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

When we did our first few Media Forums, we introduced you to the editors of JAACAP and JAACAP Open. What we didn't do was introduce you to the most important part of JAACAP, the editorial staff that makes sure that it runs every day. In this issue of the Media Forum, the amazing editorial staff of JAACAP, JAACAP Open, and JAACAP Connect will share with you their favorite children's books and shows, introducing you to stories that you can recommend to families or read to your own children. Hopefully, this will also give you a chance to get to know the people behind the hard work that goes into the orange journal that we all take for granted showing up every month to provide us with education and enjoyment.

Antipsychotics and α-2 agonists are evidence-based medications for Tourette's Disorder (TD). Tic severity, functional impairment, and risk-benefit trade-offs guide treatment planning.¹ However, much like other clinical disorders in child and adolescent psychiatry, treatment that definitively improves symptoms without also causing untoward side effects remains an unmet clinical need. This editorial reviews a metanalytic synthesis of the TD literature that focused on the magnitude of the placebo response in pharmacological trials of TD to understand how clinically meaningful efficacy results in the extent literature are, particularly in the context of some recent trial failures.

Emotional dysregulation (ED) presents a persistent and multifaceted challenge for autistic children, their families, clinicians, and educators.¹ Characterized by intense emotional responses, frequent irritability, and reactive aggression, ED can disrupt social, academic, and daily functioning, impacting the child's life and placing immense strain on families. Autistic children have a 9-fold increased risk of emergency room visits for psychiatric symptoms compared with neurotypical children,² which is at least partly attributable to the substantially high prevalence of clinically significant emotional regulation difficulties in this population.³ Understanding the trajectories of ED in autistic children is crucial for several reasons. First, ED has long-term impacts on internalizing symptomatology and maladaptive behaviors.⁴ Second, ED is correlated with all core features of ASD,⁵ making processing social information a challenging task, in turn leading to heightened emotional responses.⁶ Third, the variation in ED may reflect the heterogeneity in ASD, which may impede effective interventions that cannot accommodate between-individual differences.⁷ Finally, trajectories of ED may shed light on developmental changes, family dynamics, and educational outcomes, as well as comorbidity patterns. By focusing on these trajectories, researchers and clinicians can gain a more nuanced understanding of ED in ASD, leading to more effective, timely, and personalized interventions that can significantly improve the quality of life for autistic individuals and their families.

Objective: Adolescents' exposure to racism in online contexts is related to adverse outcomes, including poor mental health. This study aims to expand existing research by examining the unique relation between adolescents' online exposure to race-based violence and substance use, beyond experiences of racism in offline contexts, and by exploring racial differences.

Method: Data are from an observational study of 834 students (42% Black, 52% female) from four high schools (grades 9 through 12) in one county in the southeastern United States. Youth reported their frequency of exposure to online race-based violence, offline racial discrimination, and past 30-day use of cigarettes, cannabis, vaping, and getting drunk. They also completed measures of caring adult relationships and neighborhood cohesion.

Results: Most participants (92%) reported at least one exposure to online race-based violence in the past year. Racism experienced in online and offline contexts was positively associated with substance use. Controlling for demographics and exposure to offline racism, online exposure to racism was associated with greater likelihood of getting drunk and using cannabis (ORs = 1.24, 1.34, 95% CIs [1.03, 1.51], [1.10, 1.62]), but not using cigarettes and vaping. Community factors were associated with lower substance use but were not protective.

Conclusion: Adolescents' online exposure to race-based violence may be a unique risk factor for substance use, beyond their in-person exposure to racism. With youths' easy access to videos of race-based violence in the media, there is a need for research on preventing and mitigating the impacts of exposure to racism in the media.

Objective: Self-harm is common in adolescents and a major public health concern. Evidence for effective interventions that stop repetition is lacking. This individual-participant-data (IPD) meta-analysis of randomised controlled trials (RCTs) aimed to provide robust estimates of therapeutic intervention effects and explore which treatments are best suited to different subgroups.

Method: We searched databases and trial registers, to January-2022. RCTs compared therapeutic intervention to control, targeted adolescents aged 11-18 with a history of self-harm and receiving clinical care and reported on outcomes related to self-harm or suicide attempt. Primary outcome was repetition of self-harm at 12 months post-randomization . Two-stage random-effects IPD meta-analyses were conducted overall and by intervention. Secondary analyses incorporated aggregate data (AD) from RCTs without IPD. PROSPERO registration: CRD42019152119.

Results: We identified 39 eligible studies; 26 provided IPD (3,448 participants), 7 provided AD (698 participants). There was no evidence that intervention/s were more or less effective than controls at preventing repeat self-harm by 12 months in IPD (odds ratio (OR)=1.06 [95% CI 0.86, 1.31], studies=20, n=2,949) or IPD+AD (OR=1.02 [95% CI 0.82, 1.27], studies=22, n=3,117) meta-analyses and no evidence of heterogeneity of treatment effects on study and treatment factors. Across all interventions, participants with multiple prior self-harm episodes showed evidence of improved treatment effect on self-harm repetition 6-12 months after randomization (OR=0.33 [95% CI 0.12, 0.94], studies=9, n=1,771).

Conclusion: This large-scale meta-analysis of RCTs provided no evidence that therapeutic intervention was more, or less, effective than control for reducing repeat self-harm. We observed evidence indicating more effective interventions within youth with two or more self-harm incidents. Funders and researchers need to agree on a core set of outcome measures to include in subsequent studies.

Objective: Exposure to extreme temperatures has been linked to acute mental health events in young populations, but the underlying neural mechanisms are not well understood. Resting-state functional magnetic resonance imaging allows for the assessment of connectivity patterns in brain functional networks, which have been associated with mental health disorders. This study investigated the short-term effects of ambient temperature on functional connectivity of brain resting-state networks in preadolescents.

Method: The study was embedded in the Generation R Study, Rotterdam, the Netherlands. Daily mean temperature estimates at the residential addresses of participants were obtained from a high-resolution urban climate model (UrbClim). Resting-state functional connectivity data were assessed with brain magnetic resonance images of 2,229 children ages 9 to 12 years. Distributed lag nonlinear models were fitted to assess the cumulative effects of temperature during the week before the brain scan on within- and between-network connectivity of 15 resting-state networks.

Results: Higher ambient temperature during the week before the imaging assessment was associated with lower functional connectivity within the medial parietal, salience, and hippocampus networks. The effect was highest the day before the brain scan and progressively decayed in the preceding days. Lower temperatures were not related to functional connectivity.

Conclusion: Exposure to high ambient temperatures over a 7-day period was associated with lower within-network connectivity in preadolescents, suggesting impacts of heat on brain function. These findings raise new research questions on whether decreases in functional connectivity within the salience network may partially explain the association between high temperatures and suicide rates previously reported in the literature.