Following Green (Child and Adolescent Mental Health, 2023, 28, 438) the emergence of a manifest autistic phenotype, during preschool years, represents a discontinuity from preclinical or subclinical states. We propose that this discontinuity suggests that autistic children experience superior interest for, and processing of non-social information, whereas children without autism favor social information processing. This is produced by perceptual over-functioning, still allowing self-taught non-social language learning in a substantial fraction of prototypical autistic children. A new set of rigorous intervention studies using Pediatric Autism Communication Therapy (PACT), based on the synchrony principle, brought autistic children below the ADOS diagnostic threshold (Whitehouse et al., JAMA Pediatrics, 2021, 175, e213298). We now know that adaptation of the child's social environment can produce changes in the manifestations of autism in the pre-school period and later. However, the limitation of these changes, combine with evidence of non-social learning of language suggests that clinicians should combine lateral tutorship (the parallel, unsynchronous exposure of information) with the synchrony (early dyadic communication and engagement) principle to create a new generation of strength-based interventions.
{"title":"Debate: How far can we modify the expression of autism by modifying the environment?","authors":"Laurent Mottron, David Gagnon","doi":"10.1111/camh.12686","DOIUrl":"10.1111/camh.12686","url":null,"abstract":"<p>Following Green (<i>Child and Adolescent Mental Health</i>, 2023, 28, 438) the emergence of a manifest autistic phenotype, during preschool years, represents a discontinuity from preclinical or subclinical states. We propose that this discontinuity suggests that autistic children experience superior interest for, and processing of non-social information, whereas children without autism favor social information processing. This is produced by perceptual over-functioning, still allowing self-taught non-social language learning in a substantial fraction of prototypical autistic children. A new set of rigorous intervention studies using Pediatric Autism Communication Therapy (PACT), based on the synchrony principle, brought autistic children below the ADOS diagnostic threshold (Whitehouse et al., <i>JAMA Pediatrics</i>, 2021, 175, e213298). We now know that adaptation of the child's social environment can produce changes in the manifestations of autism in the pre-school period and later. However, the limitation of these changes, combine with evidence of non-social learning of language suggests that clinicians should combine <i>lateral tutorship</i> (the parallel, unsynchronous exposure of information) with the <i>synchrony</i> (early dyadic communication and engagement) principle to create a new generation of strength-based interventions.</p>","PeriodicalId":49291,"journal":{"name":"Child and Adolescent Mental Health","volume":"29 1","pages":"101-103"},"PeriodicalIF":6.1,"publicationDate":"2023-12-04","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/camh.12686","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138483304","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Psychopathological conditions in adolescence and young adulthood often result from an altered neurodevelopment already phenotypically expressed in childhood. Child and adolescent mental health services are ideally placed to intercept in the developmental trajectories of younger adolescents and contribute to the early detection of a risk for psychosis, as proposed by Salazar de Pablo and Arango (2023, Child and Adolescent Mental Health), opening a debate to which we contribute. The early detection of a specific risk for psychosis and of a broader risk for severe mental illness requires an understanding of the clinical staging of psychosis, neurodevelopmental antecedents of severe mental illness and of heterotypic trajectories between childhood phenotypes and adult disorders.
青春期和青年期的精神病理状况通常是由于儿童时期已经表现出的神经发育改变所致。正如Salazar de Pablo和Arango(2023年，《儿童和青少年心理健康》)所提出的那样，儿童和青少年心理健康服务的理想位置是拦截较年轻的青少年的发展轨迹，并有助于早期发现精神病风险，从而开启了一场辩论，我们为此做出了贡献。早期发现精神病的特定风险和严重精神疾病的更广泛风险需要了解精神病的临床分期、严重精神疾病的神经发育前因以及儿童表型和成人疾病之间的异型轨迹。
{"title":"Debate: The prevention of psychosis in child and adolescent mental health services","authors":"Michele Poletti, Antonio Preti, Andrea Raballo","doi":"10.1111/camh.12685","DOIUrl":"10.1111/camh.12685","url":null,"abstract":"<p>Psychopathological conditions in adolescence and young adulthood often result from an altered neurodevelopment already phenotypically expressed in childhood. Child and adolescent mental health services are ideally placed to intercept in the developmental trajectories of younger adolescents and contribute to the early detection of a risk for psychosis, as proposed by Salazar de Pablo and Arango (2023, <i>Child and Adolescent Mental Health</i>), opening a debate to which we contribute. The early detection of a specific risk for psychosis and of a broader risk for severe mental illness requires an understanding of the clinical staging of psychosis, neurodevelopmental antecedents of severe mental illness and of heterotypic trajectories between childhood phenotypes and adult disorders.</p>","PeriodicalId":49291,"journal":{"name":"Child and Adolescent Mental Health","volume":"29 1","pages":"107-109"},"PeriodicalIF":6.1,"publicationDate":"2023-11-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138463945","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Aase Villadsen, Claire Cameron, John Evans, Jo Van Herwegen, Vivian Hill, Jane Hurry, Amelia Roberts, Dominic Wyse, Thure Johansen
Background
There is a need for causally stronger research on the association between child mental health and school exclusion and truancy. This study examines school exclusion and truancy in relation to both conduct and emotional problems and considers these problems both as predictors and as outcomes of school exclusion and truancy.
Method
The sample included 15,236 individuals from the Millennium Cohort Study, a UK longitudinal birth cohort study. Conduct and emotional problems were assessed from childhood to adolescence (age 7, 11, 14 and 17 years), and reports of school exclusion and truancy were collected at age 11 and 14. Fixed effect analyses were used.
Results
Increases in conduct problems and emotional symptoms were associated with subsequent exclusion (OR 1.22, [95% CI 1.08–1.37] and OR 1.16, [1.05–1.29], respectively). Emotional symptoms, but not conduct problems, predicted truancy (OR 1.17, [1.07–1.29]). These estimates were similar for males and females. Exclusion was associated with an increase in conduct problems at age 14 (0.50, [0.30–0.69]), and for males, it was associated with an increase in emotional symptoms both at age 14 (0.39, [0.12–0.65]) and 17 (0.43, [0.14–0.72]). Truancy was associated with an increase in conduct problems at age 14 (0.41, [0.28–0.55]), and for females also at age 17 (0.22, [0.03–0.42]), and it was associated with increased emotional symptoms at age 14 (0.43, [0.25–0.62]) and 17 (0.44, [0.21–0.66]), which was similar for males and females.
Conclusion
Results indicate a bidirectional association between emotional symptoms and school exclusion and truancy, as an increase in these symptoms was associated with later truancy and exclusion, and emotional symptoms increased following both school events. For conduct problems, the association was bidirectional for school exclusion, but unidirectional for truancy as these symptoms did not lead to truancy, but an increase in conduct problems was observed after both exclusion and truancy.
{"title":"Longitudinal association of conduct and emotional problems with school exclusion and truancy: A fixed effect analysis of the UK Millennium Cohort Study","authors":"Aase Villadsen, Claire Cameron, John Evans, Jo Van Herwegen, Vivian Hill, Jane Hurry, Amelia Roberts, Dominic Wyse, Thure Johansen","doi":"10.1111/camh.12681","DOIUrl":"10.1111/camh.12681","url":null,"abstract":"<div>\u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>There is a need for causally stronger research on the association between child mental health and school exclusion and truancy. This study examines school exclusion and truancy in relation to both conduct and emotional problems and considers these problems both as predictors and as outcomes of school exclusion and truancy.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Method</h3>\u0000 \u0000 <p>The sample included 15,236 individuals from the Millennium Cohort Study, a UK longitudinal birth cohort study. Conduct and emotional problems were assessed from childhood to adolescence (age 7, 11, 14 and 17 years), and reports of school exclusion and truancy were collected at age 11 and 14. Fixed effect analyses were used.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>Increases in conduct problems and emotional symptoms were associated with subsequent exclusion (OR 1.22, [95% CI 1.08–1.37] and OR 1.16, [1.05–1.29], respectively). Emotional symptoms, but not conduct problems, predicted truancy (OR 1.17, [1.07–1.29]). These estimates were similar for males and females. Exclusion was associated with an increase in conduct problems at age 14 (0.50, [0.30–0.69]), and for males, it was associated with an increase in emotional symptoms both at age 14 (0.39, [0.12–0.65]) and 17 (0.43, [0.14–0.72]). Truancy was associated with an increase in conduct problems at age 14 (0.41, [0.28–0.55]), and for females also at age 17 (0.22, [0.03–0.42]), and it was associated with increased emotional symptoms at age 14 (0.43, [0.25–0.62]) and 17 (0.44, [0.21–0.66]), which was similar for males and females.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Results indicate a bidirectional association between emotional symptoms and school exclusion and truancy, as an increase in these symptoms was associated with later truancy and exclusion, and emotional symptoms increased following both school events. For conduct problems, the association was bidirectional for school exclusion, but unidirectional for truancy as these symptoms did not lead to truancy, but an increase in conduct problems was observed after both exclusion and truancy.</p>\u0000 </section>\u0000 </div>","PeriodicalId":49291,"journal":{"name":"Child and Adolescent Mental Health","volume":"29 3","pages":"299-307"},"PeriodicalIF":6.8,"publicationDate":"2023-11-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/camh.12681","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"71523094","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Narrative Matters: Wasting away and fed up – dietary battles in history","authors":"Jane Whittaker","doi":"10.1111/camh.12682","DOIUrl":"10.1111/camh.12682","url":null,"abstract":"","PeriodicalId":49291,"journal":{"name":"Child and Adolescent Mental Health","volume":"29 1","pages":"110-112"},"PeriodicalIF":6.1,"publicationDate":"2023-10-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"66784502","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Day hospitals in child and adolescent mental health services are held to be helpful entities in the psychiatric care of young people. However, limited research has been done to look into how day hospitals and similar settings affect referrals, inpatient stays and in which cohort of patients do they show the most impact. This study's primary aims were to examine the impact of a new Child and Adolescent Mental Health Service (CAMHS) day hospital on referrals and admissions to the associated CAMHS in-patient unit. A secondary aim of this study was to examine the demographics and clinical outcomes of the young people attending the day hospital.
Methods
Information was gathered using retrospective reviews of clinical files and databases.
Results
There was a reduction in admissions and in the total bed days from the study area following the opening of the day hospital. There was an improvement in clinical outcomes for young people attending the day hospital.
Conclusion
Day hospital in child and adolescent mental health services can prove to be a useful modality to provide support to young people with a moderate to severe mental illness leading to reduced inpatient admissions and improving lengths of inpatient stay. It also improves clinical outcomes for cohorts of young people where inpatient stay is not warranted but higher levels of support is needed.
{"title":"Short Research Article: Opening a new CAMHS day hospital – does it affect inpatient admissions and does it help at all?","authors":"Sannie John, Dermot Cohen","doi":"10.1111/camh.12680","DOIUrl":"10.1111/camh.12680","url":null,"abstract":"<div>\u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>Day hospitals in child and adolescent mental health services are held to be helpful entities in the psychiatric care of young people. However, limited research has been done to look into how day hospitals and similar settings affect referrals, inpatient stays and in which cohort of patients do they show the most impact. This study's primary aims were to examine the impact of a new Child and Adolescent Mental Health Service (CAMHS) day hospital on referrals and admissions to the associated CAMHS in-patient unit. A secondary aim of this study was to examine the demographics and clinical outcomes of the young people attending the day hospital.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>Information was gathered using retrospective reviews of clinical files and databases.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>There was a reduction in admissions and in the total bed days from the study area following the opening of the day hospital. There was an improvement in clinical outcomes for young people attending the day hospital.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusion</h3>\u0000 \u0000 <p>Day hospital in child and adolescent mental health services can prove to be a useful modality to provide support to young people with a moderate to severe mental illness leading to reduced inpatient admissions and improving lengths of inpatient stay. It also improves clinical outcomes for cohorts of young people where inpatient stay is not warranted but higher levels of support is needed.</p>\u0000 </section>\u0000 </div>","PeriodicalId":49291,"journal":{"name":"Child and Adolescent Mental Health","volume":"29 3","pages":"276-280"},"PeriodicalIF":6.8,"publicationDate":"2023-10-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"50163365","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Gianna Cadorna, Norha Vera San Juan, Heather Staples, Sonia Johnson, Rebecca Appleton
Background
There has been an increase in children and young people attending emergency departments for mental health reasons, including self-harm. Patients often report having poor experiences when attending emergency departments for mental health support. However, there has yet to be a review exploring the experiences of young people. Our aim in this study was to synthesise qualitative literature on young people's experiences of going to emergency departments for mental health support.
Methods
A systematic review and metasynthesis were conducted. Five databases and grey literature were searched for relevant studies. Five articles met study criteria and were analysed using an iterative process of thematic synthesis.
Results
The synthesis yielded four overarching themes: (a) emergency departments' inability to meet the mental health needs of young people, (b) emergency departments exacerbating patient distress, (c) patients feeling like a burden or undeserving of treatment and (d) consequences of poor emergency department experiences.
Conclusions
These findings (based on a still very limited literature) highlight the role that emergency departments have in relation to being a key point of contact with young people who self-harm. To properly engage with patients, emergency departments need to have the resources to provide compassionate care and follow clinical guidelines regarding assessments.
{"title":"Review: Systematic review and metasynthesis of qualitative literature on young people's experiences of going to A&E/emergency departments for mental health support","authors":"Gianna Cadorna, Norha Vera San Juan, Heather Staples, Sonia Johnson, Rebecca Appleton","doi":"10.1111/camh.12683","DOIUrl":"10.1111/camh.12683","url":null,"abstract":"<div>\u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>There has been an increase in children and young people attending emergency departments for mental health reasons, including self-harm. Patients often report having poor experiences when attending emergency departments for mental health support. However, there has yet to be a review exploring the experiences of young people. Our aim in this study was to synthesise qualitative literature on young people's experiences of going to emergency departments for mental health support.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Methods</h3>\u0000 \u0000 <p>A systematic review and metasynthesis were conducted. Five databases and grey literature were searched for relevant studies. Five articles met study criteria and were analysed using an iterative process of thematic synthesis.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>The synthesis yielded four overarching themes: (a) emergency departments' inability to meet the mental health needs of young people, (b) emergency departments exacerbating patient distress, (c) patients feeling like a burden or undeserving of treatment and (d) consequences of poor emergency department experiences.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>These findings (based on a still very limited literature) highlight the role that emergency departments have in relation to being a key point of contact with young people who self-harm. To properly engage with patients, emergency departments need to have the resources to provide compassionate care and follow clinical guidelines regarding assessments.</p>\u0000 </section>\u0000 </div>","PeriodicalId":49291,"journal":{"name":"Child and Adolescent Mental Health","volume":"29 3","pages":"266-275"},"PeriodicalIF":6.8,"publicationDate":"2023-10-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/camh.12683","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41217650","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
<p>Welcome to the November issue of <i>Child and Adolescent Mental Health</i> (<i>CAMH</i>). In this issue, several pieces highlight the importance of researching, and in some cases, implementing short interventions and self-help interventions for children and adolescents with mental health concerns while highlighting the importance of finding ways to engage children and young people.</p><p>As highlighted in one of the studies providing a tertiary care centre experience for 3 years, visits to paediatric emergency departments and admission rates continue to rise, and novel strategies are needed to find solutions for the limited resources currently available (Manuel, Yen, Feng, & Patel, <span>2023</span>). These strategies need to ensure that children and adolescents receive high-quality care. These strategies also need to promote engagement for children and young people, and acknowledge that time constraints can limit engagement (Ali, Wright, Curran, & Newton, <span>2022</span>).</p><p>I invite you to read several studies relevant to this matter in this issue, showing how short interventions and self-help interventions can be useful strategies for some children and adolescents. Sams, Garrison, Walsh, Maeng, and Cross (<span>2023</span>) looked at the impact of a brief inpatient intervention on the length of stay and on readmissions in adolescents who had been admitted into the hospital. This ‘Rapid Stabilization Pathway’, where a safety planning intervention was provided, achieved a decrease in the length of stay at the hospital, and no significant differences in readmissions to the inpatient unit up to 90 days after discharge were found (Sams et al., <span>2023</span>).</p><p>A pilot randomized clinical trial found that a guided paced breathing audiovisual intervention of no more than 10 min per session decreased anxiety symptoms in the intervention group compared to the control group (Shank et al., <span>2022</span>). Another study evaluating a self-help, online programme showed improvements in anxiety symptoms in children and adolescents, and reductions in life interference in children (Rowe, Evans, Donovan, Spence, & March, <span>2023</span>).</p><p>As highlighted by Loades and Schleider (<span>2023</span>), single session interventions, even provided as one-off therapeutic interventions, can be helpful to expand current mental health provisions and help young people access evidence-based interventions promptly, including underserved populations such as ethnic minorities or L.G.B.T.Q.I.A+ populations. According to the authors, reductions in depressive symptoms can be achieved at up to 9 months later.</p><p>One of the challenges is that these strategies may be helpful for some individuals and some populations, but not necessarily for others. To note, precision strategies typically depend on the characteristics of the patients (Salazar de Pablo et al., <span>2021</span>). For instance, digital health interventions may be better accep
欢迎阅读11月份的《儿童和青少年心理健康》(CAMH)。在本期中，有几篇文章强调了研究的重要性，在某些情况下，对有心理健康问题的儿童和青少年实施短期干预措施和自助干预措施，同时强调了寻找让儿童和青少年参与的方法的重要性。正如一项提供三级护理中心3年经验的研究所强调的那样，儿科急诊科的访问量和入院率持续上升，需要新的策略来寻找目前有限资源的解决方案(Manuel, Yen, Feng， &帕特尔,2023)。这些战略需要确保儿童和青少年获得高质量的护理。这些策略还需要促进儿童和年轻人的参与，并承认时间限制可能会限制参与(Ali, Wright, Curran， &牛顿,2022)。我邀请你们阅读本期与此相关的几项研究，这些研究表明，短期干预和自助干预对一些儿童和青少年来说是有用的策略。Sams、Garrison、Walsh、Maeng和Cross(2023)研究了短暂住院干预对住院时间和入院青少年再入院的影响。这种“快速稳定路径”提供了安全规划干预措施，减少了住院时间，出院后90天内再入院率没有显著差异(Sams等，2023)。一项试点随机临床试验发现，与对照组相比，每次不超过10分钟的引导节奏呼吸视听干预可以减少干预组的焦虑症状(Shank et al.， 2022)。另一项评估自助在线项目的研究显示，儿童和青少年的焦虑症状有所改善，儿童的生活干扰有所减少(Rowe, Evans, Donovan, Spence， &2023年3月)。正如Loades和Schleider(2023)所强调的那样，单次干预，甚至作为一次性治疗干预措施提供，都有助于扩大当前的心理健康服务，并帮助年轻人迅速获得基于证据的干预措施，包括少数民族或lgbtqi.a +人群等服务不足的人群。根据作者的说法，抑郁症状的减轻可以在长达9个月后实现。其中一个挑战是，这些策略可能对某些个人和某些群体有用，但对其他人不一定有用。需要注意的是，精准策略通常取决于患者的特征(Salazar de Pablo et al.， 2021)。例如，数字卫生干预措施可能更容易被一些年轻人及其家庭所接受。Politte-Corn及其同事评估了青少年和初成成人在社交媒体使用、在线社会支持和抑郁症状方面的年龄相关差异(Politte-Corn, Nick， &Kujawa, 2023)。另一个例子，在Rowe等人(2023)的文章中评估了儿童和青少年自助在线计划的使用情况，在儿童中观察到生活干扰的减少，但在青少年中没有。其他因素，如症状的严重程度，似乎也对干预措施的效果有影响。例如，患有严重强迫症的青少年似乎从面对面的认知行为治疗中获益更多，而在患有轻度强迫症的青少年中，这两种策略同样有效(Salazar de Pablo, Pascual-Sánchez, Panchal, Clark， &克雷布斯,2023)。我最后的邀请是阅读我们关于儿童和青少年心理健康服务在为精神病和精神病状况提供预防性干预方面的作用的辩论。在其他策略中，建议采用低强度的社会心理干预来预防精神病(Tiffin &Northover, 2023)。在对我们治疗的年轻人的功能和生活质量产生更大影响之前，提供心理教育策略的短期干预或自助干预也可能在这一领域发挥作用。请考虑对这场辩论作出回应，或者在社交媒体上让我们知道你对此的看法。总之，我们需要对短期干预和自助干预进行更多的研究，以弄清楚哪些儿童和青少年可能从中受益更多，以及我们能取得什么成果。一如既往，我们的杂志致力于推进临床知识的患者和公众参与策略，找到一种方法，让儿童和年轻人参与进来，为他们提供高质量的干预，也提供短期干预和自助干预。我们希望这个问题能澄清这个问题。 作者已声明，他们没有竞争或潜在的利益冲突。
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<p>Rebecca Kingston</p><p>South London and Maudsley NHS Foundation Trust</p><p>The term ‘quasi-autism’ (QA) describes the autism-like difficulties that are observed in a high number of children who had prolonged negative social experiences in early childhood. QA is one of several challenges that can arise as a result of early deprivation. These challenges are referred to as deprivation-specific problems (DSP) and include QA, attention deficit and hyperactivity disorder (ADHD), disinhibited social engagement disorder (DSE) and cognitive impairment. Furthermore, all the DSPs continue to be seen throughout adolescence and early adulthood even when children are removed from deprivation in early childhood.</p><p>In this recent study, Rodriguez-Perez et al. (2023) investigated the persistence of QA and other DSPs in adulthood, and the impact of QA on well-being, daily functioning and relationships. A total of 217 adoptees were compared into three groups: those who experienced early deprivation and were identified as having QA in childhood, adoptees who had experienced early deprivation but did not present with childhood QA and adoptees who had no experience of deprivation (Low/No deprivation). A wide range of measures were collected throughout childhood and into early adulthood looking at the presence of DSP symptoms and the outcomes of the adoptees. As it had been demonstrated in previous research, the study finds that symptoms of QA, ADHD and DSE continue to be seen throughout childhood and into young adulthood. IQ also remains significantly lower in adoptees who had experienced early deprivation when compared to those who had not.</p><p>Looking specifically at symptoms of QA, the study shows that while the levels of social reciprocal interaction remain the same into early adulthood and repetitive and stereotyped behaviours are marginally better, communication difficulties worsen. This differs from what is typically seen in idiopathic autism where improvements have been identified across all symptom clusters. A further point of note is that, while not as prominent as they are in adoptees with childhood QA, elevated levels of QA symptoms are seen in the adoptees who have experienced childhood deprivation but do not present with QA. Although they may not meet the clinical threshold for QA, people who have experienced deprivation are more likely to experience some of the same difficulties. Regarding the impact of QA on mental health, functioning and relationships, this study demonstrates that QA is linked to higher prevalence of mental health difficulties and use of services as well as negative impact on daily functioning such as education, employment and independent living. However, while those with QA are seen to have less success with romantic relationships, familial relationships are not negatively impacted. Furthermore, the adoptees with childhood QA have comparable levels of self-esteem and life satisfaction to the other groups, in contrast to the
丽贝卡·金斯顿南伦敦和莫兹利NHS基金会信托术语“准自闭症”(QA)描述了在儿童早期长期负面社会经历的大量儿童中观察到的类似自闭症的困难。QA是早期剥夺所带来的挑战之一。这些挑战被称为剥夺特异性问题(DSP)，包括QA、注意缺陷和多动障碍(ADHD)、去抑制性社会参与障碍(DSE)和认知障碍。此外，在整个青春期和成年早期，即使儿童在幼儿期摆脱了贫困，也能看到所有的残疾人。在最近的研究中，Rodriguez-Perez等人(2023)调查了QA和其他sps在成年期的持续性，以及QA对幸福感、日常功能和人际关系的影响。共有217名被收养者被分为三组:经历过早期剥夺并在童年时期被确定为有QA的人，经历过早期剥夺但没有出现童年QA的被收养者和没有剥夺经历的被收养者(低/无剥夺)。在整个童年和成年早期收集了广泛的措施，以观察被收养者DSP症状的存在和结果。正如之前的研究所证明的那样，该研究发现，QA、ADHD和DSE的症状在整个童年和青年时期都可以看到。与那些没有经历过早期剥夺的被收养者相比，那些经历过早期剥夺的被收养者的智商也明显较低。具体来看QA的症状，该研究表明，虽然社会互惠互动水平在成年早期保持不变，重复和刻板行为略有改善，但沟通困难会恶化。这与特发性自闭症的典型情况不同，特发性自闭症在所有症状群中都得到了改善。进一步值得注意的是，虽然在患有童年期质量保证的被收养者中不那么突出，但在经历过童年剥夺但没有表现出质量保证的被收养者中，质量保证症状的水平升高。虽然他们可能达不到QA的临床门槛，但经历过剥夺的人更有可能经历一些同样的困难。关于QA对心理健康、功能和人际关系的影响，本研究表明，QA与心理健康困难和服务使用的较高患病率以及对教育、就业和独立生活等日常功能的负面影响有关。然而，虽然那些有QA的人在恋爱关系上不太成功，但家庭关系却没有受到负面影响。此外，与特发性自闭症中经常看到的消极自尊结果相比，儿童时期有QA的被收养者的自尊和生活满意度水平与其他组相当。这是第一个纵向研究，着眼于QA在多个功能方面对广泛的成人结果的影响。该研究的一个局限性是，虽然两组经历过童年剥夺的女孩的性别比例相似，但在低剥夺组/无剥夺组中，女孩的数量较少。鉴于在特发性自闭症中发现的公认的性别差异，这将值得在进一步的QA研究中加以考虑。Rodriguez-Perez, M.， Kennedy, M.， Barker, e.d.， Kreppner, J.， Solerdelcoll, M.， &;Sonuga-Barke, E.J.S.(2023)。儿童准自闭症的成人后果是由于极端的制度剥夺。儿童心理与精神病学杂志，64,1292-1302。雅典娜国立大学和卡波迪斯特里安大学的研究人员表示，忧郁症是成年人最常见的心理健康问题之一，在普通人群中发病率很高。它们还与后代的各种心理健康不良后果有关，其中焦虑症是最常见的相关疾病。反过来，儿童时期的焦虑症会导致成年后情绪障碍的风险增加，从而增加了跨代恶性循环的可能性。Tu, Manley, Saunders, and Creswell(2023)进行了一项系统回顾和荟萃分析，旨在调查患者后代的情绪障碍，即单极和双相抑郁与焦虑障碍之间的关系，并探索可能导致此类父母后代出现精神病理的其他可能因素。作者遵循了系统评价和荟萃分析(PRISMA)指南的首选报告项目，并确定了原始研究，将患有情绪障碍的父母的后代与没有这种诊断的父母的后代进行了比较，以及后代的焦虑症。 他们在最后的分析中纳入了35项横断面和队列研究，这些研究发现，除了广场恐怖症外，与对照组相比，患有情绪障碍的父母的后代患所有类型焦虑症的几率都有所增加。具体而言，荟萃分析显示，总体焦虑障碍的风险增加(RR = 1.82, 95% CI = 1.47-2.26)，恐慌障碍的风险尤其增加(RR = 3.07, 95% CI = 2.19-4.32)。基于上述结果，父母有情绪障碍的后代患焦虑症的可能性大约是父母没有情绪障碍的后代的两倍。这表明，有情绪障碍父母的孩子中，有八分之一患有某种形式的焦虑症，而在普通人群中，这一比例为十五分之一。亚组分析显示，双相情感障碍父母与单相抑郁父母在后代焦虑障碍方面没有差异。此外，该研究强调了父母情绪障碍的性别特异性传递对某些后代焦虑障碍的重要作用，以及后代年龄较大的缓解作用。本系统综述和荟萃分析的局限性包括关注白人人群和高收入西方国家，无法确定因果关系的方向，由于使用横断面研究而降低了症状回忆的可靠性，关于后代年龄等其他风险因素的个人层面数据不足，重点关注儿童焦虑症的诊断，最后纳入了五项研究，这些研究仅依赖于父母报告的诊断性访谈。图，e.n.，曼利，H.，桑德斯，k.e.a.， &;克雷斯韦尔，C.(2023)。系统回顾和荟萃分析:父母有情绪障碍的后代患焦虑症的风险。美国儿童学会杂志;青少年精神病学。https://doi.org/10.1016/j.jaac.2023.06.022No这些更新需要伦理批准。
{"title":"Clinical research updates","authors":"Marinos Kyriakopoulos, Rebecca Kingston, Konstantinos Stathias","doi":"10.1111/camh.12677","DOIUrl":"10.1111/camh.12677","url":null,"abstract":"<p>Rebecca Kingston</p><p>South London and Maudsley NHS Foundation Trust</p><p>The term ‘quasi-autism’ (QA) describes the autism-like difficulties that are observed in a high number of children who had prolonged negative social experiences in early childhood. QA is one of several challenges that can arise as a result of early deprivation. These challenges are referred to as deprivation-specific problems (DSP) and include QA, attention deficit and hyperactivity disorder (ADHD), disinhibited social engagement disorder (DSE) and cognitive impairment. Furthermore, all the DSPs continue to be seen throughout adolescence and early adulthood even when children are removed from deprivation in early childhood.</p><p>In this recent study, Rodriguez-Perez et al. (2023) investigated the persistence of QA and other DSPs in adulthood, and the impact of QA on well-being, daily functioning and relationships. A total of 217 adoptees were compared into three groups: those who experienced early deprivation and were identified as having QA in childhood, adoptees who had experienced early deprivation but did not present with childhood QA and adoptees who had no experience of deprivation (Low/No deprivation). A wide range of measures were collected throughout childhood and into early adulthood looking at the presence of DSP symptoms and the outcomes of the adoptees. As it had been demonstrated in previous research, the study finds that symptoms of QA, ADHD and DSE continue to be seen throughout childhood and into young adulthood. IQ also remains significantly lower in adoptees who had experienced early deprivation when compared to those who had not.</p><p>Looking specifically at symptoms of QA, the study shows that while the levels of social reciprocal interaction remain the same into early adulthood and repetitive and stereotyped behaviours are marginally better, communication difficulties worsen. This differs from what is typically seen in idiopathic autism where improvements have been identified across all symptom clusters. A further point of note is that, while not as prominent as they are in adoptees with childhood QA, elevated levels of QA symptoms are seen in the adoptees who have experienced childhood deprivation but do not present with QA. Although they may not meet the clinical threshold for QA, people who have experienced deprivation are more likely to experience some of the same difficulties. Regarding the impact of QA on mental health, functioning and relationships, this study demonstrates that QA is linked to higher prevalence of mental health difficulties and use of services as well as negative impact on daily functioning such as education, employment and independent living. However, while those with QA are seen to have less success with romantic relationships, familial relationships are not negatively impacted. Furthermore, the adoptees with childhood QA have comparable levels of self-esteem and life satisfaction to the other groups, in contrast to the","PeriodicalId":49291,"journal":{"name":"Child and Adolescent Mental Health","volume":"28 4","pages":"573-574"},"PeriodicalIF":6.1,"publicationDate":"2023-10-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/camh.12677","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41153220","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Children and adolescents are at risk of developing mental disorders that have lifelong consequences. This debate piece argues that youth meeting the criteria for clinical high risk for psychosis cannot be assessed and treated with the same tools as adults, given that they often present with different patterns and timecourse of symptoms, age-specific comorbidities and follow different pathways to care. It looks at the key role that Child and Adolescent Mental Health Services and other professionals can play by using an age-specific approach to detecting and preventing psychosis.
{"title":"Debate: Child and adolescent mental health services: time to take the lead in prevention of psychosis in youth","authors":"Inmaculada Baeza, Gisela Sugranyes","doi":"10.1111/camh.12679","DOIUrl":"10.1111/camh.12679","url":null,"abstract":"<p>Children and adolescents are at risk of developing mental disorders that have lifelong consequences. This debate piece argues that youth meeting the criteria for clinical high risk for psychosis cannot be assessed and treated with the same tools as adults, given that they often present with different patterns and timecourse of symptoms, age-specific comorbidities and follow different pathways to care. It looks at the key role that Child and Adolescent Mental Health Services and other professionals can play by using an age-specific approach to detecting and preventing psychosis.</p>","PeriodicalId":49291,"journal":{"name":"Child and Adolescent Mental Health","volume":"28 4","pages":"556-558"},"PeriodicalIF":6.1,"publicationDate":"2023-09-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10580858","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
There has been much academic interest in ‘the clinical high-risk state for psychosis’ (CHR-P) concept. Whilst early intervention in psychosis (EIP) services have offered input to individuals meeting the CHR-P criteria the involvement of CAMHS clinicians in supporting young people with ideational and perceptual disturbance has been more inconsistent and uncertain.
Method
We bring together our relevant lived experience, empirical evidence and clinical and research expertise to write this commentary.
Results
We assert that the CHR-P paradigm needs to be revised. This should reflect the low transition rates to psychosis and the prevalent general, impairing psychopathology in individuals meeting these criteria. Nevertheless, it is clear that both CAMHS and EIP services have potential roles in meeting the needs of young people affected by distressing ideational and perceptual disturbance.
Conclusions
We suggest that new care pathways and services are not required for young people affected by distressing psychosis-like experiences. Rather more effective joint working between CAMHS, EIP, crisis services and other agencies could meet the needs of these young people more comprehensively.
{"title":"Debate: Better use of existing services, not more new pathways, is required for psychosis prevention in young people – Commentary on Salazar de Pablo and Arango: ‘Prevention of psychosis in adolescents: does CAMHS have a role?’","authors":"Paul A. Tiffin, Guy Northover","doi":"10.1111/camh.12676","DOIUrl":"10.1111/camh.12676","url":null,"abstract":"<div>\u0000 \u0000 <section>\u0000 \u0000 <h3> Background</h3>\u0000 \u0000 <p>There has been much academic interest in ‘the clinical high-risk state for psychosis’ (CHR-P) concept. Whilst early intervention in psychosis (EIP) services have offered input to individuals meeting the CHR-P criteria the involvement of CAMHS clinicians in supporting young people with ideational and perceptual disturbance has been more inconsistent and uncertain.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Method</h3>\u0000 \u0000 <p>We bring together our relevant lived experience, empirical evidence and clinical and research expertise to write this commentary.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Results</h3>\u0000 \u0000 <p>We assert that the CHR-P paradigm needs to be revised. This should reflect the low transition rates to psychosis and the prevalent general, impairing psychopathology in individuals meeting these criteria. Nevertheless, it is clear that both CAMHS and EIP services have potential roles in meeting the needs of young people affected by distressing ideational and perceptual disturbance.</p>\u0000 </section>\u0000 \u0000 <section>\u0000 \u0000 <h3> Conclusions</h3>\u0000 \u0000 <p>We suggest that new care pathways and services are not required for young people affected by distressing psychosis-like experiences. Rather more effective joint working between CAMHS, EIP, crisis services and other agencies could meet the needs of these young people more comprehensively.</p>\u0000 </section>\u0000 </div>","PeriodicalId":49291,"journal":{"name":"Child and Adolescent Mental Health","volume":"28 4","pages":"553-555"},"PeriodicalIF":6.1,"publicationDate":"2023-09-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://onlinelibrary.wiley.com/doi/epdf/10.1111/camh.12676","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"10589742","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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