Clinical child psychology and psychiatry最新文献

BackgroundRates of psychiatric disorders and related hospitalizations among youth in the United States have risen substantially over recent decades. Despite evidence supporting outpatient care, fewer than half of youth receive treatment. When outpatient management is insufficient, inpatient psychiatric hospitalization is required, though it is costly, disruptive, and limited in availability. Prior research on predictors of inpatient length of stay has been dated and heterogenous, highlighting the need to identify current clinical and non-clinical factors associated with prolonged stays among youth populations.MethodThis IRB-approved retrospective study reviewed the medical records of 1,101 child and adolescent patients admitted to an inpatient psychiatric unit between June 1, 2018, and November 30, 2021. Baseline sociodemographic and clinical data were collected, and LOS was categorized into three groups: below-average (0-6 days), average (7-14 days), and above-average (15+ days). Comparative statistics were performed, and linear regression was used to identify independent predictors of LOS.ResultsThe average LOS was 10.5 days. Significant predictors of prolonged LOS included public insurance, admission for psychosis or suicide attempt, involvement of child protective services, number of prior hospitalizations, and number of medications prior to admission.ConclusionProlonged LOS in psychiatrically hospitalized youth is associated with specific clinical and non-clinical factors. Identifying these predictors at admission can guide treatment planning and set realistic expectations for families. Further research is required to validate these findings and explore the impact of LOS on treatment outcomes.

BackgroundParents of children with emotional or behavioural disorders (EBD) experience challenges with their own wellbeing. Parenting practices are impacted by parent wellbeing and are vital to supporting children with EBD. Programs with peer-led components, aimed at developing healthy parenting skills have been developed. While peer-led parenting interventions for parents of children with EBD have led to positive outcomes for children, outcomes related to parent wellbeing are not known. This systematic review examines the impact of peer-led parenting programs on the wellbeing of parents of children with EBD.MethodsA systematic review across 7 databases was conducted. 1009 articles were screened, and 13 met criteria for inclusion.ResultsThis study identified 8 peer-led parenting interventions. 11 outcome measures of parent wellbeing were used across the 13 studies. 7 studies reported statistically significant improvement in parent wellbeing outcomes. The 6 studies that did not report statistically significant improvement showed a trend toward improved parent wellbeing on outcome measure scores.ConclusionsFindings indicate the potential for peer-led parenting interventions to have a positive impact on parent wellbeing. Future research is needed to determine how to meaningfully measure parent wellbeing and what aspects of peer-led parenting interventions positively impact parent wellbeing.

BackgroundDialectical Behavior Therapy's (DBT) original biosocial theory and subsequent iterations as a transactional model suggest that invalidating social and family environments can contribute to emotion dysregulation and patterns of self-invalidation that may lead to suicidal and non-suicidal self-injurious behaviors over time. To our knowledge, no studies have examined the relationship between parental and self-invalidation on suicidality in a treatment setting or longitudinally over the course of treatment from pre-to post-treatment. This study examined the relationship between youth-reported parental invalidation, self-invalidation, and suicidality over the course of treatment in a comprehensive DBT partial hospitalization program (PHP).MethodsTwo hundred sixty-four adolescents and young adults admitted to a four-week comprehensive DBT PHP that incorporated family, individual, and skills group therapy components. All patients completed surveys evaluating perceived parental-invalidation, self-invalidation, and suicidality pre- and post-treatment.ResultsPatients reported significant decreases on all outcome measures: perceived mother and father invalidation, self-invalidation, and suicidality after 4 weeks. Changes (reductions) in both self-invalidation and mother invalidation were significant predictors of reduced suicidality.ConclusionComprehensive DBT is a viable treatment option for decreasing invalidation and suicidality in four weeks. These findings emphasize the importance of parent involvement in improving treatment outcomes for adolescents and young adults.

ObjectivesCaregivers of children with Pediatric Feeding Disorder (PFD) are at-risk for experiencing anxiety and stress. Given the high prevalence of PFD, many caregivers are susceptible to such symptoms. However, regular screening for caregiver mental health concerns within pediatric clinics is scarce. This study examined rates of caregiver mental health screening completion and levels of anxiety and stress among caregivers of children with PFD.MethodsCaregivers (n = 67) were approached about completing a mental health screener. Descriptive statistics were used to explore completion rates of screenings and levels of stress and anxiety.ResultsSixty-three caregivers (94%) completed the mental health screening and findings reflect high rates of anxiety and stress for this population.ConclusionsThese results highlight the high rates of anxiety and stress in this caregiver population and demonstrate the need for universal screening for caregiver mental health among pediatric feeding clinics.

Transdiagnostic screening tools (e.g., MINI-KID) are beneficial in detecting risk factors for a range of mental health problems in children; yet no research has explored how effective these tools are in detecting eating disorders (EDs). The aim of this review was to synthesise evidence on the discriminative power of transdiagnostic screening tools for identifying EDs among children aged 5-12. The review was pre-registered on PROSPERO; PRISMA guidelines were followed. PsycINFO and Medline were searched for peer-reviewed studies that used validated transdiagnostic mental health screening tools and reported on psychometric properties in children with an ED, published up until April 2025. Seven studies met inclusion criteria. Psychometric properties of the screening tools ranged from weak to excellent, with sensitivity for detecting EDs being less than acceptable (i.e., <80%) for 6 of the 7 tools identified in this review. Not all metrics of discriminative power were reported for 7 tools, and in most studies the number of children with an ED was too small to have reliable results. This suggests that existing transdiagnostic tools are not capturing EDs well, and that more effort is needed to establish comprehensive screening processes that will accurately identify children at high risk for developing EDs.

BackgroundResearch suggests that National Health Services have continued to report health inequalities in access to treatment, care and outcomes. Individuals with diverse identities continue to report feeling like their specific needs are not addressed. The current study explored young people's perspective of discussing diversity (faith/religion, gender, sexual orientation, disability) as part of therapy within a National and Specialist CAMH service.MethodsSemi-structured interviews were conducted to explore young people's perspectives of discussing diversity characteristics as part of therapy. 10 young people were interviewed, and a thematic analysis was employed.ResultsResults revealed 4 main themes including (1) perspectives on diversity and identity (2) therapeutic relationship, (3) integrating diversity in therapy and (4) Barriers to exploring diversity in therapy.ConclusionFindings of the present study demonstrates the complexities of approaching diversity in therapy and provide insights into how clinicians can adapt therapy when supporting young people with these concerns.

ObjectivesAdolescents with a chronic medical condition (CMC) are at greater risk of mental health difficulties, but demographic factors and subjective health may confound this relationship.DesignUsing data from a nationally representative adolescent sample from Northern Ireland (N = 1,299), we examined whether three CMC categories were associated with symptoms of depression, anxiety, posttraumatic stress disorder, and with suicidal thoughts or plans, and attempts.MethodsHierarchical multiple regression analyses were conducted to test whether the CMC classifications explained a significant proportion of the variance across the mental health variables, while controlling for age, sex, and subjective health. A multinomial logistic regression analysis was conducted to test whether the CMC classifications were associated with suicidality.ResultsCMC categories explained a small but statistically significant proportion of variance in mental health. Age was associated with suicidal thoughts or plans, and suicide attempts. Subjective health emerged as the factor most strongly linked to all criterion variables except suicidality.ConclusionsSubjective health may be more strongly related to adolescent mental health than previously identified. Future research could explore potential psychosocial factors associated with these CMC classifications to clarify the links between CMCs and mental health.

Obsessive-compulsive disorder (OCD) and schizophrenia spectrum disorders, while distinct phenomena, have considerable overlap in their presentations which can present a challenge in their approach to diagnosis and treatment. The changes in the DSM-5 bring these challenges to light, in allowing OCD to be specified as having absent insight or delusional beliefs. This can be especially distressing for caregivers, who play a major role in treatment, especially among youth. We present a case of a 16-year-old male presenting to care in his first episode of psychosis with overlapping obsessive-compulsive features, later found to have OCD. We discuss diagnostic and treatment approaches for someone presenting with overlapping psychotic and obsessive-compulsive features and highlight the underrecognized, but indisputably important role of caregivers throughout the process.

BackgroundAdolescents have increasingly been reported as identifying as transgender or gender-diverse and seeking gender-affirming care. Nonetheless, the proportion receiving gender-affirming medical treatment remains low; in the United States, fewer than 100 out of every 100,000 17-year-old adolescents assigned male at birth receive gender-affirming medical treatment. Attention-deficit hyperactivity disorder (ADHD), the most common childhood neurodevelopmental disorder, is a major public health concern and shows elevated prevalence among transgender and gender-diverse adolescents.Case PresentationThis case presents a 15-year-old adolescent with ADHD and co-morbidities, including gender dysphoria, harmful use of substances, and childhood mood disorders. After antipsychotic and antidepressant pharmacotherapy combined with psychological interventions, the patient demonstrated improved emotional regulation and diminished impulsive behaviors.ConclusionThis case underscores the need for life course-oriented care that addresses transgender-specific stressors and incorporates preventive substance abuse strategies. It also emphasises the urgent need for research into comorbidity-tailored pharmacotherapy to balance ADHD treatment efficacy with gender-affirming hormone safety.

ObjectiveThis study aimed to examine the effectiveness of Eye Movement Desensitization Therapy (EMDR) in Social Anxiety Disorder (SAD).MethodThe 12th-week follow-up study sample consisted of 26 adolescents, aged 12 to 16 years. Participants were screened with the Kiddie Schedule for Affective Disorders and Schizophrenia for School-Age Children Present and Lifetime version (K-SADS-PL). Additionally, the Beck Anxiety Inventory (BAI), Revised Child Anxiety and Depression Scale - Child Version (RCADS-CV), and Liebowitz Social Anxiety Scale (LSAS) were administered at baseline, 4^th week, and 12^th week. The Clinical Global Impressions-Improvement (CGI-I) and Severity (CGI-S), and SUD scales were also used. After two initial interviews, weekly EMDR sessions were conducted over 12 weeks.ResultsThe baseline mean of total BAI scores decreased from 48.35 to 2.58; the social anxiety sub-scale of RCADS-CV decreased from 20.65 to 1.84, and the baseline mean of LSAS decreased from 147 to 48.65 at the end of the 12th week of treatment. After the 12^th week of EMDR, all the adolescents showed complete improvement. The findings showed that the social anxiety symptoms significantly decreased with EMDR therapy.ConclusionIt can be said that EMDR is an effective psychotherapy in reducing the severity of social anxiety in adolescents.