Schedule for Affective Disorders and Schizophrenia for School-Age Children-Present and Lifetime Version (K-SADS-PL): initial reliability and validity data

Diverging Effects of Violence Exposure and Psychiatric Symptoms on Amygdala-Prefrontal Maturation During Childhood and Adolescence

BACKGROUND

Violence exposure during childhood and adolescence is associated with increased prevalence and severity of psychopathology. Neurobiological correlates suggest that abnormal maturation of emotion-related brain circuitry, such as the amygdala-prefrontal cortex (PFC) circuit, may underlie the development of psychiatric symptoms after exposure. However, it remains unclear how amygdala-PFC circuit maturation is related to psychiatric risk in the context of violence.

METHODS

In this study, we analyzed individual differences in amygdala-PFC circuit maturity using data collected from the PNC (Philadelphia Neurodevelopmental Cohort) (n = 1133 youths). Neurodevelopment models of amygdala-PFC resting-state functional connectivity were built using deep learning and trained to predict chronological age in typically developing youths (not violence exposed and without a psychiatric diagnosis). Using the brain age gap estimate, an index of relative circuit maturation, patterns of atypical neurodevelopment were investigated.

RESULTS

Violence exposure was associated with delayed maturation of basolateral amygdala (BLA)-PFC circuits, driven by increased BLA-medial orbitofrontal cortex functional connectivity. In contrast, increased psychiatric symptoms were associated with advanced maturation of BLA-PFC functional connectivity, driven by decreased BLA-dorsolateral PFC functional connectivity.

CONCLUSIONS

Delayed frontoamygdala maturation after exposure to violence suggests atypical, but adaptive, development of threat appraisal processes, potentially reflecting a greater threat generalization characteristic of younger children. Advanced circuit maturation with increasing symptoms suggests divergent neurodevelopmental mechanisms underlying illness after emotion circuits have adapted to adversity, exacerbated by preexisting vulnerabilities to early maturation. Disentangling the effects of adversity and psychopathology on neurodevelopment is crucial for helping youths recover from violence and preventing illness from continuing into adulthood.

The mediating effect of the striatum-based connectivity on the association between high-sensitivity C-reactive protein and anhedonia in adolescents with depressive disorder

BACKGROUND

The potential pairwise connections among high-sensitivity C-reactive protein (hs-CRP), striatum-based circuits, and anhedonia in adolescents with depressive disorder are not clear. This study aimed to explore whether hs-CRP levels in adolescents with depressive disorder influence anhedonia via alterations of striatum-based functional connectivity (FC).

METHODS

A total of 201 adolescents (92 with depressive episodes with anhedonia (anDE), 58 with DE without anhedonia (non-anDE), and 51 healthy controls (HCs)) underwent resting-state functional magnetic resonance imaging (fMRI) and completed the anhedonia subscale of the Children's Depression Inventory (CDI). hs-CRP levels were measured from peripheral blood samples in all DE patients.

RESULTS

Compared with HCs, the anDE and non-anDE groups showed increased FC between the left dorsal caudate putamen (DCP_L) and bilateral cerebellum crus I, and decreased FC between the left ventral rostral putamen (VRP_L) and right parahippocampal cortex (PHC) (all p < 0.05). Only the non-anDE group exhibited increased FC between the right visual cortex (VC_R) and left cerebellum VI, VC_R and right fusiform gyrus (FG), and the left visual cortex (VC_L) and right inferior temporal gyrus (ITG) compared to HCs (all p < 0.05). Compared to the non-anDE group, the anDE group showed reduced FC between the VC_R and left cerebellum VI and between the DCP_L and right superior frontal gyrus (SFG) (all p < 0.05). Multiple regression analysis revealed that the FC between DCP_L and right SFG negatively predicted anhedonia severity (β = -0.288, p = 0.007) in the anDE group. Although hs-CRP levels had no direct effect for anhedonia, FC between the DCP_L and right SFG fully mediated the relationship between hs-CRP and anhedonia in the anDE group (effect = 0.184, Bootstrapping 95 % CI = 0.0156, 0.436).

CONCLUSION

The findings suggest that hs-CRP influences anhedonia through a fully mediated pathway involving alterations in the frontostriatal network, contributing to a greater understanding of the neurobiological mechanisms underlying anhedonia.

Psychometric Properties and Clinical Utility of CBCL and P-GBI Sleep Items in Children and Adolescents

OBJECTIVE

Sleep is crucial to overall health, playing a complex role in a wide range of mental health concerns in children and adults. Nevertheless, clinicians may not routinely assess sleep problems due to lack of awareness or limitations such as cost or time. Scoring sleep-related items embedded on broader scales may help clinicians get more out of tools they are already using. The current study explores evidence of reliability, validity, and clinical utility of sleep-related items embedded on two caregiver-report tools: the Child Behavior Checklist (CBCL) and Parent General Behavior Inventory (P-GBI).

METHOD

Youth aged 5-18 years and their parents were recruited from both an academic medical center (N = 759) and an urban community health center (N = 618). Caregivers completed the CBCL and P-GBI as part of a more comprehensive outpatient evaluation. Exploratory factor analyses, multi-group confirmatory factor analyses, and graded response models evaluated dimensionality, reliability, and invariance across samples. Correlations and receiver operating characteristic curve analyses probed associations with diagnostic and demographic variables.

RESULTS

Two subscales emerged for each itemset. Across both samples, P-GBI sleep subscales were more reliable and consistent than CBCL sleep subscales, showed greater coverage of sleepiness and insomnia constructs, were better at discriminating individuals within a wider range of sleep complaints, and showed significant correlation with mood disorder diagnoses.

CONCLUSIONS

The P-GBI sleep items provide a brief, reliable measure for assessing distinct dimensions of sleep complaints and detecting mood symptoms or diagnoses related to the youth's sleep functioning, making them a useful addition to clinical practice.

Readdressing the Ongoing Challenge of Missing Data in Youth Ecological Momentary Assessment Studies: Meta-Analysis Update

BACKGROUND

Ecological momentary assessment (EMA) is pivotal in longitudinal health research in youth, but potential bias associated with nonparticipation, omitted reports, or dropout threatens its clinical validity. Previous meta-analytic evidence is inconsistent regarding specific determinants of missing data.

OBJECTIVE

This meta-analysis aimed to update and expand upon previous research by examining key participation metrics-acceptance, compliance, and retention-in youth EMA studies. In addition, it sought to identify potential moderators among sample and design characteristics, with the goal of better understanding and mitigating the impact of missing data.

METHODS

We used a bibliographic database search to identify EMA studies involving children and adolescents published from 2001 to November 2023. Eligible studies used mobile-delivered EMA protocols in samples with an average age up to 18 years. We conducted separate meta-analyses for acceptance, compliance, and retention rates, and performed meta-regressions to address sample and design characteristics. Furthermore, we extracted and pooled sample-level effect sizes related to correlates of response compliance. Risk of publication bias was assessed using funnel plots, regression tests, and sensitivity analyses targeting inflated compliance rates.

RESULTS

We identified 285 samples, including 17,441 participants aged 5 to 17.96 years (mean age 14.22, SD 2.24 years; mean percentage of female participants 55.7%). Pooled estimates were 67.27% (k=88, 95% CI 62.39-71.96) for acceptance, 71.97% (k=216, 95% CI 69.83-74.11) for compliance, and 96.57% (k=169, 95% CI 95.42-97.56) for retention. Despite overall poor moderation of participation metrics, acceptance rates decreased as the number of EMA items increased (log-transformed b=-0.115, SE 0.036; 95% CI -0.185 to -0.045; P=.001; R2=19.98), compliance rates declined by 0.8% per year of publication (SE 0.25, 95% CI -1.3 to -0.3; P=.002; R2=4.17), and retention rates dropped with increasing study duration (log-transformed b=-0.061, SE 0.015; 95% CI -0.091 to 0.032; P<.001; R2=10.06). The benefits of monetary incentives on response compliance diminished as the proportion of female participants increased (b=-0.002, SE 0.001; 95% CI -0.003 to -0.001; P=.003; R2=9.47). Within-sample analyses showed a small but significant effect indicating higher compliance in girls compared to boys (k=25; g=0.18; 95% CI 0.06-0.31; P=.003), but no significant age-related effects were found (k=14; z score=0.05; 95% CI -0.01 to 0.16).

CONCLUSIONS

Despite a 5-fold increase in included effect sizes compared to the initial review, the variability in rates of missing data that one can expect based on specific sample and design characteristics remains substantial. The inconsistency in identifying robust moderators highlights the need for greater attention to missing data and its impact on study results. To eradicate any health-related bias in EMA studies, researchers should collectively increase transparent reporting practices, intensify primary methodological research, and involve participants' perspectives on missing data.

TRIAL REGISTRATION

PROSPERO CRD42022376948; https://www.crd.york.ac.uk/PROSPERO/view/CRD42022376948.

Is oxytocin related to psychiatric symptoms in adolescents with obesity?

OBJECTIVES

We aimed to investigate the relation of oxytocin receptor (OXTR) gene variants (rs53576 and rs2254298) and serum oxytocin (OXT) levels with psychiatric symptoms in healthy adolescents and adolescents with obesity.

METHODS

A total of 250 adolescents with obesity and 250 healthy adolescents were included in this study. Attachment properties, anxiety, and depression were evaluated with self-reports while diagnoses were ascertained with KIDDIE-SADS-PL Turkish version. Serum OXT level was studied with the ELISA method, and OXTR gene variants were studied by quantitative polymerase chain reaction (rs53576) and restriction fragment length polymorphism (RFLP) (rs2254298) methods.

RESULTS

Serum OXT level was significantly lower in adolescents with obesity than in healthy controls. Self-reported symptoms of anxiety and depression were significantly elevated, especially in female adolescents with obesity, whereas parent/peer attachment was significantly lower. The rs53576 G/G genotype was found to be significantly more prevalent among obese youth. About 29.2 % of obese youth were diagnosed with psychopathology, especially anxiety and depression. OXT levels and receptor polymorphisms were not related to self-reported symptoms, attachment, and presence of psychopathology.

CONCLUSIONS

Further studies should evaluate the roles of other constructs (e.g., early adversity, parenting, social supports, coping, temperament, etc.) and discern the roles of parent-child synchrony in elucidating relationships between OXT, pediatric obesity, and psychopathology.

Differentiating pure cognitive disengagement syndrome and attention-deficit/hyperactivity disorder-restrictive inattentive presentation with respect to depressive symptoms, autistic traits, and neurocognitive profiles

This study aimed to differentiate "pure" cognitive disengagement syndrome (CDS) from attention-deficit/hyperactivity disorder-restrictive inattentive presentation (ADHD-RI) by examining their neurocognitive profiles and associations with autistic traits (ATs) and depressive symptoms. A cross-sectional study was conducted involving three groups: pure CDS (n = 24), ADHD-RI (n = 32), and controls (n = 31). Participants underwent neuropsychological assessments using Computerized Neurocognitive Assessment Software (CNS) Vital Signs, alongside evaluations for ATs with the Autism Spectrum Screening Questionnaire, depressive symptoms with the Children's Depression Inventory, and CDS symptoms with the Barkley Child Attention Scale. A semi-structured interview was also conducted with all participants and their parents to ensure the diagnostic validity of the groups. Findings indicated no dimensional symptomatological distinctions between CDS and ADHD-RI, except for CDS symptoms, and demonstrated no significant differences in neurocognitive test profiles between CDS and ADHD-RI, except for the neurocognition index and reaction time. ATs and depressive symptoms did not significantly differ between the pure CDS and ADHD-RI groups but were significantly elevated in both groups compared to controls. The ADHD-RI group exhibited significantly worse performance than CDS concerning the neurocognition index and reaction time, and worse than controls regarding the neurocognition index, reaction time, psychomotor speed, and complex attention. This study elucidates that ADHD-RI and "pure" CDS have substantially overlapping neurocognitive and phenotypic profiles despite certain minor differences, which is detrimental to subjects with ADHD-RI in terms of overall neurocognition and reaction time. It can be argued that, compared to "pure" CDS, executive dysfunction might be slightly more specific to ADHD-RI, while depressive symptoms and ATs are common in both psychological constructs.

Sex differences in pediatric major depressive episodes: a cross-sectional study on psychiatric symptoms in early-onset mood disorders

Background

Sex differences in psychiatric symptoms among children and adolescents with a major depressive episode (MDE) are less studied than among adults. Previous non-recent studies reported a greater severity in adolescent girls and small differences between sexes in specific symptoms. We aim to explore the differences between male and female patients in the diagnoses, comorbidities, and psychiatric symptoms in a large cohort of pediatric patients referred to a tertiary center for child and adolescent psychiatry.

Methods

We collected cross-sectional data on 382 consecutively referred patients (age 6-18 years; 73.8% female patients) with current MDEs (unipolar or bipolar) thoroughly evaluated with clinician (Children's Depression Rating Scale-Revised; K-SADS Mania Rating Scale; Columbia Suicide Severity Rating Scale) and self and parent report (Children's Depression Inventory-2; Multidimensional Anxiety Scale for Children-2; Child Behavior Checklist) standardized measures. Bivariate analyses were followed by a logistic regression model to assess significant predictors of the MDE phenotype of female (vs. male) patients.

Results

Female patients were more likely to show severe MDEs (41.5% vs. 26.0%; p = 0.006), suicidal ideation (63.9% vs. 47.0%; p < 0.001) and behaviors (29.4% vs. 13.0%; p = 0.001), and non-suicidal self-injury (58.5% vs. 27.0%; p < 0.001). Male patients were more frequently diagnosed with bipolar disorder (21% vs. 11%; p = 0.012) and/or comorbid ADHD/behavior disorders (20% vs. 8.9%; p = 0.003). Male patients also had more frequently significant mixed hypo/manic symptoms (17% vs. 7.7%; p = 0.01) and were younger at the onset of the first psychiatric symptom (6.32 vs. 7.75 years; p = 0.003), onset of mood disorder (11.3 vs. 12.5 years; p = 0.005), and evaluation (14.0 vs. 15.2 years; p = 0.001). Several symptoms were significantly and independently associated with female patients diagnosed with a current MDE, including a) excessive weeping (OR 1.53; p < 0.001), b) mood lability (OR 1.50; p = 0.014), c) excessive fatigue (OR 1.38; p = 0.002), d) appetite disturbance (OR 1.28; p = 0.041), and e) attention problems (OR 1.07; p = 0.001). Distractibility (OR 0.55; p = 0.009) and conduct problems (OR 0.93; p = 0.001) were in turn correlated with MDE among male patients.

Discussion

The study confirms that female patients with MDEs exhibit more severe affective symptoms, while male patients present with more externalizing behaviors and comorbidities. We further report more mixed symptoms and bipolar disorder diagnoses in male patients, who also have an earlier onset of psychiatric symptoms. These findings are discussed also considering implications for the diagnosis of pediatric bipolar disorder. A high clinical sensitivity is needed for highlighting subtle mixed and/or atypical features in severe MDEs among girls.

The use of atypical antipsychotic medications in the treatment of children and adolescents with avoidant/restrictive food intake disorder

INTRODUCTION

Avoidant restrictive food intake disorder (ARFID) is a childhood feeding and eating disorder often associated with marked physical and psychosocial impairment.

OBJECTIVE

We assessed the use of atypical antipsychotic (AAP) medications (mostly risperidone) in promoting weight and height gain in children with ARFID.

METHODS

The computerized medical records of 21 children with ARFID receiving AAPs in one center in Israel were retrospectively reviewed. Fourteen children received AAPs after 6.30 ± 0.75 months of no weight gain with treatment as usual (either group or individual cognitive behavioral therapy); seven children were admitted to our clinic receiving AAPs in previous facilities because of lack of weight gain. All were followed-up for 18 months. Weight and height were extracted from the medial records at eight time points.

RESULTS

A significant increase was found in weight, height, and body mass index (BMI) over 18 months of treatment with AAPs (Δweight: 9.66 ± 9.24 kg, p < 0.001; Δheight: 10.23 ± 11.54 cm, p < 0.001; ΔBMI = 2.55 ± 1.53 kg/m2; p < 0.001). Weight increased significantly for both sexes, while height increased significantly only for boys. Patients with both low and high baseline BMI percentiles gained weight, while mean height increased significantly over time only for children with low BMI percentile. The use of a retrospective clinical global impression scale indicated a marked improvement over time. Adverse effects were minimal, and no patients discontinued AAPs due to adverse events.

CONCLUSION

The addition of AAPs for a period of 18 months may be safe and effective in increasing weight and height in children with ARFID.

Gynecomastia and adolescence: Psychological effects of social appearance anxiety and peer bullying

PURPOSE

The aim of this study was to investigate the frequency of peer bullying in adolescents diagnosed with gynecomastia and its effect on depression and anxiety levels. In addition, the study aimed to compare the social appearance anxiety and self-esteem levels of these adolescents with a control group.

DESIGN AND METHODS

53 adolescents (11-18 years) with gynecomastia and a control group of 53 healthy adolescents without chronic medical or psychiatric disorders were assessed using peer victimization, social anxiety, self-esteem, and depression/anxiety scales following ethical approval.

RESULTS

The gynecomastia group had significantly higher DSM-5 Anxiety (p < 0.001), DSM-5 Depression (p < 0.001), and SAAS (p < 0.001) scores compared to the control group. Although the gynecomastia group trended toward higher peer victimization scores (p = 0.059), they experienced significantly more teasing (p = 0.005) and personal property attacks (p = 0.002). No significant difference was found in self-esteem between the two groups (p = 0.288). Multiple regression analysis revealed that depression and anxiety predicted social appearance anxiety, explaining 23.3 % of the variance (p < 0.001, F(4.373)).

CONCLUSIONS

Adolescents with gynecomastia had higher levels of anxiety, depression, and social appearance anxiety. They are more likely to be subject to teasing and attacks on property, highlighting the need for early psychological support and interventions in this population.

PRACTICE IMPLICATIONS

Multidisciplinary support and early psychosocial interventions are crucial for adolescents with gynecomastia to address bullying, anxiety, and depression.

Brain functional abnormality in drug naïve adolescents with borderline personality disorder during self- and other-reflection

A disturbed sense of identity is one of the major features of borderline personality disorder (BPD), which manifests early in the course of the disorder, and is potentially examinable using functional imaging during tasks involving self-reflection. Twenty-seven medication-naïve adolescent female patients with BPD, who had no psychiatric comorbidities, and 28 matched healthy female controls underwent fMRI while answering questions either about themselves or acquaintances. Control conditions consisted of answering questions involving factual knowledge and a low-level baseline (cross fixation). When self-reflection was compared to fact processing, BPD patients exhibited reduced activation in the right dorsolateral prefrontal cortex (DLPFC), as well as in the left parietal and calcarine cortex and the right precuneus. In contrast, other-reflection was associated with relatively lower activation in the medial frontal cortex in BPD patients, with further analysis revealing that this change reflected a failure of de-activation during the fact processing condition. There were no differences between the BPD patients and controls when self- and other-processing was examined against low-level baseline. This study provides evidence of reduced DLPFC activation during self-reflection in adolescent females with BPD, which may reflect diminished top-down cognitive control of this process, but not other-reflection in the disorder.

The moderating role of co-occurring attention-deficit hyperactivity disorder in social skills group training for autistic children and adolescents

Social skills group training is frequently used to support autistic children and adolescents in coping with everyday social demands and expectations. Meta-analytic studies suggest small to medium effect sizes. Effect moderators must be better understood to inform implementation and allow optimization of intervention protocols. Using data from two pragmatic randomized trials (N = 241) of the KONTAKT™ social skills group training program as an add-on to standard care in clinical settings, we aimed to explore the moderating role of co-occurring attention-deficit hyperactivity disorder in children (7-12 years) and adolescents (13-18 years). Two distinct response criteria were defined based on the parent-rated Social Responsiveness Scale: reliable improvement (⩾25 points) and clinically relevant improvement (⩾10 points). Moderator analyses indicated that the intervention effect was moderated by co-occurring attention-deficit hyperactivity disorder and age group. Logistic regressions stratified by co-occurring attention-deficit hyperactivity disorder showed significant effects among those without attention-deficit hyperactivity disorder (n = 63), both in terms of reliable improvement (odds ratio: 11.85, p = 0.002) and clinically relevant improvement (odds ratio: 10.00, p = 0.001). In contrast, no significant effects were observed in those with co-occurring attention-deficit hyperactivity disorder (n = 178). Explorative analyses further stratified by age suggested significant effects in adolescents, but not children, with co-occurring attention-deficit hyperactivity disorder. The findings preliminarily suggest that autistic children with attention-deficit hyperactivity disorder may need other or additional support.Lay abstractSocial skills group training can help some autistic children and adolescents improve their social life. Still, the positive effects may be less clear for those who also have attention-deficit hyperactivity disorder. We used data from two previous projects evaluating the effects of a social skills group training program called KONTAKT™ as an addition to the common healthcare provided. Our study included 241 children (8-12 years) and adolescents (13-18 years). To determine whether the participants had improved their social skills, we used ratings provided by the parents before and after the training and 3 months later. We then explored if KONTAKT led to improvement for autistic children and adolescents with and without attention-deficit hyperactivity disorder. Autistic children and adolescents often struggle to understand others and express themselves in everyday social situations. These challenges can create barriers to well-being and future life chances. Social skills group training can improve social skills in some autistic youths, but not all will benefit equally from the training. It is therefore important to better understand whether some groups need more support or other forms of assistance. Many autistic children and adolescents also have attention-deficit hyperactivity disorder, which can make the training of social skills more complicated. We found that both children and adolescents can benefit from KONTAKT. Still, preadolescent autistic children with attention-deficit hyperactivity disorder did not seem to improve as a result of the training. Based on these findings, it is important to find additional strategies to support this specific group of autistic children in handling social situations.

Transfer Learning of Deep Neural Networks Pretrained using the ABCD Dataset for General Psychopathology Prediction in Korean Adolescents

BACKGROUND

This study examines whether a deep neural network (DNN), trained to predict the general psychopathology factor (p-factor) using functional magnetic resonance imaging (fMRI) data from adolescents in the Adolescent Brain Cognitive Development (ABCD) study, generalizes to Korean adolescents.

METHOD

We trained a scanner-generalization neural network (SGNN) to predict p-factor scores from resting-state functional connectivity (RSFC) data of 6,905 ABCD adolescents, controlling for MRI scanner-related confounds. We then transferred the pretrained SGNN to a DNN to predict p-factor scores for 125 adolescents, including healthy individuals and those with major depressive disorder, using data from Seoul National University Hospital (SNUH). We compared the transferred DNN's performance with that of kernel ridge regression (KRR) and a baseline DNN.

RESULTS

The transferred DNN outperformed KRR (0.17 ± 0.16; 0.60 ± 0.07) and the baseline DNN (0.17 ± 0.16; 0.69 ± 0.11), achieving a higher Pearson's correlation coefficient (0.29 ± 0.18) and lower mean absolute error (0.59 ± 0.09; p < 0.005). We identified the default mode network (DMN) and visual network (VIS) as crucial functional networks (FNs) for predicting p-factors across both datasets. The dorsal attention network was specific to ABCD, while the cingulo-opercular and ventral attention networks were specific to SNUH.

CONCLUSION

The transferred SGNN successfully generalized to Korean adolescents. Altered RSFC in the DMN and VIS may serve as promising biomarkers for p-factor prediction across diverse populations, addressing heterogeneity in demographics, diagnoses, and MRI scanner characteristics.

Predictors of suicide attempt among subjects who were previously exposed to sexual abuse

BACKGROUND AND AIMS

Child sexual abuse is a condition that can affect the victim's life in every period and is closely related to physical and mental problems. One of the important consequences of child sexual abuse is suicide. The idea that there is a close relationship between child sexual abuse and suicidal ideation and attempts is widely accepted in the literature, but this relationship is quite complex. In this study, we investigated the factors associated with suicide risk in children and adolescents who were victims of sexual abuse.

METHODS

Two groups were formed: participants who were sexually abused and attempted suicide, and participants who were sexually abused and did not attempt suicide. They were evaluated in terms of anxiety, depression, posttraumatic stress disorder, borderline personality traits, impulsivity, traumatic experiences, and perceived social support using scales.

RESULTS

The total scores of anxiety-depression, posttraumatic-stress-disorder, impulsivity, traumatic experiences, and borderline personality traits scales were found to be significantly higher, while the perceived social support scale score was found to be significantly lower in the group who attempted suicide.

CONCLUSION

Our findings revealed factors associated with suicide attempts in child and adolescent who were sexual abuse victims. Taking these factors into account when evaluating victims of sexual abuse will provide early intervention to high risk patients.

Effects of parental characteristics on the risk of psychopathology in offspring: a 4-year follow-up study

Offspring of patients diagnosed with schizophrenia (SZoff) or bipolar disorder (BDoff) have double the risk of developing a psychiatric disorder. Here we report the effects of some parental characteristics on the offspring risk of psychopathology at 4-year follow-up. At baseline, 90 BDoff, 41 SZoff and 107 Community Control offspring (CCoff) aged 6 to 17 were included. At 4-year follow-up, 71% of the sample was assessed. Parents' and offspring's psychiatric diagnoses as well as socio-economic status (SES) and global functioning were assessed in addition to parents' ages at childbirth and offspring subclinical psychotic/bipolar symptoms. Kaplan-Meier method and Cox regression analysis were used to assess between-group differences in the cumulative incidence of psychiatric disorders and subclinical psychotic/bipolar symptoms and the association of some offspring and parents' variables with risk of psychopathology and subclinical psychotic/bipolar symptoms. SZoff and BDoff had a higher risk of psychopathology than CCoff at 4-year follow-up. SZoff showed a higher risk for attention deficit hyperactivity disorder (ADHD), disruptive disorders and subclinical psychotic symptoms, whereas BDoff displayed a heightened risk for mood disorders, ADHD and subclinical bipolar symptoms when compared to CCoff. Higher parental psychosocial functioning and SES were associated with a lower prevalence of psychopathology. Both SZoff and BDoff samples have a higher risk for psychopathology but the pattern of this psychopathology seems to be group specific. Longer follow-up studies and larger sample sizes are needed to assess the capacity of psychopathological disorder and subclinical psychotic or bipolar symptoms to predict progression to fully-fledged disorders.

Whole-brain white matter variation across childhood environments

White matter develops over the course of childhood in an experience-dependent manner. However, its role in the relationship between the early environment and later cognition is unclear, in part due to focus on changes in specific gray matter regions. This study examines white matter differences across adolescents from diverse environments, evaluating both their extent throughout the brain and their contribution to cognitive outcomes. Using data from the Adolescent Brain Cognitive Development (ABCD) study (N = 9,082, female = 4,327), we found extensive cross-sectional associations with lower white matter fractional anisotropy (FA) and streamline count in the brains of 9- and 10-y-old children exposed to a range of experiences, including prenatal risk factors, interpersonal adversity, household economic deprivation, and neighborhood adversity. Lower values of FA were associated with later difficulties with mental arithmetic and receptive language. Furthermore, white matter FA partially mediated the detrimental relationship between adversity and cognition later in adolescence. These findings advance a white matter-based account of the neural and cognitive effects of adversity, which supports leading developmental theories that place interregional connectivity prior to gray matter maturation.

Polygenic risk scores in relation to suicidality among youth with or at risk for bipolar disorder

PURPOSE

The risk of suicide among individuals with bipolar disorder (BD) is among the highest of all psychiatric disorders. The etiology of suicidality is complex and multifactorial, with genetic factors playing a prominent role according to twin-, family-, and molecular genetic studies. This study examines polygenic risk scores from adult studies in relation to suicidality in youth with or at risk for BD.

METHODS

Primary analyses examined the association of polygenic risk scores for suicide attempt, based on adult genome-wide association study data, with suicidal ideation, self-harm, and suicide attempt in 232 youth (mean age 16.7 years), including 125 with, and 107 at high-risk for, BD. We also tested polygenic risk scores for risk tolerance, schizophrenia, major depressive disorder, BD, and attention-deficit hyperactivity disorder in secondary analyses.

RESULTS

Polygenic risk scores for suicide attempt were not significantly associated with suicidal ideation, self-harm, or suicide attempt. Higher polygenic risk scores for major depressive disorder were nominally associated with increased risk of suicidal ideation in the overall sample (beta = 0.36, se(beta) = 0.16, p = 0.017), controlling for covariates.

IMPLICATIONS

Our finding that polygenic risk for depression is associated with suicidal ideation converges with prior findings in youth and adults. While present findings are constrained by sample size, they underscore the importance of undertaking genome-wide association studies in youth, rather than relying solely on prior adult genome-wide association studies.

Cognitive and behavioural processes in adolescent panic disorder

BACKGROUND

Improved understanding of the cognitive and behavioural processes underpinning panic disorder (PD) in adolescents could improve identification and treatment.

AIMS

We investigated whether the processes outlined in Clark's (1986) cognitive model of PD are observed in adolescents with PD, are specific to PD, and predict symptom severity.

METHOD

We recruited three groups of adolescents (12-17 years): 34 with a PD diagnosis, 33 with another anxiety disorder excluding PD ('clinical control'), and 34 scoring below the clinical cut-off on a measure of anxiety symptoms ('community control'). Participants self-reported on measures of PD symptom severity, catastrophic cognitions, bodily sensation fear, and safety-seeking behaviours.

RESULTS

The PD group reported significantly higher levels of catastrophic cognitions and safety-seeking behaviours than both control groups. They reported significantly higher levels of bodily sensation fear compared with the community but not the clinical control group. All process measures positively predicted PD symptom severity across all groups.

CONCLUSIONS

We found evidence of catastrophic cognitions and safety-seeking behaviours as PD-specific processes in adolescents which predict symptom severity. Bodily sensation fear also predicted symptom severity. Findings support Clark's cognitive model of PD in adolescents and suggest that catastrophic cognitions and safety behaviours may be targets for adolescent PD treatment.

Maternal interleukin 6 in pregnancy is associated with everyday, but not test-based executive functioning in 10-year-old children

BACKGROUND

Elevated maternal interleukin 6 (IL-6) during pregnancy has been associated with adverse fetal brain development and neurodevelopmental disorders, which often involve executive functioning (EF) impairments. However, the association between maternal IL-6 levels during pregnancy and EF remains largely unexplored.

METHODS

The COPSYCH study is based on the prospective COPSAC2010 birth cohort of 700 mother-child pairs, recruited during pregnancy. The children's executive functioning was assessed at age 10 using: (i) the Behavior Rating Inventory of Executive Function, Second Edition (BRIEF-2) parental questionnaire, and (ii) a comprehensive neuropsychological test battery. Maternal blood levels of IL-6 and hs-CRP were measured at gestational week 24. Associations between IL-6 (main analysis) and hs-CRP (secondary analysis) and EF in children at age 10 were investigated with regression models with extensive confounder adjustment.

RESULTS

Six hundred and four children (86% of the cohort) completed the 10-year follow-up. Higher maternal IL-6 levels were significantly associated with less efficient parental-rated executive functioning in the children: BRIEF-2 Global Executive Composite score (p = 0.003), Behavior Regulation Index (p = 0.005), Emotion Regulation Index (p=0.04), and Cognitive Regulation Index (p=0.007). Interaction analysis with sex was significant (p-value=0.01) and exploratory analyses showed that IL-6 associations to BRIEF-2 were solely driven by boys. Associations between IL-6 and neuropsychological tests, as well as associations between hs-CRP and EF outcomes, were non-significant.

CONCLUSION

IL-6 during pregnancy was associated with less efficient everyday EF in children at age 10. If replicated, preventive strategies targeting inflammation in pregnancy may ameliorate adverse cognitive outcomes in offspring.

Neural activation during processing of emotional faces as a function of resilience in adolescents

Neuroimaging studies suggest that resilience to adversity is linked to reduced emotional reactivity or enhanced emotion regulation. However, such studies are scarce and mainly use adult samples and categorical definitions of resilience. Using a novel, data-driven approach to define resilience dimensionally, based on cumulative adversity exposure across childhood and psychopathology, we investigated associations between resilience and brain activation during facial emotion processing in youth. We also tested for sex differences in the relationship between resilience and brain activation. fMRI data were acquired from 208 youths (aged 9-18 years; Mean age = 13.28), while viewing angry, fearful, and neutral faces. Whole-brain analyses were performed, followed by region-of-interest analyses focusing on the amygdala, hippocampus, and prefrontal cortex. Resilience was positively correlated with bilateral inferior frontal gyrus responses to fearful (versus neutral) faces, and negatively correlated with right superior temporal gyrus, left hippocampal, and right inferior frontal gyrus responses to neutral faces (versus fixation). Sex-by-resilience interactions were observed in the medial prefrontal cortex: males showed positive, while females showed negative, associations between resilience and brain activation, though these results did not survive correction for multiple comparisons. These findings provide further evidence that resilience in youth is associated with enhanced emotion regulation at a neural level.

Examining Narcissistic Traits in Relation To Reactive and Proactive Aggression in Children At-Risk for Attention Deficit/Hyperactivity Disorder

The current study examined narcissistic traits in relation to proactive and reactive functions of aggression in a sample of children at-risk for attention-deficit/hyperactivity disorder (ADHD). Children ages 7-13 years (N = 110) were recruited from a pediatric ADHD assessment clinic. Caregivers completed the Antisocial Process Screening Device. Caregivers and teachers completed a measure of proactive and reactive aggression. In regression analyses controlling for ADHD and oppositional defiant disorder symptom severity and sex, narcissism was uniquely associated with higher caregiver-reported proactive aggression but not reactive aggression. Findings suggest that narcissism is uniquely related to proactive aggression in children at-risk for ADHD. Consideration of narcissistic traits may aid the prediction of behavioral issues and aggression in children and may be a potential intervention target. Future research should investigate if clinical interventions addressing narcissistic behaviors are effective for reducing proactive aggression in children.

Sluggish cognitive tempo in children and adolescents: circadian preference and digital gaming addiction

This study investigates the relationship between Sluggish Cognitive Tempo (SCT) and circadian preferences in children and adolescents. We also aimed to assess the relationship between digital game addiction and SCT, as existing literature is insufficient, particularly given the similarities between SCT and Attention Deficit Hyperactivity Disorder (ADHD) in relation to internalizing symptoms and comorbidity. This study involved 72 children and adolescents with SCT and 77 healthy controls, aged 11-16 years, who were referred to the Child and Adolescent Psychiatry outpatient clinic. We used Sociodemographic Data Form, Schedule for Affective Disorders and Schizophrenia for School-Age Children-Present and Lifetime Version- Turkish Version (K-SADS-PL), Turgay's DSM-IV Based Screening and Assessment Scale for Disruptive Behavior Disorders in Children and Adolescents (T-DSM-IV-S), Child and Adolescent Behavior Inventory-SCT (CABI-SCT), Children's Chronotype Questionnaire (CCQ), Digital Game Addiction Scale (DGAS). In the group with SCT, we found that eveningness preference and digital game addiction were statistically significant. Correlation analyses revealed a moderate positive relationship between chronotype scores (eveningness preferences higher scores) and digital game addiction. Additionally, a strong positive correlation was found between chronotype and SCT scale scores, as well as between digital game addiction and SCT scale scores. These findings highlight the potential role of digital game addiction and circadian preferences in shaping profile of SCT, providing valuable insights into the understanding of SCT symptoms.

Do psychotic symptoms predict future psychotic disorders in adolescent psychiatry inpatients? A 17-year cohort study

BACKGROUND

Individuals with a psychiatric inpatient admission in adolescence have a high risk of schizophrenia-spectrum disorders (SSDs) when followed to adulthood. Whether psychotic symptoms predict subsequent SSDs in inpatient cohorts, however, is an important unanswered question.

METHODS

The sample consisted of adolescents (aged 13-17) admitted to psychiatric inpatient care (Oulu, Finland) from April 2001 to March 2006. Psychotic symptoms were assessed with the Schedule for Affective Disorders and Schizophrenia. Specialized health care use and diagnoses were followed up in national health care registers until June 2023. Cox regression was used to predict SSDs by the presence of baseline psychotic symptoms.

RESULTS

Of 404 adolescent inpatients admitted with non-psychotic mental disorders, 28% (n = 113) reported psychotic symptoms: 17% (n = 68) subthreshold and 11% (n = 45) full threshold. By the end of follow-up, 23% of the total cohort went on to be diagnosed with an SSD. Subthreshold psychotic symptoms did not differentiate patients who would subsequently develop SSDs (cumulative incidence 24%; HR = 1.42, 95%CI = 0.81-2.50). Full-threshold psychotic symptoms, on the other hand, were associated with an increased risk of subsequent SSDs (cumulative incidence 33%; HR = 2.00, 95%CI = 1.12-3.56). Most subsequent SSDs (83%), however, occurred in individuals who had not reported threshold psychotic symptoms during inpatient admission.

CONCLUSIONS

There was a high risk of subsequent SSDs among adolescent psychiatry inpatients when followed over time. SSDs were not predicted by subthreshold psychotic symptoms. Full-threshold psychotic symptoms were associated with an increased risk of subsequent SSDs, though with low sensitivity.

Bioenergetic markers in cerebrospinal fluid in first-episode psychosis: Are they predictors of early antipsychotic response and 1-year outcomes?

Psychotic disorders involve complex pathophysiological mechanisms, and identification of biomarkers for treatment response remains a major challenge. We aimed to study whether routine cerebrospinal fluid (CSF) parameters measured at baseline predict poor early response at 2 weeks with optimal antipsychotic treatment doses in patients with first-episode psychosis (FEP). We also explored whether these parameters could predict changes in social functioning and psychopathology over a 1-year follow-up. Ninety-eight inpatients with FEP who had received less than 6 weeks of antipsychotic treatment were included in the study. A lumbar puncture was performed at the index admission to measure CSF parameters (glucose, total protein, and lactate dehydrogenase [LDH]). The Positive and Negative Syndrome Scale (PANSS) was administered. A poor early treatment response at week 2 was defined as a < 20 % reduction in the PANSS positive subscore of a consensus factor. Social functioning was assessed using the Personal and Social Performance Scale (PSP) at baseline and 2, 4, 6, 9, and 12 months. Statistical analyses explored the role of CSF biomarkers in early treatment response using logistic regression and long-term social functioning and psychopathology using mixed linear regression analyses. Eighteen patients with FEP (18.4 %) were nonresponders at week 2. The CSF LDH concentration was a predictor of early treatment nonresponse. Higher CSF LDH concentrations were associated with a reduced improvement in social functioning at month 2, and higher CSF glucose concentrations were associated with lower reductions in the PANSS total scores at all visits. These findings suggest that specific bioenergetic parameters in the CSF, such as LDH and glucose, may serve as prognostic biomarkers for early treatment response and 1-year social and psychopathological outcomes in patients with FEP.

Sex differences in Cingulo-Opercular activation during risky decision-making in youth with externalizing disorders

BACKGROUND

Risky decision-making deficits predict unsafe behaviors, but sex differences in decision-making are underexplored in high-risk youth with externalizing disorders. While boys with externalizing pathology are more likely to make risky decisions, it remains unclear how these patterns manifest in girls, whose brains may process risks differently. Our study investigates sex differences in risky decision-making neurobiological activation among at-risk adolescents to identify sex-specific vulnerabilities for risky behaviors.

METHOD

168 adolescents divided into four groups of 81 externalizing males, 39 externalizing females, 33 control males, and 15 control females completed a risky decision-making task, the Balloon Analog Risk Task, during functional magnetic resonance imaging.

RESULTS

Our primary finding was that externalizing males showed greater activation in the right dorsomedial prefrontal cortex/dorsal anterior cingulate cortex as the chance of a balloon explosion increased while making riskier choices over safer choices, compared to all other groups.

CONCLUSIONS

These findings highlight key sex differences in the neurobiology of risky decision-making in youth with externalizing psychopathology within the cingulo-opercular network. With this network's involvement in cognitive control and impulse inhibition-functions critical for managing risky behaviors-understanding its role in the interaction between sex and externalizing disorders is crucial for targeted, sex-specific interventions preventing risky behaviors.

Associations Between Neighborhood Resources and Youths' Response to Reward Omission in a Task Modeling Negatively Biased Environments

OBJECTIVE

Neighborhoods provide essential resources (eg, education, safe housing, green space) that influence neurodevelopment and mental health. However, we need a clearer understanding of the mechanisms mediating these relationships. Limited access to neighborhood resources may hinder youths from achieving their goals and, over time, shape their behavioral and neurobiological response to negatively biased environments blocking goals and rewards.

METHOD

To test this hypothesis, 211 youths (aged ∼13.0 years, 48% boys, 62% identifying as White, 75% with a psychiatric disorder diagnosis) performed a task during functional magnetic resonance imaging. Initially, rewards depended on performance (unbiased condition); but later, rewards were randomly withheld under the pretense that youths did not perform adequately (negatively biased condition), a manipulation that elicits frustration, sadness, and a broad response in neural networks. We investigated associations between the Childhood Opportunity Index (COI), which quantifies access to youth-relevant neighborhood features in 1 metric, and the multimodal response to the negatively biased condition, controlling for age, sex, medication, and psychopathology.

RESULTS

Youths from less-resourced neighborhoods responded with less anger (p < .001, marginal R2 = 0.42) and more sadness (p < .001, marginal R2 = 0.46) to the negatively biased condition than youths from well-resourced neighborhoods. On the neurobiological level, lower COI scores were associated with a more localized processing mode (p = .039, marginal R2 = 0.076), reduced connectivity between the somatic-motor-salience and the control network (p = .041, marginal R2 = 0.040), and fewer provincial hubs in the somatic-motor-salience, control, and default mode networks (all pFWE < .05).

CONCLUSION

The present study adds to a growing literature documenting how inequity may affect the brain and emotions in youths. Future work should test whether findings generalize to more diverse samples and should explore effects on neurodevelopmental trajectories and emerging mood disorders during adolescence.

PLAIN LANGUAGE SUMMARY

A growing body of literature suggests that access to resources at the neighborhood level affects the neurodevelopment and mental health of youth. This study explores how access to neighborhood resources shapes the behavioral and neurobiological responses to negatively biased environments in youth. During brain imaging, 211 youth participated in a task where rewards were randomly withheld under the pretense that the youth performed poorly, an "unfair" intervention that elicits frustration. The authors found that youth from less-resourced neighborhoods exhibited less anger and more sadness in response to the unfair condition compared to youth from well-resourced neighborhoods. Limited access to neighborhood resources was also associated with reduced connectivity between the control and motor brain networks. These findings suggest that neighborhood inequity may impact the neurodevelopment and mental health of youth.

DIVERSITY & INCLUSION STATEMENT

One or more of the authors of this paper self-identifies as a member of one or more historically underrepresented racial and/or ethnic groups in science. One or more of the authors of this paper self-identifies as a member of one or more historically underrepresented sexual and/or gender groups in science. One or more of the authors of this paper received support from a program designed to increase minority representation in science. We actively worked to promote sex and gender balance in our author group. We actively worked to promote inclusion of historically underrepresented racial and/or ethnic groups in science in our author group.

Neural Substrates of Emotion Processing and Cognitive Control Over Emotion in Youth Anxiety: An RDoC-Informed Study Across the Clinical to Nonclinical Continuum of Severity

OBJECTIVE

Clinically anxious youth are hypervigilant to emotional stimuli and display difficulty shifting attention from emotional to nonemotional stimuli, suggesting impairments in cognitive control over emotion. However, it is unknown whether the neural substrates of such biases vary across the clinical-to-nonclinical range of anxiety or by age.

METHOD

Youth aged 7 to 17 years with clinical anxiety (n = 119) or without an anxiety diagnosis (n = 41) matched emotional faces or matched shapes flanked by emotional face distractors during magnetic resonance imaging, probing emotion processing and cognitive control over emotion, respectively. Building from the National Institute of Mental Health Research Domain Criteria (RDoC) framework, clinically anxious youth were sampled across diagnostic categories, and non-clinically affected youth were sampled across minimal-to-subclinical severity.

RESULTS

Across both conditions, anxiety severity was associated with hyperactivation in the right inferior parietal lobe, a substrate of hypervigilance. Brain-anxiety associations were also differentiated by attentional state; anxiety severity was associated with greater left ventrolateral prefrontal cortex activation during emotion processing (face matching) and greater activation in the left posterior superior temporal sulcus and temporoparietal junction (and slower responses) during cognitive control over emotion (shape matching). Age also moderated associations between anxiety and cognitive control over emotion, such that anxiety was associated with greater right thalamus and bilateral posterior cingulate cortex activation for children at younger and mean ages, but not for older youth.

CONCLUSION

Aberrant function in brain regions implicated in stimulus-driven attention to emotional distractors may contribute to anxiety in youth. Results support the potential utility of attention modulation interventions for anxiety that are tailored to developmental stage.

PLAIN LANGUAGE SUMMARY

Preferential attention to threat, an adaptive mechanism for detecting danger, is exaggerated in clinically anxious youth. This study included 150 youth aged 7 to 17 years spanning the clinical-nonclinical range of anxiety to examine the effects of anxiety and age on markers of emotion processing and cognitive control over emotion while undergoing MRI scanning. The authors found that more severe anxiety was associated with greater activation in the left ventrolateral prefrontal cortex, a region supporting cognitive control over emotion, which may prevent anxiety-related slowing of response times. Conversely, when participants were prompted to ignore emotional faces, anxiety severity was associated with slower performance and greater activation of the ventral attention network, suggesting greater stimulus-driven attention to emotional distractors. Age moderated associations between anxiety and brain activity during cognitive control over emotion, supporting the potential utility of tailoring interventions for anxiety.

CLINICAL TRIAL REGISTRATION INFORMATION

Dimensional Brain Behavior Predictors of CBT Outcomes in Pediatric Anxiety; https://clinicaltrials.gov; NCT02810171.

Factors linked to juvenile delinquency among forced migrant children

PURPOSE

Conditions of war have caused millions of children to be displaced both externally and internally worldwide. The present study aims to evaluate individual and trauma-caused risk factors and sociodemographic characteristics associated with juvenile delinquency among forced migrant children.

METHODS

40 juvenile delinquents and 40 controls aged 13-17 who were forced migrants took part in the study. Schedule for Affective Disorders and Schizophrenia for School-Age Children, Harvard Trauma Scale, Strengths and Difficulties Scale, Multidimensional Scale of Perceived Social Support, Relationship Scales Questionnaire-Adolescent Form were administered to both groups. Chi-square test(x2) and Fisher's Exact test were used to compare categorical variables across two groups. Normality was assessed by Kolmogorov- Smirnov test. Normally distributed continuous variables were compared by the student's t-test whereas for non-normal continuous variables Mann-Whitney U test was used.

RESULTS

Juvenile delinquency was related to larger family structure, lower socioeconomic and parental education levels, greater prevalence of smoking, alcohol, and substance use, and psychiatric diagnoses such MDD, PTSD, ADHD, ODD, DD among children. Traumatic migration experiences, longer migration periods, forced internal migration, having witnessed death or injury, not having attended school prior to migration, illiteracy, fragmented family structure, living apart from the parents, refugee camp experience, and were more prevalent among delinquents than non-delinquents.

CONCLUSIONS

These risk factors should be considered when designing prevention and intervention strategies and identifying protective factors to mitigate the negative effects of juvenile delinquency.

A new psychometric tool for evaluating nonverbal social cue-following: regression-based normative data for children 6 to 10 years old

The ability to follow nonverbal social cues is impaired in several disorders. Our aim was to collect normative data for the first psychometric test (TooN) that assesses this skill in children. The normative sample consisted of 339 typically developing children aged 6 to 10. TooN is a computerized tool that includes 120 trials in which children must press a button as soon as possible when an object appears on the right or left side of the screen. Each object is preceded by a video of a model gazing and/or pointing to the side where the object appears (i.e. congruent condition) or the opposite side (i.e. incongruent condition). Linear regression analyses were conducted for reaction times (RTs) and for gaze and pointing cuing effects (i.e. the difference between RTs in incongruent and congruent conditions). Regression analyses showed that age, sex and parental education significantly predicted RTs. Age and sex, but not parental education, were significant predictors of gaze cuing effects. However, age was the only significant predictor of pointing cuing effects. Based on these analyses, we provided the equations to calculate the z-scores for RTs and cuing effects. Accuracy scores, stratified by age and/or sex, are reported as percentiles. Based on the performances of typically developing children, we present the normative data of a new psychometric tool designed to assess nonverbal social cue-following. This tool can be valuable for evaluating children with neurodevelopmental disorders. To support this claim, its validity should be tested across various clinical populations.

Executive functions and ADHD symptoms predict educational functioning in children with ADHD: A two-year longitudinal study

The aim of this two-year longitudinal study was to investigate whether deficits in executive functions (EF) predict impaired everyday functioning after two years in children and adolescents with ADHD. A sample of 135 participants with and without ADHD were assessed with neuropsychological tests of EF and parent ratings of everyday functioning with the Child Behavior Checklist at baseline (Mage = 11.6, SD = 2.0), and after two years (Mage = 13.6, SD = 2.1). Results showed that ADHD symptoms and impaired EF at baseline predicted lower educational functioning when controlling for general cognitive ability (i.e. "IQ") at two-year follow-up. Furthermore, the results indicated that increased ADHD symptoms predicted problems both with social functioning and functioning in leisure activities (i.e. sport/hobbies/chores/jobs), whereas higher IQ predicted better functioning in leisure activities. The current study primarily highlights the importance of detecting and treating ADHD symptoms in order to prevent reduced functional outcomes, and that EF tests may contribute to identify children in need of educational interventions targeting EF deficits.

Hikikomori (prolonged social withdrawal) and co-occurring psychiatric disorders and symptoms in adolescents and young adults: A scoping review

BACKGROUND

Hikikomori, or prolonged social withdrawal, is a clinical condition usually emerging during adolescence or young adulthood, characterized by severe self-isolation in one's home, and often associated with other psychiatric disorders and symptoms.

OBJECTIVE

The study summarized evidence of hikikomori diagnostic criteria, clinical manifestations, and comorbidity with psychiatric disorders and symptoms in adolescents and young adults.

METHODS

A scoping review was conducted following PRISMA guidelines, with four electronic databases searched for original works in English, French, and Italian published since 2010.

RESULTS

A total of 15 studies were selected, 7 involved adolescents, 4 young adults, and 4 participants from both age groups. Most studies relied on the diagnostic criteria proposed for hikikomori inclusion in the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5). Differences in hikikomori and comorbidity profiles were identified between adolescents and young adults.

CONCLUSIONS

Heterogeneity characterized hikikomori diagnostic criteria, comorbidity, demographic and clinical features of the study samples. Studies adopting more homogeneous populations, shared diagnostic criteria, consistent assessment tools and longitudinal designs are needed to better clarify the clinical features of hikikomori in young people.

Within-person Relations Between Social Skills and Symptoms of Oppositional Defiant Disorder and Conduct Disorder from Preschool to Adolescence - A Birth Cohort Study

Effective treatment of oppositional defiant disorder (ODD) and conduct disorder (CD) is dependent on etiological knowledge about what factors contribute to their development and maintenance. Previous research points to a role for social skills in this process, but findings are mixed, possibly due to methodological factors. A sample drawn from two birth cohorts (n = 1,079, 50.1% girls) in the city of Trondheim, Norway, was assessed biennially from age 4 to 16 years. Social skills were rated by teachers and parents and measures of symptoms of ODD and CD were obtained through diagnostic interviews of parents and children (from age 8). Bidirectional relations between within-person changes in social skills and symptoms of ODD and CD, respectively, were assessed by a random intercept cross-lagged model. Increased parent-reported social skills predicted reduced symptoms of both ODD and CD from preschool to adolescence, while teacher-rated social skills predicted reduced symptoms of ODD from 4 to 14 years but predicted reduced symptoms of CD from 6 to 8 years only. Symptoms of ODD and CD predicted reduced teacher-rated social skills on two occasions (6 to 8 years for CD and 8 to 10 years for ODD), but there were no reciprocal paths involving parent-rated social skills. Findings provide support for including social skills training in the prevention and treatment of symptoms of ODD and CD.

Evaluation of sluggish cognitive tempo in children and adolescents with obesity and morbid obesity

ObjectiveThis study's primary aim is to evaluate the relationship between obesity and sluggish cognitive tempo (SCT).MethodThe study group consisted of obese (n = 37) and morbidly obese (n = 42) patients. The healthy control group included 38 children and adolescents. SCT was evaluated using the Barkley Child Attention Scale (BCAS). Clinical interviews were supplemented with standardized questionnaires to assess symptoms of depression, anxiety, and ADHD.ResultsBCAS scores were significantly higher in both the morbidly obese and obese groups than in the control group (p < .001). BCAS cutoff point showed that the prevalence of SCT was significantly higher in both the obese and morbidly obese groups compared to the control group (p < .001). Moreover, a logistic regression analysis identified screen time (OR = 1.330), maternal education (OR = 0.164), and BCAS scores (OR = 1.122) as independent risk factors for obesity.ConclusionThe current study found a significant relationship between SCT and obesity in children and adolescents. Given that obesity is a public health issue, our findings underscore the importance of evaluating SCT in morbidly obese and obese children. This understanding can lead to more comprehensive and effective treatment strategies for these children.

Emotion regulation difficulties in children and adolescents with obsessive-compulsive disorder: A multi-informant and multi-method study

Pediatric obsessive-compulsive disorder (OCD) is associated with emotion regulation (ER) difficulties. Most studies are based on self-reports, while few have examined how these difficulties are expressed across modalities, which may hold important diagnostic and therapeutic information. We applied a multi-informant and multi-method approach to examine ER difficulties in 211 children aged 8-17 years: 121 with OCD and 90 non-clinical controls. Child ER difficulties were assessed with The Difficulties in Emotion Regulation Scale (self-report and parent-report) and a Tangram frustration task with investigator-rated behavior, self-rated frustration, and heart rate variability (HRV). Children with OCD differed significantly from non-clinical controls in showing: (i) elevated child ER difficulties on self-report (partial eta squared =.068-.165) and parent-report (partial eta squared =.207-.369); (ii) more investigator-rated ER difficulties during the task (Cohen's d = -.33); (iii) increased levels of self-rated frustration before and after the task (partial eta squared =.089); notably, the magnitude of this increase did not differ between children with and without OCD. Finally, (iv) all children, regardless of group, demonstrated significant HRV changes during the frustration task, with no discernible group differences in the magnitude of these changes. Results suggest the OCD-related experience of ER difficulties may not impact autonomic functioning.

Trauma Exposure Moderates the Link Between Cognitive Flexibility and Suicide Risk in Pre-Adolescent Children

OBJECTIVES

Trauma exposure (TE) and cognitive flexibility (CF) are risk factors for self-injurious thoughts and behaviors (SITBs). However, it is unknown whether these risk factors contribute to mechanisms associated with distinct categories of SITBs. The current study examined the potential moderating role of TE in the relationships between CF and multiple SITBs, including active suicidal ideation (SI), passive SI, non-suicidal self-injury (NSSI), and history of suicide attempt (SA), among pre-adolescent children.

METHODS

A total of 11,326 children from the Adolescent Brain Cognitive Development study were included in the present study. SITBs and TE were measured by the Kiddy Schedule for Affective Disorder and Schizophrenia (KSADS). CF was measured using the NIH Cognitive Toolbox.

RESULTS

Cumulative TE moderated the relationship of CF to active SI. Higher CF was associated with lower odds of current SI in children with a single lifetime TE, but not in children without trauma or with two or more TE. As a main effect, two or more TE predicted higher odds of active SI, passive SI, and lifetime SA, but not NSSI. Higher CF was associated with lower odds of passive SI, with effects not moderated by trauma exposure.

CONCLUSION

The current results clarify previously inconsistent findings about the relationship of CF to SI by identifying cumulative TE as a moderator. CF served as a protective factor against SI, but only in children with a single lifetime trauma. Implications for screening and treatment targets of children at risk for distinct categories of SITBs are discussed.

Neural and Behavioral Correlates of Binge Eating in 9- to 10-Year-Old Children

OBJECTIVE

This observational study compared children with and without binge eating (BE) on biobehavioral measures of reward responsiveness, inhibitory control, and emotion processes, while accounting for the impact of weight.

METHOD

Children aged 9 to 10 years completed the baseline wave of the Adolescent Brain Cognitive Development Study (316 with BE; 7,681 without BE [no-BE]). The prevalence of binge-eating disorder in the BE group was 17.0%; clinically significant internalizing and externalizing symptoms were endorsed by 8.5% and 4.5% of the sample, respectively. The monetary incentive delay (MID) task, stop signal task (SST), and emotional N-Back (EN-Back) task were administered during neuroimaging. Analyses assessed effects of group (BE vs no-BE) on task performance and corresponding neural signal in regions of interest (ROIs). Weight status was evaluated as a covariate and as a moderator of effects.

RESULTS

Adjusting for weight status, the BE group (vs no-BE) group showed lower activation during anticipation of reward, specifically large reward (vs no reward), in the composite ROI consisting of the dorsal striatum, nucleus accumbens, orbital frontal gyrus, amygdala, and insula. Groups did not differ significantly in other behavioral or neural outcomes. No interactions between group and weight status were observed.

CONCLUSION

Blunted anticipatory responses to monetary reward were associated with binge eating during peri-adolescence and may play a role in binge eating pathophysiology. Results challenge prior findings in BE that may be confounded by weight, and highlight the importance of future prospective research across binge-eating disorder stage of illness.

PLAIN LANGUAGE SUMMARY

Binge eating disorder, the most common eating disorder, is associated with several negative psychosocial consequences. This study used data from the Adolescent Brain Cognitive Development (ABCD) Study and compared children (ages 9-10) with and without binge eating on neurobiological and behavioral measures of reward responsiveness, inhibitory control, and emotion processes. Children with binge eating showed lower neural activation during anticipation of reward, specifically large reward, compared to youth without binge eating. These findings suggest that blunted anticipatory response during peri-adolescence may play a role in binge eating pathophysiology.

Latent Trajectories of Change in Dietary Restriction During Treatment in Avoidant/Restrictive Food Intake Disorder and Anorexia Nervosa

OBJECTIVE

Outcomes for low-weight restrictive eating disorders, including anorexia nervosa, restricting type (AN-R) and avoidant/restrictive food intake disorder (ARFID), are sub-optimal. Reducing dietary restriction is a key treatment target. Understanding heterogeneity in patterns of change in dietary restriction may aid in improving outcomes. We examined latent trajectories of change in dietary restriction during treatment and follow-up in AN-R and ARFID.

METHODS

Adolescents and adults with R-EDs (N = 276, 18% ARFID, 90% female, M age = 18) receiving intensive ED treatment completed assessments at five timepoints. Latent growth mixture modeling examined trajectories of change in dietary restriction, measured using the Eating Pathology Symptoms Inventory Restricting subscale. Classes were compared on clinical features at admission to determine characteristics prospectively associated with trajectory.

RESULTS

A 3-class solution emerged: Class 1 comprising individuals with "good response" (n = 138; 33% of those with ARFID in the sample); Class 2 with "good response, rebounding" (n = 81; 41% of ARFID); and Class 3 with "gradual response, low symptoms" (n = 57; 26% of ARFID). Class 3 had lower anxiety and R-ED symptoms than Classes 1 and 2. Class 2 presented with older age than Class 1.

DISCUSSION

No ARFID-specific classes emerged, underscoring similarities in response to intensive treatment between AN-R and ARFID.

Investigating the Association Between Heavy Metals and Attention Deficit Hyperactivity Disorder in Children: An Exploratory Study

Exposure to heavy metals has been associated with affecting children's neurodevelopment, particularly increasing the risk of developing attention-deficit hyperactivity disorder (ADHD). The current exploratory study aims to investigate potential associations between presence of 15 different heavy metals in urine and ADHD. A total of 190 urine samples of participants from clinical and non-clinical population (non-ADHD = 66; ADHD = 124) aged between 6 and 15 years from Barcelona and Tarragona (Spain) were analysed. Logistic regressions adjusted by sex, age, SES, BMI and diet quality were performed. Highest quartiles (3rd and 4th) of Pb (lead) (aOR 5.33; CI [1.89, 14.98]), Cd (cadmium) (aOR 3.69, CI [1.38, 9.83]), Cu (copper) (aOR 16.46, CI [4.66, 58.14]) and Sb (antimony) (aOR 3.04, CI [1.12, 8.23]) were significantly associated with increased odds of ADHD DSM-5 diagnosis. Additionally, Cu and Cd were associated with higher scores of inattention symptoms. Whereas, Cu and Sb were associated with hyperactivity-impulsivity severity. This exploratory study provides preliminary valuable evidence, suggesting potential associations between environmental factors, such as metal exposure, with ADHD in school-aged children. These findings highlight the importance of further research to support these associations and, if confirmed, explore strategies to mitigate the potential impacts of these toxicants on children's health.

Co-morbid psychiatric disorders in children with arachnoid cyst

Arachnoid Cysts (AC) are benign lesions containing cerebrospinal fluid, and although most of them are asymptomatic, they can cause neurological symptoms like headaches, seizures, and neuropsychiatric problems. The aim of this study was to asses and document co-morbid psychiatric disorders in children with AC aged between 6 and 17. Wechsler Abbreviated Scale of Intelligence-Second Edition (WASI-II), a clinical measure used to assess the intelligence quotient (IQ) scores of the patients, Kiddie Schedule for Affective Disorders and Schizophrenia Present and Lifetime Version (K-SADS-PL; semi-structured interview) was used to assess psychiatric disorders among the patients. A total of 12 patients with AC was evaluated with an even distribution of males and females. Half of the patients had a normal IQ score with a mean IQ score of 104.5. Among patients with normal IQ scores, one patient had epilepsy and attention deficit hyperactivity disorder and two patients had epilepsy without any psychiatric disorder. The remaining six patients had moderate intellectual disability with a mean IQ of 48.2. Among them, three out of six had epilepsy and four had accompanying psychiatric disorders. It is therefore apparent that patients with AC have a high rate of co-morbid psychiatric disorders. Our study demonstrates that intellectual disability and psychiatric disorders should be evaluated in children with AC in the clinical settings.

Factors associated with gender specific adolescent presentations to the emergency department for suicide risk behaviors during the COVID-19 pandemic

BackgroundAdolescent presentations to the emergency department (ED) for suicide-related thoughts and behaviors (SRTBs) increased during the COVID-19 pandemic. Gender expansive youth were particularly impacted by the loss of gender-specific services, however, data examining ED pandemic presentations of gender expansive youth for SRTBs are scarce.MethodsData were collected at a tertiary care center in Canada. Adolescents aged 12 to 17 presenting with SRTBs were recruited during two periods: March 2018 - March 2020 (pre-pandemic) and March 2021 - May 2023 (during pandemic). Patient demographics, mental health symptoms, and pre-ED visit healthcare utilization were examined.ResultsWe identified 202 adolescents (70 pre-pandemic; 132 during pandemic), with a mean age of 14.3 years. Compared with pre-pandemic, during pandemic adolescents were more likely to identify as gender expansive [pre: 5.7% versus during: 24.2%; p = .01] and were of European descent [pre: 28.6% versus during: 59.1%; p < .01]. During the pandemic, gender expansive adolescents, on average, exhibited higher suicidal ideation, measured by Suicide Ideation Questionnaire Junior scores, compared with cisgender adolescents [gender expansive: mean = 64.3 (standard deviation = 12.1) versus cisgender participants: mean = 58.0 (standard deviation = 14.5); p = .03]. There were no differences in demographics, healthcare utilization, depression or anxiety symptom severity between gender expansive and cisgender adolescents.ConclusionsAdolescents presenting to the ED with SRTBs during the pandemic were more likely to identify as gender expansive than those presenting pre-pandemic. Gender expansive adolescents exhibited increased suicidal ideation compared to cisgender adolescents during the pandemic.

Poor performance of PHQ-9 and GAD-7 in screening clinical depression and anxiety among a large sample of Chinese children and adolescents

BACKGROUND

The Patient Health Questionnaire (PHQ-9) and the Generalized Anxiety Disorder scale (GAD-7) are widely used symptom-based instruments for screening depression and anxiety. However, their validation in Chinese children and adolescents remains insufficient. We aim to investigate the performance and optimal cut-offs of PHQ-9 and GAD-7 in Chinese children and adolescents in screening clinical depression and anxiety, and to discuss the influencing factors of the cut-offs.

METHODS

The study subjects were chosen from 3 sites of the Mental Health Survey for Children and Adolescents in Yunnan (MHSCAY), a total of 2,237 participants who had been screened positive by self-administered questionnaire and further diagnosed by using the gold standard were included in the final analysis. The Receiver Operating Characteristic (ROC) curves were used to determine the discriminative ability of the two instruments, measured by using the area under curve (AUC). The optimal cut-offs of the two instruments were determined by the maximum Youden's index. A series of stratified analyses were performed to discover the best cut-offs for children and adolescents of different characteristics. Logistic regression models were adopted to evaluate the influence of self-harm (SH) on identified optimal cut-offs.

RESULTS

We found the performance was generally poor for both the PHQ-9 and GAD-7 in screening clinical depression and anxiety in our study sample, with the AUCs ranged only between 0.622-0.712. When using the two instruments for diagnosis purpose, 11 was the optimal cut-off for both clinical depression and anxiety (AUC for PHQ-9: 0.664, AUC for GAD-7: 0.669). For study subjects of different age, gender, race, and left-behind status, discordant cut-offs were identified. SH also showed conspicuous influence on the optimal cut-offs of PHQ-9 and GAD-7, and the combination of SH information can increase screening accuracy of PHQ-9 in some subgroups.

CONCLUSIONS

Both the PHQ-9 and GAD-7 showed poor performance in screening clinical depression and anxiety in our study sample. This crucial finding suggests that, despite the wide use of the two scales, they might be fundamentally inadequate for depression and anxiety screening in Chinese children and adolescents. Other screening tools of higher accuracy should be developed and used in this age group.

Symptoms of Depression, Physical Activity, and Sedentary Time: Within-Person Relations From Age 6 to 18 in a Birth Cohort

OBJECTIVE

To examine the within-person relations between objectively measured physical activity and clinically assessed symptoms of depressive disorders from childhood to late adolescence.

METHOD

Seven waves of biennially collected data from a Norwegian birth-cohort (n = 873; 53% girls) followed from age 6 to 18 years were used. Accelerometers were used to assess total physical activity, moderate-to vigorous physical activity, and sedentary time, and symptoms of depression were assessed by semi-structured psychiatric interviews. Mediators (athletic self-esteem, body image, sports participation) were captured by questionnaires. Random intercept cross-lagged panel models were estimated to test the within-person relations and their potential mediators.

RESULTS

From ages 14 to 16 and 16 to 18 years, significant within-person relations were found. Decreased levels of total physical activity (PA) and moderate-to-vigorous physical activity (MVPA) predicted more symptoms of depression (PA: 14-16 years: β = -0.08; 16-18 years: β = -0.09; MVPA: 14-16 years: β = -0.10; 16-18 years: β = -0.07). These relations were not evident at earlier ages. From ages 10 to 12 and 14 to 16 years, an increased number of depressive symptoms predicted decreased levels of physical activity (PA: 10-12 years: β = -0.10; 14-16 years: β = -0.14: MVPA: 10-12 years: β = -0.10; 14-16 years: β = -0.17). We found no evidence for within-person relations between sedentary time and depressive symptoms, and no significant sex differences or mediations.

CONCLUSION

Individuals who increase their physical activity levels from middle to late adolescence are less likely to develop symptoms of depression compared to what they otherwise would. Thus, in this age period, physical activity may protect against depressive symptoms.

Online search and activities of parents of children with ADHD: a qualitative study

BACKGROUND

Parents' perceptions of their child's mental health play a crucial role in their decision to seek mental health services. Additionally, mental health literacy, which includes knowledge about mental health disorders, is essential for identifying, managing, and preventing mental health problems. Online health information searches are a vital resource for parents of children with attention deficit hyperactivity disorder (ADHD)- one of the most common neurodevelopmental disorders- as they provide emotional support and information on risk factors, treatments, and prognosis. However, while online resources are widely used, little is known about how parents navigate, interpret, and integrate this information into their care decisions. This study explored parents' lived experiences of seeking ADHD-related information online, examining how these searches shape their perceptions, decision-making, and interactions with healthcare professionals.

METHOD

This qualitative study followed the Inductive Process to analyze the Structure of lived Experience (IPSE) approach. Twenty parents of children with ADHD were recruited using a purposive sampling strategy, and data were collected through semi-structured interviews until saturation was reached. Data analysis was conducted using a descriptive and structuring procedure to identify key experiential themes.

RESULTS

Data analysis produced three central experiential axes: [1] Internet and the care pathway; [2] Internet knowledge and its supporting role; and [3] Internet and discordant discourse on ADHD between health professionals. Most parents reported using social networks as a crucial source of support, guidance, and mutual aid. Specifically, online parent groups helped them navigate obstacles in the care pathway, manage conflicting perspectives on ADHD, and alleviate feelings of guilt.

CONCLUSION

Healthcare professionals and stakeholders should consider the impact of web-based resources on parental decision-making and work towards improving the accessibility and reliability of online health information.

Psychoneuroendocrine stress response in female and male youth with major depressive disorder

BACKGROUND

Exposure to psychosocial stress is one of the strongest risk factors for major depressive disorder (MDD) in youth, but underlying neurobiological mechanisms are poorly understood. Previous studies on the neuroendocrine stress response in youth with MDD are scarce, limited to cortisol, and rarely considered sex differences. Due to puberty-associated neuroendocrine transitions increasing the risk for MDD onset in adolescence, this study aimed to investigate sex-specific stress responses of stress and sex hormones as well as of neuropeptides.

METHODS

In 103 pubertal youths with MDD and 72 healthy controls (HCs; 62% females, 12-18 years), psychological stress as well as salivary cortisol, testosterone, and oxytocin reactivity to a standardized psychosocial stress test (Trier Social Stress Test, TSST) were assessed. Effects of group and sex, and their interactions were analyzed using hierarchical linear models, while controlling for potentially confounding factors (such as age and pubertal status).

RESULTS

Females and males with MDD showed a stronger psychological stress response than HCs. In contrast, both female and male youth with MDD showed blunted cortisol, testosterone, and oxytocin stress responses compared to HCs. In addition, baseline testosterone was elevated in MDD compared to HCs.

CONCLUSIONS

Results indicate a discrepant stress reactivity in youth with MDD, with increased psychological, but decreased neuroendocrine responses to psychosocial stress. Blunted neuroendocrine stress responses in youth with MDD were found across different neuroendocrine systems and in both females and males with MDD. These novel findings point to a fundamentally changed stress response in youth with MDD irrespective of sex, which may influence successful stress regulation in the affected adolescents.

Exploring the impact of Flash technique on test anxiety among adolescents

This study aims to investigate the specific effects of Flash Technique (FT) on adolescents with test anxiety. This follow-up study consists of 38 adolescents, 14-17 years of age (M = 15.39, SD = 1.13). Pre-post assessments were conducted using the Test Anxiety Inventory (TAI), Scale of Attitudes Negatively Affecting the Performance I/Test (POET), and Beck Anxiety Inventory (BAI) at baseline, at the end of the 4th and 12th weeks of therapy. The FT was applied for 12 weeks, with one weekly session as an intervention. As a result of the therapy process, the baseline means of total BAI scores decreased from 25.26 to 2.18; the baseline means of TAI decreased from 149.79 to 39.13, and the baseline mean of POET decreased from 298.47 to 73.84 at the end of the 12th week of therapy. Also, the baseline means of SUD scores decreased from 9.42 to zero at the end of the 12th week of treatment. All the adolescents showed complete improvement after the 12th week of the FT. The study findings showed that the test anxiety symptoms significantly decreased with the treatment of the FT. FT can be an effective intervention for test anxiety in adolescents.

The MNK-SYNGAP1 axis in specific learning disorder: gene expression pattern and new perspectives

Specific learning disorder (SLD) is a neurodevelopmental disorder that significantly affects children's academic performance. This study aimed to investigate the expression levels of the MAP Kinase Interacting Serine/Threonine Kinase 1-2 (MNK1, MNK2), Synaptic Ras GTPase Activating Protein 1 (SYNGAP1) genes, and the long non-coding RNA Synaptic Ras GTPase Activating Protein 1-Anti Sense1 (SYNGAP1-AS1), which are believed to play a key role in neurodevelopmental pathways, in children with SLD. Understanding the role of these genes in synaptic plasticity and cognitive function may provide insights into the molecular mechanisms underlying SLD. This study included 38 children diagnosed with SLD and 35 healthy controls aged 6 to 16. RNA was isolated from blood samples, and gene expression levels were measured using quantitative polymerase chain reaction (qPCR). The statistical analysis was conducted to compare the expression levels between the SLD and control groups and within SLD subgroups based on severity and sex. MNK1 and SYNGAP1 expression levels were significantly upregulated in the SLD group compared to the control group (8.33-fold and 16.52-fold increase, respectively; p < 0.001). lncSYNGAP1-AS1 showed a 26.58-fold increase, while MNK2 was downregulated by 2.2-fold, although these changes were not statistically significant. No significant differences were observed between sexes or between the severity subgroups of SLD.

CONCLUSION

he upregulation of MNK1 and SYNGAP1 in children with SLD suggests their involvement in the neurodevelopmental pathways associated with cognitive processes such as learning and memory. These findings provide a foundation for future research into the molecular basis and potential therapeutic targets of SLD.

WHAT IS KNOWN

• SYNGAP1 is a key regulator of synaptic plasticity and learning, primarily functioning through Ras signaling inhibition. Its deficiency impairs long-term potentiation (LTP) and is associated with neurodevelopmental disorders (NDDs) such as autism spectrum disorder (ASD) and intellectual disability. • The MAPK/ERK pathway plays a crucial role in learning and memory, and its dysregulation has been linked to several neurological conditions. MNK1/2 interacts with SYNGAP1 in synaptic signaling.

WHAT IS NEW

• This study is the first to demonstrate significant upregulation of SYNGAP1 and MKNK1 in children with SLD. • Understanding the role of the MKNK-SYNGAP1 axis may guide the development of targeted therapies aimed at enhancing synaptic plasticity to improve learning and memory outcomes in children with SLD.

Multivariate prediction of temper outbursts in a sample of youth enriched for irritability using ecological momentary assessment data: A registered report

Irritability and temper outbursts are among the most common reasons youth are referred for psychiatric assessment and care. Identifying in vivo clinical variables that precede the onset of temper outbursts would provide valuable clinical utility. Here, we provide the rationale for a study testing the performance of a classifier trained to predict temper outbursts in a group of clinically-referred youth presenting with symptoms of irritability and temper outbursts. Due to the large sample sizes needed for multivariate classification studies, here, we demonstrated the feasibility of our approach using a relatively large preliminary dataset. Our preliminary data included digital based event sampling from an existing Ecological Momentary Assessment dataset consisting of n = 54 participants with a total of 932 time points. We used this data to develop a logistic regression-based classifier for predicting the temper outburst prospectively. Our initial evaluation provided encouraging evidence for the possibility of predicting the presence of a temper outburst based on individual's momentary clinical responses (e.g., whether the participant is feeling grouchy, hungry, happy, sad, anxious, tired, etc.) prior to the outburst event, as well as external features (e.g., time of day, day of week). However, due to the risk of false positive discoveries and overfitting, these preliminary results are insufficient to conclusively establish the discovery of predictive rules for irritability in Ecological Momentary Assessment data. To more rigorously assess this classifier, we will collect a large confirmatory set, consisting of at least an additional 20 subjects with an expected total of 400 time points, in which will perform confirmatory analyses of the precision and recall of the classifier already fit using preliminary data. This work will potentially provide the foundation for the identification of features predictive of risk and future development of novel mobile-device-based interventions in youth affected with severe and impairing psychopathology.

Measuring adversity in the ABCD® Study: systematic review and recommendations for best practices

BACKGROUND

Early life adversity (ELA) has substantial, lifelong impacts on mental and physical health and development. Data from the ABCD® Study will provide essential insights into these effects. Because the study lacks a unified adversity assessment, our objective was to use a critical, human-driven approach to identify variables that fit ELA domains measured in this study.

METHODS

We clarify best practices in measurement of adversity in the ABCD Study through the creation of adversity scores based on the well-established Adverse Childhood Experiences (ACEs) questionnaire and another inclusive of broader ELA. Variables previously used to measure adversity in the ABCD dataset were determined via literature review. We assessed each variable to identify its utility in measuring domains of adversity at baseline and follow-up time points and by individual completing the assessment (i.e., youth or caregiver). Variables were selected that align with decades of ELA measurement, and therefore, can be used by research teams as measures of ELA.

RESULTS

The literature review and critical analysis of items led to the development of three measures of ELA: an ACES-proxy score, a youth-reported ACEs-proxy score, and a broader ELA score (ELA+). We provide code using R to calculate these scores and their constituent domains for use in future ABCD adversity-related research.

CONCLUSIONS

The ABCD Study is one of the largest longitudinal studies of youth development, with data available for secondary analysis. Our review of existing measures and development of a coding schema will allow examination of ELA using this dataset, informing our understanding of risk, resilience, and prevention.

Interpersonal Sensitivity and Social Problem-Solving in Adolescents with Suicide Attempts or Non-suicidal Self-Injury

OBJECTIVE

Interpersonal dysfunction robustly predicts suicide attempts (SA) and non-suicidal self-injury (NSSI) in adolescents. We sought to better elucidate how two interpersonal constructions (interpersonal sensitivity and social problem-solving strategies) may lead to NSSI vs. SA in adolescents.

METHOD

We compared non-overlapping groups of adolescents engaged in either SA (n = 49, Mage = 15.80, SD = 1.23, 63% female) or NSSI (n = 50, Mage = 15.35, SD = 1.34, 82% female), and healthy controls (HC; n = 43, Mage = 15.46, SD = 1.30, 61% female). We hypothesized: (1) greater interpersonal sensitivity and deficits in social problem-solving strategies would differentiate the three groups and indicate higher risk for being in the NSSI and SA groups, relative to the HC groups, and (2) amongst clinical groups, there would be greater deficits in social problem-solving in the SA group, and greater interpersonal sensitivity in the NSSI group.

RESULTS

NSSI and SA groups demonstrated more interpersonal sensitivity and lower (i.e., worse) social problem-solving skills vs. HCs. Participants were more likely to be in both the SA and NSSI groups based on interpersonal sensitivity (ORSA = 2.61; ORNSSI = 2.75) and social problem-solving (ORSA = 19.11; ORNSSI = 10.89). Significant differences were observed between the NSSI and SA groups on interpersonal sensitivity [t(97) = 4.28, p < .001, d = 0.86; higher levels in the NSSI group], but not on social problem-solving [t(97) = 1.97, p = .052, d = 0.40].

CONCLUSIONS

Both greater interpersonal sensitivity and challenges in social problem-solving predict NSSI and suicidal behavior in adolescents, and interpersonal sensitivity may be a particularly salient risk factor for NSSI. Implications for treatment and future research are discussed.

Screening for Psychotic Experiences and Psychotic Disorders in General Mental Health Treatment Settings: A Systematic Review and Meta-Analysis

BACKGROUND

The absence of systematic psychosis screening within general mental health services contributes to substantial treatment delays and poor long-term outcomes for individuals with psychotic symptoms. We conducted a meta-analysis to estimate rates of subclinical psychotic symptoms for psychotic experiences (PE), clinical high-risk for psychosis syndrome (CHR-P), and psychotic disorders that were identified via studies screening treatment-seeking individuals. These rates can inform implementation recommendations for routine psychosis screening in general mental health settings.

METHODS

PubMed and Web of Science databases were searched to identify empirical studies with information on PE, CHR-P, or psychotic disorder prevalence identified by screening inpatients and outpatients (age < 65 years) receiving general mental health care. PE was identified using threshold scores on validated self-reported questionnaires, and CHR-P and psychotic disorder were identified using gold-standard structured interview assessments. A meta-analysis of each outcome was conducted using the restricted maximum likelihood estimator method to assess effect sizes in a random effects model.

RESULTS

The analyses included 41 independent samples (k = 32 outpatient, k = 2 inpatient, k = 7 combined settings) with a total of 25,751 patients (58% female, mean age: 24.1 years). PE prevalence was 44.3% (95% CI: 35.8-52.8%; 28 samples, n = 21,957); CHR-P prevalence was 26.4% (95% CI: 20.0-32.7%; 28 samples, n = 14,395); and psychotic disorder prevalence was 6.6% (95% CI: 3.3-9.8%; 32 samples, n = 20,371). Rates did not differ by sex, age, or setting type.

CONCLUSIONS

The high prevalence of psychotic symptoms in general mental health treatment settings underscores the need for early-detection psychosis screening. These base rates can be used to plan training and allocation of resources required to conduct psychosis assessments and build capacity for delivering interventions for CHR-P and early psychosis in non-specialty mental health treatment settings.