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

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.

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.

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.

Reflecting on our experiences-whether they stem from clinical practice, a moment of connection with a patient, or an event that shifted our perspective-offers us the opportunity to create something lasting that reaches beyond the moment. The JAACAP Reflections section provides a space for sharing these moments, allowing us to weave together stories that inform, challenge, and ultimately shape our understanding of child and adolescent psychiatry.

Despite decades of suicide prevention research and advances in clinical practice, suicide rates among youth-especially youth from minoritized racial, ethnic, and sexual identity groups, and living in rural populations-have rapidly increased since 2010.^1,2 Because of the rising suicide rates in the United States, the US Surgeon General called mental health the "defining health crisis of our time."³ Although there was a decline in the overall suicide rates for people aged 10 to 14 years and those aged 15 to 24 years, with rates falling by 18% and 9%, respectively, in 2022⁴ and reduced suicidal ideation and behavior for some youth in 2023,⁵ suicide is still the second and third leading cause of death for youth in these age groups, showing the magnitude of this public health problem.

Disruptive child behaviors, such as aggression and oppositional behaviors, are the most common problems for which parents seek professional intervention. Historically, mental health professionals primarily addressed problematic behaviors through child therapy, adolescent institutionalization, or juvenile adjudication, all focused exclusively on changing the child's undesirable behaviors. Since the 1960s, researchers have proposed developmental models that highlight the contribution of parenting practices to the genesis, progression, and maintenance of disruptive behaviors across childhood, hence placing parents in the pivotal position as the most important agent of the child's socialization. For instance, Bandura's¹ social learning theory posits that children's learning takes place in the context of parenting and that disruptive behaviors develop and are maintained by coercive parent-child interaction patterns. Accordingly, parenting programs grounded in this theory typically target ineffective parenting skills that constitute dysfunctional learning situations, such as punitive and inconsistent discipline. These theoretical premises have driven a shift in intervention efforts from focusing on changing children's behavior to changing parents' behaviors. Parenting programs have since proliferated, with a burgeoning number of reviews reporting small to moderate effects of these parenting programs.² However, more important questions that require further elucidation are why these programs are effective and for whom they are effective.

Objective: No previous studies have evaluated the efficacy of Internet-based cognitive-behavioral therapy (ICBT) among children below age 13 years screened at the population level. This study was an open, 2 parallel-group randomized controlled trial (RCT), stratified by sex, that compared ICBT with telephone coaching vs an educational control.

Method: Altogether 465 children (mean age = 11.5 years, SD = 1.0 years, 71.4% girls) were randomly allocated to ICBT or psychoeducation. The 10-week ICBT included weekly digital material and exercises and weekly telephone calls. Assessments comprised child and parent reports on anxiety (Screen for Child Anxiety Related Emotional Disorders questionnaire [SCARED]), impacts of anxiety, quality of life, comorbidity, and parental mental health assessed at baseline and at 6-month follow-up.

Results: The ICBT group yielded significantly higher improvement in primary outcomes (SCARED total scores) when compared with control group in the child reports (p = .04, Cohen d = 0.17) but not in the parent reports (p = .41, d = 0.03). The ICBT group had significantly higher improvement in several secondary measures of outcome, including child-reported SCARED generalized anxiety (p = .047, d = 0.09), separation anxiety (p = .004, d = 0.40), social anxiety (p = .007, d = 0.27), the parent-reported Strengths and Difficulties Questionnaire total score (p = .002, d = 0.22), emotional difficulties (p = .02, d = 0.20), hyperactivity (p = .003, d = 0.19), and quality of life (p = .02, d = 0.16).

Conclusion: When children were screened at the population level for anxiety and enrolled in this RCT study of ICBT combined with telephone guidance, they showed efficacy in improving anxiety and quality of life. These findings are encouraging when developing early population-based intervention strategies for childhood anxiety.

Clinical trial registration information: A Randomized Controlled Study of Digitalized Cognitive-behavioral Intervention for Childhood Anxiety; https://clinicaltrials.gov/study/NCT03310489.