Frontiers in child and adolescent psychiatry最新文献

Obsessive-compulsive disorder (OCD) secondary to structural brain pathology is rarely described in pediatric populations. This single-case report describes a child with a pineal germinoma and obstructive hydrocephalus who developed prominent obsessive-compulsive symptoms, highlighting a potentially reversible neurobiological contributor to atypical pediatric OCD. The case illustrates the temporal association between symptom evolution, neurosurgical and oncologic management, and subsequent changes in obsessive-compulsive behaviors, contributing to understanding the role of cortico-striato-thalamo-cortical (CSTC) circuit disruption in secondary OCD. A 15-year-old boy initially presented with a 12-month history of mild generalized anxiety and intermittent insomnia, which progressed over the subsequent 8 months to severe obsessive thoughts and compulsive behaviors, including checking and repetition, significantly impairing sleep and food intake. Two months prior to tertiary referral, he developed progressive neurological symptoms, including afternoon headaches, blurred vision, gait instability with falls, polyuria, enuresis, and one witnessed episode of loss of consciousness. A neurological examination demonstrated Parinaud's syndrome, hyperreflexia with ankle clonus, extensor plantar responses, past-pointing, and papilledema. Neuroimaging (CT and MRI) revealed a pineal mass causing aqueductal obstruction with hydrocephalus, periventricular edema, and a suspected vestibular schwannoma. Endoscopic third ventriculostomy with biopsy and external ventricular drainage confirmed germinoma and relieved the cerebrospinal fluid (CSF) obstruction, with postoperative imaging demonstrating restored CSF flow. The patient subsequently received chemotherapy and focal radiotherapy. Following CSF diversion, the patient's caregivers reported a marked reduction in compulsive rituals and improved sleep, with further attenuation of OCD symptoms during oncologic treatment. Residual anxiety and mild obsessive-compulsive symptoms were managed with adjunctive selective serotonin reuptake inhibitor therapy. At the 12-month follow-up, standardized assessments indicated subclinical to mild OCD, and the patient had returned to full academic participation. This case underscores the importance of considering hydrocephalus-related CSTC circuit disruption as a potential, and occasionally reversible, contributor to pediatric OCD. Recognizing hydrocephalus-associated obsessive-compulsive symptoms may significantly influence both psychiatric and neurosurgical management. Clinicians evaluating atypical or treatment-refractory pediatric OCD should consider neuroimaging to identify underlying structural causes, emphasizing the value of interdisciplinary collaboration in optimizing outcomes.

This study aimed to test whether a more positively perceived school climate and more frequent physical activity are related to better mental health among adolescents. Additionally, the research examined the gender differences in adolescents' self-reported mental health, perceptions of school climate, and the frequency of their physical activity. A total of 2,526 students (52.6% girls; 43.8% boys) from grades 5 through 12 from various schools in Latvia participated in the study. The research used the Georgia School Climate Survey (GSCS) and three questions from the Physical Activity Questionnaire for Older Children (PAQ-C). The results of multiple linear regression analysis confirmed that a more positively perceived overall school climate (B = -1.05, p < .001) and greater engagement in physical activity (B = -1.05, p < .001) were both significantly associated with better mental health in adolescents. The findings also revealed gender differences in self-reported mental health: girls reported significantly higher levels of mental health difficulties (M = 2.22 compared to boys' M = 1.87). In contrast, girls rated such factors of the school climate as adult and peer support, social/civic learning and physical environment more positively, while boys reported significantly higher levels of physical activity (28.98 compared to girls' 26,43). Despite such limitations of the research as self-report bias and cross-sectional design, these findings underscore the critical role of the school environment in predicting mental health outcomes, highlighting the need for targeted improvements that both mitigate risk factors and promote inclusive access to physical activity among all students.

Background: Absence from school is an increasing concern internationally, with significant consequences for children's mental health, academic achievement, and future opportunities. The multifaceted causes of absenteeism, including factors like emotionally based school avoidance (EBSA), have prompted a variety of interventions aimed at addressing this complexity. These efforts include recent plans from the UK government. This systematic review evaluates the effectiveness of school-based interventions targeting persistently absent secondary school students, to inform evidence-based strategies.

Methods: A systematic search was conducted across six electronic databases in health and education for studies published up to April 2024. Eligible studies assessed school-based interventions aimed at improving attendance among persistently absent secondary school students. The Effective Public Health Practice Project (EPHPP) and Critical Appraisal Skills Programme (CASP) tools were used to assess study quality. A bioecological framework was applied to map interventions to influence levels and evaluate their impact on attendance.

Results: Sixteen studies, mostly from the United States with one from Australia, were included. Study designs varied, including randomised controlled trials, quasi-experimental designs, and cohort studies, with quality ratings from weak to moderate. Interventions demonstrated variable effectiveness, reflecting the challenges of addressing persistent absenteeism. Favourable outcomes were reported for mentoring schemes, family involvement initiatives, school counselling, incentive programmes, school-based healthcare, and a police partnership strategy. However, inconsistencies in significance and impact were observed across studies.

Conclusion: The evidence base for interventions to improve attendance among persistently absent secondary school students remains limited. High-quality research is needed to build robust evidence, incorporating comprehensive attendance metrics alongside academic and health outcomes. Future studies should document and analyse demographic subgroups and include qualitative approaches to address the needs of diverse at-risk groups and guide intervention design.

Systematic review registration: https://www.crd.york.ac.uk/PROSPERO/view/CRD42024490992, PROSPERO [CRD42024490992].

Introduction: The Autism Diagnostic Observation Schedule (ADOS-2) is widely used to assess Autism Spectrum Disorder (ASD) symptom severity. To allow comparisons across modules and developmental levels, the Calibrated Severity Score (ADOS-CSS) was developed. However, concerns have been raised about potential changes in the measurement signal introduced by the calibration process, which may alter the signal captured by the ADOS-2 raw scores (ADOS-RS).

Methods: Using longitudinal data from the ELENA cohort (N = 145 children with ASD assessed at baseline and after 3 years), we examined the psychometric properties of the ADOS-CSS and ADOS-RS. The Social Responsiveness Scale (SRS-2) was used as an external reference. Bootstrap resampling was used to estimate means and 95% confidence intervals (CIs).

Results: Variance explained by module, age, and IQ was higher for the ADOS-RS (R² = 0.45, 95% CI: 0.38-0.52) than for the ADOS-CSS (R² = 0.16, 95% CI: 0.10-0.24). Stability of ASD severity scores over time was lower for the ADOS-CSS (ρ = 0.34, 95% CI: 0.23-0.45) than for the ADOS-RS (ρ = 0.60, 95% CI: 0.51-0.68). Correlations with SRS-2 scores were consistently lower for ADOS-CSS (ρ = 0.14, 95% CI: 0.06-0.22) than for ADOS-RS (ρ = 0.24, 95% CI: 0.17-0.32). Similar patterns were observed for change scores (Δ indicating score differences between baseline and follow-up): ΔSRS-2 correlated more strongly with ΔADOS-RS (ρ = 0.19, 95% CI: 0.09-0.28) than with ΔADOS-CSS (ρ = 0.13, 95% CI: 0.06-0.21). Differences between ADOS modules were reflected in SRS-2 and ADOS-RS, but markedly attenuated in ADOS-CSS, suggesting that calibration reduces module-related variance but also induces changes in the measurement signal that may affect sensitivity to individual differences.

Discussion: While the ADOS-CSS facilitates standardized comparisons across modules, clinicians and researchers should be aware of potential distortions in the measurement signal associated with the calibration process.

Clinical trial registration: NCT02625116.

Background: Exposure to adverse childhood experiences (ACEs) is linked to the development of various psychological disorders, particularly post-traumatic stress disorder (PTSD). This study aimed to determine the prevalence rates of ACEs and high PTSD symptoms and to investigate their association among children and adolescents in Jordan.

Methods: A large-scale school-based national survey was conducted among children and adolescents in the host and refugee populations aged 8-18 years in Jordan, utilizing a multi-stage stratified cluster sampling technique. The study questionnaires contained standardized and psychometrically validated instruments to assess ACEs and PTSD.

Results: A total of 8,000 children and adolescents were included. The most prevalent ACEs among children were COVID-19 infection (43.2%), food insecurity or inadequate clothing (22.1%), and exam failure (21.7%), while for adolescents, COVID-19 infection (60.3%), exam failure (43.2%), and the death of a family member (31.7%). High PTSD symptoms were observed in 31.4%, more prevalent in females than males (33.0% vs. 29.3%, p = 0.003) and adolescents than children (35.5% vs. 24.6%, p < 0.001). For both children and adolescents, feeling unloved by family was significantly associated with high PTSD symptoms (OR = 2.1, p < 0.001). Other significant ACEs included death of a family member (children: OR = 1.9; adolescents: OR = 1.8) and food insecurity/inadequate clothing (OR = 1.7 for both). In children, exam failure was significant (OR = 1.5), while in adolescents, it included physical assault (OR = 1.4), COVID-19 infection (OR = 1.3), serious accidents (OR = 1.3), and emotional abuse (OR = 1.6). Experiencing ≥4 ACEs greatly increased PTSD odds (children: OR = 5.0, adolescents: OR = 4.3; p < 0.001).

Conclusion: Findings highlight a high prevalence of PTSD among children and adolescents exposed to ACEs, with multiple ACEs linked to higher PTSD symptoms and a cumulative pattern further increasing this risk. Results underscore the need for targeted interventions addressing key ACEs by age group and the development of comprehensive prevention programs involving parents, families, schools, communities, and broader society. Interventions should also aim to mitigate the cumulative impact of multiple ACEs and address them collectively rather than individually.

Autism spectrum disorder (ASD) encompasses a set of behavioural features with a diverse range of presentations, challenges, and trajectories. Previous research has demonstrated how behavioural and developmental markers can differentiate autistic from non-autistic children as early as the first year of life, however there is a dearth of literature demonstrating heterogeneity amongst the clinical presentations of autistic infants. An understanding of the breadth of experiences is necessary to refine and expand early identification methods to identify those currently being overlooked. The current study examined the heterogeneity of early behaviour in a longitudinal cohort of infant siblings of autistic children (n = 72) who later received an ASD diagnosis. Parent reports of early behaviour, generated at six time points between six and 24 months of age, describing the presence or absence of concerns across 10 developmental domains, were assessed to compare subgroups of infants based on the earliest age they were diagnosed as autistic (18, 24, or 36 months). The average number of concerns across domains, in addition to the proportion of each subgroup reporting a concern in each of the 10 domains, was compared at each time point. The infants diagnosed at 18 months had a higher average number of concerns across all time points compared to those diagnosed at 24 or 36 months, who demonstrated similar profiles. Play, language, and language regression concerns resulted in the largest effect sizes between groups. These findings indicate that (i) there is heterogeneity in early autism presentations, (ii) within the context of early identification, lack of diagnosis at one age does not eliminate the possibility of future diagnosis, and (iii) that parent reports of early concerns can provide valuable information that can alert clinicians to the features of autism, further attention to which may help reduce disparities in age of diagnosis.

Objective: To evaluate the efficacy and safety of atomoxetine in the treatment of adolescents with ADHD, comparing its effects with other available treatments. The primary outcome was the reduction of ADHD symptoms, and the secondary outcome was the occurrence of adverse effects.

Methods: A search was conducted in the Medline/PubMed, EMBASE, and Web of Science databases. The research question and strategy were based on the PICO model. Inclusion criteria were restricted to studies involving children and adolescents aged 6-16 years, focusing on comparisons between atomoxetine and other treatments. Eligible studies were published in English, Spanish, or Portuguese, with no restrictions on publication year. A total of 575 articles were initially retrieved. After removing duplicates, 527 references were screened by title and abstract, and 69 were selected for full-text review. Following this stage, 63 references were excluded, and 6 studies were ultimately deemed eligible.

Results: The six included studies involved a total of 905 participants. Atomoxetine demonstrated comparable efficacy to methylphenidate in reducing ADHD symptoms. The most common adverse effects were nausea, fatigue, and appetite changes. No severe adverse events were consistently reported. Atomoxetine's efficacy was particularly evident in patients who did not tolerate or respond to stimulant medications.

Conclusion: Available evidence suggests that atomoxetine is an effective and safe option for treating ADHD in adolescents, representing a valid alternative particularly for patients who do not tolerate stimulant medications. Continued research, especially long-term studies, is necessary to confirm its efficacy across different patient subgroups.

Systematic review registration: Identifier CRD420251152121.

Introduction: Suicidality in adolescence is a significant public health concern. One potential correlate of suicidality is exposure to childhood trauma. Research shows that cumulative trauma is associated with a higher risk of suicidality during adolescence, with a dose-response pattern between the number of adversities and suicidal outcomes. However, not all adolescents exposed to adversity report suicidal thoughts or behaviors, suggesting that protective factors, such as social support, may buffer this association. This cross-sectional study examined gender differences in the prevalence of suicidal thoughts and behaviors, cumulative trauma, and social support among high school students. The study also sought to determine whether cumulative trauma was related to an increased likelihood of suicidal thoughts and behaviors, and whether social support moderated the association.

Methods: Data were collected from a representative sample of 8,194 adolescents in Grades 9-11 in Quebec, Canada.

Results: Girls were more likely than boys to report both suicidal ideation and attempts. The number of traumas experienced was positively associated with the prevalence of suicidal ideation and attempts, with each additional trauma linked to an estimated 65%-80% increase in odds, indicating a large dose-response association. After controlling for sociodemographic characteristics, social support was associated with an attenuation of the relationship between cumulative trauma and suicidal ideation. For suicide attempts, social support showed a direct protective effect among adolescent girls, but this association was not observed among boys.

Discussion: These findings highlight the relevance of early identification and support services for youth reporting multiple adversities and lower social support.