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

Background: Clinical characteristics of children with school refusal may differ depending on whether school refusal onset occurs during childhood or adolescence.

Objective: To determine variations in clinical characteristics of Japanese psychiatric outpatients with school refusal by age.

Method: Participants were patients (aged <15 years) who consulted the Department of Child and Adolescent Psychiatry, Kohnodai Hospital, between January 1, 2016 and December 31, 2022. The proportion of diagnoses according to the ICD-10 classification grouped into "developmental and psychological domains" were calculated at each age of school refusal onset. Additionally, clinical characteristics of patients with school refusal onset during adolescence (11-15 years) were compared with child-onset (6-10 years).

Results: Of 3,119 patients who had their initial consultation at Kohnodai Hospital, 36.7% (n=1,145) had school refusal. At age 7, 75.9% were classified as having a diagnosis in the "developmental domains," a proportion which subsequently declined with age. In contrast, 36.2% of 7-year-olds had a diagnosis in the "psychological domains," and the proportion subsequently increased with age. Based on a logistic regression model, students with psychological domain diagnoses and suicide-related behaviors had higher odds ratios of school refusal onset during adolescence, whereas those with developmental domain disorders had lower odds ratios, compared to child-onset.

Conclusions: Gaining insight into the differences between child and adolescent school refusal may help develop targeted interventions and preventive strategies tailored to different developmental stages. Further research encompassing diverse populations and longitudinal studies could deepen our understanding and clarify causal relationships.

Major Depressive Disorder in adolescents (MDD-A) is prevalent and a risk factor for suicide. Integrated care pathways (ICPs) offer a structured approach to care, leveraging recommendations from clinical practice guidelines. The CARIBOU pathway is an ICP for MDD-A co-designed with youth. While the literature is rich in benefits and theoretical approaches for involving youth in the research process ("youth engagement"), there is a growing need for practical frameworks and exemplars to support researchers in implementing such approaches. Informed by the McCain Model for Youth Engagement, this article outlines where, when, and how youth engagement occurred throughout the development of the CARIBOU pathway. Youth who were engaged ("Youth Partners") included Youth Engagement Specialists (YESs) and Youth Advisors, who held distinct but overlapping roles at each stage of development. Engagement activities throughout the research process are described. Youth Partners provided significant contributions to various ICP components, including the design and piloting of the pathway, the development of educational resources, and knowledge dissemination. Youth engagement activities supported the development of the CARIBOU pathway by increasing the relevance to the target youth population and enhanced the research team's understanding of community- and equity-based approaches to interacting with youth participants in clinical research. This article highlights the importance of early and sustained youth engagement in complex clinical research, emphasizing their expertise as crucial assets. These insights underscore the necessity of flexibility, adaptability, and meaningful collaboration, setting a precedent for future multi-component interventions to prioritize youth engagement to ensure interventions resonate with their intended youth audience.

Background: It is crucial to prioritize mental health (MH) promotion among adolescents, as the initial onset of mental illnesses commonly occurs during this developmental stage. Adopting a multi-pronged approach to mental health literacy (MHL) may help promote adolescent mental well-being.

Objective: We aimed to determine baseline adolescents' knowledge and attitudes on mental illness and any changes following a multidimensional MHL program.

Method: A pre-post study was conducted among 600 adolescents in grades 10-12 recruited by multistage sampling in southwest Nigeria. MHL training was implemented using multidimensional tools which included peer-led education, MH booklets, posters, and role plays over a six-week period. Pre- and post-intervention questionnaire data on the knowledge and attitudes of respondents on MH issues were collected and analyzed.

Results: Of 600 students, 594 (99%) [mean age of 14.87 (SD 1.44), a range of 11-21 years, and a female: male ratio of 1.3:1] completed the study. Post-intervention there were significant improvements in some but not all domains assessed. Participants' views on care seeking and willingness for friendship improved post-intervention with a significant reduction in the concern for personal safety as a reason for unwillingness for friendship. Mean knowledge scores significantly increased from 11.89 (SD 2.56) to 13.51 (SD 2.62).

Conclusions: The findings suggest that school-based multidimensional interventions may improve MHL. However, additional studies are needed to more rigorously assess their impact to inform effective integration of MHL into school curricula to enhance adolescent MHL.

In 2004, the Canadian Supreme Court upheld the right of Canadian parents to use open-handed swats to a child's buttocks to correct child misbehavior, but only as developmentally appropriate (i.e., between the ages of 2 and 12). Some social scientists believe that the Canadian Supreme Court did not go far enough. These researchers support total bans on physical discipline. Other social scientists support Canada's existing age-specific legislation. This commentary provides a concise overview of physical discipline research since 2004, emphasizing the methodological rigor of the research used to argue for and against total spanking bans. Advocates of total bans primarily cite reviews based on bivariate correlations and non-randomized methods known to be inherently biased against disciplinary actions (i.e., methods known to make all disciplinary responses to defiance appear harmful). In contrast, those who support Canada's existing legislation have systematically compared methods known to be inherently biased in opposite directions (i.e., harmful- and beneficial-looking), to demonstrate that the true average effect size of customary spanking on child outcomes is likely very near zero. These researchers also emphasize four randomized clinical trials in which spanking increased compliance in defiant preschoolers. Other issues discussed in this commentary are: the developmental trajectories for children who do not learn to comply with parental directives while they are young; and children's risk of assault in countries with and without total bans. We conclude that the most rigorous empirical studies and available crime statistics validate the appropriateness of Canada's existing legislation on disciplinary spanking.

Background: In response to the increasing need for mental health services in Canadian children and youth, the Canadian Institutes of Health Research launched funding towards developing pan-Canadian standards for children and youth mental health services.

Objective: The objective of this rapid review is to synthesize current evidence-based recommendations on assessment and treatment for children and youth with anxiety, depression, obsessive-compulsive disorder (OCD) and Tourette syndrome (TS).

Methods: This rapid review was developed and conducted using the STARR decision tool and the Cochrane organization's minimum standards. We included evidence-based guidelines providing recommendations for and comparative studies evaluating the effectiveness of implementation of evidence-based guideline recommendations on assessment and/or treatment of anxiety, depression, OCD, or TS in children and youth compared to usual care.

Results: Twenty guidelines and one study of the effectiveness of treatment approximating guideline standards were included in this review. There was reasonable consistency in recommendations between guidelines, especially for the management of anxiety disorders and TS, where psychological therapies were recommended as first line. For depression, some minor differences were noted in recommendations for the management of moderate to severe depression, with psychological therapies or SSRIs recommended as first-line in the some guidelines, whereas other guidelines prioritized psychological therapies.

Conclusion: Current evidence-based guidelines prioritize psychological therapies for children and adolescents with anxiety, depression, OCD, or TS. If adequate and equitable service provision is a priority for decision makers, it is essential for the healthcare system to fund appropriately trained mental health therapists to deliver these interventions.

Catatonia is a neuropsychiatric syndrome that is an increasingly recognized cause of acute behavioural changes in children and adolescents with neurodevelopmental disorders (NDD). Literature suggests that catatonia can present differently in this population and can be missed due to diagnostic overshadowing. Catatonia is a treatable condition, and management strategies in children with NDD include benzodiazepines and electroconvulsive therapy (ECT). Untreated, it can cause significant morbidity including severe medical complications, and therefore timely recognition and management of catatonia in children and adolescents with NDD is essential. In this case series, we present three cases of children ages 7, 14, and 10, with diagnoses of autism spectrum disorder, Down syndrome, and Prader-Willi syndrome, respectively. All were admitted to a pediatric inpatient unit for acute behavioural regression. Each had symptoms consistent with catatonia, resulting in trials of benzodiazepine therapy with inadequate response, and were then treated with bilateral ECT. In all cases, marked improvement was noted after ECT, with no apparent adverse effects. The cases are used to highlight the nuances of diagnosis and management of catatonia in children and adolescents with NDD. This includes insights on how presentations of catatonia may differ in this population, challenges with the use of available diagnostic tools, and how these patients may respond differently to recommended treatments such as benzodiazepines. The case series aims to increase clinicians' awareness of pediatric catatonia when children and adolescents with NDD present with acute behavioural changes, and to encourage consideration of the full spectrum of treatments, including bilateral ECT.