Child and Adolescent Psychiatry and Mental Health最新文献

Background: This study aimed to evaluate the efficacy of the Attention Skill Training (ASTride) protocol, an Equine-Assisted Occupational Therapy (EAOT) intervention, for children diagnosed with Attention Deficit/Hyperactivity Disorder (ADHD) in enhancing and promoting cognitive and emotional aspects including executive functions, self-efficacy, anxiety and hope perception.

Methods: A prospective cohort study with an Interrupted Time-Series design was conducted. Fifty participants (mean age = 9.51 years, SD = 1.52) were assessed at four time points: baseline, pre-test (following a 12-week waiting period), post-test (after 12 weeks of intervention), and after three-month follow-up. The intervention was administered by a licensed equine assisted occupational therapists, and assessments were conducted by a blinded occupational therapist. Measures included The Behavior Rating Inventory of Executive Function (BRIEF) for executive functions, and the Hope, Child Anxiety Related Emotional Disorders (SCARED), and The New General Self-Efficacy Scale (NGSE) questionnaires for emotional factors.

Results: Significant improvements were found in executive functions, hope perception, and self-efficacy. Anxiety levels significantly decreased post-intervention.

Conclusion: The ASTride intervention showed efficacy in improving executive functions, hope, and self-efficacy, while reducing anxiety in children with ADHD, supporting its potential as a comprehensive therapeutic approach. Trial registration The research is registered at Clinical Trials.gov, identifier number NCT05869253, first registration at 22/5/2023.

Background: Availability of psychological services for adolescents cannot keep up with demand. Integrating digital interventions with face-to-face care into a blended model, an approach to treatment that incorporates the benefits of both digital and face-to-face therapy, may help address some access barriers by aiming to optimise treatment efficiency and effectiveness. This study explored mental health professionals' perspectives on incorporating a CBT-based app (ClearlyMe®) into their clinical practice with adolescents experiencing depression.

Methods: Semi-structured focus groups and interviews were conducted with 37 mental health professionals (psychologists, counsellors, social workers) working with adolescents in schools or private practices. ClearlyMe® is a self-directed, CBT-based smartphone app designed to address depressive symptoms among adolescents. Participants trialed the ClearlyMe® app for 10 min prior to focus groups and interviews. The discussions explored how mental health professionals would prefer to integrate ClearlyMe® into their face-to-face therapy when working with adolescents with depression, as well as the training and support requirements for doing so. Data was analysed using a deductive thematic analysis approach.

Results: Five key themes were identified: (1) Optimal ways to integrate the app with therapy; (2) Suitability of clients for blended care; (3) Facilitators and barriers to adopting blended care; (4) Data and privacy issues; and (5) Training and support requirements for those delivering care.

Conclusions: Clinicians supported ClearlyMe® in a blended care format if it were to complement their practice without adding workload and was supported by flexible training. They emphasized caution with data sharing and noted the model would be best suited to motivated clients, with at-risk clients likely needing more support. Future work will develop a blended care framework and training resources.

Background: Several psychosocial treatments for adolescents with anxiety and depressive disorders have been shown to be effective. However, when evaluated in community clinics, response rates are poor, in part due to higher attrition and low treatment compliance. The working alliance between clinician and client is one important predictor of therapy attendance and compliance. Working alliance is comprised of three different components (i.e., goal consensus, task agreement, and bond). However, there is little research examining the unique contributions of two key components, goal consensus and task agreement. Exploring these components individually may shed light on important clinician-client interactions during therapy that might reduce attrition and improve compliance. The purpose of this study is to evaluate whether clinician and adolescent perceptions of agreement on (1) therapy goals (referred to as goal consensus) and (2) the tasks or actions needed to reach the goals (referred to as task agreement) predict therapy attendance and compliance in the context of a community-based randomized controlled trial of treatments for adolescents with emotional disorders.

Methods: Participants include 89 clinicians (87.7% White) and 166 adolescents (mean age 14.7; 62.0% White) with a primary anxiety or depressive disorder enrolled in the Community Study of Outcome Monitoring for Emotional Disorders in Teens (COMET) study. Data on goal consensus and task agreement were collected digitally eight weeks after the initiation of treatment using the Working Alliance Inventory, reported by clinician and adolescent. Treatment compliance was rated by the clinician after each weekly session (1 = poor compliance to 7 = good compliance), and therapy attendance was measured by the total number of therapy sessions attended over 16 weeks.

Results: Results of linear regression models, controlling for baseline anxiety/depression severity, treatment condition, and adolescent demographic characteristics, revealed that higher goal consensus (reported by both adolescent and clinician) significantly predicted higher attendance and compliance. Similarly, adolescent and clinician reports of higher task agreement predicted higher session attendance and treatment compliance.

Conclusion: The current findings suggest that the more that adolescents and clinicians agreed on setting goals and the therapeutic tasks to achieve those goals, the more frequently adolescents attended therapy and complied with therapy expectations. Creating structured approaches to confirming goals and agreement on therapy tasks throughout treatment may be important and promote better treatment attendance and compliance and ultimately better outcomes for adolescents with emotional disorders.

Purpose: To evaluate the feasibility and effectiveness of the culturally adapted Triple P intervention in improving parenting competence and reducing behavioral symptoms among children with ADHD in Palestine.

Methods: A randomized controlled trial was conducted with 64 Palestinian mothers of children aged 5-13 diagnosed with ADHD. Participants were randomly assigned to either the intervention group (Triple P) or a control group receiving standard care. Pre- and post-intervention assessments were conducted using the Parenting Sense of Competence (PSOC) scale, the Parenting Scale (PS), and the Strengths and Difficulties Questionnaire (SDQ). Feasibility was assessed through retention rates, session adherence, cultural congruence, and participant satisfaction.

Results: Feasibility findings indicated high session attendance, strong participant engagement, and positive reception of the program, including its online adaptation. Post-intervention, the intervention group reported significantly higher parenting competence (PSOC) compared to the control group. There was also a significant reduction in lax parenting practices and an increase in children's prosocial behavior. Hyperactivity symptoms showed marginal improvement.

Conclusion: The culturally adapted Triple P intervention was both feasible and effective in enhancing parenting skills and improving child behavior among Palestinian families affected by ADHD. Findings support the integration of Triple P into national mental health services and highlight the importance of culturally responsive, evidence-based interventions in low-resource and conflict-affected settings. Trial Registration Submitted to (ClinicalTrials.gov) on 06/21/2025. Registration number pending.

Background: Self-harm is associated with significant distress in children and adolescents. The objective of this scoping review was to map the age of onset of self-harm in people aged ≤ 18 years alongside the definitions, operationalisation, and research methods used to determine onset.

Method: Following JBI guidance, this review included studies reporting the age of onset of self-harm in people aged ≤ 18 years in any context. Medline, PsycInfo, Embase, CINAHL Plus, and Web of Science were searched last on 7th May 2025 and supplemented by a grey literature search. Data were subject to basic coding and narrative and graphical presentation.

Results: A total of 42 studies were included in the review. Age of onset ranged from 9 to 18 years, but most studies reported a mean age between 12 and 14 years. The majority of studies defined self-harm as either suicidal or non-suicidal (85%), with non-suicidal self-harm distributed in favour of a slightly younger onset age. Studies with a younger sample tended to report a younger age of onset. Most studies used cross-sectional methods (81%) and retrospective report (71%) to capture onset age.

Conclusions: Earlier age of onset is associated with the use of multiple methods of self-harm, self-harm of longer duration and increased frequency. A clear understanding of age of onset of self-harm is necessary to inform clinically relevant research and the timely targeting of developmentally prevention and early intervention strategies.

Background: Language impairments are among the most prevalent co-occurring conditions in children with autism spectrum disorder (ASD), and delayed language milestones often serve as early developmental warning signs. However, it remains unclear whether specific language milestones can reliably predict the severity of ASD symptoms, particularly in regions where there is a long delay between initial screening and formal diagnosis.

Methods: This study included 574 children diagnosed with ASD, stratified into two age groups: under 4 years (n = 288) and 4 years or above (n = 286). A total of 33 language milestone items covering receptive, expressive, and pragmatic aspects were evaluated. The Boruta algorithm was applied to identify significant predictors of symptom severity, and random forest models were constructed separately for each age group. Nested cross-validation and grid search were used for hyperparameter tuning. Model performance was assessed using bootstrapping with 1,000 replications to estimate area under the receiver operating characteristic curve (AUC), accuracy, sensitivity, specificity, and F1 scores.

Results: In children under 4 years, 14 features were identified as significant predictors of ASD severity, with "Identifies 1 picture" and "Expresses demands by language" ranked highest. In children aged 4 years and above, 16 features were significant, with "Identifies 2 colors" and "Calls partner by name" being the most influential. The random forest models demonstrated robust predictive performance, with AUC values of 0.81 ± 0.01 (younger group) and 0.85 ± 0.00 (older group).

Conclusion: Our findings suggest that specific early language milestones, particularly those reflecting pragmatic abilities, may serve as valuable predictors of ASD severity. Leveraging these milestones in clinical practice could support earlier severity stratification and facilitate more tailored intervention planning, particularly in primary care settings.

Background: Correlations between self-reported and clinician-rated severity of depression are often only moderate, but studies in adults have shown that they increase over time. This study explored whether a similar effect occurs in adolescents and whether initial agreement vs. disagreement between self- and clinician ratings predicts differential outcomes.

Method: The analyzed data stem from a randomized controlled trial (DeLight) that explored the effect of bright light therapy as an add-on to treatment as usual in an inpatient sample of adolescents (n = 224). Depression was assessed at four time points (baseline, 4 weeks, 16 weeks, 28 weeks) using the Beck Depression Inventory (BDI-II) as a self-report measure and the Children's Depression Rating Scale - Revised (CDRS-R) as a blinded clinician rating.

Results: The correlation between self- and clinician ratings was only moderate at baseline (r = .40) but increased considerably to a strong correlation at four weeks (r = .72), which was maintained thereafter. The predictive value of initial rater agreement / disagreement for the outcome was small (BDI-II) or non-significant (CDRS-R). Further analyses revealed that the reliability of both instruments increased over time and the factor structure became simpler, with fewer factors and higher factor loadings.

Conclusions: These findings indicate increasing homogeneity within self- and clinician ratings over time and suggest that some type of response shift occurred, with adolescents appearing to increasingly view their depression as a unified concept. A consideration of response shifts could lead to more accurate assessments of treatment effectiveness.

Background: Of the twelve youth prisons in the German Democratic Republic, known as Jugendhäuser, the one in Halle was notorious for the violence among its inmates. Self-harm in the form of suicides and attempted suicides had been common throughout the prison's existence since 1971, but hunger strikes also became frequent in the 1980s. The aim of this paper is to explain the causes of self-harm in the Jugendhaus Halle, the risks for young people and the chances of achieving their goals, and to discuss a concept of "nonviolent" resistance in this context.

Methods: We analyzed the personal files of juvenile prisoners from the Archive of the Correctional Facility Halle and the Stasi Records Archive Halle concerning the situation and incidents in the Jugendhaus Halle. The historical-critical method was used to analyze these sources.

Results: Most of the youths involved in the hunger strikes were political prisoners who wanted to leave East Germany and felt their sentences were unjust. The hunger strikes usually lasted one or two days, but in persistent cases, the youths were force-fed. Suicide attempts were caused by abuse and humiliation. After medical treatment, those attempting were restrained in "chain beds."

Conclusions: While suicide attempts expressed despair, hunger strikes were frequent among political prisoners protesting their sentences and demanding freedom of movement. Self-harm as a resistance was largely ineffective and met with punitive measures. The idea of "nonviolent" resistance through self-harm is controversial, as it involves harming one's own body and often provokes further violence by prison authorities.

Introduction: Early child-caregiver attachment is foundational to mental health (MH). While prevention efforts often aim to improve attachment quality, clinicians frequently encounter infants and young children already exhibiting clinical symptoms of MH disorders. A comprehensive summary of attachment-based dyadic interventions for this population is lacking. This scoping review aims to address this gap.

Methods: We conducted a scoping review of CINAHL, MEDLINE, PsycINFO, Web of Science, Cochrane CENTRAL and hand-searched articles to identify and characterize dyadic, relationship-based interventions for children aged 0-6 years with clinical symptoms of MH disorders. Studies were screened for eligibility and included if they examined therapeutic modalities used in clinical populations beyond preventive approaches.

Results: Screening identified studies that evaluated several therapeutic modalities, e.g., Parent Child Interaction Therapy (PCIT), Early Pathways (EP), Watch, Wait, and Wonder, Parent-Infant Psychotherapy, and Video Feedback Interventions. PCIT and EP had the most published data, treated the largest number of participants, and demonstrated significant improvements in child or relational outcomes. However, most studies had small sample sizes and methodological limitations. Only a few interventions had been evaluated using rigorous designs such as randomized controlled trials.

Conclusions: Two interventions that had the most evidence were EP and PCIT, particularly for families affected by adverse social determinants of health. Both require further research to explore barriers for implementation (e.g., adaptability in multiple settings and cultures, lessen resources required for service delivery, etc.). Additional research is needed to strengthen the evidence base for dyadic, attachment-based treatments targeting clinical MH concerns in infants and young children.

Background: Trait resilience is a well-established protective factor against diverse social-emotional challenges and stress-associated psychiatric disorders. Its cultivation may thus be exceptionally critical for children exposed to early financial adversity, which has been demonstrated to confer elevated vulnerabilities to psychosocial maladjustment. Grounded in the Family Stress Model with a focus on an understudied Asian population, this longitudinal study investigates how early family socioeconomic disadvantage indirectly shapes children's trait resilience through key parenting dimensions-warmth, rejection, and autonomy support-by both mothers and fathers.

Methods: This longitudinal study was embedded in a multi-ethnic, pre-birth cohort involving Singaporean families (57.3% Chinese, 30.0% Malay, 12.7% Indian), comprising 430 biological mothers (M_Age = 30.5, SD_Age = 5.13), 430 children (47.9% female), and 348 biological fathers (M_Age = 33.9, SD_Age = 6.03). Key family socioeconomic characteristics were measured at baseline during the 11th week of pregnancy via maternal report (maternal education, household income, and housing type), and at 2 or 3 years postnatal via paternal report (paternal education). Children reported on mothers' and fathers' parenting practices (warmth, rejection, and autonomy support) separately at 8.5 years with the Parental Bonding Instrument, and trait resilience at 10.5 years with the Connor-Davidson Resilience Scale-25.

Results: Children from families with lower socioeconomic status during early childhood (indexed by lower levels of mothers' and fathers' educational attainment, and household income) demonstrated lower trait resilience in late childhood. Parallel mediation analyses with 5,000 bootstrapped samples revealed that maternal and paternal educational attainment influenced trait resilience in late childhood via greater maternal and paternal rejection during middle childhood, respectively. Meanwhile, the relationship of household income with children's trait resilience was mediated by lower levels of maternal warmth only. No significant indirect effects of both parents' autonomy support were observed.

Conclusions: Maternal and paternal parenting practices play salient roles in nurturing children's trait resilience, in part substantiating the cultural validity of the Family Stress Model within a Southeast Asian family ecology. Specifically, family interventions could seek to ameliorate both maternal and paternal rejection, as well as enhance maternal warmth behaviors to mitigate the influence of socioeconomic disadvantage on children's trait resilience.