Frontiers in child and adolescent psychiatry最新文献

Introduction: This study aimed to capture experiences and perspectives of parents of children with autism participating in an intervention program based on the Early Start Denver Model (ESDM). Specifically, we wanted their views regarding feasibility, acceptability, and significance of the intervention program, i.e., its social validity.

Methods: Fourteen parents, whose children has been diagnosed with autism, were interviewed.

Results: The results included three themes (1) Comprehensive approach: the participants emphasized the importance of early detection and interventions in their local setting in close cooperation between themselves, health care professionals, and preschool staff. They also highlighted the individual goals based on the child's needs in different developmental areas, as well as the whole family's needs and prioritizations. (2) Hands on-available locally and accessible: focused on different aspects of procedures, including features of the ESDM, parent education, the parent-therapist relationship and nearby location. (3) Sense of empowerment-parents got increased knowledge: the intervention was significant within family daily living and daily activities. The participants expressed that the interventions program contributed to an increased knowledge about autism and the ESDM strategies, positively impacted their child, and improved the collaboration with the preschool.

Conclusion: Parents emphasized the naturalistic, comprehensive, and local setting of the intervention and described that they had gained new knowledge as well a sense of empowerment. The results indicated that the intervention program based on the ESDM was socially valid according to parent descriptions.

Autism spectrum disorder (ASD) is a multifaceted developmental condition characterized by persistent challenges in social communication, restricted interests, and repetitive behaviors. Though there is no cure, early and intensive interventions can significantly improve the quality of life for those affected. The aim of this paper is to examine the complexities of autism spectrum disorder (ASD) from a public health perspective in South East Asian region, highlighting the global rise in prevalence and the compounded challenges posed by the COVID-19 pandemic. The rise in ASD prevalence from 4 to 5 cases per 10,000 children in the 1980s to 11.3 per 1,000 children in 2012 highlights the need for effective interventions. The pandemic exacerbated behavioral issues, anxiety, and screen time-related health problems, underscoring the importance of adjusting strategies for early identification and support. Diagnostic tools like the Modified Checklist for Autism in Toddlers (M-CHAT) and the Social Communication Questionnaire (SCQ) play a critical role in community-based screening. Effective prevention strategies include primary measures such as public awareness campaigns and genetic counseling, secondary measures focusing on early identification and intervention, and tertiary measures involving ongoing support and therapy. Addressing implementation challenges, particularly in low-income countries, requires enhanced public awareness, training of community health workers, and integration of ASD services into primary healthcare systems. Future research should aim to develop and evaluate scalable, culturally relevant interventions and explore the impact of environmental factors on ASD. Comprehensive strategies at the community level, combined with robust public health policies, are crucial for improving outcomes for individuals with ASD and their families.

Accessibility to developmental interventions for children and adolescents could be increased through virtual, at-home delivery of training programs. Virtual childhood training programs and their effects on cognitive outcomes have not been well studied. To that end, this study examined the effects of the at-home Brain Balance® (BB) program on the cognitive task performance of children and adolescents with baseline developmental and attentional difficulties. The study included students with reported diagnosis of ADHD, autism, anxiety, sensory processing disorder, or dyslexia, and students with no reported diagnosis (aged 4-17 years). The at-home BB program is delivered through (1) a computer-based format utilizing multimodal program activities previously studied in-center (multisensory stimulation, gross motor, coordination, balance, and nutritional recommendations); and (2) the BB app (visual motor, auditory and visual processing, and rhythm and timing training) - creating a comprehensive program experience delivered remotely. Cognitive performance was measured by six cognitive tasks from Creyos Health before and after 3 months of participation in the at-home BB program (N = 316) or in-center BB program (N = 4,232), compared to controls. Results showed that overall cognitive assessment scores (including attention, response inhibition, and working memory) improved after participation in either the at-home or the in-center program, compared to controls. Importantly, significant improvements over the controls were observed for two tasks involving attention and inhibitory control, in both programs. Further, two analyses support that the effects on cognitive performance from either delivery format, in-center or at home, are comparable in magnitude. This research: (1) presents new findings demonstrating improved cognitive performance after completing the at-home BB program; (2) replicates previous findings of cognitive improvements after completing the BB program; and (3) suggests that the cognitive effects of virtual at-home BB training are similar to those observed for in-center BB training. Overall, the results demonstrate the effectiveness of the at-home BB program in improving cognitive functioning in pediatric populations with preexisting developmental and attentional difficulties. Virtual delivery and ease of use, provide at-home programs the potential to reduce barriers of access to much-needed developmental and cognitive support, for individuals who may otherwise lack access to high-quality, evidence-based developmental programs.

Introduction: The COVID-19 pandemic had significant impacts on youth health and well-being. Youth with prior inequities, such as those exposed to child maltreatment, may have experienced greater psychosocial challenges and long-term difficulties than their peers, including sustained interpersonal relationships problems. Given the importance of healthy relationships during adolescence and early adulthood, the significant impact the pandemic had on youth, and the potential disproportionate challenges for youth with a child maltreatment history, the purpose of the present study was to better understand changes in relational conflict among youth with and without a child maltreatment history from the perspectives of youth themselves. Specifically, the aims were to examine if youth child maltreatment history was associated with an increased likelihood of reporting increased conflict with (a) parents, (b) siblings, or (c) intimate partners during the first three years of the COVID-19 pandemic.

Methods: Data were drawn from the Well-Being and Experiences (WE) Study; a longitudinal and intergenerational cohort study of 1,000 youth/parent dyads in Manitoba, Canada that began in 2017. WE study data were collected annually via self-reported youth surveys between 2017 and 2022 for a total of 5 waves of data collection, and COVID-19 questions were included in Waves 3 (2020), 4 (2021) and 5 (2022) (n = 586, 56.43% female, ages 18 to 21 at Wave 5). Multinomial regressions models were computed to examine whether a youth's child maltreatment history was associated with increased, decreased, or consistent levels of conflict with parents, siblings, and intimate partners in 2020, 2021, and 2022 compared to pre-pandemic levels.

Results: Results indicated that compared to youth with no child maltreatment history, youth with a child maltreatment history were more likely to report increased conflict across all three types of relationships during first three years of the pandemic.

Discussion: Findings contribute to our understanding of the association between the COVID-19 pandemic and interpersonal relationships among youth who have a child maltreatment history compared to their peers without child maltreatment histories, signal potential long-term challenges or inequities for youth and families with a history of maltreatment, and may inform policy, programming, intervention, and recovery efforts in the post-COVID-19 period, and for future global emergencies.

Introduction: The COVID-19 pandemic placed many restrictions on families and affected the mental health of parents and children. The present study examines how the restrictions imposed during the pandemic and parental mental health affect early childhood psychopathology.

Method: From September 2019 to December 2021, the Outpatient Department of Family Therapy at the Institute for Psychosocial Prevention, Heidelberg surveyed a clinical sample of 249 families who sought consultation for early childhood psychopathology. Early childhood psychopathology in children aged 0-3 years was assessed using the German Questionnaire for Crying, Feeding and Sleeping and the German version of the Child Behavior Checklist 1½-5. The Patient Health Questionnaire provided information on parental depressiveness and generalized anxiety. At the same time, the Stringency Index as part of the Oxford Coronavirus Government Response Tracker indicated the severity of COVID restrictions in Germany.

Results: Dependent comparisons did not reveal significant differences in the infants' regulatory problems (n = 165, mean age = 8 months) during the lockdown compared to reopening phases. However, older children (n = 84, mean age = 25 months) exhibited more behavioral problems during lockdowns compared to reopening phases (Cohen's d = 0.32, p = .04). Subsequent regression analyses confirmed a slight increase in behavioral problems only among children aged 1.5-3 years (p = .047, R ² = .08), but did not indicate any increase in parental mental health problems when more restrictions were in place. However, parental depressiveness had a strong independent effect on early childhood psychopathology. A hierarchical regression analysis indicated that psychopathology in children aged 1.5-3 years is best explained by female child gender, high parental depressiveness, and more severe restrictions during the COVID-19 pandemic (p < .001, R ² = .17) whereas early childhood psychopathology in infants aged 0-1.5 years is more prevalent in younger and male children with parents experiencing higher levels of depressiveness (p < .001, R ² = .26).

Discussion: The study found no increase in infant regulatory disorders or parental depressiveness and generalized anxiety during the pandemic. However, older children exhibited more behavioral problems during more severe pandemic restrictions. The study supports the provision of parent-child support during crises and beyond, as early childhood psychopathology was strongly associated with parental depressiveness.

Introduction: Psychotropic medication can be effective at stabilizing emotional and behavioural disturbances associated with physiological processes in children and youth. When medication benefits, indication or adverse effects are queried, deprescribing should be considered. Current guidelines for deprescribing are mainly for adults/elderly and largely theoretical, not practical, especially for polypharmacy.

Methods: At a tertiary center for children and youth with complex emotional and behavioural needs, physicians on staff have expertise in conducting assessments of medication efficacy, side effect burden, and safety concerns. Deprescribing is routinely undertaken in the context of inpatient and outpatient services in partnership with children/youth and their families. A qualitative initiative leveraged the specialized deprescribing expertise of eight physicians (six psychiatrists and two pediatricians).

Results: Emerging themes were medication review, timing, a stepwise approach, and setting conditions (inpatient and outpatient), with recurring subcategories of patient/family engagement as well as the underlying importance of continuity of care with psychosocial/behavioural supports.

Discussion: The findings from this expert focus group serve as a step towards supporting prescribing clinicians in mindful deprescribing when medications are no longer in the best interest of young patients.

Introduction: The extreme male brain (EMB) theory, a major causal hypothesis of autism (ASD: autism spectrum disorder), attributes excess androgens during early development as one of the causes. While studies have generally followed the EMB theory in females at birth, the co-occurrence of ASD in males at birth has been observed in conditions that are assumed to be associated with reduced androgen action during early development, including Klinefelter syndrome (KS) and sexual minorities. ASD is also associated with atypical sensory sensitivity, synesthesia, and savant syndrome.

Methods: In the present study, we examined adult KS individuals (n = 22), sexual minorities assigned male at birth (n = 66), and control males matched for age and educational background to those with KS [Exploratory analysis (control 1st): n = 36; Reanalysis (control 2nd): n = 583]. Participants completed a self-report questionnaire assessing sensory hypersensitivity/hyposensitivity, savant tendency (developed for the present study), synesthesia, and sexual aspects, including gender identity and sexual orientation.

Results: The results of the exploratory analysis suggested that individuals with KS exhibited a higher tendency toward sensory hypersensitivity/hyposensitivity than the tendency exhibited by the controls. In the Reanalysis, sexual minorities were more likely to be synesthetes, and in both analyses sexual minorities exhibited a higher savant tendency and sensory hypersensitivity/hyposensitivity than the controls. Moreover, the gender dysphoric state was associated with phenotypes observed in individuals with ASD, such as synesthesia, savant tendency, and sensory hypersensitivity/hyposensitivity.

Discussion: These results suggest a common physiological background among gender dysphoria, synesthesia, savant tendency, and atypical sensory sensitivity. Thus, androgynous features (reduced effects of sex steroids during early development) in males at birth may be partially related to the phenotype commonly observed in individuals with ASD. Based on the present results, we propose that the reduction of sex steroids during early development may lead to atypical neurodevelopment and be involved in the atypicality of external and internal sensory perception, and thus in the atypicality of self-concept integration, through the disruption of oxytocin and the gamma-aminobutyric acid system modulating the neural excitation/inhibition balance.

Introduction: Autism Spectrum Disorder (ASD) is characterized by deficits in social cognition, self-referential processing, and restricted repetitive behaviors. Despite the established clinical symptoms and neurofunctional alterations in ASD, definitive biomarkers for ASD features during neurodevelopment remain unknown. In this study, we aimed to explore if activation in brain regions of the default mode network (DMN), specifically the medial prefrontal cortex (MPC), posterior cingulate cortex (PCC), superior temporal sulcus (STS), inferior frontal gyrus (IFG), angular gyrus (AG), and the temporoparietal junction (TPJ), during resting-state functional magnetic resonance imaging (rs-fMRI) is associated with possible phenotypic features of autism (PPFA) in a large, diverse youth cohort.

Methods: We used cross-sectional parent-reported PPFA data and youth rs-fMRI brain data as part of the two-year follow-up of the Adolescent Brain Cognitive Development (ABCD) study. Our sample consisted of 7,106 (53% male) adolescents aged 10-13. We conducted confirmatory factor analyses (CFAs) to establish the viability of our latent measurements: features of autism and regional brain activation. Structural regression analyses were used to investigate the associations between the six brain regions and the PPFA.

Results: We found that activation in the MPC (β = .16, p < .05) and the STS (β = .08, p < .05), and being male (β = .13, p < .05), was positively associated with PPFA. In contrast, activation in the IFG (β = -.08, p < .05) was negatively associated.

Discussion: Our findings suggest that regions of the "social brain" are associated with PPFA during early adolescence. Future research should characterize the developmental trajectory of social brain regions in relation to features of ASD, specifically brain regions known to mature relatively later during development.