

Objective: Most children and adolescents with mental disorders do not access appropriate help, facilitating a lifetime of entrenched difficulties. School-based, universal, mental health screening has been used as one method to increase pediatric service use and subsequently reduce mental health problems. Despite its popularity, there are no randomized trials that demonstrate the efficacy of this method to improve pediatric mental health.

Method: The current trial randomly allocated 84 schools, of which 53 provided data (10,660 students; aged 7.4-19.0 years) across the state of New South Wales, Australia, to receive either immediate screening with caregiver feedback or no screening. Approximately 12 months later, students in all schools were assessed for mental health, service use, and school attendance.

Results: At 12 months, students enrolled in schools that received screening with feedback 12 months earlier self-reported lower total mental health difficulties (primary outcome) than students enrolled in schools that did not engage in screening (mean difference= 0.09, SE = 0.02, t(6713) = 3.78, p < .001, 95% CI difference = 0.04 to 0.13). Interestingly, the groups did not differ significantly on use of mental health services over the previous year (primary outcome) (mean difference = 0.00, SE = 0.02, t(6707) = 0.19, p = .851, 95% CI difference = -0.04 to 0.03). Schools that engaged in screening reported fewer days' absence for students than did control schools.

Conclusion: This is the first randomized trial indicating that school-based screening with feedback to caregivers may reduce mental health difficulties, although the mechanism through which this occurs remains unclear.

Study preregistration information: Development and validation of a universal mental health screening tool and follow-up referral system to identify at-risk students in Australian schools; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=380905.

This Letter to the Editor reports the effectiveness of a pilot program to increase interest in child and adolescent psychiatry (CAP) research among diverse trainees. Medical trainees at all career levels were invited to participate in a free, year-long, monthly virtual research workshop series sponsored by the American Academy of Child and Adolescent Psychiatry (AACAP). Sessions featured diverse CAP researchers sharing their career journeys and research interests during hour-long live workshops with interactive participants. These live sessions were also recorded to allow for later viewing. Survey results from workshop participants indicated that the sessions were effective in improving participant understanding of available CAP research. Sessions were also effective in inspiring participants to learn more about CAP research and how to participate in it. Overall, participants rated the sessions as helpful and would recommend the series to others. Based upon the pilot program, future recommendations include ongoing expansion of such programs highlighting diversity and representation within the CAP research workforce. In addition, optimization of programs should consider ways to maximize recruitment and retention of diverse medical trainees in CAP research.