Clinical child psychology and psychiatry最新文献

The increasing prevalence of digital media use among children and adolescents has raised concerns about its potential impact on attention deficit hyperactivity disorder (ADHD) symptoms. This narrative review explores the relationship between screen time and ADHD in young people, with a particular focus on the impact of different treatment approaches in the context of digital engagement. A structured search identified 147 studies published between January 2018 and December 2024, of which 14 met the inclusion criteria for detailed review.The findings indicate that excessive and unstructured screen time is consistently associated with the worsening of ADHD symptoms, particularly inattention and hyperactivity. Sleep disruption and neurobiological vulnerabilities, including altered reward processing and white matter changes, appear to mediate these associations. At the same time, certain forms of digital activity, particularly interactive or cognitively engaging tasks, may provide benefits, highlighting the complexity of this relationship.Treatment approaches reflected a similar complexity. Pharmacological interventions remain central but are most effective when complemented by behavioural therapies and lifestyle modifications, such as structured screen time reduction, improved sleep routines, and increased physical activity. This review suggests that the management of ADHD in the digital era requires a holistic approach that recognises both the risks and potential benefits of screen use. Further longitudinal research is needed to clarify long-term effects and identify which forms of digital media can be harnessed constructively in clinical care.

Adolescence represents a crucial period of development, during which exposure to stress can significantly impact mental and physical health. As such, school based psychoeducational interventions aimed at reducing stress may hold promise for promoting adolescents' wellbeing. In the current study, a literature review was conducted using PubMed and PsychInfo databases to evaluate school-based psychoeducational interventions that target sub-clinical anxiety and stress in healthy adolescents. Eleven studies met the inclusion criteria, comprising six primary and five secondary studies. Cognitive-behavioural therapy demonstrated significant reductions in anxiety symptoms and improvements in emotional regulation. Mindfulness-based interventionsalleviated physiological stress, while physical activity programs such as yoga, showed potential in improving psychological well-being, albeit with limited evidence. . Findings on the duration of interventions were mixed, with some meta-analyses indicating larger effects for longer or higher intensity programs, while limited evidence suggests caregiver involvement may enhance outcomes. Future research should focus on evaluating the long-term effectiveness of these interventions and examining their applicability across diverse cultural and socioeconomic contexts. Although harms were not identified within the studies included in this review, other research has reported potential unintended effects of school-based psychological interventions in specific subgroups and therefore cautious implementation with routine monitoring is recommended.

This paper explores how an adoptive family's feelings of blame and embarrassment shifted after receiving an accurate diagnosis for their 9-year-old child. Narratives of attachment and trauma had been used previously to explain the child's rumination and regurgitation symptoms and excessive appetite from an early age. The paper outlines the assessment that ruled the previous explanation out and gave a diagnosis of Tourette syndrome, a neurodevelopmental disorder with an evidence-based pathway of care. It also examines the theory behind this revised formulation, integrating both environmental influences, biological predispositions and their interaction. The discussion explores the negative implications of neglecting biological factors in the mental health assessments of adopted children and interpreting their presentations through the lens of past trauma and attachment disruptions only, as lack of early identification and therefore, intervention can lead to serious long-term consequences. Conducting complex assessments require multidisciplinary specialist services with professionals trained in making differential diagnoses in adopted children, that include the consideration of neurodevelopmental and mental health problems. Such services should also offer consultation and provide training to other professionals working within the children's complex systems.

Aims: To retrospectively examine clinical health records to investigate the characteristics and outcomes of children and young people who first attended specialist gender services aged ≤13 years in the UK and the Netherlands across a seven-year period (2009-2016). Methods: Routinely collected outcome measures and clinical data were examined, including gender dysphoria diagnosis, social transition, referral to endocrine services and emotional and behavioural functioning. Results: Similar proportions of children and young people fulfilled criteria for a diagnosis of gender dysphoria and had either fully or partially socially transitioned prior to accessing the services in the UK and the Netherlands. Differences were observed in relation to the proportion of children and young people referred to endocrine services, with a higher proportion reported in the Netherlands. Conclusions: In both services, children and young people who had socially transitioned (fully or partially) prior to attending the service were more likely to receive a diagnosis of gender dysphoria and to be referred to endocrine services.

Aims: Dyadic Developmental Psychotherapy (DDP) is a family-based psychotherapeutic intervention designed to help children and young people with the psychological difficulties resulting from developmental trauma. The study aims to understand the experience of DDP from a child's perspective. Method: Six children participated, aged between 8 and 12 years old, adopted or living with extended family under special guardianship orders, and accessing ongoing DDP interventions. Narrative story stem methodologies were utilised to elicit projective responses, alongside creative visual methodologies. Data was analysed using Interpretative Phenomenological Analysis. Results: Two master themes and eight subthemes were identified, describing a dynamic process where the qualities of the therapeutic interactions were salient, generating potential for increased caregiver closeness and connection. A cycle of interactive repair was important to maintain the process of developing trust. Five of the six participants were able to express benefits of the therapy, depicting increased connection and closeness with caregivers. Implications: Findings infer that the attuned presence of therapeutic adults in DDP may influence perceived differences in attachment security, through the active involvement of caregivers. Outcomes are likely to be moderated through therapist effects. Play and activity-based research techniques were helpful in promoting meaningful inclusion for this group of children.

BackgroundUnderstanding inequalities in mental health care is vital for the development of more equitable services. This study investigates inequalities in out-of-area admissions to general adolescent units, a controversial but necessary part of Child and Adolescent Mental Health care in England.MethodsAnonymised data on 279 out-of-area (at-distance or out-of-region) admissions to general adolescent units in England between February 2021-2022 were analysed for an association between demographics (age, sex, ethnicity) or clinical characteristics (diagnosis and risks) and admission characteristics (7+ day wait for a bed, distance from home, admission out-of-region, compulsory admission and length of stay >6 months).ResultsNo association was found between demographic characteristics and admission characteristics. Personality disorder was the only diagnosis associated with admission greater distance from home. Young people with personality disorder or neurodevelopmental disorder were more likely to be admitted compulsorily (OR = 8.89 and OR = 1.93 respectively). Those with suicide risk were more likely to be admitted non-compulsorily (OR = 2.06) but more likely to be admitted out-of-region (OR = 2.25).DiscussionWithin these data, the clinical presentation of the young person influenced their out-of-area admission characteristics. Young people with a diagnosis of personality disorder may be particularly likely to experience more negative aspects of out-of-area admission.

Background: Early-onset depression is an increasing concern, contributing to long-term disability and suicide. Diagnostic assessments are essential for effective treatment. However, research suggests that Child and Adolescent Psychiatry practices remain inadequate. Knowledge of healthcare processes is limited, with no consensus on conceptualising or measuring quality. This study aimed to investigate depression assessments in Swedish outpatient Child and Adolescent Psychiatry, including associations with predictors and diagnostic timeliness. Methods: Medical records (n = 284) from patients aged 8-17 with depression were collected from 10 services. Quality indicators for depressive symptoms, suicidality, comorbidities, and functioning were developed from guidelines. Indicator occurrences were assessed, summarised into components, and analysed using regression and correlations. Results: Indicator occurrences ranged from 8% to 84%, averaging 49%. Documentation varied considerably for risk aspects (57%). Distinct depressive characteristics (63%) occurred nearly twice as often as subtler symptoms (35%). Comorbidities (13%-22%) were rarely documented, whereas functioning and life situation (69%) were well-recorded. Predictors explained up to 28% of variance, with unidentified service-related factors explaining 10%. Better documentation weakly correlated with earlier diagnoses. Conclusions: Findings indicate the need for guideline implementation and further investigation into assessment inequities. Improving quality might promote earlier diagnoses. The indicators may be applicable in similar settings.

PurposeThe present research leveraged a nationally representative dataset to examine between-group differences in adolescent suicide consideration and attempts by weight status and perceived closeness to others.FindingsAdolescents with overweight and obesity were more likely to report past year suicide consideration (1.54x and 1.43x as likely) and attempts (1.74x and 1.59x as likely) compared to adolescents with healthy weight. A significantly smaller proportion of adolescents with obesity endorsed closeness to others at school compared to adolescents with healthy weight. Adolescents who felt close to others were less likely to report either suicidal ideation or attempts, regardless of weight status. Compared to the healthy weight group, significantly higher proportions of adolescents with overweight or obesity endorsed attempting suicide, both among adolescents who felt close to others, X²(2) = 14.76, p = .001, n = 4773, and those who did not, X²(2) = 18.58, p < .001, n = 2859.ConclusionsAdolescents with overweight and obesity were more likely to consider and attempt suicide relative to those with healthy weight, regardless of perceived closeness to others. Perceived closeness was associated with lower likelihood of suicide consideration and attempts among all weight groups. Further investigation may clarify the prospective utility of social closeness for adolescent suicide risk reduction, especially among those with overweight/obesity.

Young people (YP) have long been underserved in mental health research. Co-production is part of a significant shift in youth mental health research from tokenistic involvement practices towards more genuine, meaningful collaboration with the group that the research affects: young people. This commentary reflects on learnings from a co-production process in the context of Can We Connect (CWC), a qualitative study on where YP seek mental health information online and their attitudes towards what is available. Young researchers were involved in planning, co-conducting the interviews, contributed to the data analysis and dissemination. Based on our shared experiences as a research team, we aim to provide insights into and recommendations for co-production within qualitative youth mental health research. We (n = 12, including 4 young researchers, aged 16-18) reflected on our experiences of either being, or collaborating with, a young researcher in CWC. For us, having young researchers in a research team brings (1) value to YP and (2) value to research. (3) Capitalising on differences is important, (4) having structured support for young researchers and (5) balancing levels of involvement. Open, transparent and honest communication is key to building trust, enabling young researchers to be meaningfully involved members of research teams.

BackgroundChild and Adolescent Mental Health Services (CAMHS) currently seeks to implement service models that are better suited for young service users with complex mental health needs. This study explored what adolescents view as the key components of a well-functioning contact with CAMHS.MethodsThis study was conducted as part of the ongoing implementation of Flexible Assertive Community Treatment (FACT) in the CAMHS in Stockholm, Sweden. Interviews were conducted with 14 adolescents (64% females) aged 14 to 18 (M = 15.78, SD = 1.32) with intensive or longstanding contact with CAMHS. The interviews were analyzed using reflexive thematic analysis.ResultsFive key themes were generated: (1) "being involved in my care" - receiving relevant information and being part of important care decisions; (2) "accessing care when I need it" - ensuring services are easily accessible and present in the community; (3) "building a good relationship" - developing strong connections with mental health professionals; (4) "sharing the burden" - improving support and organization to reduce stress related to the healthcare system; and (5) "personalizing my care" - tailoring care to individual preferences and circumstances.ConclusionsThe findings emphasize the importance of engaging young service users in developing a mental health service that meets complex needs.