Frontiers in child and adolescent psychiatry最新文献

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.

Parents of children with autism spectrum disorder (ASD) and attention deficit hyperactivity disorder (ADHD) face unique challenges that may significantly increase stress levels, potentially impacting the emotional well-being of the entire family. In Mexico, limited research has examined the association between parental stress and coping strategies among families with children with developmental disabilities. This study aimed to compare stress levels and coping strategies among parents of children with ASD, ADHD, and neurotypical developing (NTD) children, as well as to analyze differences in coping styles across these groups. A cross-sectional, descriptive-comparative design was employed with 212 parents of children aged 3 to 5 years, with a formal clinical diagnosis made by a pediatric neurologist. Participants completed validated questionnaires assessing parental stress and coping styles. Results revealed that parents of children with ASD and ADHD reported significantly higher stress levels (M = 116.7 and M = 88.1, respectively) compared to parents of NTD children (M = 67.2). Significant differences in coping strategies were observed (p < .001); 100% of ASD/ADHD parents used emotion-focused coping, whereas 94.93% of NTD parents used problem-focused coping. These findings emphasize the importance of designing interventions to support coping and stress regulation in parents of children with developmental disorders.

Chronic school absenteeism (CSA) and emotionally-based school absenteeism or avoidance (EBSA) are highly prevalent conditions linked to multiple short- and long-term problems across academic, social-emotional, physical and mental health, family, and occupational and economic domains of functioning. In addition, CSA and EBSA occur disproportionately across vulnerable student groups and have been the focus of extensive preventative and intervention efforts. As such, CSA and EBSA may meet criteria as formal public health problems. This perspective article illustrates various ways of framing CSA and EBSA in this fashion utilizing contemporary public health models. Categories of public health models are emphasized in this regard and include ecological, systems and policy, epidemiologic and statistical, environmental and occupational, and behavioral and social science approaches. Each approach closely parallels research and other work regarding school absenteeism. The article is designed as a step toward advocacy for recognizing CSA and EBSA as formal public health problems contingent upon consensus among key constituencies in this area.

Introduction: There has been a growing presence of screentime, in the lives of children, with an escalation in use during the COVID-19 pandemic restrictions. Children with autism spectrum disorder show a particular preference for engagement in screentime. Gaining parental understandings of the steps they take to mediate excessive screentime can assist in developing interventions which mitigate the well documented negative impacts of screentime for children with autism spectrum disorder. This paper presents the findings of a study which explored parental perceptions of the screentime use and the strategies parents used to manage the screentime engagement of their children with autism spectrum disorder.

Methods: A qualitative descriptive design, using semi-structured, in-depth interviews with seven purposively selected parents, was used to achieve the above objectives. Data was thematically analysed using an inductive approach.

Results: One of the four themes generated during the study; Striving to provide conditional access to screentime details the varied mediation strategies parents used to manage their child's screentime under the two categories of Content monitoring and Setting limits.

Discussion: The findings of this study, describing the various restrictive strategies parents use to manage the screentime use of their children, were comparable to prior studies. Findings that built on existing evidence, describe the strategies parents used i.e., distraction and preparing for the cessation of screentime, to manage screentime in a way that avoided negative behaviour in their child and parental stress linked to this behaviour. It is certain, that screentime will remain a predominant occupation for children with autism spectrum disorder therefore, early childhood interventionists need to consider how to optimize the nature of engagement of screentime.

Introduction: Evolutionary hypotheses propose that fetuses show "predictive adaptive" responses to the prenatal environment based on likely continuity with the postnatal environment, and males and females have different adaptive priorities. Female adaptations appear to implicate hypothalamic-pituitary-adrenal (HPA) axis mechanisms moderated by early tactile stimulation. Based on these hypotheses we predict that lack of prenatal-postnatal environmental continuity (mismatch), will be associated with poorer outcomes in females, an effect that will be ameliorated by tactile stimulation. We previously reported that this prediction was supported by evidence from the Wirral Child Health and Development Study (WCHADS) of a three-way interaction between maternal prenatal anxiety, postnatal anxiety, and infant stroking in the prediction of irritability at age 7 years, seen only in girls. Here, we ask whether this effect persists over another 6 years into early adolescence.

Methods: Mothers in a general population cohort (WCHADS) provided self-reported anxiety scores at 20 weeks of pregnancy, and at 9 weeks, 14 months and 3.5 years postpartum, and frequency of infant stroking at 9 weeks. Their children self-reported symptoms of depression in early adolescence at age 13 years. Structural equation modelling (SEM) with maximum-likelihood estimation was conducted using data from N = 695 mother-child dyads.

Results: There was a three-way interaction between prenatal and postnatal anxiety and maternal stroking in the prediction of early adolescent depression, seen only in girls, consistent with our previous reports. When examining self-reported depression at age 13 years, increased stroking was associated with decreased symptoms of depression in girls in the mis-match group characterised by low prenatal and high postal anxiety, but not the high prenatal and low postnatal mis-match group.

Discussion: We provide preliminary novel evidence that mechanisms likely to have evolved well before the emergence of humans, contribute to the risk of adolescent depression in girls. These findings have implications for understanding developmental origins of sex differences in adolescent depression.

Introduction: Adolescent suicidality is a significant public health issue. To develop effective interventions aimed at preventing suicide in this vulnerable population, it is essential to understand the complex interplay of health-related quality of life, depression and suicidal ideation.

Methods: For this purpose, we analyzed longitudinal data of 250 children and adolescents diagnosed with major depressive disorder (M = 15.7, SD = 1.6, range 8-18 years, 74% females). The main goal of the study was to examine whether the effect of health-related quality of life on individual trajectories of suicidal ideation is mediated by depression severity. A series of t-tests, Chi-squared-tests, Fisher's exact tests and a mediation analysis including three robust linear mixed-effects models were conducted.

Results: Depressed adolescents with suicidal ideation reported lower health-related quality of life across physical, psychological, peer, and school domains compared to those without suicidal ideation, while no significant difference was observed in the family-related domain. Psychological well-being emerged as the sole domain of health-related quality of life with a direct influence on suicidal ideation. Notably, depression severity mediated the effect of physical, psychological, peer- and school-related quality of life on suicidal ideation.

Discussion: Our findings suggest that improving health-related quality of life reduces depressive symptoms, which in turn leads to lower suicidal ideation. This highlights the importance of including health-related quality of life in the clinical assessment of suicide risk as well as targeting health-related quality of life in therapeutic interventions. In the light of the results of this study, interventions should not only focus on classical clinical criteria of psychiatric diagnoses such as major depressive disorder, but also on broader, more resource-oriented constructs such as health-related quality of life to better mitigate the risk of suicide in this vulnerable population.

Clinical trial registration: www.ClinicalTrials.gov, identifier [NCT03167307].