Objective: Addressing the disproportionate use of school detentions and suspensions among Black youth is crucial for reducing educational and health disparities across the lifespan. Yet, few studies have explored external factors beyond school or individual characteristics as potential contributors to school discipline disparities, such as state-level racial bias and neighborhood opportunity.
Method: A subsample from the larger Adolescent Brain Cognitive DevelopmentSM (ABCD) Study® was used (M age at baseline = 9.5; n = 8,668; 71% White; 29% Black). Anti-Black racial bias was measured using state-level indicators of racial prejudicial attitudes. Neighborhood opportunity was measured using census tract indicators within the education, healthcare, and social/economic domains. We used logistic regression to examine risk of receiving a detention/suspension by the fourth wave of the study.
Results: Black youth had significantly higher detention/suspension rates than White youth, which could not be explained by teacher- or caregiver-reported externalizing concerns or by family characteristics. As hypothesized, social/economic indicators of neighborhood opportunity moderated the association between state-level racial bias and school discipline among Black youth but not among White youth. Black youth living in states with greater racial bias were at higher risk for receiving school discipline when living in neighborhoods with more social/economic opportunities. In contrast, Black youth were at high risk for school discipline when living in neighborhoods with the lowest levels of opportunity regardless of state-level racial bias.
Conclusion: Place-based characteristics appear to play a key role in explaining the inequitable use of school discipline among Black youth compared to White youth.
Objective: Callous-unemotional traits (CU), characterized as a lack of guilt and empathy, and irritability, a tendency to show anger and frustration, are 2 risk factors for externalizing behavioral problems. Externalizing problems, CU, and irritability are all heritable. However, there is a dearth of studies examining the genetic and environmental associations between the 3 domains. The present study partitioned joint and independent etiological pathways from CU and irritability to externalizing problems.
Method: The sample consisted of 614 pairs of 3-year-old twins from the Boston University Twin Project. Primary caregivers reported twins' externalizing problems, CU, and irritability using the Child Behavior Checklist. Biometric Cholesky models were used to estimate common and unique genetic and environmental variances among the 3 domains.
Results: There were common genetic, shared environmental and nonshared environmental factors operating across all 3 domains. In addition, there were unique genetic and nonshared environmental factors, independent of the common effects, linking externalizing problems and CU, and externalizing problems and irritability, respectively. There were also genetic and nonshared environmental influences unique to externalizing problems, independent of CU and irritability.
Conclusion: Common genetic as well as shared and nonshared environmental associations among externalizing problems, CU, and irritability suggest, to some extent, that etiological influences are common to all 3 constructs. However, distinct genetic and child-specific nonshared environmental links separately from CU and irritability to externalizing problems, reveals the heterogeneity of externalizing problems, and suggests that they should not be considered a unitary outcome.
Study preregistration information: Study Preregistration: Understanding the Etiology of Externalizing Problems in Young Children: The Roles of Callous-Unemotional Traits and Irritability; https://doi.org/10.1016/j.jaac.2023.09.549.
Throughout history, epidemics of infections and the response of human societies to contain them expose and interact with disparities in health, economic, political, environmental and societal systems.1 Works of literature such as the play Romeo and Juliet by William Shakespeare serve as witnesses to these interactions. The COVID-19 pandemic was the biggest recent global public health crisis, and its toll had surpassed 7 million deaths worldwide as of late December 2024, among which 1.2 million occurred in the United States.2 Studies on the effects of this pandemic on the mental health of youth continue to underline its impact and provide clues for disparities.
Objective: This study tests the effectiveness of leader- and provider-level implementation strategies to implement evidence-based interventions (EBIs) in 2 of the service systems caring for autistic children. The TEAMS Leadership Institute (TLI) targets implementation leadership and climate, and TEAMS Individualized Provider Strategy (TIPS) targets provider motivation and engagement.
Method: A cluster randomized hybrid type 3 implementation-effectiveness trial tested the effects of the implementations strategies when paired with AIM HI (An Individualized Mental Health Intervention for Autism) in mental health programs (study 1) and CPRT (Classroom Pivotal Response Teaching) in classrooms (study 2). The combined sample included 65 programs/districts across 4 training cohorts (2018-2019 to 2020-2021). Organizations were randomized to receive a leader-level strategy, provider strategy, both strategies, or neither strategy (EBI provider training only). Leader and provider participants were recruited from enrolled programs/districts, and child participants were recruited from providers' caseloads or classrooms. Data from a total of 387 providers (mean age = 36.39 years; 91% female participants; 30% Latino/a/x participants) and 385 children (mean age = 9.13 years; 84% male participants; 60% Latino/a/x participants) were analyzed. Outcomes were assessed over 6 months. Provider outcome measures included provider EBI certification and observed EBI fidelity. Clinical outcome measures included the Eyberg Child Behavior Inventory (ECBI) (study 1) and the Pervasive Developmental Disorder Behavior Inventory (PDD-BI) (study 2). Outcomes were analyzed using intent-to-treat models.
Results: There was no significant effect of TLI on EBI Certification. TLI was associated with significantly higher EBI fidelity compared to non-TLI (B = 0.37, p = .04). Moreover, a statistically significant TLIX1Time interaction was found for child outcome T scores (B = -10.47, p = .03), with a significant reduction in T-scores across time only for those in the TLI condition. There were no significant effects of TIPS on any outcomes.
Conclusion: Findings support the effectiveness of leader-focused strategies to promote implementation and clinical outcomes of autism EBIs in multiple public service systems and for multiple EBIs.
Clinical trial registration information: Translating Evidence-based Interventions for ASD: Multi-Level Implementation Strategy (TEAMS); https://clinicaltrials.gov/; NCT03380078.
Objective: Selective serotonin reuptake inhibitors (SSRIs) are the first choice in pharmacotherapy for children and adolescents with obsessive-compulsive disorder (OCD). SSRI trials for pediatric OCD have not been investigated using individual participant data (IPD), which is crucial for detecting patient-level effect modifiers. This study performed an IPD meta-analysis of efficacy of SSRIs compared with placebo and a meta-regression on baseline patient characteristics that might modify efficacy.
Method: Crude participant data from short-term, randomized, placebo-controlled SSRI trials for pediatric OCD were obtained from the registry of the Dutch regulatory authority. A systematic literature search was also performed, and authors were approached to provide IPD. A 1- and 2-stage analysis was conducted, with change on Children's Yale-Brown Obsessive-Compulsive Scale (CY-BOCS) as the primary outcome. Odds ratio (OR) with ≥35% CY-BOCS reduction was used as the responder outcome measure. Modifying effect of age, sex, weight, duration of illness, family history, and baseline symptom severity was examined. The Cochrane RoB 2.0 tool was used to examine methodological rigor, and Grading of Recommendations Assessment, Development, and Evaluation (GRADE) was used to examine certainty of evidence.
Results: Data were obtained from 4 studies comprising 614 patients. The sample represented 86% of all participants ever included in double-blind placebo-controlled SSRI trials for pediatric OCD. Meta-analysis showed reduction of 3.0 CY-BOCS points compared with placebo (95% CI 2.5-3.5), corresponding to a small effect size (0.38 Hedges' g). Analysis of response showed an odds ratio of 1.89 (95% CI 1.45-2.45). Of all possible modifiers, severity was correlated negatively with odds ratio for response (β = -0.92, p = .0074). Risk of bias was generally low. All studies were performed in North America with an overrepresentation of White participants. Findings were limited by inability to include data on additional variables such as socioeconomic status and comorbidities.
Conclusion: This IPD meta-analysis showed a small effect size of SSRIs in pediatric OCD, with baseline severity as a negative modifier of response. Generalizability of findings might be limited by selective inclusion of White, North American participants.
Study registration information: Patient Characteristics and Efficacy of SSRI Treatment in Children and Adolescents With Obsessive Compulsive Disorder: An Individual Participant Data Meta-analysis of Randomized, Placebo-Controlled Trials; https://www.crd.york.ac.uk; CRD42023486079.
Far too commonly, children and adolescents are exposed to adversity. These experiences include not only abuse (ie, physical, sexual, or emotional abuse) or neglect within the immediate family, but also exposure to deprivation and violence in the wider community (ie, neighborhood violence, bullying victimization, economic hardship). According to findings from a representative study of more than 45,000 children in the United States, 22.5% were affected by economic hardship, 14.8% lived in a disrupted household (ie, incarcerated parent, drug abuse/mental illness of parent), and 6.5% were exposed to violence in their home or neighborhood.1 These numbers roughly translate to between 1 and 5 children per classroom being affected by different types of adversity.
Objective: The aim of this study was to determine whether advanced puberty at age 9 and 10 years, relative to that in same-aged peers, predicts current and/or new-onset self-injurious thoughts and behaviors (SITBs). New predictors of SITBs in preadolescence are urgently needed to address this escalating public health crisis of youth self-harm and suicidality.
Method: Data from the baseline, 1-year, and 2-year waves of the Adolescent Brain and Cognitive Development Study were used. Bayesian mixed-effects models were estimated for test and replication split halves, and tested whether relatively advanced youth-reported pubertal development at 9 or 10 years predicted SITBs (suicidal ideation, suicide attempts, and non-suicidal self-injury) as reported by preadolescents (each wave) and their caregiver (baseline, 2-year follow-up) in a computerized version of the Kiddie Schedule for Affective Disorders and Schizophrenia (KSADS). Preadolescents with baseline self-reported puberty, KSADS (N = 8,708; 44.6% female; 60.8% White non-Hispanic), and demographic information were included.
Results: Baseline preadolescent-reported puberty predicted the presence of any SITB before or at baseline (odds ratio = 1.50, 95% credible interval = 1.23-1.85) and the new-onset SITBs between baseline and 2-year follow-up in preadolescents SITB-naive at baseline (odds ratio = 2.26, 95% credible interval = 1.66-3.21).
Conclusion: Preadolescents reporting relatively advanced puberty were more likely to have experienced SITBs and, if SITB naive, were more likely to experience the onset of SITBs across the following 2 years. Findings were not explained by child psychopathology or other familial and psychosocial factors known to predict SITBs. Screening preadolescents for advanced puberty at ages 9 and 10 years and applying targeted suicide screening for those youth showing advanced puberty should be considered in primary care and mental health settings.
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