Frontiers in child and adolescent psychiatry最新文献

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.

Self-identification of neurodivergence is increasingly common, yet remains contentious in psychiatric, medical, and public discourse. While concerns have been raised about the reliability and potential impact on clinical services, these discussions often neglect the systemic barriers and personal experiences that can lead to self-identification in the first place. This article explores why individuals might self-identify, highlighting inequities in diagnostic access and clinician biases, as well as individual experiences and beliefs around clinical diagnosis. We argue that while self-identification can be a personal preference, it is often a survival strategy in the face of inaccessible, exclusionary, and sometimes harmful diagnostic systems. Drawing on theories of epistemic justice, we critique medical gatekeeping that delegitimises self-identification and propose a shift towards neurodiversity-affirming care. Rather than policing self-identification, we suggest that efforts should be made to address structural failures that render it necessary. Until access to clinical diagnosis become equitable, self-identification will remain an essential and legitimate means of understanding neurodivergence.

Aims: To examine pre-pandemic predictors of parent substance use during COVID-19 in Australia, where some of the longest periods of public health restrictions in the world occurred.

Methods: We used data from the Australian Temperament Project Generation 3 Study on 560 parents (59% female) who completed COVID-19 specific surveys (2020/2021), including assessment of alcohol, tobacco, and illicit substance use. Comprehensive pre-pandemic assessments were conducted during the postpartum period when offspring turned 1-year of age (2012-2018), including 33 indicators spanning parent and child factors (individual, relational, and contextual).

Results: During the pandemic, 39% of parents reported drinking alcohol 3-to-4 days per week or more, 12% used tobacco, and 6% used illicit substances. In Least Absolute Shrinkage and Selection Operator (LASSO) logistic regression models, a variety of pre-pandemic predictors [k] were identified across alcohol (AUC = 0.72, k = 2; OR = 0.92-2.03), tobacco (AUC = 0.96, k = 10; OR = 0.61-4.21), and illicit substance use (AUC = 0.78, k = 2; OR = 1.44-1.60). The strongest predictors were pre-pandemic use of the same substance (OR = 1.60-4.21). While few other predictors were identified for alcohol and illicit substance use, several family characteristics predicted tobacco use.

Conclusions: Results indicated that parents engaging in alcohol, tobacco and illicit drug use in our cohort reported strong continuity of use from before, to during the COVID-19 pandemic in Australia. This highlights the importance of public health initiatives that provide accessible substance use support and treatment options to parents during periods of public health emergencies. Further, enriched population interventions targeted across socioeconomic and family contexts may be important in identifying risk, particularly for tobacco use.

Parallels may exist between consequences of underage pornography use and the post-traumatic symptoms of child sexual abuse. Could pornography alter child and adolescent development and become a trauma in itself? Child victims of these images could face a conflict similar to witnesses of domestic violence, but instead of impacting mainly on the bonding system, it would affect the sexual system. Victims faced with the erotisation of violence are subjected to contradictory, incomprehensible, and sometimes inexplicable forces, which can lead to a traumatised sexuality with negative consequences in interpersonal relationships. The inability to explain something, or to make sense of it, activates the three classic pathways of trauma. One response to trauma is flight, which can lead to distancing from oneself and from others. This isolation, moreover, reinforces the consumption of pornography. Another response is the struggle to overcome the impact through self-control and aggression. Sexual coercion may appear as an attempt to modulate one's own contradictory emotions, as a form of self-protection and avoidance of the dreaded humiliation. Finally, there may be a dissociation response in the re-victimisation that appears in affected children. Unable to find a way to integrate the scenes, these minors may end up learning to adopt a posture of absolute surrender. The reconceptualisation of pornography in underage consumers as something potentially traumatic would help to better our understanding of its effects and the differing susceptibility of the victims, so that we may develop real and effective legislation and more appropriate therapeutic interventions.

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.