Child and Adolescent Mental Health最新文献

Childhood anxiety problems are prevalent and impairing, yet many children are unable to access evidence-based treatment (i.e. cognitive behavioural therapy, CBT). Digitally augmented psychological interventions represent one way to help increase access to CBT for children with mental health problems, as these interventions can substantially reduce the amount of therapist time required to deliver the intervention, as well as bringing a range of other potential advantages for therapists and families. Online Support and Intervention (OSI) is an example of a brief digitally augmented, therapist-supported, parent-led CBT intervention for child anxiety problems that is now being commissioned and delivered in child mental health services. This article outlines the journey of OSI from research to implementation into routine clinical practice and highlights key considerations for translating digitally augmented mental health interventions into routine care in child mental health services.

This special issue captures the multifaceted and dynamic human–environment relationship across a critical stage of development and illustrates the importance of the physical environment in understanding child and adolescent mental health. Illustrated through original articles, action research, systematic reviews, debates, editorial perspectives and commentaries, our authors showcase the nuances of this relationship through diverse methodologies, data sources, interdisciplinary teams and international perspectives. Authors evidence the impact of physical environmental characteristics on psychosocial outcomes early in life, for both community and clinical populations. Exposure to adversities early in life or during critical developmental periods, such as early childhood and adolescence, has the potential to shape later life outcomes. We hope this special issue provides helpful examples of good practice and the ways of working together needed to inspire future youth-led context-specific health research. We also hope that this special issue can encourage us to rethink public health and education policies, urban planning and design priorities, and clinical research and practice to have young people in the centre of this work.

This letter responds to Birrell et al.'s (Child and Adolescent Mental Health, 30, 92) article on universal school-based mental health interventions, emphasizing the importance of refining universal approaches rather than discarding them. The letter discusses critical aspects of program adaptation to cultural contexts, the role of meaningful co-design with students and staff, and the integration of targeted strategies in concert with universal approaches. It also highlights the potential of digital health technologies, emphasizing equitable access and personalization to diverse populations. Additionally, the letter calls for a broader evaluation of intervention impacts beyond symptom reduction, including stigma reduction, school climate, and help-seeking behaviors. Drawing from recent evidence, the letter advocates for integrated models that combine universal and targeted strategies, offering practical recommendations for future research and policy.

We appreciate the commentary by Tiffin and Kelleher on our systematic review and meta-analysis. The CHR-P paradigm remains one of the most established preventive approaches in mental health. While concerns have been raised regarding the clinical utility of the CHR-P paradigm, its implementation in specialized services worldwide supports its relevance. These services provide evidence-based interventions, reducing unnecessary antipsychotic use and guiding treatment strategies. Tiffin and Kelleher's critique largely focuses on transition rates and age cutoffs. While we argue that transition rates in adolescents at CHR-P are significant, other outcomes need to be considered. Among others, negative symptoms are clinically significant in adolescents at CHR-P, impairing functioning and long-term outcomes. We think we should refine and improve the CHR-P paradigm rather than simply abandoning it. With advancements in precision medicine, we can improve risk stratification and tailor interventions to better serve individuals at risk. We can also expand the paradigm, so it supports other help-seeking adolescents at risk requiring transdiagnostic, developmentally sensitive interventions to prevent psychosis.

There has been much academic interest in ‘the clinical high risk for psychosis’ (CHR-P) concept. Indeed, as two child and adolescent psychiatrists interested in psychosis prediction and prevention, we enthusiastically embraced the paradigm in our clinical and academic work. However, despite more than two decades of research, there is no definition of CHR-P in adolescence that has proven to be able to usefully predict transition to psychosis. Indeed, research suggests that much, if not all, of the risk associated with CHR diagnoses in adolescents is captured by being help-seeking for mental health problems, rather than being associated with a CHR diagnosis itself. In this commentary, we critique the systematic review by Frearson et al. (2025). In particular, we challenge the conceptualisation around the CHR-P concept, as applied to under 18 s, and the assumptions underpinning it. We also highlight issues with the terminology used when describing the experiences of young people categorised as being at CHR-P. Rather, we make the case for understanding and supporting help-seeking young people with distressing perceptual and ideational disturbance employing a needs-based, person-centred approach.