Frontiers in child and adolescent psychiatry最新文献

Background: Approximately one in four adolescents in Sub-Saharan Africa experiences significantly elevated symptoms of anxiety and depression. Those living in resource-constrained communities face heightened risks due to acute distress, trauma, and less responsive health care services. Boikoetliso Ba Boko (meaning 'exercising the mind') is an intervention prototype designed for adolescents and young people experiencing common mental health conditions.

Methods: The prototype aims to implement a youth-centred community mental health intervention, through collaboration with existing public health systems and community resources. It seeks to enhance access to mental health support for adolescents and young people in Soweto, South Africa, by creating a dynamic and engaging therapeutic environment for those dealing with anxiety, depression, and suicidal ideation. This protocol outlines how we will evaluate the feasibility, acceptability, and implementation process of the prototype mental health intervention. We will enrol 200 at-risk adolescents and young people, aged 14-24 years, who will serve as their own controls, into the intervention and collect assessment and process evaluation data using mixed methods.

Discussion: This study aims to provide a comprehensive understanding of how the Boikoetliso Ba Boko adolescent mental health prototype can be effectively evaluated and scaled up in resource-constrained communities. The findings will inform the development of a Phase II randomized controlled trial protocol to assess the prototype's efficacy.

Ethics: Ethical approval was granted by the Human Ethics Research Committee of the University of the Witwatersrand (M231045 MED23-09-040). Boikoetliso Ba Boko is registered with the Pan African Clinical Trial Registry (PACTR202409702283764).

Background: Despite known risks of substance use, mortality following adolescent substance treatment has not been examined. Knowing which youth have greatest risk and how youth die may inform future interventions.

Methods: This retrospective chart review combined records from a single adolescent substance treatment program at an urban, safety-net health system (n = 2,957, ages 10-19 years) with a public health registry of deaths from 2003 to 2024. Records from the child mental health treatment program at the same health system (n = 4,400, ages 10-19 years) were used for comparison. The crude mortality rate per 100 person years was calculated for both samples for all 21 years. The standard mortality rate using death within one year of intake was also calculated. Finally, a logistic regression model was used to test the project hypotheses that self-identification as a person of color, no engagement in care, male sex at birth, and involvement in substance treatment would predict mortality.

Results: Overall, 92 (2.1%) adolescents in mental health treatment had a death record compared to 119 (4.0%) of adolescents in substance treatment. The crude mortality rate per 100 person years for adolescents in mental health treatment was 0.19 (CI: 0.18-0.20) compared to 0.37 (CI: 0.36-0.38) for adolescents in substance treatment. The standard mortality rate was 120 (32.7-308) for adolescents in mental health treatment compared to the standardized mortality rate of 944 (CI: 599-1,420) for adolescents in substance treatment. Accidental death, which includes overdose, was the most common cause of death in both groups. Results of the logistic regression showed male sex at birth (p = 0.0434, OR = 2.10, CI 1.06-4.53) and substance treatment (p = 0.0035, OR = 3.02, CI 1.47-6.55) as predictors of death within 5 years of treatment intake.

Conclusions: Adolescents in substance treatment compared to those in mental health treatment are more likely to die within 5 years of intake. Males compared to females are also more likely to die. Interventions to prevent overdose and other causes of mortality may be indicated.

Introduction: This systematic review aimed to synthesize existing research on the symptomatological and behavioural differences between male and female attention-deficit/hyperactivity disorder (ADHD) in individuals aged 6-18 years. ADHD is a prevalent neurodevelopmental disorder that manifests differently across genders, potentially impacting the diagnosis, treatment, and overall management of the condition.

Methods: Following the Preferred Reporting Items for Systematic reviews and Meta-Analyses 2020 (PRISMA guidelines), we conducted a comprehensive literature search and identified 67 records published between 2008 and 2024 that met our inclusion criteria. The review examined both direct sex differences-comparing female ADHD subjects to their male counterparts-and the disorder's sex-specific effects, revealing nuanced patterns of compromission.

Results: Findings were organized into seven thematic areas: core symptoms, executive and attention performance, neuropsychomotor aspects, psychopathological aspects, behavioural and social aspects, substance use and academic performance. Differences between males and females with ADHD have been highlighted across several domains, including prevalence and intensity of core symptoms, cognitive functioning, and the nature of externalizing vs internalizing behaviours. Notably, variations were observed in the ways symptoms manifest, such as in aggression and emotional regulation. Furthermore, the review highlighted how ADHD's impact is influenced by the subject's sex, specifically affecting neuropsychomotor development, social interactions, and self-esteem. Age-related differences concerning the evolution of symptoms and cognitive functions were also explored, shedding light on how developmental trajectories may differ between sexes.

Conclusion: A comprehensive understanding of sex specificity in relation to ADHD is critical for informing effective diagnosis and treatment strategies. This review underscores the need for further research to elucidate these differences, ultimately contributing to more tailored and sex-sensitive approaches in ADHD management.

Systematic review registration: https://doi.org/10.37766/inplasy2025.4.0093, identifier INPLASY202540093.

Introduction: This study aims to explore parents' experiences collaborating with support systems in a Norwegian municipality for children who experience school attendance problems (SAP). The heterogeneity of SAP highlights the need for individualized measures tailored to each student's needs and collaboration between schools, municipal support systems, and the Child and Adolescent Psychiatric Outpatient Clinic (BUP). Empowering parents to advocate for their children is crucial in managing challenging situations.

Method: In total, 11 parents of students who received support from a school absenteeism team (SAT) participated in the study. This qualitative study uses focus group interviews as a data collection method.

Results: The results underscore the complexity of addressing SAP within municipal support systems and the need for a dedicated SAT to support students and empower parents. The parents underline the importance of having collaborative practices, evidence-based knowledge, structures, and procedures to ensure interventions are relevant and predictable. They emphasized the importance of establishing collaborative practices within the municipality.

Conclusion: Collaborating with parents as equal partners increased the sense of wellbeing for the parents and enhanced the students' decision-making process.

Introduction: Autism is characterized by a wide range of core and associated behavioral features that can be influenced by co-occurring conditions such as attention-deficit hyperactivity disorder (ADHD) and anxiety disorders. Executive function difficulties are proposed as a common feature of autism and ADHD and are also evident in persons with anxiety disorders. However, little is known about how anxiety disorders or ADHD differentially impact executive functioning or how these difficulties may influence the presentation of core and associated autistic features in young children. In the current study, we explored the unique executive function difficulties associated with co-occurring anxiety and/or ADHD and elucidated how they differentially impact the clinical presentation of autism in young children.

Methods: We assessed 69 autistic children, aged 3 to 5 years. Anxiety and ADHD were assessed through parent interview using the Preschool Age Psychiatric Assessment (PAPA). Executive functions were assessed using the Behavior Rating Inventory of Executive Function - Preschool Version (BRIEF-P). Core autistic features were measured with the Autism Diagnostic Observation Schedule-Second Edition (ADOS-2) and additional features were measured with the Restricted and Repetitive Behaviors Scale, Revised (RBS-R) and the Sensory Experiences Questionnaire (SEQ). Using an additive main effect general linear model, we examined the unique contributions of an anxiety disorder and/or ADHD on core and associated autistic features as well as executive function. Mediation analyses explored the contribution of the executive function profiles to specific features of autism.

Results: Results showed that greater difficulty with attentional shifting was uniquely associated with anxiety, whereas greater difficulty inhibiting behavioral responses was uniquely associated with ADHD. Attentional shifting mediated the relationship between anxiety and ritualistic behaviors, sameness behaviors, sensory hyper-responsivity, and overall autistic features. Conversely, inhibitory control mediated the relationship between ADHD and both irritability and self-injurious behaviors.

Discussion: These findings implicate components of executive functioning as important cognitive processes associated with co-occurring psychiatric conditions in autism. Future research should investigate the impact of early intervention for executive function difficulties on psychiatric and neurodevelopmental outcomes in autistic children.

Parent-Child Interaction Therapy (PCIT) is a widely known evidenced-based treatment (EBT) that has been used with Latine, Black, and neurodiverse children to improve the parent-child relationship and reduce challenging behaviors. Although considerable efforts have been made to disseminate PCIT to the wider community, fewer strides have been made to reach Black and Latine families in underserved communities-especially for families with neurodiverse children. One method to bridge the service gap for Black and Latine families is to train Black and Latine clinicians who primarily serve Black and Latine communities. Thus, the current pilot utilized a qualitative design and the Ecological Validity Model to examine the clinical and cultural impact of a culturally infused PCIT training pilot, the Creating Communities Initiative, for Black and Latine mental health providers (N = 8)., Black and Latine clinicians highlighted several beneficial cultural adaptations (e.g., racially-ethnically matched community) and barriers (e.g., low caseloads) to training completion and competency development. Overall, the results of the culturally infused PCIT training pilot provide a useful template for future dissemination efforts of PCIT to culturally diverse providers and families.

Introduction: There is debate into the impact of universal, school-based interventions to improve emotional outcomes. Previous reviews have only focused on anxiety and depression symptoms, omitting broader internalising symptoms, nor include the proliferation of newer studies which have focused on mindfulness in schools.

Methods: We conducted a systematic review and meta-analysis, searching MEDLINE, Embase, PsycINFO, and Cochrane Central Register of Controlled trials for studies focusing on universal interventions to improve emotional outcomes for young people aged 8-18 until 15/12/2022. The primary focus were post-intervention self-report anxiety, depression and internalising outcomes. We prospectively registered the study with PROSPERO, number (CRD42020189845). Risk of bias was assessed using specially devised tools adopted from Cochrane.

Results: In total, 71 unique studies with a total sample of 63,041 young people met the inclusion criteria. This included 40 studies with 35,559 participants for anxiety outcomes, 50 studies with 49,418 participants for depression outcomes, and 15 studies with 21,473 participants for internalising outcomes. Pupils who received universal school-based interventions had significantly improved anxiety (d = -0.0858, CI = -0.15, -0.02, z = -2.46, p < .01) and depression (d = -0.109, CI = -0.19, -0.03, z = -2.60, p < 0.013), but not internalising outcomes. For anxiety disorders, intervention theory moderated the intervention effectiveness (Q = 24.93, p < 0.001), with CBT principles being significantly more effective than those that applied mindfulness or other/multiple theories.

Discussion: Evidence suggests that universal, school-based approaches for anxiety and depression produce small effect sizes for pupils. We conclude that used as a population health approach, these can have an impactful change on preventing anxiety and depression. However, intervention developers and researchers should critically consider which theories/approaches are being applied, particularly when trying to improve anxiety outcomes.

Systematic review registration: PROSPERO CRD42020189845.

Introduction: School attendance problems (SAPs) are a vexing issue that pose significant challenges for youth, families, and professional stakeholders. Despite growing research efforts, studies that explore the perspectives of youth on SAPs remain limited, particularly in Nordic countries. This qualitative study investigated Norwegian youths' retrospectives on the development and persistence of SAPs and the support they received from professionals in addressing their challenges.

Methods: Semi-structured interviews were conducted with 10 youth (aged 12-22) with a history of SAPs in compulsory education. Participants were recruited by professionals from the educational-psychological service and alternative provisions in three Norwegian municipalities. Data were analyzed using reflexive thematic analysis.

Results: The results indicate that lacking positive relationships with peers and teachers along with falling behind academically lead to school alienation and contributes to the onset or maintenance of SAPs. Similar experiences of gradual onset of SAPs, anxiety and depression, emotional and somatic distress, and conflicting feelings around avoidance were outlined. The youths' initial experiences of support within the school setting were described as inappropriate, insufficient, or initiated too late, while attending alternative provisions appeared as a primary intervention that had enduring positive effects on attendance and engagement in academic and social activities.

Conclusion: The findings highlight the need for early intervention, coherence between initiatives across support services and effective collaboration between youth, families, schools, and external services.

Sudden-onset, unexplained, and treatment-resistant neuropsychiatric symptoms have been reported in numerous pediatric patients. Prior to the identification of neuroimmune conditions including PANS and PANDAS, children with these conditions were diagnosed with psychiatric and neurological conditions and offered conventional psychiatric and therapeutic care. As connections between the immune and nervous systems become clearer, alternate curative treatments have emerged. This case series presents three pediatric patients' treatment experiences with sudden-onset severe neuropsychiatric symptoms such as disabling anxiety, tics, eating restriction, or hallucinations, and their full recoveries following treatment of their underlying infections, inflammatory responses, and gastrointestinal dysbiosis. Treatments included antimicrobials, nutraceuticals, probiotics, and dietary changes. Converging lines of research highlight the importance of considering neuroinflammatory conditions in the differential diagnosis of children with treatment-resistant neuropsychiatric symptoms.