Frontiers in child and adolescent psychiatry最新文献

Expert consensus previously established a framework for characterizing patients with pediatric feeding disorder (PFD) through a multidisciplinary case report form (CRF) methodology. Field testing of the PFD CRF and creation of a shared patient database represented next steps in the development of this clinical tool. The current study assessed the acceptability and feasibility of the PFD CRF through data collection across three feeding programs involved in the initial development of the CRF. A total of 80 patients completed multidisciplinary team evaluations and contributed data to the current evaluation of clinical implementation. Data analysis and feedback from end users (i.e., multidisciplinary care teams) subsequently guided CRF revisions. Results suggests the PFD CRF represents a feasible and practical method of common data collection across institutions, while also providing important insights into future research and dissemination efforts.

Threat exposure and resource scarcity increase psychopathology risk throughout childhood and adolescence. However, it remains unclear whether these dimensions of early life adversity interact to impact psychopathology, whether different indicators of resource scarcity perform similarly in such interactions, and whether these relationships are similar between males and females. This analysis used a cross-sectional, multi-informant approach to investigate interactions between threat exposure and different indicators of resource scarcity (achievement-based, financial-based) for three major dimensions of psychopathology. Data are from 236 community-based non-help seeking youth aged 8-17 (M = 11.58, SD = 2.74) enrolled in the census-matched Nathan Kline Institute-Rockland Sample. Linear models were used to estimate interactions between threat exposure, and achievement-based scarcity (caregiver education and occupation) vs. financial-based scarcity (income-to-needs ratio), for major dimensions of psychopathology (internalizing, externalizing, thought disturbance). Linear models showed increasing threat exposure was associated with elevated internalizing and externalizing psychopathology symptoms, but not thought disturbance symptoms, when controlling for resource scarcity indicators. Achievement-based scarcity, but not financial-based scarcity, moderated these relationships, such that the impact of threat exposure on psychopathology depended on the level of caregiver achievement moreso than on the amount of familial financial resources. These patterns were similar in males (N = 132) and females (N = 104) when examined separately. Caregiver achievement may protect against symptoms of psychopathology in youth exposed to threat, suggesting that policies geared towards increasing education accessibility and job opportunities may have considerable downstream impact for child and adolescent well-being. Future work should explore interactions between adversity dimensions in population-based samples with greater variability in systems-level factors (e.g., neighborhood advantage).

Introduction: Paternal postnatal depression (PND) and its likely adverse impact on child development are receiving increased attention. However, research that examines processes transmitting risks of paternal PND to adverse child outcomes remains limited.

Methods: This study examines pathways from paternal PND (Edinburgh Postnatal Depression Scale; 8 months) to child emotional and behavioral development (Strengths and Difficulties Questionnaire; 7 years) through paternal parenting confidence, warmth, and father-child conflict (birth-4 years) in a UK-based birth cohort, the Avon Longitudinal Study of Parents and Children (N = 9,628). Analyses were adjusted for socioeconomic, familial, parental, and child characteristics, including maternal PND during early postnatal period.

Results: Adjusted models revealed evidence of total associations between paternal PND, child emotional symptoms, peer problems, and hyperactivity (albeit with wide 95% CIs), but not conduct problems. Indirect effects emerged from paternal PND to child emotional symptoms, hyperactivity, and peer problems through the combination of all paternal parenting factors, with no evidence of direct effects. Specificity analyses revealed indirect effects through paternal parenting confidence and father-child conflict in the associations between paternal PND and child emotional symptoms, hyperactivity, and peer problems (albeit with wide 95% CIs).

Conclusions: Targeted intervention to increase paternal parenting confidence and decrease father-child conflict may improve outcomes in children whose fathers experience postnatal depression.

Background: There is increased interest in adolescent wellbeing and the factors that increase or decrease the risk of mental health difficulties during adolescence. Extensive research exists for risk and protective factors, but few qualitative studies have been conducted in this area. Analysis of qualitative data can add insights into adolescents' perceptions and provide an opportunity to observe patterns in their subjective experiences.

Objectives: The aim of this research was to explore patterns in adolescent-reported risk and protective factors in relation to the outcomes of mental wellbeing and mental health.

Methods: The data for this study were drawn from interviews across five sites in England, conducted as part of the 5-year national evaluation of the HeadStart Programme. The sample comprised 63 adolescents aged 11-12 years from the first annual wave of qualitative data collection in 2017. Ideal-type analysis was used to construct a qualitative typology to delineate patterns in adolescents' experiences of risk and protective factors.

Findings: Three distinct "types" or patterns of risk and protective factors in relation to adolescents' mental wellbeing and mental health were identified across the sample: the adolescent with "Uncertain Sources of Support," the adolescent with "Self-Initiated Forms of Support," and the adolescent with "Multiple Sources of Support."

Conclusions: Findings illustrate that distinct patterns exist in terms of adolescents' profiles of perceived risk and protective factors, with adolescents having clear differences in the levels of support that they perceived around them and the extent to which they felt that they could initiate, access, or find support to manage reported risk and stressors. These profiles may offer insight into the varied pathways through which adolescents attempt to navigate and manage threats to their mental wellbeing.

Background: School refusal among children and adolescents with mental health issues carries long-term risks for their educational trajectories, future employment, mental health, and social participation. Despite the availability of multiple treatment approaches, a significant number of adolescents continue to experience difficulties with school attendance following inpatient therapy or partial hospitalization. To enhance reintegration into school, a rehabilitation project called "educational participation and integration for children and adolescents with mental illness through a seamless stepwise rehabilitation program" ("SchuTIng-stAR") was developed specifically for children and adolescents with severe and persistent school refusal associated with psychiatric disorders who are at risk of continued school attendance problems after psychiatric inpatient treatment or partial hospitalization.

Methods/study design: After describing the therapeutic rationale, the development, and the content of the program, the study protocol for its evaluation using both quantitative and qualitative methods is presented. The primary objectives of the evaluation are firstly to assess the effects of the treatment on psychological symptoms and school attendance, and secondly to identify factors that influence the participation and engagement of patients, parents, and other stakeholders involved (teachers, youth welfare services). The operationalization of outcomes, measurement methods and hypotheses regarding effectiveness are described. Measurements will be taken at three points in time: at the beginning of the rehabilitation intervention (T1), at the end of treatment (T2) for the main outcome and after a six-month follow-up period (T3) for follow-up assessment. Therefore, it is a one-group pretest-posttest design with follow-up period. Additionally, it is explained how interviews with families will be analyzed using qualitative content analysis.

Discussion: The formative and summative evaluation of innovative treatment programs for children and adolescents, including the perspectives of relevant stakeholders, is essential to ensure their sustainability and their integration into already existing services provided by health and social care systems. As chronic school avoidance is a multifactorial and complex condition and its course is often characterized by relapses, it is important to develop sustainable treatment approaches and to closely examine treatment commitment using qualitative methods. The discussion focuses on the extent to which the rehabilitation intervention and the study produce the expected results, and what factors might contribute to divergent outcomes.

Objective: To investigate the effects of exercise doses recommended by the American College of Sports Medicine (ACSM) on motor skills, social interaction, behavioral patterns, and verbal and non-verbal communication domains in children with autism.

Methods: A systematic search was conducted across PubMed, Embase, Web of Science, and the Cochrane Library, focusing on the effects of physical activity on children with autism. Randomized controlled trials comparing exercise interventions with no intervention were included, and changes in motor skills, social interaction, behavioral patterns,and communication domains were assessed using standardized mean differences (SMD), 95% confidence intervals (CI), and p-values (p < 0.05).Interventions were categorized based on high or low adherence to exercise prescriptions developed or recommended by ACSM.Studies in which ≥70% of components met ACSM criteria were classified as having high adherence, while those with <70% were classified as having low adherence, based on thresholds established in previous literature. A fixed-effects or random-effects model was applied for meta-analysis, and subgroup comparisons were conducted.

Results: A total of 27 studies (29 exercise interventions) involving 1,012 participants were included. In the motor skills domain,the pooled standardized mean difference (SMD) was 1.35, 95% confidence interval (CI) [0.66,2.03]. Subgroup analysis revealed that the high-adherence group showed an SMD of 1.44, 95% CI [0.51,2.36], while the low-adherence group showed an SMD of 1.26, 95% CI [0.15,2.36]. For the social interaction domain,the overall SMD was -0.22, 95% CI [-0.54,0.99]. The high-adherence subgroup had an SMD of -0.41, 95% CI [-0.62,-0.21], whereas the low-adherence group had an SMD of 0.42, 95% CI [-0.50,1.33]. In the behavioral patterns domain, the overall SMD was -0.79, 95% CI [-1.26,-0.32]. Subgroup analysis indicated an SMD of -0.42, 95% CI [-0.73,-0.11] for the high-adherence group and -2.79, 95% CI [-5.63,0.06] for the low-adherence group.For the verbal and non-verbal communication domain, the overall SMD was 0.33, 95% CI [-0.31,0.97]. Subgroup SMD were 0.21,95% CI [-0.14,0.57] for the high-adherence group and 0.59, 95% CI [-1.67,2.84] for the low-adherence group.

Conclusion: Exercise interventions had a significant positive impact on motor skills and behavioral patterns in children with autism spectrum disorder (ASD). Interventions with high adherence to ACSM-recommended exercise dosages were more effective in improving motor skills, social interaction,and behavioral patterns compared to low-adherence dosages.Future evidence-based exercise prescriptions may be established for children with ASD, optimizing motor-functional outcomes.

Systematic review registration: PROSPERO, identifier (CRD42024565241).

Is it possible to maintain some of the precious wisdom of our ancestors, while embracing the post-modern revolution of family therapy and systemic thinking? This paper tries to offer an exploratory answer to this question. Milan Approach designed its interventions relying on the therapist's expert position, their moral neutrality and their ability to identify, as an external observer, the "family games" that were responsible for the identified patient's symptoms. Despite its success in offering a fresh perspective and some innovative therapeutic strategies to deal with a range of issues, including, but not limited to, eating disorders, the Milan Approach has undergone criticism, mainly due to its lack of reflexivity about social justice and elements of inequality that might have been at the foundation of problematic family dynamics. In the commendable attempt of purifying family therapy from elements of oppressive practice, post-Milan approaches have distanced themselves from their "ancestors" and showed increasing reluctance to use their tools. Particularly, counter-paradoxical interventions such as the invariable prescriptions have been progressively abandoned in favor of more collaborative tools. This paper, through the means of a clinical example, explores the usefulness of a counter-paradoxical intervention in a second-order family therapy, embracing a social-constructionist perspective while maintaining the importance of counter-paradox in allowing change. The paper discusses the underpinning principle, the delivery and the outcome of such intervention, and addresses potential criticism, indications for practice and scope for further research.

Background: In February 2022, Russia launched a full scale-invasion of Ukraine, which is the largest European ground offensive since the Second World War. However, the Russian-Ukrainian war began in 2014, when Russia invaded and annexed the Crimea peninsula and occupied part of the eastern regions of Ukraine. This prolonged exposure to war, with its many casualties and massive displacement, has negatively affected the mental health of adolescents, although a comparison of the impacts on adolescents exposed to the various stages of war has not been documented. Our aim is to explore the effects of differential wartime traumatic stressor exposure and displacement on the mental health of adolescents exposed to the Russian invasion in Ukraine since 2014.

Methods: The Ukraine Adolescent Mental Health Study (UAMS) is a time-trend study comprising two cross-sectional school surveys. The first survey was carried out in 2016-2017, two years after eastern Ukraine was invaded by Russia. The second survey was conducted after the 2022 full-scale Russian invasion. Both surveys used the same method and included participants aged 11-17 years from two areas in Ukraine, the Donetsk region and the Kirovograd region. In 2016-2017, we focused on adolescents living in the eastern Donetsk region who had been exposed to war since 2014 and those living in the central Kirovograd region, which was not directly affected by the invasion. The new survey will enable us to compare exposure to traumatic wartime stressors and mental health problems among adolescents over time and between the two regions. Several standardized tools will be used to assess post-traumatic stress disorder, depression, anxiety, suicidal ideation, suicide attempts and self-harm behavior.

Discussion: This study will provide a unique opportunity to examine the escalating psychological consequences of the ongoing war on adolescents in Ukraine. Such information is crucial for understanding adolescents' mental health needs, and thus for providing psychosocial support and developing mental health interventions.