Journal of Clinical Child and Adolescent Psychology最新文献

Objective: Autism diagnosis is fraught with inequities, including misdiagnosis and delayed identification that disproportionately affect minoritized youth. Aspects of clinician decision-making, particularly diagnostic certainty, may contribute to these inequities. Little is known about how closely clinician certainty corresponds with autistic traits, nor whether certainty relates to socio-demographic factors.

Method: Autistic youth from the Simons Simplex Collection (N = 2,853) completed assessments after which clinicians rated how certain they were that the child met autism diagnostic criteria. Core clinical factors included clinician-observed (Autism Diagnostic Observation Schedule; ADOS) and parent-reported autistic traits (Social Communication Questionnaire), and an overall IQ score.

Results: Clinician certainty was moderately positively associated with parent-reported and observed autistic traits and was just as strongly negatively associated with IQ. Socio-demographic factors significantly associated with certainty, even accounting for clinical measures. Lower income and older child age related to less certainty. In contrast, clinicians rated higher certainty for youth identified as Hispanic, Black or African American, or Asian. Race and income also moderated the concordance between certainty with clinical factors. The agreement between higher ADOS scores and higher certainty was significantly weaker for lower-income families. The association between lower IQ and higher certainty was non-significant for Asian youth.

Conclusions: Diagnostic certainty ratings do not necessarily correspond closely with the level of autistic traits, and clinician perception of autism diagnosis may be related to demographic factors. Caution is needed when relying on clinician certainty to inform diagnosis. Future research on diagnostic practices is urgently needed among diverse and minoritized communities.

Objective: Youth disruptive behavior disorders (DBDs) have a male preponderance, but the extent to which gender biases in clinical assessment influence this imbalance remains unclear. The present study investigates whether a child patient's gender affects clinicians' diagnostic decision-making regarding Oppositional Defiant Disorder (ODD), Conduct Dissocial Disorder (CDD), and Intermittent Explosive Disorder (IED).

Method: Clinicians (N = 403; 57.1% male; M_age = 48.96 years, SD = 11.09) participated in a global ICD-11 field study. Following an experimental design, participants were asked to use ICD-10 or ICD-11 diagnostic guidelines to evaluate two clinical case vignettes, randomly manipulating the patients' gender (boy, girl) and symptom presentation (ODD-Defiant, ODD-Irritable, CDD, IED). Analyses tested whether clinicians' diagnostic accuracy and perceptions of impairment and severity were affected by the patient's gender.

Results: Overall, clinicians identified the correct diagnosis 64.7% of the time. Patient gender was not associated with clinicians' diagnostic accuracy (ps= .090-.895, |φs| = 0.01-0.18) or severity or impairment ratings (ps = .079-.404, |ds| = 0.04-0.19). This pattern of nonsignificant differences and negligible/small effect sizes was consistent across all clinical presentations and analyses.

Conclusions: We found no evidence of an association between patient gender, diagnostic accuracy, or perceived severity or impairment when assessing youth DBDs in the present study. Results suggest that diagnostic judgments may be driven by clinical presentation rather than gender and that the male DBD preponderance may not be due to gender diagnostic biases. Further research is needed to replicate these findings among youths in clinical settings, with diverse gender identities, and with other mental health conditions.

Objective: Research to date has produced compelling evidence of the potentially traumatic consequences of racial discrimination among Black adolescents and adults. Seldom explored, however, is how the potentially traumatic effects of racial discrimination may be shared across the family context. To clarify the relevance of racial trauma across the family system, the current study examined the relationship between racial discrimination and trauma symptoms among a sample of Black adolescent-caregiver dyads.

Method: Data were drawn from a larger self-report survey study examining Black family life experiences. For this study, data from 202 Black adolescents (Mage = 14.50, 52% female) and their caregiver (Mage = 41.63, 83% female) were used to test actor-partner interdependence models examining the associations of racial discrimination and trauma symptoms.

Results: Significant actor effects revealed that racial discrimination was positively associated with self-reported trauma symptoms among adolescents and caregivers. Additionally, partner effects were found, such that adolescent and caregiver experiences of discrimination were positively associated with the trauma symptoms of their family member. Analyses also revealed that the association between racial discrimination and trauma symptoms among caregivers was dependent upon youth experiences of racial discrimination.

Conclusion: The current study lends credence to theories linking racism and trauma-related symptomatology across the life course and family system. Collectively, study findings highlight the importance of understanding the effects of racism beyond the individual and underscores the value and need for family tailored interventions that can repudiate the shared impact and potential intergenerational effects of racial discrimination across Black families.

Objective: Impulsivity has been recognized as an important factor in suicidal thoughts and behaviors (STBs). However, previous research linking impulsivity to STBs has largely relied on cross-sectional designs, considered only a subset of impulsivity measures, and typically focused on middle-to-older adolescents. Here, we explored multiple measures of impulsivity and assessed their predictive relation to suicidal ideation and suicide attempts.

Method: In a sample of 10,286 adolescents (ages 9-12; 47.4% female, 76.4% White, 19.4% Black, 6.4% Asian, 3.5% American Indian/Alaskan Native, 0.6% Native Hawaiian/Pacific Islander, 6.4% Other, 19.4% Hispanic, 12.1% Mixed/Multiple Race) from the Adolescent Brain Cognitive Development℠ Study (ABCD Study®), we assessed impulsivity when youth were 9-10 years old, and suicidal ideation and attempts when youth were 11-12 years old. We measured impulsivity in three ways: a trait-like measure (UPPS-P Impulsive Behavior Scale), a behavioral measure (delay discounting task), and a neural measure (Cortical Delay Discounting [C-DD]). Suicidal ideation and attempts were assessed using the Kiddie Schedule for Affective Disorder and Schizophrenia (KSADS) suicide module.

Results: Negative urgency and lack of perseverance (at ages 9-10) significantly predicted a higher likelihood of suicidal ideation (Negative Urgency: Odds Ratio [OR] = 1.254, p < .001; Lack of Perseverance: OR = 1.152, p = .035) and suicide attempts (Negative Urgency: OR = 1.328, p = .009; Lack of Perseverance: OR = 1.270, p = .009) when youth were 11-12 years old.

Conclusions: Negative urgency and lack of perseverance are robust predictors of future suicidal ideation and suicide attempts in young adolescents. These findings highlight the importance of assessing for and targeting these dimensions of impulsivity in clinical settings.

Objective: The purpose of this systematic review and meta-analysis is to provide an updated examination of the adolescent Dialectical Behavioral Therapy (DBT) literature and synthesize study findings across treatment settings (e.g. inpatient, outpatient, school), and treatment levels (e.g. clinical intervention, targeted, universal prevention). We also provide meta-analytic findings of the impact of DBT across key problem behaviors: depression, emotion dysregulation, suicidal and self-harm behaviors, externalizing problems, and eating disorders.

Method: A reference database search was used to identify studies conducted on adolescent DBT interventions from 2000 through 2023 (N = 72). In addition to ensuring that the review process conformed to the PRISMA statement, we independently verified that each study met inclusion criteria before triple coding each article to examine variables of interest and extracted outcome data needed to conduct meta-analyses.

Results: DBT appears to demonstrate effectiveness in improving mental health outcomes in adolescents across a range of psychiatric problems. To meet these treatment needs, DBT interventions have been appropriately adapted based on care setting, suggesting empirical support in inpatient, residential, partial hospitalization, and intensive outpatient programs, as well as in outpatient settings, juvenile correctional facilities, and schools.

Conclusions: The growing evidence base for adolescent DBT appears to reflect its promise and versatile clinical utility. Clinical implications and recommendations for future directions are discussed, including the need for more randomized controls and representation of diverse communities.

Objective: Suicidal thoughts and behaviors are a leading cause of death, injury, and hospitalization among adolescents. Few evidence-based interventions exist, and these tend to be inaccessible for most youth. Electronic safety plan interventions represent a new avenue to disseminate an evidence-based suicide prevention tool. However, it is not clear whether youth find electronic, self-guided safety plans helpful, nor whether they will use the resulting safety card when experiencing suicidal thoughts or urges. This study examines adolescents' perceptions and use of an electronic, self-guided safety plan intervention.

Method: We recruited 322 adolescents with a past-year history of suicidal thoughts or behaviors, ages 13-17 (55.9% white and non-Hispanic; majority reporting diverse sexual orientations and genders) online via social media to participate in this two-part longitudinal study. At baseline, participants completed the electronic safety plan interventions and reported on key aspects of its usefulness and areas of improvement. Participants reported their use and perceptions of the plan one month later.

Results: Results suggested that adolescents understood, liked, and believed they would use a self-guided safety plan. One month later, about ⅓ of youth who experienced suicidal thoughts or urges used their safety card. Open-ended responses highlighted several features that adolescents enjoyed, including clarity, ease of use, and privacy. Participants also highlighted key areas for improvement, including formatting and language.

Conclusion: This study provides initial support for adolescent use of electronic self-guided safety plans. Next steps include updating this intervention based on youth feedback and testing the effectiveness of this tool using gold standard research methods.

Objective: Although life stress has been linked to adolescent suicidal ideation, most past research has been cross-sectional, and potential processes characterizing this relation remain unclear. One possibility may be a lack of emotional clarity. Informed by stress generation, the current study examined prospective relations between episodic life stress, lack of emotional clarity, and suicidal ideation in an adolescent clinical sample.

Methods: The sample consisted of 180 youths (M_age = 14.89; SD = 1.35; 71.7% female; 78.9% White; 43.0% sexual minority) recruited from a psychiatric inpatient facility. Suicidal ideation severity was assessed at baseline and 18-month follow-up. Lack of emotional clarity and life stress were assessed at baseline, as well as 6-, and 12-month follow-ups. Two random-intercepts cross-lagged panel models were created to estimate within-person relations for variables of interest.

Results: At the within-person level, lack of emotional clarity at baseline predicted greater 6-month impact of interpersonal dependent stressors (b = 0.29, p = .012, 95% CI [0.07, 0.52]), which subsequently predicted a greater 12-month lack of emotional clarity (b = 0.41, p = .005, 95% CI [0.12, 0.70]). Next, a 12-month lack of emotional clarity but not interpersonal dependent stress, predicted greater 18-month suicidal ideation (b = 0.81, p = .006, 95% CI [0.23, 1.30]; R² = .24, p < .001). No significant relations were found for the lack of emotional clarity and independent stress.

Conclusions: Results support the stress generation hypothesis and suggest that future research should be conducted evaluating whether bolstering youth's understanding of their emotional experiences may reduce subsequent suicidal ideation.