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

Transactional models employing cross-lagged panels have been used for over 40 years to examine the longitudinal relations and directional associations between variables of interest to child and adolescent mental health. Through a narrative synthesis of the literature, we provide an accessible overview of cross-lagged panels with attention to developing a research question, study design and assumptions, dynamic effects (including the random-intercept cross-lagged panel model), and reporting and interpretation of results. Implications and critical appraisal guidelines for readers are discussed throughout. Overall, several key points are highlighted, with particular emphasis on the intended level of inference, model and measure selection, and timing of assessments. Despite limitations in establishing causation, cross-lagged panel models are fundamental to non-experimental epidemiologic research in child mental health and development.

During the COVID-19 pandemic, several countries have observed an unexpected increase in the number of adolescents and young adults presenting with rapid onset functional tic-like behaviours after being exposed to social media content of others displaying a similar pattern of functional tics. Many of these patients have been referred to Movement Disorders Clinics with misdiagnoses of late-onset refractory Tourette Syndrome after failing different pharmacological treatments for tics. Tourette Syndrome is a well-known condition with clear clinical diagnostic criteria and which presents with the insidious onset of simple motor and phonic tics in a rostro-caudal evolution starting in early childhood. Clinical and demographic aspects can differentiate rapid onset functional tic-like behaviours from Tourette Syndrome, including the former having abrupt and explosive presentation of severe symptoms, later age of onset, female gender predominance, lack of suppressibility, comorbid anxiety and depression, atypical premonitory urge and history of exposure to social media content displaying tic-like behaviours. This new presentation of a functional neurological disorder may be explained in part by the relationship between social media exposure to tic-like behaviours, and maladaptive response to anxiety caused by life stressors (e.g. COVID-19 pandemic), especially in young individuals. Rapid onset functional tic-like behaviours may be considered a spreading neuropsychiatric disorder that is potentially fostered by the psychosocial impact caused by the COVID-19 pandemic.

Background: Several studies have linked neighbourhood environment to preschool-aged children's behavioural problems. Income inequality is an identified risk factor for mental health among adolescents, however, little is known as to whether this relationship extends to younger children.

Objective: To explore the association between neighbourhood-level income inequality and general psychopathology problems among preschool-aged children.

Methods: We analyzed data from the All Our Families (AOF) longitudinal cohort located in Calgary, Canada at 3-years postpartum. The analytical sample consisted of 1615 mother-preschooler dyads nested within 184 neighbourhoods. Mothers completed the National Longitudinal Survey of Children and Youth Child Behaviour Checklist (NLSCY-CBCL), which assessed internalizing and externalizing symptoms. Income inequality was assessed via the Gini coefficient, which quantifies the unequal distribution of income in society. Mixed effects linear regression assessed the relationship between neighbourhood income inequality and preschooler's general psychopathology.

Results: The mean Gini coefficient across the 184 neighbourhoods was 0.33 (SD = 0.05; min, max: 0.20-0.56). In the fully adjusted model income inequality was not associated with general psychopathology in children β = 0.07 (95%CI: -0.29, 0.45). Neighbourhood environment accounted for 0.5% of the variance in psychopathology in children.

Conclusion: The lack of significant findings may be due to a lack of statistical power in the study. Future studies should investigate this relationship with appropriately powered studies, and over time, to assess if income inequality is a determinant of preschooler psychopathology in Canada.

Objective: As a result of the COVID-19 pandemic, public health agencies and school boards across Canada enacted new protocols, including face masks, physical distancing and enhanced hygiene, to support the safe reopening of in-person school. This study explored the experiences and perceptions of teachers instructing children and adolescents in person during a two-day school simulation.

Method: This study was part of a large school simulation exercise conducted in Toronto, Ontario. Kindergarten to grade 12 teachers taught in classrooms with either masked students, or students who were un-masked or only masked when physical distancing was not possible. A qualitative descriptive phenomenology approach was utilized, and data were collected via virtual focus groups. Qualitative data analysis involved multiple rounds of inductive coding to generate themes.

Results: The sample included 14 teachers (92.9% female; 85.7% White), with a median of 9.5 years teaching experience. Three primary themes emerged: 1) learning to navigate public health measures, 2) needing to adapt teaching strategies and 3) striving to manage conflicting priorities. The majority of teachers reported that mask-wearing and physical distancing impacted their classroom teaching, communication and connection with students.

Conclusions: As schools transition to in-person instruction, teachers will be required to play dual roles in education and public health, with implications on safety, teaching and professional identity. Public health agencies and school boards are encouraged to engage teachers in ongoing conversations regarding in-person school planning and operations. Furthermore, evidence-based interventions, including increased teaching development programs, are recommended to support teachers during the COVID-19 pandemic.

Objective: Multiple informants are often used in the assessment of child psychopathology; however, parent-child agreement is low in child psychiatry. The objective of this exploratory study was to assess informant agreement on the Mini International Neuropsychiatric Interview for Children and Adolescents (MINI-KID) in a clinical sample of children with mental disorders and their parents, and to examine health and demographic factors associated with agreement.

Method: MINI-KID results were analyzed for 88 parent-child dyads. Children were between 8-17 years old and were receiving in- or outpatient services for at least one mental disorder at a pediatric hospital. Kappas were calculated to assess parent-child agreement and logistic regression models were used to identify factors associated with agreement.

Results: Agreement was low to moderate (κ=0.19-0.41) across the MINI-KID modules. Household income was associated with agreement for major depression, generalized anxiety, and attention-deficit hyperactivity disorder. Recruitment setting and parent psychological distress were associated with agreement for generalized anxiety and separation anxiety, respectively. Age, sex, and child disability/impairment were not associated with agreement.

Conclusions: Parent-child agreement on the MINI-KID was low to moderate, and few factors were associated with agreement. These initial findings reaffirm the need for multiple informants when assessing psychopathology in children and can be used by health professionals to facilitate parent-child discussions in clinical settings in child psychiatry.