Frontiers in child and adolescent psychiatry最新文献

Objective: School attendance problems (SAPs) often develop and persist through complex interactions among numerous influences. This study used network analysis to identify: (i) the most central symptoms reported by youths with SAPs; (ii) the most central functions underlying those symptoms; and (iii) the relationships among symptoms and among functions.

Method: Self-reported symptoms and their functions were assessed via an online survey comprising the Inventory of School Attendance Problems. We analysed data from Finnish middle school students (M age = 14.9 years, range 12-17, gender: 40% male, 57% female, 3% other) reporting school absence of ≥10%. There were 349 responses for symptoms and 333 responses for functions. Network analysis was used to identify the most central symptoms and functions (nodes) along with the associations between different symptoms, and the associations between different functions (edges).

Results: Results indicated complex networks among the symptoms and among the functions. Depression emerged as the descriptively most central node in both networks. In the symptoms network, it showed moderate links to Performance Anxiety, Aggression, and Social Anxiety. In the functions network, its strongest links were to School Aversion/Attractive Alternatives and Social Anxiety. Social Anxiety was also highly central in the functions network, with links to Agoraphobia/Panic and Problems with Peers. All 13 nodes were interlinked in both the symptoms and functions networks, reflecting widespread co-occurrence among symptoms and among functions.

Conclusions: Depression's central position across both the symptom and function networks may make it a valuable intervention target, even when other symptoms are also salient.

Background: Family history of substance use (FHSU), along with sociodemographic and psychosocial factors, has been identified as a key risk factor for adolescent substance use and progression to substance use disorders (SUD). However, the interaction between distinct sociodemographic and psychosocial profiles in adolescents with FHSU and constitutional factors, such as psychopathological symptom severity, impulsivity, and reward processing, remains unclear. Given the complexity of these factors, it is crucial to explore how these elements contribute to the differential vulnerability to SUD among youth with family history of substance use. Particularly as, the identification of clinically relevant subgroups of at-risk youth may inform precision prevention and treatment approaches to reduce adverse outcomes related to SUDs.

Methods: Here, we used data from the Adolescent Brain Cognitive Development (ABCD) study and grouped the participants (age: 9-10 years) into positive and negative FHSU [i.e., FHSU-P (n = 1955; female 49.7%, White 57.95%), and FHSU-N (n = 4,369; female 48.33%, White 61.16%), respectively]. We used K-means clustering to identify latent subgroups in the FHSU-P population based on psychosocial variables and then compared the resulting subgroups on internalizing, externalizing, and total psychopathology, impulsivity, and reward prediction errors.

Results: K-means clustering revealed five subgroups within FHSU-P: Subgroups 1 (n = 744) and 2 (n = 300) exhibited favorable psychosocial profiles, marked by higher school involvement, social engagement, and parental acceptance. Subgroups 3 (n = 267), 4 (n = 201), and 5 (n = 443) were characterized by lower engagement across peer, school, and parental domains. Group comparisons showed that Subgroups 1 and 2 had comparable levels of psychopathology and impulsivity, while Subgroups 3, 4, and 5 displayed higher psychopathology and impulsivity. Reward prediction errors were similar across all subgroups. Other group differences are also presented and discussed in the main text.

Conclusion: These findings highlight significant heterogeneity within the FHSU-P group and emphasize the importance of stratifying adolescents based on sociodemographic and psychosocial factors. Such stratification can help identify adolescents at higher risk for psychopathologies, including SUDs, offering insights for targeted prevention and intervention strategies.

Introduction: Clinics providing mental health treatment to children and families experience a multitude of barriers shepherding patients from their first clinic contact through to graduation from treatment, including difficulty retaining families, getting families to complete screening forms, and finding patients who are eligible for the services offered. This study describes the iterative strategies used by a mental health clinic for child behavior management training to increase families' likelihood of completing their screening forms, attending sessions, and graduating from treatment.

Methods: Over the course of five years, this clinic implemented four subsequent strategies to improve intake, including introducing a structured follow-up to get patients to complete screening forms, shortening the screening forms to reduce family time burden, moving screening procedures online, and distributing a public survey link where the intake forms could be accessed without an initial phone screen.

Results: Results of logistic regression analyses indicate that, although none of the screening interventions was successful for increasing a child's likelihood of attending intake or graduating from treatment, the addition of the public survey link significantly increased families' chances of completing their initial screening forms.

Discussion: Findings indicate that, while other interventions are needed to improve chances of child intake attendance and graduation, it appears that the combination of screening strategies described in this study may begin to overcome barriers to families accessing treatment.

Conduct problems (CPs), including aggression, antisocial behavior, and rule-breaking, emerge in childhood and adolescence. Evidence from twin studies shows that CPs are heritable, with approximately 50% of the variance accounted for by genetic influences. Parenting is one prominent and, importantly, modifiable environmental factor in the development of CPs. This study tested whether parental monitoring moderated the associations between genetic liability and CPs in adolescents aged 12-14. We found parental monitoring significantly moderated the association between genetic risk for externalizing and CPs in adolescence. These findings underscore the utility of family-based prevention and intervention efforts, particularly for children at elevated genetic risk.

Latina immigrants seeking asylum in the U.S. report high levels of trauma exposure and posttraumatic distress. Our clinical and research experiences highlight the prevalence of these health disparities for pregnant migrants, with serious consequences for them as well as for the developmental trajectory of their children. This minireview focuses on asylum seeking Latina pregnant migrants, and the implications current polices, and circumstances have on their health and wellbeing as well as their children's health and well-being.

Introduction: This retrospective chart review examined 37 youth with pediatric bipolar disorder from a private practice in the Lyme-endemic state of New Jersey, expanding on findings from 27 previously reported cases to explore the potential contribution of tick-borne infections to disease etiology.

Methods: Diagnoses were based on DSM-IV-TR and DSM-V criteria using parent and child interviews, questionnaires, and school reports. Initial screening evaluated for possible PANDAS/PANS, with testing for Group A beta-hemolytic streptococcus, Borrelia burgdorferi, Babesia, Bartonella, and Mycoplasma pneumoniae. Lyme disease testing included ELISA, Western Blot (IgM/IgG), and immunoblots, interpreted per CDC guidelines. Other pathogens were assessed via IgM/IgG titers, anti-streptolysin O, anti-DNAase B, fluorescent in situ hybridization, and blood cultures. A positive diagnosis required both laboratory evidence and clinician confirmation.

Results: Babesia was detected in 51% (19/37), Bartonella in 49% (18/37), Mycoplasma pneumoniae in 38% (14/37), Borrelia burgdorferi in 22% (8/37), and Group A Streptococcus in 19% (7/37). Overall, 92% (34/37) had evidence of tick-borne exposure, with 81% (30/37) meeting both laboratory and clinical criteria.

Discussion: More than three-quarters of the cohort demonstrated confirmed tick-borne infections. Overlaps between bipolar disorder and tick-borne illness-such as immune dysregulation, chronic symptomatology, and responsiveness to treatments like minocycline and anti-inflammatory agents-support further exploration of infectious contributors to pediatric bipolar disorder. While limited by its single-practice retrospective design, these findings suggest that tick-borne pathogens may play a role in the pathogenesis of bipolar symptoms in youth, warranting larger, controlled studies.

Culturally Informed and Flexible Family Based Treatment for Adolescents (CIFFTA) is a manualized treatment that has been shown to reduce youth substance misuse and a variety of behavior problems but it has not been used to treat self-harm behavior in youth. The purpose of this manuscript is to describe enhancements that can address the treatment needs of diverse youth reporting suicide risk, cutting, and other self-harming behavior. We describe the enhancements to psychoeducational, individual therapy and family therapy content and processes as well as technological enhancements to improve access to treatment and to engage the adolescent in therapeutic work between therapy sessions. We believe that to help reduce barriers to service utilization in diverse populations, the treatment must also be ecologically valid. We present the case of a 15 year old Latine female who received treatment for cutting behavior and demonstrate CIFFTA's components in action. As we have reported separately, the acceptability of this enhanced intervention is supported by data showing that 93% of the youth and families attended at least 8 sessions and that on average they received over 23 sessions of treatment. This treatment enhancement effort resulted in new tools that were integrated into the manualized CIFFTA making it easier to engage families and deliver interventions. These enhancements culminated in an adaptive, replicable, and culturally informed treatment for diverse youth reporting self-harm and their families.

Background: Parental mental health difficulties have been associated with variation in parent-infant interactions, including facial expressions and visual attention. Most prior research has relied on clinical samples and structured observational settings, limiting ecological validity and generalisability to population-level variation.

Aims: This study aimed to (i) characterise the duration of facial expressions and visual attention behaviours in parents and infants during naturalistic interactions at home, and (ii) explore associations between parental depressive symptoms and personality difficulties-measured prenatally or preconception-and these observed behaviours.

Methods: Interactions were recorded at home using synchronised head-mounted cameras worn by parents and infants. Facial expressions and gaze behaviours were micro-coded for each dyad member using a validated behavioural coding system. Parental depressive symptoms and personality difficulties were assessed using the Edinburgh Postnatal Depression Scale (EPDS) and the Standardised Assessment of Personality-Abbreviated Scale (SAPAS). Associations were estimated using bivariate two-level models, adjusting for relevant covariates and clustering at the dyad level.

Findings: A total of 142 video observations were obtained from 97 families participating in the Avon Longitudinal Study of Parents and Children (ALSPAC), including 102 unique parent-infant dyads. Of the 142 observations, 74% involved mothers as the primary caregiver. Infants were on average 7 months old, and 66% were first-born. We found suggestive evidence that higher parental depressive symptoms and personality difficulties were associated with shorter durations of expressions such as "mock surprise" and "woe face", and with longer durations of negative affect. Infants of parents with higher depressive symptoms showed longer smiling and increased visual attention to others in the room, potentially reflecting social referencing.

Conclusions: Wearable cameras offer a feasible and ecologically valid method for observing parent-infant interactions in home settings. Findings suggest that variation in parental mental health is associated with differences in both parental and infant emotional and attentional behaviours. These preliminary results underscore the potential of wearable technology for advancing research on early relational processes.

Background: Autism spectrum disorder (autism) is a neurodevelopmental condition with a high prevalence of approximately 1 in 50 children. Early intervention can support long-term outcomes. Caregiver-mediated interventions (CMIs) are evidence-based and appropriate for toddlers with autism or early social communication challenges. The Social ABCs, one such CMI, is supported by robust evidence. Originally developed for toddlers (12-42 months), it shows potential for supporting social communication development even earlier, i.e., for infants with early signs of autism. The current project adapted the toddler Social ABCs for use with infants (aged 6-15 months) showing early signs of autism or with a confirmed diagnosis. This paper describes the development, acceptability, feasibility, and preliminary outcomes for the Baby Social ABCs.

Methods: Nine infants (aged 6-14 months) participated. Families either self-referred or were referred by community clinicians and were eligible based on age and clinician and/or parent concerns about social communication and/or behavioral differences. Each infant and one of their primary caregivers participated in the 12-week Baby Social ABCs intervention online via Zoom for Healthcare.

Results: Caregiver implementation fidelity increased significantly, along with infant responsivity and social communication behaviors (social orienting, shared smiling, and gesturing). The caregivers reported high satisfaction with the coaching approach, session structure, and curriculum.

Discussion: This pilot study demonstrated the feasibility and acceptability of the Baby Social ABCs as a novel CMI for infants with signs of emerging autism and showed promising effects on the caregivers' fidelity and the infants' social communication and engagement. Future research should consider the optimal timing (or personalized "fit") for families to access such support to better understand the type and intensity of pre-diagnostic care that best meets families' diverse needs.