Frontiers in child and adolescent psychiatry最新文献

Background: Attention Deficit Hyperactivity Disorder (ADHD) among children younger than 6 years is quite impairing, nearly half these youth with ADHD experience school exclusion from mainstream preschool classes due to related emotional and behavioral outbursts. While a range of behavior rating scales and subjective measures are used to assess these youth, objective methods of assessment and prediction derived from technology have potential to improve therapeutic and academic interventions outcomes for these youths. We hypothesized that biometric sensors would provide objective, highly sensitive and specific information regarding the physiological status of children prior to an impulsive outburst and could be feasibly implemented using a wearable device in the special education classroom.

Methods: We recruited two whole classrooms (N = 5 youth in the pre-K class and N = 5 youth from the first grade) of a specialized therapeutic day-school for youth with ADHD and other psychiatric and developmental disorders to examine feasibility of obtaining continuous physiological data associated with behavioral and emotional outbursts through smartwatch use. Children wore a sensor watch during their daily classroom activities for two weeks and trained observers collected data using behavioral logs. Using Ecological Momentary Assessment methodology, to examine correlations between objective sensor data and observer observation. Data collected from parents regarding prior night's sleep was also examined.

Results: All participants completed the study. With a few tolerability or palatability issues. Associations were found between physiological and behavioral/questionnaire data. The methodology holds promise for reliably measuring behavioral and emotional outbursts in young children.

Conclusions: This is the first study to use a bio-marker device in vivo among severely dysregulated pre-school aged youth throughout a full school day. This study established the feasibility of utilizing sensor derived physiological data as an objective biomarker of ADHD within the special education therapeutic classroom. Further research with larger samples is required to build a more robust and personalized AI predictive model.

Youth depression is a global emergency. Redressing this emergency requires a sophisticated understanding of the multisystemic risks and biopsychosocial, economic, and environmental resources associated with young people's experiences of no/limited versus severe depression. Too often, however, personal risks and a focus on individual-level protective resources dominate accounts of young people's trajectories towards depression. Further, studies of depression in high-income countries (i.e., "western") typically inform these accounts. This article corrects these oversights. It reports on the methodology of the Wellcome-funded R-NEET study: a multidisciplinary, multisystemic, mixed method longitudinal study of resilience among African youth whose status as "not in education, employment or training" (NEET) makes them disproportionately vulnerable to depression. Co-designed by academics, community-based service providers and youth in South Africa and Nigeria, with partnerships in the United Kingdom, Canada and the United States, the R-NEET study is identifying the physiological, psychological, social, economic, institutional, and environmental risks and resources associated with distinct trajectories of depression. Using the methodology of the R-NEET study as exemplar, this article advances an argument for understanding resilience as a contextually and culturally rooted capacity that draws on the multiple, co-occurring systems that young people depend upon to support their wellbeing. Acknowledging and harnessing the multiple systems implicated in resilience is critical to researchers and mental health providers who seek to support young people to thrive, and to young people themselves when protecting or promoting their mental wellbeing.

Introduction: Families from racial/ethnic minoritized backgrounds and families of children with developmental delay (DD) often face more obstacles to engaging in psychosocial interventions compared to White families and families of typically developing children. Yet, research on engagement in behavioral parenting interventions has predominantly focused on typically developing children and White families from majority cultural groups. The present study offers the first examination of acculturation and enculturation as predictors of homework engagement among caregivers of children with DD from underrepresented racial/ethnic backgrounds participating in a telehealth behavioral parenting intervention.

Methods: Data were collected from 65 caregiver-child dyads participating in the Advancing Child Competencies by Extending Supported Services (ACCESS) Study evaluating Internet-delivered Parent-Child Interaction Therapy (iPCIT) for children with DD. Homework engagement was measured as the proportion of days caregivers practiced "special time" with their child. Acculturation and enculturation were assessed using the Abbreviated Multidimensional Acculturation Scale (AMAS). Linear regression analyses evaluated associations between these two cultural factors and subsequent homework engagement, controlling for caregiver nativity, language of preference, income-to-needs ratio (INR), and caregiver work status.

Results: While higher levels of acculturation (B = .110, p = .054) did not significantly predict homework engagement, enculturation (B = .140, p = .007) significantly predicted greater homework engagement throughout treatment with small and small-to-medium effect sizes (Cohen's f² = 0.029 and 0.104, respectively).

Discussion: These findings underscore the nuanced role of acculturation and enculturation in predicting homework engagement in telehealth behavioral interventions for children with DD. Although acculturation did not facilitate homework engagement, caregivers who retained a stronger connection to their cultural heritage demonstrated higher homework engagement within the context of iPCIT. The study highlights the need for incorporating cultural considerations into treatment planning and flexibility in adapting treatment protocols to optimize family engagement and improve outcomes in this population.

Clinical trial registration: ClinicalTrials.gov, identifier (NCT03260816).

This study presents the validation of the parent version of the Inventory of School Attendance Problems (ISAP-P), which assesses a broad spectrum of symptoms associated with school attendance problems. A model with 49 items loading on 13 factors derived from the child version showed an acceptable fit (N = 296). Correlations with other measures indicated convergent and discriminant validity of the scales, but associations with the extent of school absences were not detected. Concordant scales of the child vs. parent version were correlated in the expected directions, but some scales showed low interrater agreement. Albeit these initial results support the validity of the ISAP parent version, further studies on its psychometric properties as well as on children's and parents diverging views on SAPs are needed.

Background: Urban areas, particularly in developing nations like Uganda, face heightened risks due to poverty, unemployment, and environmental challenges, intensifying the vulnerability of urban youth to poor mental health. This study aims to determine the psychological well-being of adolescents and to assess the risks and associated factors of mental health problems among adolescents in the context of COVID-19 pandemic in Kampala City, Uganda.

Methods: We conducted a cross-sectional survey of 500 adolescents aged 13-19 years residing within the five divisions of Kampala City, Uganda. We utilized standardized psychological assessment tools including the Patient Health Questionnaire, Generalized Anxiety Scale, to assess severity of depression and anxiety levels among the adolescents. A logistic regression model was used to evaluate the correlates associated with depression and generalized anxiety disorders. Variables with a p-value <0.25 in the univariate model were included in the multivariable regression model. Subsequently, we conducted a qualitative study using semi-structured interview guides through focused group discussions, and key informant interviews with teachers, parents, representatives of civil society organizations, and religious leaders. Qualitative data were analyzed using a thematic analysis approach.

Results: The prevalence of depression was relatively higher among out-of-school adolescents at 21.5% compared to school-going adolescents at 14.0%. Furthermore, out-of-school adolescents had significantly higher anxiety scores when compared to their school-going counterparts (17.5% vs. 10.3%) respectively. Key factors identified associated with poor mental health include loneliness, being out of school, COVID-19, and familial conflicts.

Discussion: This study highlights the impact of the COVID-19 pandemic on the mental well-being of adolescents in Kampala, Uganda. The reported prevalence of depression and anxiety, particularly among out-of-school adolescents, underscores the urgent need for targeted interventions in this vulnerable population. Investing in the mental well-being of Ugandan adolescents is paramount for fostering resilience and ensuring long-term success, especially in marginalized urban settings.

Introduction: About half of all adolescents with major depressive disorder (MDD) have frequent suicidal thoughts and of those with suicidal ideations, about one-third attempt suicide. Identifying clinical characteristics associated with suicidal ideation and attempts is important for suicide prevention and clinical care.

Methods: Participants were four groups of adolescents diagnosed with MDD (n = 246, 180 females): (a) non-suicidal youths (n = 76), (b) ideators (n = 102; current suicidal ideation), (c) ideator-attempters (n = 56; current suicidal ideation and lifetime history of suicide attempt), and (d) lifetime attempters (n = 12; no current suicidal ideation but lifetime history of suicide attempt). Adolescents underwent clinical interviews and completed questionnaires assessing sociodemographic and clinical variables. Multivariate analyses of variance, logistic regression models, mediation and moderation analyses were run to assess which variables were associated with group membership.

Results: Suicidal ideators, irrespective of whether they had attempted suicide previously, had higher depression severity, higher anxiety and lower resilience compared to non-ideators. Hopelessness was associated with greater odds of being a suicidal ideator (p < .001, OR = 1.18) or an ideator-attempter (p = 0.036, OR = 1.13) than a non-suicidal youth. Attempter-ideators engaged more often in self-harm behavior compared to ideators (p = 0.046, OR = 1.13) and non-suicidal youths (p < .001, OR = 1.45). Ideator-attempters had experienced more childhood maltreatment, with hopelessness mediating the relationship between childhood maltreatment and suicidal ideation. Self-harm moderated the relationship between suicidal ideation and the probability of having made a suicide attempt.

Limitations: Only cross-sectional data was included, and data was based mostly on self-report measures.

Conclusions: Suicidal thoughts are associated with increases in hopelessness while suicide attempts are linked to non-suicidal self-harm behavior. Treatment of non-suicidal self-harm behavior might be an effective suicide prevention strategy in young people with depression.

Clinical trial registration: www.ClinicalTrials.gov, identifier (NCT03167307).

Audiovisual environmental perception has been the focus of numerous empirical studies. This study employs virtual reality (VR) to explore how different hydrodynamic waterscapes in Jiuzhaigou World Natural Heritage Site affect physiological and psychological restoration in youth. According to the results, audiovisual interactions, particularly with water sounds and birdsongs, significantly enhance physiological restoration compared to visuals alone. High-intensity hydrodynamic landscapes, regardless of birdsongs, exhibit the highest physiological restoration. There is a linearly positive correlation between physiological restorativeness and hydrodynamic landscapes. Medium-intensity hydrodynamic landscapes with rich forms are most psychologically restorative. In low-medium-intensity settings, visuals contribute more to psychological restoration than soundscapes. It is further found that waterscapes rich in flora and fauna feature a higher level of biodiversity. In the waterscapes with both elements of vegetation and water, the restorativeness of plant and animal resources is greater than that of water. This work highlights the need to focus on the application of different hydrodynamic landscapes in urban areas and the conservation of World Heritage Sites.

Background: Small pilot studies have indicated that transcranial photobiomodulation (tPBM) may help alleviate symptoms of neurological conditions like depression, traumatic brain injury and Autism Spectrum Disorder (ASD).

Objective: To examine the effect of tPBM on the behavioral symptoms of ASD and brain electrophysiology in children aged 2-7.

Methods: We conducted an open label, one-arm study with 23 participants, aged 2-7, previously diagnosed with ASD. We delivered non-invasively to all participants pulses of near-infrared light (wavelength 850 nm, pulse 40 Hz) to cortical nodes of Default Mode Network, Broca and Wernicke areas, and occipital lobe of the brain, twice weekly for 10 weeks. The tPBM was delivered using an investigational medical device designed for this purpose. Changes in ASD symptoms were measured using pre- and post-intervention scores on the Childhood Autism Rating Scale (CARS-2, 2nd Edition). We collected electroencephalogram (EEG) data after each treatment session from all children who tolerated wearing the EEG cap to monitor changes in brain activity.

Results: The intervention resulted in a significant 7-point reduction in average CARS-2 scores (t = 10.23, p < .0001), along with decreased delta power and increased gamma and beta power in EEG readings. The increase in gamma power was statistically significant [t(14) = 2.30, p = 0.047]. Changes in EEG power were significantly correlated with the number of sessions (delta: r(192) = -0.18, p = .013; gamma: r(192) = .19, p = .007; beta: r(192) = .15, p = .04). Improvements in CARS-2 scores were negatively correlated with changes in delta and beta power (delta: r(15) = -.59, p = .020; beta: r(15) = -.54, p = .037). No moderate or severe side effects were reported.

Conclusion: This study supports the potential of tPBM as a safe and effective treatment for ASD, and it suggests that EEG measurements may serve as a useful biomarker for future research.

Trial registration: https://clinicaltrials.gov/ct2/show/NCT04660552.

Introduction: As health systems struggled to respond to the catastrophic effects of SARS-CoV-2, infection prevention and control measures significantly impacted on the delivery of non-COVID children's and family health services. The prioritisation of public health measures significantly impacted supportive relationships, revealed their importance for both mental and physical health and well-being. Drawing on findings from an expansive national collaboration, and with the well-being of children and young people in mind, we make recommendations here for post-pandemic recovery and re-build.

Methods: This consensus statement is derived from a cross-disciplinary collaboration of experts. Working together discursively, we have synthesised evidence from collaborative research in child and family health during the COVID-19 pandemic. We have identified and agreed priorities areas for both action and learning, which we present as recommendations for research, healthcare practice, and policy.

Results: The synthesis led to immediate recommendations grouped around what to retain and what to remove from "pandemic" provision and what to reinstate from pre-pandemic, healthcare provision in these services. Longer-term recommendations for action were also made. Those relevant to children's well-being concern equity and relational healthcare.

Discussion: The documented evidence-base of the effects of the pandemic on children's and family services is growing, providing foundations for the post-pandemic recovery and re-setting of child and family health services and care provision. Recommendations contribute to services better aligning with the values of equity and relational healthcare, whilst providing wider consideration of care and support for children and families in usual vs. extra-ordinary health system shock circumstances.

Introduction: Neurodevelopmental disorders (NDDs) have high comorbidity rates and shared etiology. Nevertheless, NDD assessment is diagnosis-driven and focuses on symptom profiles of individual disorders, which hinders diagnosis and treatment. There is also no evidence-based, standardized transdiagnostic approach currently available to provide a full clinical picture of individuals with NDDs. The pressing need for transdiagnostic assessment led to the development of the Neurodevelopment Assessment Scale (NAS).

Methods: This paper describes the co-design process used in the development of NAS prototype with stakeholders including individuals with NDDs, parents of children with NDDs, and health professionals.

Results and discussion: Results indicated stakeholder consensus that NAS would be useful for NDD assessment, and included recommendations for fine-tuning the way some questions were asked (e.g., child's diagnoses), question flow (e.g., branching logic), and the language and presentation of the prototype (e.g., readability). Stakeholders also suggested the administration protocol should be flexible using electronic, face-to-face, online formats etc.