JCPP advances最新文献

Background

Self-harm in adolescents is an international concern. Evidence highlights that therapeutic intervention (TI), such as cognitive behaviour therapy informed treatments, after self-harm leads to reduced self-harm repetition. However, there is no prior literature about the effects of TI on future mortality in adolescents. We examined the effect of TI on mortality rates in adolescents across RCTs.

Methods

This review was reported in accordance with PRISMA guidance. MEDLINE, EMBASE, PsycINFO, and Cochrane Library were searched to 19 June 2024. Two authors independently screened titles, abstracts, and full texts against pre-defined criteria. RCTs were included if they compared a TI versus a comparator in adolescents up to 18 years with at least one prior self-harm episode. There was no lower age limit. For the pooled effect size of mortality, the DerSimonian-Laird method was used, and a random effects model for self-harm and suicide attempts. The primary outcome was intra or post-trial mortality in adolescent post TI, and the effect of TIs on self-harm including attempted suicide episodes were secondary outcomes. Analyses were done in Stata.

Results

Twenty-four trials of TIs consisting of 3470 randomised adolescents were included. The pooled risk difference for mortality of participants in the TI group was 0.002 (95% CI −0.003 to 0.008, p = 0.42). There were 6 deaths in the TI group compared to 15 deaths in the comparator group. The pooled risk difference for TI on repeat self-harm was −0.07 (95% CI −0.132 to −0.007, p = 0.028), and −0.05 (95% CI −0.086 to −0.007, p = 0.022) for suicide attempts compared to comparator.

Conclusions

This review found no significant impact of TIs on future mortality in adolescents. We also demonstrated that TIs can reduce suicide attempts which can lead to substantial benefits for adolescents, families, and clinical services.

Background

Childhood mental health conditions typically affect the entire family, including siblings, however there is a lack of research investigating interventions supporting siblings.

Methods

The review was prospectively registered with PROSPERO (CRD42022377163). We conducted systematic searches of 7 databases (Medline, EMBASE, PsycINFO, Child and Developmental and Adolescent Studies, Applied Social Science Index and Abstracts, Education Research Information Centre, and British Eduction Index) for studies evaluating interventions for children and young people (CYP) with siblings presenting with mental health conditions from January 1980 to August 2024. We included interventions for young people aged 4 to 24 years who have a sibling with a mental health condition, with symptoms and impact lasting at least 3 months. Quality of reporting was assessed using the Critical Appraisal Skills Programme qualitative checklist for qualitative and the Effective Public Health Project Practice quality assessment Tool for quantitative studies.

Results

We identified 4 eligible studies; 2 of family-based treatment and the other of drop-in group support from 2469 studies that were screened in total. Quantitative results were rated weak for three out of four studies, while qualitative results were rated moderate for two studies, and high for one study. The two studies of sibling support groups reported high acceptability.

Conclusion

The evidence for the effectiveness of interventions for siblings of CYP with mental health conditions is limited in both size and quality, highlighting a significant gap in research and practice. We cannot draw definitive conclusions from the available evidence, but it suggests support groups have potential to improve sibling outcomes. Additional research is required to determine sibling mental health trajectories and to identify risk and resilience factors possibly influencing poorer mental health outcomes. Clinicians should be mindful of potential effects of mental health conditions on other family members and encourage parents to communicate openly with siblings about family dynamics and the challenges they may face.

Background

Oppositional behaviors are often an important issue for parents who have a child with autism spectrum disorder (ASD), and have been shown to be related to their Quality of Life (QoL). The present study examines the possible mediation and moderation effects of parenting stress and coping in the relationship between oppositional behaviors in the child with ASD and parental QoL.

Method

Parental stress, coping strategies, parental QoL and children's challenging behaviors (CBCL oppositional problem domain) were studied through parent-report (335 mothers and 230 fathers) over two occasions in a cohort of 485 children and adolescents with ASD (398 boys and 87 girls) with a mean age of 6.14 years (SD = 3.46) at baseline. Mediation and moderation effects were examined using structural equation modeling.

Results

Strong associations between child behaviors, parental stress and parental QoL were evidenced. Parental stress mediated the relationship between opposition in the child and parental QoL at diagnosis, but this effect was much smaller 3 years after diagnosis. Surprisingly, problem solving and social support, two commonly recommended coping strategies, had little or no effect on reducing impact on QoL 3 years later.

Conclusions

Longitudinal analysis allowed us to estimate the causal pathway between child oppositional behaviors, parental stress and impact on parental QoL. Our findings emphasize the crucial role of parental stress, which can mediate the impact of the children's oppositional behaviors on parental QoL. They argue for the need to develop specific interventions for parents focusing on parental stress and child's behavior management.

Background

Low socioeconomic status is associated with lower cognitive performance and long-term disparities in achievement and success. However, not all children from low-income backgrounds exhibit lower cognitive performance. Characterizing the factors that promote such resilience in youth from low-income households is of crucial importance.

Methods

We used baseline data from participants in the lowest tertile of income-to-needs in the Adolescent Brain Cognitive Development study and machine learning to identify the factors that predict fluid and crystallized cognitive resilience among youth from low-income backgrounds. Predictors included 164 variables across child characteristics, family and developmental history, and environment.

Results

Our models were reliably able to predict resilience but were substantially more accurate for crystallized cognition (AUC = 0.75) than for fluid cognition (AUC = 0.67). Key predictors included developmental factors such as birthweight and duration of breastfeeding, neighborhood-level factors (e.g., living in concentrated privilege, enrollment in advanced placement courses), children's own temperament and mental health, and other factors such as physical activity and involvement in extracurricular activities.

Conclusion

Our findings highlight the importance of a multifaceted approach to promoting cognitive resilience among children from low-income households in future intervention work.

Background

Attention Deficit Hyperactivity Disorder (ADHD) is a common neurodevelopmental condition, more often diagnosed in males. In many individuals, particularly females, ADHD is diagnosed later or missed, the reasons for this are not fully understood. Timely diagnosis is needed to provide support, management, and treatment to improve outcomes. This study aimed to understand why some young people with ADHD experience later or missed diagnosis and to consider sex differences.

Methods

This study included 9991 (females = 43.69%) individuals from the Millenium Cohort Study, a UK based population study which defined recognised ADHD by a parent-reported clinician diagnosis, and unrecognised ADHD by parent-reported questionnaires. Behavioural and emotional difficulties, engagement in leisure activities, and parental characteristics, were compared between those recognised earlier (by ages 5/7, n = 264, f = 19.3%) versus later (by ages 11/14, n = 260, f = 21.2%), and those recognised (n = 524, f = 20.2%) versus unrecognised (n = 1,138, f = 38.7%) using logistic regression, with odds ratios (OR) and 95% confidence intervals (CI) analysed. Sex differences were investigated with an interaction analysis.

Results

Those recognised with ADHD earlier had more peer, conduct, and emotional problems, emotional dysregulation, lower cognitive ability, and poorer prosocial skills compared with those recognised later, ORs ranged from 0.27 (95% CI = 018, 0.41) to 1.20 (95% CI = 1.20, 1.32). Similar findings were seen when comparing those with recognised and unrecognised ADHD; ORs ranged from 0.11 (95% CI = 0.09, 0.15) to 1.31 (95% CI = 1.19, 1.43). Additionally, those recognised were more likely to have diagnosed autism and have less reported physical activity. Sex stratification showed that recognised males had higher emotional dysregulation than unrecognised males, but this was not seen in females.

Conclusions

Our findings highlight the need to consider ADHD referral, regardless of cognitive and prosocial ability or comorbidities, if children are displaying ADHD symptoms. Additionally, symptoms of ADHD not traditionally included in screening criteria, such as emotional dysregulation, should be considered to improve gender-inclusive recognition of ADHD.

Background

Adolescent girls with diagnoses of autism, ADHD and/or developmental coordination disorder (DCD) are at higher risk for mental health problems than boys with the same diagnoses and neurotypical girls. These girls are called neurodivergent here, though neurodivergence includes a broader range of diagnoses. One possible reason for this mental health disparity could be camouflaging, a coping strategy used more by girls. Camouflaging is when the individual pretends to be neurotypical, often involving substantial effort. This study aims to understand: (a) if the use of camouflaging has started by early adolescence, (b) how components of camouflaging (assimilation, masking, and compensation) present at this age, (c) if age predicts camouflaging and (d) what is the relationship with mental health.

Methods

Participatory methods: A co-production team of 15 adult neurodivergent women co-produced the project and ranked camouflaging as their most important research theme.

Main Study: Participants were 119 girls (70 neurodivergent, 49 neurotypical) aged 11–14 years. A transdiagnostic approach was adopted and the neurodivergent group had a diagnosis of autism, ADHD and/or DCD. Girls completed self-report measures of camouflaging, anxiety, and depression in an online meeting with a researcher.

Results

Neurodivergent and neurotypical girls presented similarly on two components of camouflaging namely masking and compensation, components related to presenting in a socially acceptable way and mimicry. Groups differed on the assimilation component, which is related to trying to fit in and involves the feelings of pretending/acting. Age had a medium effect on camouflaging with higher levels of camouflaging observed in older girls. Camouflaging scores strongly predicted anxiety and depression scores in both groups.

Conclusions

The use of camouflaging, specifically assimilation, is evident in a transdiagnostic sample of 11–14 year old neurodivergent girls. Importantly, the strong relationship between camouflaging and poor mental health is present at this early age, substantiating the co-production team's insights.

Background

Self-harm and suicide related behaviours are increasing in young people, and clinical support is not adequately meeting needs. Improved approaches to assessment and the clinical management of self-harm will result from codesign processes and include greater shared decision-making between young people and practitioners. The CaTS-App (an adapted digital version of the existing Card-Sort Task for Self-harm research tool) aims to facilitate a collaborative understanding of adolescent self-harm and support decision-making within clinical settings. The codevelopment of a digital, clinical tool which meets the needs of multiple stakeholders requires careful consideration.

Methods

We present a case-study describing the participatory aspects of the development of the CaTS-App, which included comprehensive patient involvement, research activities and coproduction with diverse young people aged 17–24 with lived experience of self-harm. We share our processes and activities to deliver safe, engaging, sustainable, ethical and responsible participatory practice and co-created knowledge, in the codevelopment of the CaTS-App.

Results

Activities spanned a 48-month period in both face-to-face and online settings. Example processes and activities are provided in narrative, tabular and diagrammatic form, alongside discussion of the rationale for choices made. A summary methodology is also shared to stimulate continued discussion and development of participatory approaches in digital mental health.

Conclusions

The paper contributes important insight and practical detail for the delivery of genuine participatory processes in digital mental health development when working with a population who may be considered vulnerable.

Background

There is a growing expectation that neurodivergent young people, such as those with diagnoses of attention-deficit/hyperactivity disorder (ADHD) and/or autism, should play a central role in shaping research on neurodevelopmental conditions. However, currently, their involvement is typically limited to arms-length advice. To address this, the Regulating Emotions-Strengthening Adolescent Resilience (RE-STAR) programme has co-developed a framework for deepening the involvement of neurodivergent participants in translational research. Here we apply this to build, implement and evaluate a new approach to participatory qualitative research.

Methods

Development – Building on the track record of successful collaboration between RE-STAR academic researchers (ARs) and its Youth Researcher Panel (Y-RP), a cycle of meetings was convened to co-develop a collaborative protocol for the participatory approach. Implementation – ARs and Y-RPers applied the general protocol to study a specific topic. This involved co-designing and co-delivering an interview schedule to study the emotional experiences of 12 adolescents with diagnoses of ADHD and/or autism and then co-analysing the interviews. Evaluation – ARs, Y-RPers and interviewees shared their reflections on the participatory approach and its implementation, during interviews (N = 36) and short open-ended surveys (N = 22).

Results

Development - The protocol for the participatory approach gave detailed advice on how to engage Y-RP members (or equivalent) in the co-design, co-delivery and co-analysis of interviews. Implementation - The approach was successfully implemented by ARs and Y-RPers working together to co-design an interview to study the emotional lives of adolescents with diagnoses of ADHD and/or autism, co-deliver it and then co-analyse the interview scripts. Evaluation - The implementation experience of the Y-RP, ARs and interviewees was characterised by common themes relating to (a) adapting research methods and making practical adjustments; (b) taking on new roles, adding value to research and (c) valuing neurodivergent characteristics.

Conclusions

This new RE-STAR protocol proved feasible to implement in a way that was generally perceived, from multiple perspectives, to add depth and authenticity to research into the experiences of neurodivergent young people.