Child and Adolescent Mental Health最新文献

We are at a time of unparalleled flux in our understanding of what autism is and now to respond to it, including our understanding of the role of clinical services. For any clinician working in the context of child development and child mental health services, the majority experience is probably of overwhelming demand, and then perhaps confusion. Referrals for neurodevelopmental conditions, and particularly autism, have become an increasing proportion of UK CAMHS referrals in recent years—with the consequent lengthening of wait times extending to years, sometimes equivalent to the whole length of a child's life up until that point. Services are struggling to develop response strategies to meet user frustration, a task not helped by the fact that most interventions in current use have no good evidence of effectiveness. Consequently, a plethora of local approaches and initiatives have developed. In this article I address these clinical and related issues. I discuss current different uses of the term autism, the relation to intellectual disability, and introduce a conceptualisation of autism as emergent and transactional, which is consistent with current developmental and intervention science. This could bridge between neurodiversity and clinical perspectives and implies a framing of early intervention support that has strong clinical trials evidence and provides the basis for a rational and pre-emptive evidenced care pathway, which I describe.

The broadening of the clinical definition of autism over time—the so-called, autism spectrum—has run in parallel with the growth of a neurodiversity movement that has reframed the concept of autism entirely. Without a coherent and evidence-based framework through which both of these advances can be situated, the field is at risk of losing definition altogether. In his commentary, Green describes such a framework, which has appeal because of its grounding in basic and clinical evidence, and its ability to guide its users through its real-world application in health care. An endless spectrum creates barriers to autistic children having their human rights met, but a denial of neurodiversity principles has the same effect. Green's framework holds great promise in coherently framing this sentiment. The real test of the framework is in its implementation, and all communities should walk that path together.

Current mental health service provision for young people was primarily designed based on an assumption of repeat attendance to enable access to interventions. This applies to in-person therapy and, in recent years, digitally provided apps and programmes. Yet, discontinuation after only one or two attendances or uses is a common problem. However, there is a different model, which is intentionally designing provision without assuming repeat attendance, that is, single session interventions. Evidence from the United States, where a suite of digital, self-help single session interventions, accessible anonymously, have been designed, indicates that these are helpful to young people with reductions in depression symptoms at up to 9 months later. These interventions also have had better reach into currently underserved populations (e.g. LGBTQ+ and ethnic minority adolescents). Therefore, these may be a potentially helpful way to expand existing provision at scale, enabling all young people to access evidence-based help quickly.

In their article, Drs. Patalay and Demkowicz raise important questions about research regarding the sex/gender gap in depression rates. However, their perspective on this topic is rather polarizing and yields statements of questionable accuracy. In this Commentary, I respond to several statements in the Article, which I consider potentially misleading. My goal is to present a broader perspective on sex/gender and depression and encourage further discussion of this important topic.

We are in a competitive, burgeoning market for journals and currently in a transition to open access publications, with the aim of making research more widely accessible. Where is the place for practice-based journals in this new and evolving world of publishing? The recent growth of CAMH in terms of Impact Factor, downloads and submissions suggests there is a need for such journals. Professionals are swamped with research findings, often contradictory, sometimes inflammatory, with little time to explore the meaning of these findings within the real world. This editorial reflects on the need for academics and practitioners to be able to debate the evidence base within the real world context (or to consider the lack of it) to inform practice and policy, and also on the importance of providing a platform for topics that are current and/or controversial. Recent contributions to CAMH are highlighted, namely the perceived gender gap in research on emotional disorders in women and girls, and the need for an ethical data sharing framework for academics to investigate the potential harms and benefits of technology. CAMH will continue to ask questions, and aim to remain relevant by focusing on both the evidence and real world context, in order to inform best practice and policy decisions.

No ethics approval was required for these updates.