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

A precision health approach to medication management in neurodivergence: a model development and validation study using four international cohorts

Background

Psychotropic medications are commonly used for neurodivergent children, but their effectiveness varies, making prescribing challenging and potentially exposing individuals to multiple medication trials. We developed artificial intelligence (AI) models to predict medication success for stimulants, anti-depressants, and anti-psychotics. We first demonstrate feasibility using cross-sectional data from three research cohorts, then use a cohort of patients from a pharmacology clinic to predict medication choice by class, longitudinally, from electronic medical records (EMRs).

Methods

Models were built to predict cross-sectional medication usage from the Child Behaviour Checklist. Data from the Province of Ontario Neurodevelopmental (POND) network (N=598) trained and tested the models, while data from the Healthy Brain Network (HBN; N=1,764) and Adolescent Brain Cognitive Development (ABCD; N=2,396) studies were used for external validation. For the EMR cohort, data from the Psychopharmacology Program (PPP; N=312) at Holland Bloorview Kids Rehabilitation Hospital were used to predict longitudinal success. Stacked ensemble models were built separately for each medication class, and area under the receiving operating characteristic curve (AU-ROC) evaluated performance.

Findings

The research cohorts demonstrated feasibility, with internal testing (POND) achieving an AU-ROC (mean [95% CI]) of 0.72 [0.71,0.74] for stimulants, 0.83 [0.80,0.85] for anti-depressants, and 0.79 [0.76,0.82] for anti-psychotics. Performance in external testing sets (HBN and ABCD) confirmed generalizability. In the EMR cohort (PPP), AU-ROC were high: 0.90 [0.88,0.91] for anti-psychotics, 0.82 [0.92,0.83] for stimulants and 0.82 [0.80,0.84] for anti-depressants.

Interpretation

This study demonstrates the feasibility of using AI to enhance medication management for neurodivergent children, with expert clinician decisions learned with high accuracy. These findings support the potential for AI decision aids in community settings, promoting faster access to personalized care while highlighting the complexity of clinical and sociodemographic factors influencing medication decisions.

A Developmental Perspective on Early and Current Motor Abnormalities and Psychotic-Like Symptoms

BACKGROUND AND HYPOTHESIS

Psychotic-like experiences (PLEs) are prevalent in the general population and, because they represent a lower end of the psychosis vulnerability spectrum, may be useful in informing mechanistic understanding. Although it is well-understood that motor signs characterize formal psychotic disorders, the developmental trajectory of these features and their relationships with PLEs are less well-understood.

STUDY DESIGN

Data from 7559 adolescents and young adults (age 11-21) in the Philadelphia Neurodevelopmental Cohort were used to investigate whether early-life milestone-attainment delays relate to current adolescent sensorimotor functioning and positive and negative PLEs. Current sensorimotor functioning was assessed using the Computerized Finger Tapping task (assessing motor slowing) and Mouse Practice task (assessing sensorimotor planning).

STUDY RESULTS

Early developmental abnormalities were related to current adolescent-aged motor slowing (t(7415.3) = -7.74, corrected-P < .001) and impaired sensorimotor planning (t(7502.5) = 5.57, corrected-P < .001). There was a significant interaction between developmental delays and current sensorimotor functioning on positive and negative PLEs (t = 1.67-4.51), such that individuals with early developmental delays had a stronger positive relationship between sensorimotor dysfunction and PLEs. Importantly, interaction models were significantly better at explaining current PLEs than those treating early and current sensorimotor dysfunction independently (χ2 = 4.89-20.34).

CONCLUSIONS

These findings suggest a relationship between early developmental delays and current sensorimotor functioning in psychosis proneness and inform an understanding of heterotypic continuity as well as a neurodevelopmental perspective of motor circuits. Furthermore, results indicate that motor signs are a clear factor in the psychosis continuum, suggesting that they may represent a core feature of psychosis vulnerability.

Body as expression of psychiatric distress: insights from restrictive eating disorders, non-suicidal self-injuries, and suicide attempts

Introduction

Adolescence is a developmental period marked by vulnerabilities where psychological distress often manifests through the body. Restrictive Eating Disorders (REDs), Non-Suicidal Self-Injury (NSSI), and Suicide Attempts (SAs) represent distinct yet overlapping expressions of this phenomenon.

Methods

This cross-sectional study compared 60 adolescents (20 for each group) aged 12-18 across these groups using a comprehensive multimethod assessment, including the Kiddie Schedule for Affective Disorders and Schizophrenia (K-SADS-PL), the Structured Clinical Interview for DSM-5 Personality Disorders (SCID-5-PD), and the Rorschach Performance Assessment System (R-PAS).

Results

The RED group exhibited the highest obsessive-compulsive symptoms and distorted interpersonal representations linked to perfectionism and body image concerns. R-PAS scores highlighted disorganized thinking and maladaptive self and other perceptions. The NSSI group displayed significant borderline traits, emotion regulation deficits, and impressionistic responses, with elevated R-PAS indices reflecting interpersonal defensiveness and vulnerability to emotional distress. The SA group showed severe depressive symptoms, dysregulation, and impaired thought organization, with the lowest functional scores (CGAS). Across all groups, adverse childhood experiences and distorted interpretations of stimuli emerged as common factors, supporting shared vulnerability.

Discussion

This study provides a nuanced understanding of bodily expressions of psychological distress by integrating structured interviews, personality assessments, and performance-based tools. These findings emphasize the importance of tailored diagnostic and therapeutic strategies that address the unique and overlapping characteristics of these groups, advancing precision in adolescent mental health care.

Cognitive disengagement syndrome and depressive symptoms in early adolescents: Examining the moderating role of a negative interpretation bias

BACKGROUND

Despite previous research demonstrating an independent association between cognitive disengagement syndrome (CDS; previously termed sluggish cognitive tempo) and depressive symptoms, studies have yet to examine what factors may moderate this link. A negative interpretation bias (i.e., maladaptive information processing whereby emotionally aversive meaning is perceived in ambiguous situations) is associated with the development and maintenance of depression and may moderate the association between CDS and depression. Using a multi-informant, multi-method design, this study examined whether negative interpretation bias exacerbated the association between CDS and depressive symptoms.

METHODS

336 adolescents (ages 10-12 years; 52.7% female; 61.9% White) and their caregivers completed measures of CDS and depressive symptoms. Adolescents completed the Scrambled Sentences Test, a task-based measure of interpretation bias. Regression analyses were conducted to examine interpretation bias as a potential moderator of the association between CDS and depressive symptoms.

RESULTS

For adolescent-reported depressive symptoms, higher caregiver- and adolescent-reported CDS symptoms and interpretation bias scores were each independently associated with higher depressive symptoms (all ps < .01), but CDS and interpretation bias did not interact in predicting depression (ps > .05). By contrast, significant CDS symptoms × interpretation bias interactions were found in models using both caregiver- and adolescent-reported CDS symptoms in relation to caregiver-reported depressive symptoms (ps = .01 and .003, respectively), such that CDS was more strongly associated with depression at higher levels of interpretation bias.

CONCLUSIONS

Negative interpretation bias strengthens the association between CDS symptoms and depressive symptoms when depressive symptoms are rated by caregivers, but not by adolescents. Findings highlight the importance of multiple informants when examining CDS and internalizing symptoms, with a need for longitudinal research to examine CDS and interpretation bias in relation to the progression and maintenance of depression across adolescence.

Conduct disorder is associated with heightened action initiation and reduced learning from punishment but not reward

BACKGROUND

Theoretical and empirical accounts of conduct disorder (CD) suggest problems with reinforcement learning as well as heightened impulsivity. These two facets can manifest in similar behaviour, such as risk-taking. Computational models that can dissociate learning from impulsively initiating actions are essential for understanding the cognitive mechanisms underlying CD.

METHODS

A large, international sample of youths from 11 European countries (N = 1418, typically developing (TD) n = 742, CD n = 676) completed a learning task. We used computational modelling to disentangle reward and punishment learning from action initiation.

RESULTS

Punishment learning rates were significantly reduced in youths with CD compared to their TD peers, suggesting that they did not update their actions based on punishment outcomes as strongly. Intriguingly, those with CD also had a greater tendency to initiate actions regardless of outcomes, although their ability to learn from reward was comparable to their TD peers. We additionally observed that variability in action initiation correlated with self-reported impulsivity in youths with CD.

CONCLUSIONS

These findings provide empirical support for a reduced ability to learn from punishment in CD, while reward learning is typical. Our results also suggest that behaviours appearing superficially to reflect reward learning differences could reflect heightened impulsive action initiation instead. Such asymmetric learning from reward and punishment, with increased action initiation, could have important implications for tailoring learning-based interventions to help those with CD.

Using Machine Learning to Determine a Functional Classifier of Retaliation and Its Association With Aggression

Objective

Methods to determine integrity of integrated neural systems engaged in functional processes have proven elusive. This study sought to determine the extent to which a machine learning retaliation classifier (retaliation vs unfair offer) developed from a sample of typically developing (TD) adolescents could be applied to an independent sample of clinically concerning youth and the classifier-determined functional integrity for retaliation was associated with antisocial behavior and proactive and reactive aggression.

Method

Blood oxygen level-dependent response data were collected from 82 TD and 120 clinically concerning adolescents while they performed a retaliation task. The support vector machine algorithm was applied to the TD sample and tested on the clinically concerning sample (adolescents with externalizing and internalizing diagnoses).

Results

The support vector machine algorithm was able to distinguish the offer from the retaliation phase after training in the TD sample (accuracy = 92.48%, sensitivity = 89.47%, and specificity = 93.18%) that was comparably successful in distinguishing function in the test sample. Increasing retaliation distance from the hyperplane was associated with decreasing conduct problems and proactive aggression.

Conclusion

The current study provides preliminary data of the importance of a retaliation endophenotype whose functional integrity is associated with reported levels of conduct problems and proactive aggression.

Diversity & Inclusion Statement

We worked to ensure sex and gender balance in the recruitment of human participants. We worked to ensure race, ethnic, and/or other types of diversity in the recruitment of human participants. We worked to ensure that the study questionnaires were prepared in an inclusive way. We worked to ensure sex balance in the selection of non-human subjects. We worked to ensure diversity in experimental samples through the selection of the cell lines. We worked to ensure diversity in experimental samples through the selection of the genomic datasets. Diverse cell lines and/or genomic datasets were not available. 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. 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. While citing references scientifically relevant for this work, we also actively worked to promote sex and gender balance in our reference list. While citing references scientifically relevant for this work, we also actively worked to promote inclusion of historically underrepresented racial and/or ethnic groups in science in our reference list. The author list of this paper includes contributors from the location and/or community where the research was conducted who participated in the data collection, design, analysis, and/or interpretation of the work.

Intrinsic functional brain connectivity in adolescent anxiety: Associations with behavioral phenotypes and cross-syndrome network features

BACKGROUND

Considerable research has mapped the human brain networks implicated in anxiety. Yet, less is known about the intrinsic features of the brain implicated in adolescent anxiety and their generalizability to affective and behavioral problems. To this end, we investigated the intrinsic functional connectomes associated with anxiety, their associations with behavioral phenotypes of clinical interest, and the cross-syndrome overlap between the anxiety network and other affective syndromes in an adolescent sample.

METHODS

We used the Boston Adolescent Neuroimaging of Depression and Anxiety (BANDA) dataset which comprises 203 clinical and healthy adolescents aged 14-17. Participants underwent a resting-state magnetic resonance imaging scan and completed the Child Behavior Checklist (CBCL) and Behavioral Inhibition/Activation System scale. Using network-based statistics, we identified functional networks associated with anxiety and other behavioral syndromes. The anxiety network strengths were then correlated with behavioral measures.

RESULTS

A significant resting-state functional network associated with anxiety was identified, largely characterized by hyperconnectivity between the somatomotor and both the default mode network and subcortical regions. Network strengths derived from the anxiety network were significantly correlated to various behavioral syndromes, including internalizing and externalizing tendencies. Cross-syndrome overlapping edges were also observed in networks of internalizing disorders, more prominently post-traumatic stress syndromes.

CONCLUSIONS

Our results revealed the functional connectomes characteristic of anxiety in adolescents. This resting-state functional network was also predictive of and shared similar features with behavioral syndromes typically associated with anxiety-related disorders, providing evidence that the high comorbidity of anxiety with other clinical conditions may have a neurobiological basis.

The Go/No-Go P3 and Depressive Symptoms in Adolescents: Trial-Level Change and Mean Amplitude Relate Differently to Anhedonic Versus Negative Mood Symptoms

Prior studies have found an association between reduced P3 brain responses-a neural marker of task engagement-and increased depressive symptoms during adolescence. However, it is unclear whether P3 correlates with depression globally, or with certain facets. Existing depression studies have also typically quantified P3 as a cross-trial average, neglecting possible trial-by-trial effects. Among 72 adolescents (44% female), the current study evaluated relations of distinct depression symptom facets-anhedonia and negative mood-with P3s from a three-stimulus go/no-go task, quantified both in average- and trial-level terms. Although no relationship was evident between overall depressive symptoms and average P3 amplitudes, opposing relations were found for each symptom facet with P3 to frequent and infrequent 'go' stimuli: higher anhedonia predicted smaller P3, whereas increased negative mood predicted larger P3. Single-trial, multilevel modeling analyses clarified these effects by showing reduced P3 across stimuli types at task outset, along with greater trial-to-trial attenuation of P3 to infrequent-go stimuli, for adolescents experiencing greater anhedonia. Conversely, increased negative mood was distinctly related to larger P3 at task onset but was unrelated to amplitude change across trials. Results demonstrate differential relations for anhedonic and negative mood symptoms with P3-indicative of task disengagement versus heightened vigilance, respectively-that may be obscured in analyses focusing on overall depressive symptoms. The divergent associations for anhedonia and negative mood with P3 underscore the need to consider these distinct symptom facets in research aimed at clarifying the nature of neural-circuitry dysfunction in depression.

Exploring the associations between the presence, characteristics, and biopsychosocial covariates of pain and lifetime depression in adolescents: A cross-sectional ABCD study analysis

INTRODUCTION

Depression and pain co-occur, even during adolescence. However, there is limited knowledge on the association between pain and lifetime depression, and which biopsychosocial measures are associated with this co-occurrence.

METHODS

Cross-sectional analysis of the Adolescent Brain and Cognitive Development (ABCD) two-year follow-up. We explored associations between the presence and characteristics of past month pain (intensity, duration, activity limitations, and number of pain sites) and lifetime depression using logistic regression. We explored associations of brain structure, physical, behavioural, emotional, social, and cognitive measures with lifetime depression and past month pain compared to having had one or neither condition using multinomial logistic regression.

RESULTS

A total of 5211 adolescents (mean age = 12.0 years) who had: (1) no lifetime mental ill-health and no pain (n = 3327); (2) pain only (n = 1407); (3) lifetime depressive disorder but no pain (n = 272); and (4) lifetime depressive disorder and pain (n = 205) were included. Pain presence was associated with lifetime depression (OR[95%CI]: 1.76 [1.45, 2.13], p < 0.001). Pain-related activity limitations (1.13 [1.06, 1.21], p < 0.001) and the number of pain sites (1.06 [1.02, 1.09], p < 0.001) were associated with lifetime depression. Various behavioural, emotional, social, and cognitive, but not brain structure or physical measures, were associated with lifetime depression and past month pain.

LIMITATIONS

Longitudinal analyses should validate prognostic markers for predicting co-occurring depression and pain.

CONCLUSIONS

Results support an association between the presence and characteristics of pain and lifetime depression during adolescence and could indicate the need for more integrated recognition and clinical care of youth experiencing both depression and pain.

Anxiety Symptoms Predict Subsequent Depressive Symptoms in Neurodivergent Youth: A 10-Year Longitudinal Study

Neurodivergent youth often experience anxiety and depressive symptoms that may hamper adaptive functioning and well-being. There is little knowledge of how anxiety and depression are related in neurodivergent youth. Therefore, we aimed to examine whether the relationship between anxiety and depressive symptoms is uni- or bidirectional in neurodiverse youth. We assessed self-reported anxiety and depressive symptoms over time in 173 youth (Mbaseline age = 11.7 years, SD = 2.1, 64% males, 36% females). The sample comprised 38 autistic youth, 85 youth diagnosed with attention-deficit/hyperactivity disorder (ADHD), and 50 comparison youth assessed at baseline (T1), 2-year follow-up (T2, 97% retention), and 10-year follow-up (T3, 73% retention). We used cross-lagged models to analyze the data. In neurodivergent youth, more anxiety symptoms at T1 and T2 predicted more depressive symptoms at T2 and T3. Preceding anxiety symptoms were linked with later depressive symptoms, even after accounting for autoregressive effects of depressive symptoms. The results are consistent with a prodromal model in which anxiety symptoms can independently foreshadow the emergence of depressive symptoms over the course of development among neurodivergent youth. Potentially, addressing anxiety symptoms among youth with autism or ADHD could play a role in preventing the onset of youth depression.

Predictive Validity of the K-CAT-SS in High-Risk Adolescents and Young Adults

OBJECTIVE

Suicide is a leading cause of death in adolescents and young adults and has increased substantially in the past 15 years. Accurate suicide risk stratification based on rapid screening can help reverse these trends. This study aimed to assess the ability of the Kiddie Computerized Adaptive Test Suicide Scale (K-CAT-SS), a brief computerized adaptive test of suicidality, to predict suicide attempts (SAs) in high-risk youth.

METHOD

A total of 652 participants (age range, 12-24 years), 78% of whom presented with suicidal ideation or behavior, were recruited within 1 month of mental health care contact. The K-CAT-SS, scaled from 0 to 100, was administered at baseline, and participants were assessed at about 1, 3, and 6 months after intake. Weekly incidence of SAs was assessed using the Adolescent Longitudinal Interval Follow-up Evaluation and Columbia-Suicide Severity Rating Scale. A secondary outcome was suicidal behavior, including aborted, interrupted, and actual SAs.

RESULTS

The K-CAT-SS showed a 4.91-fold increase in SAs for every 25-point increase in the baseline score (95% CI 2.83-8.52) and a 3.51-fold increase in suicidal behaviors (95% CI 2.32-5.30). These relations persisted following adjustment for prior attempts; demographic variables including age, sex, gender identity, sexual orientation, and race/ethnicity; and other measures of psychopathology. No moderating effects were identified. At 3 months, area under the receiver operating characteristic curve was 0.83 (95% CI 0.72-0.93) for 1 or more SAs.

CONCLUSION

The K-CAT-SS is an excellent tool for suicide risk stratification, particularly in higher-risk populations where other measures have shown lower predictive validity.

PLAIN LANGUAGE SUMMARY

We studied the ability of the Kiddie Computerized Adaptive Test Suicide Scale (K-CAT-SS), a brief computerized adaptive test of suicidality, to predict suicide attempts (SA) in high-risk youth. At total of 652 participants aged 12 to 24, 78% of whom presented with suicidal ideation or behavior, were recruited within one month of mental health contact. In follow-up that averaged 7 months following baseline, there was a 5-fold increase in suicide attempts and 3.5-fold increase in suicidal behaviors for every 25-point change in the baseline K-CAT-SS score (100-point scale), which persisted after adjusting for demographic covariates. The K-CAT-SS is an excellent tool for suicide risk stratification, particularly in higher-risk populations where other measures have shown lower predictive validity.

Real-World Social Reward Processes are Linked to Momentary Positive Affect in Adolescent Girls

Positive peer interactions are critical for adolescent development and well-being. Showing little interest in interacting socially with peers and/or extracting little reward from positive peer interactions can be markers of social anhedonia, which impacts many youths, especially girls, with social anxiety and depressive disorders. Reduced interest or reward in peer interactions may contribute to social anxiety and depression in girls through effects on positive affect (PA), though associations between social anhedonia and momentary PA have yet to be tested. The present study used ecological momentary assessment to test such associations between real-world anticipatory social reward (i.e., interest in upcoming peer events), consummatory social reward (i.e., reward extracted from positive peer interactions), and momentary PA in a sample of 129 girls (aged 11-13 years) who were oversampled for high shy/fearful temperament, a risk factor for future social anxiety and depression. Girls reported higher PA following a more socially rewarding peer interaction, and higher PA on days they reported higher anticipatory social reward. Exploratory analyses showed that these associations were specific to PA; neither anticipatory nor consummatory social reward was associated with changes in negative affect. Findings may inform the development of clinical interventions that target social anhedonia to modify PA in youth with affective disorders.

Preadolescent Suicidal Thoughts and Behaviors: An Intensive Longitudinal Study of Risk Factors

OBJECTIVE

Dramatic increases in rates of suicidal thoughts and behaviors (STBs) among youth highlight the need to pinpoint early risk factors. This study used intensive longitudinal sampling to assess what the concurrent associations were between risk factors and STB status, how proximal changes in risk factors were related to STB status, and how risk factors prospectively predicted changes in STB status in a preadolescent sample enriched for early childhood psychopathology.

METHOD

A total of 192 participants were included from the Parent-Child Interaction Therapy-Emotional Development (PCIT-ED) Study, a longitudinal study of children with and without preschool depression. Participants 7 to 12 years of age completed a diagnostic interview, followed by 12 months of intensive longitudinal sampling, assessing experiences of suicidal ideation and 11 psychosocial variables with known links to STBs in adolescents and adults. Preadolescents with STB history (high-risk) received surveys weekly, and those without STB history (lower-risk) received surveys monthly.

RESULTS

Female sex, elevated depressive symptoms, greater use of expressive suppression and rumination, emotional clarity, and perceived burdensomeness were uniquely concurrently associated with the likelihood of STB endorsement. Within the high-risk group, (1) increases in depression, expressive suppression, rumination, and perceived burdensomeness, and decreases in positive affect from weekt to weekt+1 were associated with a higher likelihood of a positive STB status at weekt+1; and (2) higher expressive suppression, perceived burdensomeness, and caregiver criticism and conflict at weekt compared to participants' mean levels prospectively predicted increases in the likelihood of a positive STB report from weekt to weekt+1.

CONCLUSION

Psychosocial factors influencing STBs in adolescents and adults also affect preadolescents in day-to-day life. Expressive suppression and perceived burdensomeness consistently emerged as novel risk indicators and potential targets for treatment. In addition, increases in depression, rumination, and caregiver criticism and conflict, as well as decreases in positive affect, might prompt heightened STB screening and assessments for preadolescents with a history of STBs.

PLAIN LANGUAGE SUMMARY

There have been large increases in rates of suicidal thoughts and behaviors (STBs) among youth, highlighting the need to identify early risk factors in preadolescents. Over one year, 192 seven- to 12-year-old Midwestern children, some of whom had a history of STBs, repeatedly reported on several risk factors and occurrence of STBs over the previous week or month. Suppressing one's emotions and feeling like a burden emerged as risk factors and predicted the increased likelihood of the emergence of STBs, suggesting these may be potential targets for treatment. Findings also suggest that increases in depression, rumination, and caregiver criticism and conflict, as well as decreases in positive emotion, should prompt STB screening and assessments for preadolescents with a history of STBs.

DIVERSITY & INCLUSION STATEMENT

We worked to ensure race, ethnic, and/or other types of diversity in the recruitment of human participants. We worked to ensure that the study questionnaires were prepared in an inclusive way. 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. While citing references scientifically relevant for this work, we also actively worked to promote sex and gender balance in our reference list.

A Systematic Review of Parental Involvement in Digital Cognitive Behavioural Therapy Interventions for Child Anxiety

Cognitive behavioural therapy (CBT) is an efficacious intervention for child anxiety that has been translated into accessible digital formats, many of which involve parents in treatment. However, the value of parental involvement in treatment is not clearly understood. This systematic review examined characteristics of parental involvement (i.e., format and content of sessions, level of therapist guidance, and parent session compliance) in digital CBT for child anxiety (mean child age ≤ 12 years) and their relation to child outcomes (primary disorder remission, clinician-, parent-, and child-rated anxiety, and global functioning). Systematic searches in CINAHL, Embase, ERIC, PsychINFO, PubMed, and Scopus up to 14th August 2023, and citation searching, identified 27 articles (as 23 studies) assessing 14 interventions. Two were parent-only programmes for 3-6-year-old children, with the remaining being parent-child programmes targeting older children. Parents were actively involved as coaches/collaborators, assisting their children with anxiety management and exposure, and less often as co-clients working on their own difficulties. Benefits of treatment were observed across interventions, except for one, psychoeducation-based programme. Higher remission rates were more frequently observed in interventions delivered in controlled settings, those with fewer parent-only sessions, or those incorporating more parent- or therapist-led exposure sessions. Most studies were conducted with affluent samples, limiting generalisability, and several received a high risk of bias rating. Future research should examine parent and family related mechanisms of change and modify interventions for improved adherence, such as restricting the number of modules parents are required to complete and teaching key therapeutic strategies such as exposure early in the programme.

Alterations of subcortical structural volume in pediatric bipolar disorder patients with and without psychotic symptoms

BACKGROUND

Pediatric bipolar disorder (PBD) with psychotic symptoms may predict more severe impairment in social functioning, but the underlying biological mechanisms remain unclear. The aim of this study was to investigate alterations in subcortical structural volume in PBD with and without psychotic symptoms.

METHODS

We recruited 24 psychotic PBD (P-PBD) patients, 24 non-psychotic PBD (NP-PBD) patients, and 18 healthy controls (HCs). All participants underwent scanning with a 3.0 T Siemens Trio scanner. The FreeSurfer 7.4.0 software was employed to calculate the volume of each subcortical structure. An analysis of covariance (ANCOVA) was performed to identify brain regions with significant volume differences among the three groups, and then the inter-group comparisons were calculated. Partial correlation analyses were conducted to identify relationships between subcortical structural volumes and clinical features. Finally, receiver operating characteristic curve (ROC) analysis was employed to verify the capacity to distinguish between P-PBD and NP-PBD, P-PBD and HCs, and NP-PBD and HCs.

RESULTS

ANCOVA revealed significant differences in the volumes of bilateral lateral ventricles, third ventricle, left thalamus, and right pallidum among three groups. Compared with HC, the third ventricle volume was increased in both groups of PBD patients, whereas the left thalamus and right pallidum volumes were decreased, and the bilateral lateral ventricles were enlarged in P-PBD patients. In contrast, only the third ventricle showed further enlargement in the group of P-PBD patients compared with NP-PBD patients. Partial correlation analyses revealed that episode times were associated with the third ventricle volume in P-PBD patients. Furthermore, ROC analyses indicated that volume in the left lateral ventricle exhibited the greatest capacity to distinguish between the P-PBD and NP-PBD, and the third ventricle performed best in distinguishing both the P-PBD group from HCs and the NP-PBD group from HCs. The combined metrics demonstrated greater diagnostic value in two-by-two comparisons.

CONCLUSION

Current research suggests that PBD with psychotic symptoms may have more extensive lateral and third ventricular volume enlargement. Bilateral lateral ventricles may serve as potential neurobiomarkers to distinguish P- PBD patients from NP-PBD patients.

Pediatric Bipolar Disorder: Challenges in Diagnosis and Treatment

Despite an opportunity to prevent adult psychopathology associated with bipolar disorder through early diagnosis in children, there is insufficient information and awareness among healthcare providers about the unique features and treatment of mania and its comorbid conditions in children. Converging evidence from disparate sites describe a developmentally distinct presentation of bipolar disorder in youth that is highly morbid, persistent and responds to treatment with the mood stabilizer medications used in the treatment of adult bipolar disorder, such as divalproex sodium and carbamazepine. Some are additionally approved for use in pediatric populations including, for manic or mixed states, risperidone, aripiprazole, and asenapine for those aged 10-17 years and also including lithium and olanzapine for ages 13-17 years. Quetiapine is approved as monotherapy or as adjunct to lithium or divalproex sodium for manic states in those aged 10-17 years. Delayed or missed diagnosis, inappropriate treatment, worsening course, and treatment resistance unfortunately still occur. While an array of mood-stabilizing medications is available for treatment, such as second-generation antipsychotics, lithium, and anticonvulsants, these can be only partially effective and fraught with annoying and serious side effects. This article will review current practice in the diagnosis and treatment of pediatric bipolar disorder and its comorbid conditions, highlighting areas of need for future research.

Sleep disturbances in autistic youth with and without bipolar disorder: A matched case-control study

BACKGROUND

Sleep disturbances are common in individuals with autism spectrum disorder (ASD) or bipolar disorder (BD). However, to the best of our knowledge, there has been no study investigating prevalence and features of sleep disorders in youth with ASD with and without comorbid BD. The aim of this case-controlled study was to investigate sleep disturbances in autistic youth with and without comorbid BD.

METHODS

The study included 43 individuals with both ASD and BD as the case group, and 43 age and gender-matched participants with ASD but no mood disorders as the control group. Both groups were assessed using the Sleep Disturbance Scale for Children (SDSC), the Childhood Autism Rating Scale (CARS), and the Aberrant Behavior Checklist (ABC).

RESULTS

The case group exhibited significantly higher levels of sleep breathing disorders, disorders of arousal, disorders of excessive somnolence, and sleep hyperhidrosis on the SDSC compared to the control group (p < 0.05). Partial correlation analysis revealed a significant association between total SDSC scores and total ABC scores in the case and control groups (r = 0.424, p = 0.005; r = 0.629, p < 0.001, respectively) CONCLUSIONS: Sleep disturbances are common in youth with ASD with further increased rates in the presence of comorbid BD. Sleep disturbances are also associated with more behavioral problems among youth with ASD regardless of comorbid BD diagnosis. Clinicians working with youth with ASD should routinely assess sleep habits and related problems and should give particular attention in the presence of comorbid mood disorders. This study highlights the importance of recognizing and managing sleep disturbances in this unique population.

A western dietary pattern during pregnancy is associated with neurodevelopmental disorders in childhood and adolescence

Despite the high prevalence of neurodevelopmental disorders, the influence of maternal diet during pregnancy on child neurodevelopment remains understudied. Here we show that a western dietary pattern during pregnancy is associated with child neurodevelopmental disorders. We analyse self-reported maternal dietary patterns at 24 weeks of pregnancy and clinically evaluated neurodevelopmental disorders at 10 years of age in the COPSAC2010 cohort (n = 508). We find significant associations with attention-deficit hyperactivity disorder (ADHD) and autism diagnoses. We validate the ADHD findings in three large, independent mother-child cohorts (n = 59,725, n = 656 and n = 348) through self-reported dietary modelling, maternal blood metabolomics and foetal blood metabolomics. Metabolome analyses identify 15 mediating metabolites in pregnancy that improve ADHD prediction. Longitudinal blood metabolome analyses, incorporating five time points per cohort in two independent cohorts, reveal that associations between western dietary pattern metabolite scores and neurodevelopmental outcomes are consistently significant in early-mid-pregnancy. These findings highlight the potential for targeted prenatal dietary interventions to prevent neurodevelopmental disorders and emphasise the importance of early intervention.

Rumination induction task in fMRI: Effects of rumination focused cognitive behavioral therapy and stability in youth

BACKGROUND

Rumination is implicated in the onset and maintenance of major depressive disorder (MDD). Rumination-Focused Cognitive Behavioral Therapy (RF-CBT) effectively targets rumination and may change resting-state brain connectivity and change in activation during a rumination induction task (RIT) post-intervention predicts depressive symptoms two years later. We examined brain activation changes during an RIT in adolescents with remitted MDD following RF-CBT and evaluated RIT reliability (or stability) during treatment as usual (TAU).

METHOD

Fifty-five adolescents ages 14-17 completed an RIT at baseline, were randomized to 10-14 sessions of RF-CBT (n = 30) or treatment as usual (n = 25) and completed an RIT at post-treatment or equivalent time delay. The RIT includes recalling negative memories (Rumination Instruction), dwelling on their meaning/consequences (Rumination Prompt), and imagining unrelated scenes and objects (Distraction). We assessed activation change in the RF-CBT group using paired-samples t-tests. We assessed reliability (or stability) via intraclass correlation coefficients (ICCs) of five rumination-related ROIs for TAU and RF-CBT separately across task blocks.

RESULTS

Following treatment, participants receiving RF-CBT demonstrated increased activation of left precuneus during Rumination Instruction and of left angular and superior temporal gyri during Rumination Prompt blocks (p < .01). From baseline to post-treatment, across most ROIs and task blocks, the RF-CBT group demonstrated poor stability (M = 0.21, range = -0.19-0.69), while the TAU group demonstrated fair-to-excellent stability (M = 0.52, range = 0.27-0.86).

CONCLUSION

RF-CBT changes activation of rumination-related circuitry during state-induced rumination, offering exciting avenues for future interventions. The RIT has fair-to-excellent stability among individuals not explicitly treated for rumination, and as expected, RIT stability is disrupted by RF-CBT.

Applying machine learning to ecological momentary assessment data to identify predictors of loss-of-control eating and overeating severity in adolescents: A preliminary investigation

OBJECTIVE

Several factors (e.g., interpersonal stress, affect) predict loss-of-control (LOC) eating and overeating in adolescents, but most past research has tested predictors separately. We applied machine learning to simultaneously evaluate multiple possible predictors of LOC-eating and overeating severity in pooled and person-specific models.

METHOD

Twenty-eight adolescents (78.57% female, age = 15.87 ± 1.59 years, BMI %ile = 92.71 ± 8.86) who endorsed ≥ two past-month LOC-eating episodes completed a week-long ecological momentary assessment protocol. Pooled models were fit to the aggregated data with elastic-net regularized regression and evaluated using nested cross-validation. Person-specific models were fit and evaluated as proof-of-concept.

RESULTS

Across adolescents, the median out-of-sample R2 of the pooled LOC-eating severity model was .33. The top predictors were between-subjects food craving, sadness, interpersonal conflict, shame, distress, stress (inverse association), and anger (inverse association), and within- and between-subjects wishing relationships were better. The median out-of-sample R2 for pooled overeating severity model was .20. The top predictors were between-person food craving, loneliness, mixed race, and feeling rejected (inverse association), and within-subjects guilt, nervousness, wishing for more friends (inverse association), and feeling scared, annoyed, and rejected (all inverse associations). Person-specific models demonstrated poor fit (median LOC-eating severity R2 = .003, median overeating R2 = -.009); 61% and 36% of adolescents' models performed better than chance for LOC-eating and overeating severity, respectively.

DISCUSSION

Altogether, group-level models may hold utility in predicting LOC-eating and overeating severity, but model performance for person-specific models is variable, and additional research with larger samples over an extended assessment period is needed. Ultimately, a mix of these approaches may improve the identification of momentary predictors of LOC eating and overeating, providing novel and personalized opportunities for intervention.

A Calibrated Sensitivity Analysis for Weighted Causal Decompositions

Disparities in health or well-being experienced by minority groups can be difficult to study using the traditional exposure-outcome paradigm in causal inference, since potential outcomes in variables such as race or sexual minority status are challenging to interpret. Causal decomposition analysis addresses this gap by positing causal effects on disparities under interventions to other intervenable exposures that may play a mediating role in the disparity. While invoking weaker assumptions than causal mediation approaches, decomposition analyses are often conducted in observational settings and require uncheckable assumptions that eliminate unmeasured confounders. Leveraging the marginal sensitivity model, we develop a sensitivity analysis for weighted causal decomposition estimators and use the percentile bootstrap to construct valid confidence intervals for causal effects on disparities. We also propose a two-parameter reformulation that enhances interpretability and facilitates an intuitive understanding of the plausibility of unmeasured confounders and their effects. We illustrate our framework on a study examining the effect of parental support on disparities in suicidal ideation among sexual minority youth. We find that the effect is small and sensitive to unmeasured confounding, suggesting that further screening studies are needed to identify mitigating interventions in this vulnerable population.

Narrative enhancement and cognitive therapy for self-stigma among youth with bipolar disorder or multiple mental health conditions: protocol for a pilot randomised basket trial

INTRODUCTION

Self-stigma occurs when individuals internalise negative stereotypes about their mental health conditions. Self-stigma is common among those with serious mental illnesses, including youth, and is considered a major barrier to recovery through its impact on hope, self-esteem and self-identity. This patient-oriented protocol aims to assess the feasibility of conducting a future full-scale randomised controlled trial (RCT) of a youth-oriented adaptation of narrative enhancement and cognitive therapy for self-stigma among youth (NECT-Y).

METHODS AND ANALYSIS

This is a two-site, two-arm pilot basket RCT with 1:1 randomisation to NECT-Y or treatment as usual (TAU). Participants are youth, ages 16-29 diagnosed with bipolar disorder, any subtype (Basket 1) or with any two or more mental health conditions (Basket 2). After informed consent, we will conduct baseline assessments and randomisation, then either a 14-week NECT-Y group intervention or TAU. Diagnostic interviews will be used to confirm diagnosis at baseline. A range of self-report questionnaires will be administered at baseline, post-treatment and 3 month follow-up. The primary outcome is feasibility as indicated by the achievement of recruitment goals, retention and adherence, intervention fidelity and the absence of serious adverse events. Secondary outcomes include acceptability and the intervention's impact on self-stigma, wellness, symptomatology, treatment-seeking attitudes and other related constructs. A youth advisory group is informing all stages of the study process.

ETHICS AND DISSEMINATION

The Research Ethics Board for Centre for Addiction and Mental Health (#062/2024) has approved this study protocol. Ethics is also approved at London Health Sciences Centre (Western Health Sciences Research Ethics Board (HSREB) #125812). Results will be published in international peer-reviewed journals and presented at relevant conferences. Summaries will be provided to the funders of the study, as well as to lay audiences, including study participants.

TRIAL REGISTRATION NUMBER

NCT06672562.

Treatment adherence, therapeutic alliance, and clinical outcomes during an exposure-based cognitive-behavioral therapy for pediatric irritability

BACKGROUND

This study explores changes in treatment adherence and alliance during a novel parent- and child-psychotherapy for pediatric irritability. Associations between in-session therapeutic processes and symptom change were examined.

METHODS

Forty participants (Mean age = 11.23, SD = 1.85; 37.5% female, 77.5% white) with severe irritability, and their parents, received 12 sessions of exposure-based cognitive behavioral therapy (CBT) with parent management training (PMT). Measures included clinician-rated adherence to the manual, alliance scales (Alliance Scale for Children-revised; TASC-r, and Working Alliance Inventory; WAI, respectively), and clinician-, parent- and child-reported irritability scales (Affective Reactivity Index; ARI). Linear mixed models examined session-by-session changes and associations between adherence/alliance and subsequent irritability, and vice versa.

RESULTS

First, adherence to standard treatment elements decreased over time (Bs ≥ - 0.03, ps ≤ 0.010), while the focus on specific treatment components increased (i.e., exposure: B = 0.15, p = 0.001; PMT: B = 0.07, p = 0.002). Second, adherence to standard treatment elements were associated with decreased clinician-reported irritability (Bs ≥ - 2.23, p ≤ 0.042). For the alliance measures, parent-reported alliance increased over time (Bs ≥ 0.10, p ≤ 0.01); child-reported alliance did not change. Bidirectional associations were found between alliance and symptoms; specifically, child-reported alliance predicted clinician-rated irritability at next session (Bs ≥ - 0.66, p ≤ 0.053), and decreases in clinician- (Bs ≥ - 0.02, ps ≤ 0.043) and parent- (B = - 0.15, p = 0.024) reported irritability predicted increased alliance at next session.

CONCLUSIONS

Findings underscore the predictive role of treatment adherence and therapeutic alliance on outcomes, in exposure-based CBT for pediatric irritability.

TRIAL REGISTRATION

ClinicalTrials.gov identifier: NCT02531893; date of registration: 25/08/2015.

Cognitive Aspects of Generalised Anxiety Disorder in Adolescents: Exploring Intolerance of Uncertainty, Cognitive Avoidance, and Positive Beliefs About Worry

Intolerance of uncertainty, cognitive avoidance, and positive beliefs about worry have been well researched in adults with Generalised Anxiety Disorder (GAD), but few studies have explored these aspects in adolescent clinical samples. To address this gap, we compared the three cognitive variables amongst 12-18 year-olds with diagnoses of GAD (n = 46), those with other anxiety disorders (n = 18), and a group with low self-reported anxiety (n = 38). Adolescents with GAD reported significantly higher intolerance of uncertainty and positive beliefs about worry relative to their peers with other anxiety diagnoses, whilst levels of cognitive avoidance did not differ significantly. Intolerance of uncertainty and cognitive avoidance, but not positive beliefs about worry, were significantly higher amongst young people with GAD compared to the non-anxious community group. This novel study provides preliminary evidence for the relevance and specificity of intolerance of uncertainty to the maintenance of GAD in adolescence.

Interoceptive Exposure Impacts Food-Cue Extinction in Adolescents With Low-Weight Eating Disorders: A Functional Magnetic Resonance Imaging Study

OBJECTIVE

This randomized controlled study tested the effect of interoceptive exposure on anterior insula function and connectivity for the extinction of palatable and rotten food-cue associations in adolescent girls with low weight eating disorders (LWED).

METHOD

A food-related conditioning paradigm was performed by 39 adolescent girls with LWED and 19 matched controls during functional magnetic resonance imaging (fMRI). Adolescents with LWED were then randomized to 6 sessions of either interoceptive exposure (n = 18) or family-based (n = 21) treatment, followed by a second functional magnetic resonance imaging scan. Whole-brain activation and insula-driven connectivity for the extinction of palatable and rotten food-cue associations were compared between groups, and changes over treatment were compared between the 2 therapies.

RESULTS

Adolescents with LWED exhibited diminished bilateral anterior insula activation for the extinction of palatable food-cue associations compared with controls (t1,55 = 3.9-4.1, p < .001; Hedges g = 0.47-0.55). Brief interoceptive exposure treatment increased left anterior insula activation for the extinction of palatable food-cue associations (t1,37 = 5.10, p < .001; Hedges g = 1.59) and nonsignificantly improved palatability ratings for these associations during extinction compared with family-based treatment (β = -1.492, p = .087). There were no effects of group or therapy on connectivity or activation for rotten food-cue associations.

CONCLUSION

These results suggest that targeting food avoidance in adolescent girls with LWED using interoceptive exposure engages anterior insula regions that mediate the visceral sensation of disgust and may underlie the resistance to extinction. The findings present a window into possible pathophysiological mechanisms of anorexia nervosa and other LWED.

Functional network disruptions in youth with concussion using the Adolescent Brain Cognitive Development study

OBJECTIVE

This study aimed to compare psychosocial outcomes and functional neuroimaging among youth with concussion, youth with anxiety, and age- and sex-matched controls.

METHODS

Using archival data from the Adolescent Brain Cognitive DevelopmentSM Study, we analyzed between-group differences in psychosocial outcomes measured by the Child Behavior Checklist's internalizing and externalizing problem scales, and assessed brain function using resting-state fMRI network-region connectivity (specifically frontoparietal network (FPN) and default mode network (DMN) connectivity with the amygdala).

RESULTS

Significant differences in psychosocial outcomes were found across all groups, with the anxiety group reporting the most internalizing problems, followed by the concussion group which significantly differed from controls. Additionally, FPN-amygdala connectivity was significantly reduced in the concussion group only; this reduced connectivity did not predict psychosocial outcomes across groups.

CONCLUSION

This study provided preliminary findings that brain connectivity is reduced exclusively in individuals with concussion. Although disruptions were observed in the concussion group, further investigation is warranted to understand how disruptions may be associated with concussion symptoms. Studies that utilize well-defined control and study groups, and comprehensive cognitive and mental health measures will offer a deeper understanding of the relationship between brain function and psychosocial outcomes.

Independent and joint effects of genomic and exposomic loads for schizophrenia on psychotic experiences in adolescents of European ancestry

This study aimed to assess the independent and joint associations of genomic and exposomic liabilities for schizophrenia with distressing psychotic experiences (PEs) and their persistence in early adolescence. The Adolescent Brain and Cognitive Development Study data from children with European ancestry were used (N = 5122). The primary outcome was past-month distressing PEs at the 3-year follow-up. Secondary outcomes were distressing PEs at varying cutoffs of persistence. Multilevel logistic regression models were used to test the associations of binary modes (>75th percentile) of polygenic risk score for schizophrenia (PRS-SCZ75) and exposome score for schizophrenia (ES-SCZ75) on the outcomes. Relative excess risk due to interaction (RERI) calculation indicated additive interaction. When analyzed independently, PRS-SCZ75 was not significantly associated with past-month distressing PEs but with lifetime (OR 1.29 [95% CI 1.08, 1.53]) and repeating distressing PEs ≥2 waves (OR 1.34 [95% CI 1.08, 1.65]); whereas, ES-SCZ75 was consistently associated with all outcomes, with increasing strength of association as a function of PEs persistence (one wave: OR 2.77 [95% CI 2.31, 3.31]; two waves: OR 3.16 [95% CI 2.54, 3.93]; three waves: OR 3.93 [95% CI 2.86, 5.40]; four waves: OR 3.65 [95% CI 2.34, 5.70]). When considered jointly, ES-SCZ75 and PRS-SCZ75 did not additively interact to predict past-month distressing PEs but showed significant additive interactions for lifetime (RERI = 1.26 [95%CI 0.14, 2.38]) and repeating distressing PEs ≥2 waves (RERI = 1.79 [95%CI 0.35, 3.23]). Genomic and exposomic liabilities for schizophrenia were independently and jointly associated with distressing PEs and their persistence in early adolescence.

Resting-State Cortical Network and Subcortical Hyperconnectivity in Youth With Generalized Anxiety Disorder in the ABCD Study

BACKGROUND

Generalized anxiety disorder (GAD) frequently emerges during childhood or adolescence, yet few studies have examined functional connectivity differences in youth with GAD. Functional magnetic resonance imaging (fMRI) studies of adults with GAD have implicated multiple brain regions; however, frequent examination of individual brain seed regions and/or networks has limited a holistic view of GAD-associated differences. The current study therefore used resting-state fMRI data from the Adolescent Brain Cognitive Development (ABCD) Study to investigate connectivity in youths with GAD across multiple cortical networks and subcortical regions implicated in adult GAD, considering diagnosis changes across 2 assessment periods.

METHODS

In 164 youths with GAD and 3158 healthy control participants, within- and between-network connectivity for 6 cortical networks and 6 subcortical regions was assessed using linear mixed-effect models. Changes in GAD-associated connectivity between baseline and 2-year follow-up were then compared for participants with continuous GAD, GAD at baseline and not follow-up (GAD remitters), and GAD at follow-up and not baseline (GAD converters) versus control participants.

RESULTS

Youths with GAD showed greater within-ventral attention network (VAN) connectivity and hyperconnectivity between the amygdala and cingulo-opercular network and between striatal regions and the cingulo-opercular, default mode, and salience networks (false discovery rate p < .05). Within-VAN connectivity decreased for GAD remitters between baseline and follow-up. Sensitivity analyses revealed that these hyperconnectivity patterns were not observed in youths with major depressive disorder (n = 19), separation anxiety (n = 33), or social anxiety disorder (n = 111) who did not have GAD.

CONCLUSIONS

Results indicate that GAD in childhood and adolescence is associated with altered subcortical to cortical network connectivity and that within-VAN hyperconnectivity, in particular, is associated with clinically significant GAD-specific symptoms.

Impact of Relapse in BDNF Receptors Expression in Patients With a First Episode of Schizophrenia

BACKGROUND AND HYPOTHESIS

Relapsing after a first episode of schizophrenia (FES) is a main predictor of clinical and functional prognosis. Brain-derived neurotrophic factor (BDNF) plays a critical role in neuronal development and plasticity, and its signaling may be altered by successive relapses.

DESIGN

We assessed the impact of first relapse in the expression of the 2 isoforms of the BDNF tropomyosin-related kinase B (TrkB) receptor (active full-length TrkB-F and inactive truncated TrkB-T) in peripheral blood mononuclear cells from 53 FES patients in clinical remission followed up for 3 years.

RESULTS

The group of participants that relapsed (n = 24) during the follow-up presented a significant decrease in the expression of the active TrkB-F receptor compared to baseline (M = 100 ± 28.13 vs. M = 83.42 ± 33.84, t = 2.5, P = .02), with no changes in the inactive TrkB-T receptor expression nor in BDNF plasma levels. This decrease also led to a significant decline in the F/T ratio (M = 1.13 ± 0.38 vs. 0.94 ± 0.36, t = 2.17, P = .041). No significant differences were found in the receptors' expression nor in plasma levels in the group of cases that remained in remission (n = 29). These results were not associated with baseline differences between the groups in terms of the BDNF signaling pathway biomarkers, clinical or treatment variables.

CONCLUSIONS

These findings highlight the biological impact that a relapse produces over the systemic BDNF-TrkB signaling pathway, potentially undermining crucial neuronal functions. Identifying the actors involved can help design specific interventions for relapse prevention and improve the functional prognosis of people in the early stages of schizophrenia.

Transcriptional evidence of HPA axis dysregulation in adolescent females: Unique contributions of chronic early-life stressor exposure and maternal depression history

BACKGROUND

Depression risk increases dramatically for adolescent females following the pubertal transition. Although chronic early-life stressor exposure and a maternal history of depression are established risk factors for depression onset in this population, we know little about the biological mechanisms underlying these associations.

METHOD

To investigate, we examined how chronic early-life stressor exposure and maternal depression history were associated with stress-related gene expression patterns, using a high-risk family design in 48 psychiatrically healthy adolescent females, 20 of whom had a mother with a lifetime history of depression. Lifetime chronic stressor exposure was assessed using the STRAIN and gene expression patterns were estimated using transcriptional profiling of whole blood.

RESULTS

Consistent with hypotheses, we found that adolescent females with greater chronic stressor exposure had higher NR3C1 expression levels compared to those with less chronic stressor exposure. Additionally, youth with a depressed mother had lower levels of FKBP5 expression compared to those without a depressed mother. Levels of FKBP5 expression, in turn, interacted with chronic stressor exposure to predict NR3C1 expression. Specifically, for those with low chronic stressor exposure, levels of FKBP5 and NR3C1 expression were strongly interrelated, whereas for those with high chronic stressor exposure, NR3C1 expression was high regardless of levels of FKBP5 expression.

LIMITATIONS

This study was correlational, the sample size was limited, and additional research is needed to elucidate the underlying mechanisms and predict who subsequently develops depression.

CONCLUSIONS

Notwithstanding these limitations, these data indicate that having low FKBP5 expression, alongside high NR3C1 expression, may be a potential preclinical marker of depression risk in adolescent females that warrants additional investigation.

Atypical attentional network dynamics in adolescent depression during emotional movie viewing

Emotion studies have commonly reported atypical emotional processing in clinically depressed adolescents in the context of short-lasting emotional cues. However, interindividual differences in the moment-to-moment brain network dynamics that underlie this impaired emotional reactivity remain unclear, and the use of poorly matched controls and relatively small sample sizes represents major limitations in most neuroimaging depression studies to date. Here, we address these concerns by using the temporal features of a rich naturalistic paradigm (i.e. a clip from the movie 'Despicable Me') to investigate brain network dynamics in 42 clinically depressed and 42 nondepressed adolescents aged 16-21 years, matched for age, gender, and psychiatric comorbidities. Using a dynamics functional connectivity analysis technique called Leading Eigenvector Dynamics Analysis, we found that the clinical group exhibited significantly higher probability of occurrence of the dorsal attention network and lower recruitment of the fronto-parietal, default mode network, ventral attention, and somato-motor networks throughout the task. This brain/behaviour relationship was prominent during less emotional moments of the movie, consistent with previous findings. Our findings demonstrate the key role of continuous affective measures in providing information about how activity in the depressed brain evolves as emotional intensity unfolds throughout the movie. Future studies with a larger sample size are needed in order to corroborate the present findings.

False Positives for Criterion A Trauma Events and Posttraumatic Stress Disorder Symptoms with Questionnaires Are Common in Children and Adolescents and Could Not be Eliminated with Enhanced Instructions

Objective: Self-report questionnaires are common for measuring posttraumatic stress disorder (PTSD). The experience of life threat-Criterion A-serves a gatekeeper function for diagnosing PTSD, and evidence suggests false positives are common on questionnaires. It remains unknown how common they are and whether extra instructions can reduce them. Methods: The present study assessed 42 youths, 10-17 years of age, from a clinic setting. Youths and parents completed regular PTSD questionnaires and then enhanced versions with more detailed instructions and examples of Criterion A and non-Criterion A events. Parents completed a semistructured interview as the verification of true versus false positives. Results: In the full sample, parents endorsed 41 and children endorsed 45 false positive events. The mean was significantly greater than zero for both parents and children. Parents endorsed 59 and children endorsed 138 false positive symptoms. When false positive events were endorsed, this was significantly associated with more false positive symptoms for both parents and children. An enhanced questionnaire failed to reduce false positive events for the full sample. Discussion: The common occurrence of false positives suggests caution is warranted when interpreting estimates from questionnaire-based research about the prevalence of PTSD. While this attempt to eliminate false positives was not fully successful, there may be other useful enhancements to consider in future research.

Machine learning reveals sex differences in distinguishing between conduct-disordered and neurotypical youth based on emotion processing dysfunction

BACKGROUND

Theoretical models of conduct disorder (CD) highlight that deficits in emotion recognition, learning, and regulation play a pivotal role in CD etiology. With CD being more prevalent in boys than girls, various theories aim to explain this sex difference. The "differential threshold" hypothesis suggests greater emotion dysfunction in conduct-disordered girls than boys, but previous research using conventional statistical analyses has failed to support this hypothesis. Here, we used novel analytic techniques such as machine learning (ML) to uncover potentially sex-specific differences in emotion dysfunction among girls and boys with CD compared to their neurotypical peers.

METHODS

Multi-site data from 542 youth with CD and 710 neurotypical controls (64% girls, 9-18 years) who completed emotion recognition, learning, and regulation tasks were analyzed using a multivariate ML classifier to distinguish between youth with CD and controls separately by sex.

RESULTS

Both female and male ML classifiers accurately predicted (above chance level) individual CD status based solely on the neurocognitive features of emotion dysfunction. Notably, the female classifier outperformed the male classifier in identifying individuals with CD. However, the classification and identification performance of both classifiers was below the clinically relevant 80% accuracy threshold (although they still provided relatively fair and realistic estimates of ~ 60% classification performance), probably due to the substantial neurocognitive heterogeneity within such a large and diverse, multi-site sample of youth with CD (and neurotypical controls).

CONCLUSIONS

These findings confirm the close association between emotion dysfunction and CD in both sexes, with a stronger association observed in affected girls, which aligns with the "differential threshold" hypothesis. However, the data also underscore the heterogeneity of CD, namely that only a subset of those affected are likely to have emotion dysfunction and that other neurocognitive domains (not tested here) probably also contribute to CD etiology.

CLINICAL TRIAL NUMBER

Not applicable.

Population-adjusted numbers, demographics and mental health among children and adolescents referred to the Norwegian National Center for Gender Incongruence over two decades

Over the last decade, there has been a sharp increase in young people seeking medical treatment for gender dysphoria/gender incongruence (GD/GI). The aims of this study were to calculate yearly population-adjusted numbers of children and adolescents referred to the Norwegian National Center for Gender Incongruence (NCGI) at Oslo University Hospital (OUS) from 2000 to 2022; to describe the demographic characteristics and prevalence of psychiatric diagnoses, self-harm and suicide attempts among the referred from 2000 to 2020; and to investigate time trends. The study used data from the Gender Incongruence Registry for Children and Adolescents (GIRCA) in Norway. All persons under 18 years (n = 1258) referred to the NCGI between 2000 and 2020 were included: 68.4% assigned female gender at birth (AFAB) and 31.6% assigned male gender at birth (AMAB). We found a sharp increase in referrals to the NCGI favouring AFAB over AMAB. Nearly two in three (64.5%) had one or more registered psychiatric diagnoses. Self-harm was registered among 35.5%, and 12.7% had attempted suicide. Registered psychiatric diagnoses were significantly (p ≤ 0.001) more prevalent among AFAB (67.8%) than AMAB (57.4%). The number of registered diagnoses per person decreased significantly over time, with an average reduction of 0.02 diagnoses per person per year. Although there was a downward time trend in registered diagnoses per person, the total mental health burden among children and adolescents with GI emphasizes the need for a holistic approach.

Optimization of self- or parent-reported psychiatric phenotypes in longitudinal studies

BACKGROUND

The Adolescent Brain Cognitive Development (ABCD) study is a longitudinal study of US adolescents with a wide breadth of psychiatric, neuroimaging and genetic data that can be leveraged to better understand psychiatric diseases. The reliability and validity of the psychiatric data collected have not yet been examined. This study aims to explore and optimize the reliability/validity of psychiatric diagnostic constructs in the ABCD study.

METHODS

Parent-and-child-reported psychiatric data for 11,876 children (aged 9.5 ± 0.5 at first assessment) were examined over 4 years to derive specific constructs for psychiatric diagnoses using longitudinal information. Rates of psychiatric disorders were calculated and compared to those reported in the epidemiological literature.

RESULTS

The rates of self-reported psychiatric disorders at any single time point (broad diagnostic construct) were higher than indicated by epidemiological studies. Narrow diagnostic constructs, which required the endorsement of psychiatric disorders at a majority of longitudinal assessments, demonstrated a better rate approximation of literature-reported prevalences for most disorders (e.g. the prevalence of broad obsessive-compulsive disorder (OCD) was 13.3% compared to narrow OCD at 2.6% and a literature-reported prevalence of 2.3%). Analysis of comorbidity, using OCD as a representative example, also showed a better approximation of literature-reported comorbidity rates using the narrow construct, with some exceptions.

CONCLUSIONS

Self- or parent-report-based assessments tend to overestimate prevalences of psychiatric disorders in the ABCD Study, particularly when longitudinal data are summed to create lifetime prevalences. Such assessments should be accompanied by more in-depth assessments or clinician-administered structured interviews if using data where accurate disorder classifications are paramount.

Emotion dysregulation in youths with obsessive-compulsive disorder and its implication for treatment - An exploratory study from the TECTO trial: A protocol and statistical analysis plan

Background

Research on improving psychotherapy for youths with obsessive-compulsive disorder (OCD), including cognitive behavioral therapy (CBT), should explore what works for whom and how by examining baseline moderators and potential mechanisms of change. Emotion dysregulation is proposed as an intermediate therapy factor in a transdiagnostic framework. This study investigates emotion dysregulation as an outcome, mechanism, and moderator of psychotherapy in youths aged 8-17 years with OCD.

Methods

Data are from a randomized clinical trial and a parallel prospective study of healthy controls. Participants with OCD (n = 130; 121 in this study) were randomized to 14 sessions of either family-based CBT with exposure and response prevention versus family-based psychoeducation and relaxation training. We will; 1) assess if emotion dysregulation, measured by the Difficulties in Emotion Regulation Scale (DERS), decreases from baseline to end-of-treatment; 2) compare the proportion of participants with normative emotion regulation to a 90% reference interval from healthy controls (n = 90); 3) use linear regression to examine if baseline emotion dysregulation moderates treatment effects measured by the Children's Yale-Brown Obsessive-Compulsive Scale; 4) investigate if changes in emotion dysregulation mediate treatment effects; and 5) investigate the stability of emotion regulation over time in the healthy controls. Analyses 1-4 will be conducted for all OCD participants and separately for the two treatment groups. Two independent investigators will perform the analyses.

Conclusion

This protocol and statistical analysis plan are presented to enhance analytical transparency and limit bias.

Seasonal mood variation in youth and young adults with bipolar spectrum disorder: A longitudinal prospective analysis

OBJECTIVE

To determine whether there are latitude and seasonal differences in the prevalence of mood episodes (depression and mania) in youth and young adults with Bipolar Spectrum Disorder (BD).

METHODS

Mood polarity was prospectively evaluated in 413 participants with BD. Participants were enrolled in the Course and Outcome of Bipolar Youth (COBY) study at three sites (University of California Los Angeles-UCLA, Brown University, and the University of Pittsburgh Medical Center-UPMC) and interviewed on average every 7 months for an average of 91.9 months (range: 6-228 months), with a total of 274,123 weekly mood ratings. Associations between light exposure and mood polarity were estimated using generalized linear mixed models with time-varying covariates, considering the latitude and seasonality of the study sites and other potential confounders.

RESULTS

Average age at intake and at last assessment was 12.6 ± 3.3 and 27.2 ± 4.8 years-old, respectively. There were significantly more depressive episodes during winter than during summer, spring, and autumn. Considering latitude, UCLA showed significantly lower prevalence of depressive episodes, and an absence of seasonal pattern of depression, compared to the Brown/UPMC sites. For the entire sample, there were more manic/hypomanic episodes during summer than during winter. However, there were no significant between site seasonal differences in the prevalence of manic/hypomanic episodes.

CONCLUSIONS

Depressive episodes are more prevalent during the winter and although less significant, manic/hypomanic episodes during the summer. Awareness and interventions to prevent or ameliorate the effects of seasonal variations in mood changes in BD are warranted.

Neurodevelopment within the first three years of life does not predict psychotic experiences at age 10: A prospective cohort study

BACKGROUND

Early childhood developmental delays and lower cognitive and motor function have been found to be related to psychotic experiences (PE) in middle childhood. These findings suggest a neurodevelopmental pathway to PE in childhood. This study examined if prospectively assessed neurodevelopment in infancy from birth to age 3 predicted PE at age 10.

METHODS

We included data from the population-based prospective longitudinal cohort COPSAC2010 (n = 700). Parents reported on children milestones starting at 1 week old, language acquisition at 1 and 2 years of age, and children were evaluated on cognition at 2.5 years and general development at 3 years. At age 10, children were clinically assessed regarding PE. We used adjusted logistic regression models to assess the association between developmental within the first years of life and later PE.

RESULTS

We evaluated 593 children at 10 years regarding PE, of which 77 (13 %) reported having experienced PE. We did not find significant associations between early life neurodevelopment and childhood PE. Analyses excluding children with neurodevelopmental diagnosis (i.e, ADHD, autism and tics) yielded similar results.

CONCLUSIONS

Delays in developmental milestones, language acquisition, and cognition during the first 3 years of life were not associated with PE in middle childhood. The findings do not support that childhood PE occurs associated with atypical early neurodevelopment. Given that we report results on one time point PE, clarification of associations with persistent PE are warranted.

Startle potentiation to unpredictable threat predicts adolescent development of generalized anxiety disorder

BACKGROUND

An elevated startle reflex in anticipation of unpredictable threat has been associated with concurrent anxiety disorders. However, only one study to date has examined whether startle potentiation in anticipation of unpredictable threat predicts the development of anxiety disorders.

METHOD

In a community sample of 309 adolescents, we examined whether the startle reflex in anticipation of predictable or unpredictable threat at age 15 predicted onset of generalized anxiety disorder (GAD) and social anxiety disorder (SAD) at age 18. To evaluate the specificity of these relationships, we also examined the development of depressive disorders. Startle reflex was measured using the no, predictable, and unpredictable threat task at age 15. Semi-structured diagnostic interviews were administered at both waves to assess lifetime anxiety disorders and depression.

RESULTS

Average startle reflex and startle potentiation to unpredictable, but not predictable, threat at age 15 predicted GAD at age 18, independent of lifetime GAD through age 15 and lifetime depression through age 18. Startle responses at age 15 did not predict SAD or depression at age 18.

CONCLUSIONS

The present study suggests that elevated startle potentiation in anticipation of unpredictable threat is a risk factor for the development of GAD in adolescence.

Childhood maltreatment and internalizing/externalizing disorders in trauma-exposed adolescents: Does posttraumatic stress disorder (PTSD) severity have a mediating role?

Childhood maltreatment is associated with wide-ranging psychopathology at all stages of life. In the current study, we investigated whether posttraumatic stress disorder (PTSD) severity mediated the association between childhood maltreatment and internalizing and externalizing disorders among 262 South African trauma-exposed adolescents (aged 12-18 years). Childhood maltreatment and PTSD symptom severity were assessed using the Childhood Trauma Questionnaire and the Child PTSD Checklist, respectively. Psychiatric disorders were assessed utilizing the Kiddie-Schedule for Affective Disorders and Schizophrenia-Present and Lifetime version and were grouped into internalizing or externalizing disorders. Hierarchal logistic regression was used to assess the association of childhood maltreatment subtype with internalizing and externalizing disorders, controlling for age and gender, with PTSD symptom severity added to the final model. We found that sexual abuse was significantly associated with internalizing disorders, although this effect was no longer significant when PTSD was added to the model demonstrating that PTSD mediated the association between sexual abuse and internalizing disorders. Physical abuse, but not PTSD, was associated with externalizing disorders. Physical abuse, emotional neglect, and PTSD were associated with comorbid internalizing and externalizing disorders. These findings have implications for intervention and prevention strategies targeted at trauma-exposed adolescents with a history of childhood maltreatment.

Reciprocal relations between dimensions of attention-deficit/hyperactivity and anxiety disorders from preschool age to adolescence: sex differences in a birth cohort sample

BACKGROUND

Symptoms of anxiety and attention-deficit/hyperactivity disorder (ADHD) are prospectively related from childhood to adolescence. However, whether the two dimensions of ADHD-inattention and hyperactivity-impulsivity-are differentially related to anxiety and whether there are developmental and sex/gender differences in these relations are unknown.

METHODS

Two birth cohorts of Norwegian children were assessed biennially from ages 4 to 16 (N = 1,077; 49% girls) with diagnostic parent interviews used to assess symptoms of anxiety and ADHD. Data were analyzed using a random intercept cross-lagged panel model, adjusting for all unobserved time-invariant confounding effects.

RESULTS

In girls, increased inattention, but not hyperactivity-impulsivity, predicted increased anxiety 2 years later across all time-points and increased anxiety at ages 12 and 14 predicted increased inattention but not hyperactivity-impulsivity. In boys, increased hyperactivity-impulsivity at ages 6 and 8, but not increased inattention, predicted increased anxiety 2 years later, whereas increased anxiety did not predict increased inattention or hyperactivity-impulsivity.

CONCLUSIONS

The two ADHD dimensions were differentially related to anxiety, and the relations were sex-specific. In girls, inattention may be involved in the development of anxiety throughout childhood and adolescence and anxiety may contribute to girls developing more inattention beginning in early adolescence. In boys, hyperactivity-impulsivity may be involved in the development of anxiety during the early school years. Effective treatment of inattention symptoms in girls may reduce anxiety risk at all time-points, while addressing anxiety may decrease inattention during adolescence. Similarly, treating hyperactivity-impulsivity may reduce anxiety risk in boys during late childhood (at ages 8-10).

Effect of ketamine on task-based functional magnetic resonance imaging findings in major depressive disorder: A mini-review

BACKGROUND

Over the last two decades, ketamine has gained significant interest in psychiatry as a potential treatment for major depressive disorder (MDD), especially in individuals who are resistant to traditional therapies or are at a high risk of suicide. Task-based functional magnetic resonance imaging (fMRI) studies can provide insight into how ketamine alters brain function and contributes to its antidepressant properties.

METHODS

This mini-review followed the MOOSE guidelines for systematic reviews of observational studies. We conducted a literature search in PubMed, Web of Science, and Scopus aiming at identifying fMRI studies investigating the effect of ketamine on brain function in MDD.

RESULTS

Eight articles were included in the study. Results showed that ketamine affects brain activity in MDD, especially in the anterior cingulate cortex (ACC), dorsolateral prefrontal cortex, and amygdala. Interestingly, the majority of the reviewed studies showed a correlation between the changes in brain activity induced by ketamine and improvements in clinical depressive symptoms. These correlations involved the prefrontal cortex, ACC, and cortico-cerebellar circuits.

LIMITATIONS

Lack of longitudinal data on the lasting effects of ketamine on brain activity and the small number of studies.

CONCLUSIONS

This review identifies key research areas that can enhance our understanding of ketamine's effects on the brain in MDD. It calls for studies on ketamine's mechanisms of action, long-term impact, dose-response optimization, and comparisons with other fast-acting antidepressants. Addressing these areas can optimize ketamine's therapeutic use and reveal new treatment targets.

Prevalence and associated factors of developmental coordination disorder in primary school children

Developmental coordination disorder (DCD) is one of the most frequently observed movement disorders in childhood, yet data on its prevalence are still unclear. This two-stage epidemiological study aims to determine the prevalence of DCD in children between 6 and 10 years of age according to the diagnostic criteria of the Diagnostic and Statistical Manual of Mental Disorders-5 (DSM-5). In the first stage, the Developmental Coordination Disorder Questionnaire (DCDQ'07) were given to primary school students. In the second stage, clinicians conducted psychiatric interviews with children who had an indication of DCD or were suspected of having DCD according to the DCDQ'07 and their parents. The interviews utilized the DSM-5 diagnostic criteria for DCD and applied the Schedule for Affective Disorders and Schizophrenia for School-Age Children-Present and Lifetime Version-Turkish Adaptation (K-SADS-PL) and Wechsler Intelligence Scale for Children (WISC-R) to identify co-occurring disorders. In the first stage, 2,306 children were evaluated, and 205 were invited for a clinical interview. Of the 198 children interviewed, 49 met the diagnostic criteria for DCD. The prevalence of DCD in Türkiye was found to be 2.1%. High parental education level, a previous psychiatric admission of the child, mother's postpartum depressive symptoms, co-occurring disorders, and co-occurring attention deficit hyperactivity disorder (ADHD) were significantly more common among children with DCD. Potentially associated factors were evaluated by logistic regression analysis. The mother's education level, the presence of postpartum depressive symptoms, and co-occurring disorders in the child were found to be associated factors.

Gut-derived appetite regulating hormones across the anorexia nervosa spectrum

BACKGROUND

Appetite-regulating hormones are implicated in anorexia nervosa (AN) pathophysiology, however, data are limited for appetite-regulating hormones across the AN weight spectrum. We aimed to investigate fasting and post-prandial concentrations of appetite-regulating hormones - peptide YY (PYY), cholecystokinin (CCK), and ghrelin - among adolescent and young adult females across the AN weight spectrum, specifically those with AN and Atypical AN, and healthy controls (HC).

METHODS

Participants (N = 95; ages 11-22 years) included 33 with AN, 25 with Atypical AN, and 37 HC. AN was differentiated from Atypical AN by BMI < 10th percentile for age and sex (if <18 years) or < 18.5 kg/m2(if ≥18 years). Blood samples were collected fasting and 30, 60 and 120 minutes following a standardized meal to assess total PYY, CCK, and total ghrelin concentrations.

RESULTS

Median fasting and post-prandial PYY concentrations were significantly higher in AN vs. HC with medium differences (p = .001-.006, r = .34-.43). Atypical AN had significantly higher PYY concentrations compared to HC at T-0 (p = .027, r = .29) only, and did not significantly differ from concentrations in AN (p = .105-.413, r = .11-.22). Area under the curve (AUC; p = .001; r = .41) and peak PYY concentrations (p = .003; r = .41) were also significantly higher in AN vs. HC with medium differences. There were no significant differences in fasting (p = .885) or post-prandial (p = .846-.993) CCK concentrations across groups. AN and Atypical AN each had significantly higher ghrelin concentrations than HC with small to medium effect (AN vs HC p = .004-.025, r = .27-.36; Atypical AN vs HC p = .004-.033; r = .28-.28).

CONCLUSIONS

Higher peak postprandial concentrations of anorexigenic PYY in AN (compared to HC) may facilitate dietary restriction and contribute to maintenance of lower weight. Lack of CCK suppression in AN is maladaptive in the context of undernutrition. Despite continued restriction, ghrelin is adaptively higher in AN overall and may not be differentiated by weight status.

Assessing cognitive functions in non-neuropsychiatric childhood systemic lupus erythematosus: Cross-sectional study

OBJECTIVES

Systemic Lupus Erythematosus (SLE) is an autoimmune disease characterized by multisystem, including neuropsychiatric, involvement. The nervous system is affected in 20-27 % of patients within approximately two years after diagnosis. This study aimed to examine neurocognitive impairment in childhood-onset SLE (cSLE) patients before the development of any neurological, psychiatric, or cognitive manifestations.

METHODS

The study included 98 children and adolescents. Of these, 34 (35 %) were cSLE groups, and the remaining formed two control groups: 31 (31 %) oligoarticular Juvenile Idiopathic Arthritis (oJIA) patients served as a "patient control" group, and 33 (34 %) healthy participants socio-demographically matched to the cSLE and oJIA patients formed the healthy control (HC) group. None of the subjects in the study exhibited neurological or psychiatric symptoms.

RESULTS

The Wechsler Intelligence Scale for Children-IV (WISC-IV) was applied to all groups. Test results showed that the Perceptual Reasoning Index Score (PRIS) was significantly lower in cSLE than in HC (F(2, 95) = 3.365, p = 0.042, Tukey HSD: p = 0.01). 'Comprehension' subtest scores were significantly lower in the cSLE group compared to the HC group (H(2) = 8.133, p = 0.017; U = 352.5, p = 0.009). Similarly, 'symbol search' subtest scores were significantly lower in the cSLE group compared to the HC group (F(2, 95) = 3.545, p = 0.036, Tukey HSD: p = 0.014).

CONCLUSION

Our results revealed that cSLE may have neurocognitive impairment without presenting any symptoms. Early detection is possible with the neurocognitive test WISC-IV. These results support the inclusion of objective neurocognitive assessment methods into the routine clinical follow-up of childhood-onset SLE.

Retrospective assessment of ICD-10/DSM-5 criteria of childhood ADHD from descriptions of academic and social behaviors in German primary school reports

BACKGROUND

The diagnosis of attention-deficit/hyperactivity disorder (ADHD) in adolescence and adulthood is particularly challenging because retrospective confirmation of previous childhood ADHD is mandatory. Therefore, collecting valid diagnostic information about behavior at school is important. Primary school reports often contain descriptions of academic performance and social behaviors associated with ADHD criteria. Yet, there is no systematic approach available how to assess such reports quantitatively, and therefore, there is also no study on how valid such an approach could predict an ADHD diagnosis.

METHODS

We examined primary school reports from Germany (ADHD: n = 1197, typically developing controls: n = 656) for semantic references to ICD-10/DSM-5 main and sub-criteria of ADHD. Descriptions were assessed on a quantitative scale (blinded clinical expert rating) for disorder-associated behaviors (symptoms scale) as well as for desired, adaptive behaviors (competencies scale) according to these criteria. The scores of these developed scales have been summarized to summary scores. Scores were analyzed using linear mixed models, and sensitivity and specificity were estimated using receiver operating characteristics (ROC).

RESULTS

Ratings showed highly significant differences between school reports of children with and without ADHD. For the summary scores, both symptoms and competencies scales showed high diagnostic accuracy (ROC area under the curve at least 0.96) with best discrimination when combining both into an integrated index (sensitivity and specificity > 0.97).

CONCLUSIONS

Our findings suggest that systematic quantitative analysis of primary school reports should be further explored to construct a valid instrument for retrospective assessment of childhood ADHD criteria to aid the diagnostic process in adolescents and adults.

Longitudinal Predictors of Adaptive Functioning in Emerging Adults with and without Autism Spectrum Disorder

Individuals with autism spectrum disorder (ASD) display heterogeneity in adaptive functioning, underscoring the need to identify predictors to inform clinical and scientific interventions. We investigated the longitudinal associations between an autism diagnosis, co-occurring psychopathology symptoms, executive functions (EF) and subsequent adaptive functioning in individuals with and without ASD (IQ > 70). Sixty-six individuals (26 with ASD, 40 without ASD) were assessed at baseline (mean age = 11.8 years, SD = 2.1) and at 10-year follow-up (mean age 21.4, SD = 2.3). The diagnostic evaluation comprised a comprehensive assessment of autism symptoms and emotional and cognitive functioning. Co-occurring psychopathology symptoms were assessed with two measures: self-reported depressive symptoms with the Short Mood and Feelings Questionnaire and parent-reported total problems with the Child Behavior Checklist 6-18. Participants completed neuropsychological tests to evaluate EF. We investigated adaptive functioning by using the Weiss Functional Impairment Rating Scale (WFIRS) which is a self-report measure of impairment in the following domains: family, work, school, life skills, self-concept, social and risk-taking. Among the emerging adults previously diagnosed with ASD, 46% reported living independently, 75% had at least one friend, and 71% were employed or in education. Individuals with ASD reported significantly lower adaptive functioning compared to individuals without ASD (WFIRS Total, Hedges' g = 0.92). Greater EF difficulties in childhood/adolescence predicted lower adaptive functioning in emerging adulthood, surpassing the influence of autism diagnosis and co-occurring symptoms. The findings highlight the influential role of EF, implying that interventions targeting EF difficulties could improve long-term outcomes for individuals with ASD.

Unveiling cognitive disengagement syndrome: A hidden challenge in children with epilepsy

BACKGROUND

In our study, we aimed to investigate the prevalence of cognitive disengagement syndrome (CDS) and attention deficit hyperactivity disorder (ADHD) in children with epilepsy and to identify the associated factors.

METHOD

The study included 62 patients with epilepsy aged 6-18 and 51 healthy controls. Sociodemographic data, epilepsy characteristics, and medication usage were collected. Psychiatric evaluations used various structured interviews and scales.

RESULTS

The mean ages for patients and controls were 9.7 and 9.9 years, respectively. CDS was present in 76 % of patients with epilepsy compared to 26 % of controls (p < 0.01). Patients with epilepsy scored higher on Barkley Child Attention Scale (BCAS) and Turgay DSM-IV Disruptive Behavior Disorders Symptom Screening Scale (T-DSM-IV-S). CDS prevalence was higher in patients without seizure control and those over age 12. Linear regressions demonstrated that age predicted BCAS-sluggish scores (R2: 0.284, p < 0.001) and T-DSM-IV-S hyperactivity scores (R2: 0.065, p: 0.023). The number of antiseizure medications (R2: 0.065, p: 0.023) and the duration of antiseizure medication usage (R2: 0.079, p: 0.014) predicted T-DSM-IV-S oppositional scores.

CONCLUSION

Our study is the first study in this field. Our study findings highlight the need for further research to understand the pathophysiological mechanisms underlying CDS in epilepsy and to develop targeted interventions.

Effects of immune modulatory treatment on language and psychiatric profile in patients with electrical status epilepticus in sleep (ESES)

Electrical status epilepticus in sleep (ESES) is an electrographic pattern associated with cognitive impairment. Our study aimed to prospectively evaluate the psychiatric findings and language skills in patients diagnosed with ESES and to determine the immune modulatory treatment-responsive subgroups. We assessed the patients for psychiatric features and language skills at the baseline and 12 months after. Psychiatric disorders were screened according to DSM-V criteria. We implemented standardized tests including Clinical Global Impressions-Severity Scale (CGI-S), Revised-Children Anxiety and Depression Scale, Children's Sleep Habits Questionnaire-Abbreviated, Aberrant Behavior Checklist (ABC), and Childhood Autism Rating Scale. We used tests adapted/developed for Turkish language including Test of Language Development-Primary-Fourth Edition: Turkish (TOLDP-4:T), Turkish Non-word Repetition Test (TNRT), Turkish Multilingual Sentence Repetition Test (MultiSIT-TR) and Turkish Communication Development Inventory (TCDI). Disability was evaluated by Pediatric Evaluation of Disability Inventory (PEDI). Thirty-nine patients were included. Psychiatric evaluation revealed attention deficit hyperactivity disorder-like symptoms in 25 patients, intellectual disability in 12, and specific learning disability in 8. Patients were treated with corticosteroids or IVIg in addition to anti-seizure medication. The spike wave indexes improved significantly at the end of follow-up period (80 % (65-91) vs. 37 % (24-65), p < 0.001). After 12 months, statistically significant improvement was found in ABC, CGI-S, TOLDP-4:T, TNRT, MultiSIT-TR, TCDI, and PEDI scores (p < 0.05). Patients with improvement in psychiatric symptoms had earlier age. Phonologic working memory performance was significantly preserved and improved compared to other language domains. Immune modulatory treatments may contribute to improvement of psychiatric symptoms and language skills. Preservation of phonologic working memory and grammar performance might be a valuable feature to differentiate ESES-related language impairment.

Sleep difficulties related to psychopathology and neurocognition in people with 22q11.2 deletion syndrome

The 22q11.2 Deletion Syndrome (22q11.2DS) is a multisystem genetic disorder with prominent sleep disturbances, neuropsychiatric conditions and neurocognitive challenges. Poor sleep can impact cognitive development, psychopathology and daily functioning. An integrative approach in clinical settings can help link these manifestations and suggest interventions. A comprehensive sleep interview was conducted with 100 affected individuals and their parents, complemented with electronic health record review. Independent psychiatric and neurocognitive assessments were conducted in 92 participants, divided into Good Sleeper (score 1-4) and Poor Sleeper (score ≥ 5) groups based on the Pittsburgh Sleep Quality Index (PSQI). Sleep disorders were common, 78% of participants met International Classification of Sleep Disorders criteria. Most prevalent were Insomnia, Sleep Disorder Breathing, Delayed Sleep Phase Disorder and Restless Leg Syndrome. 74% of participants met criteria for at least one current psychiatric disorder. Poor Sleepers had lower Global Assessment of Function (GAF), higher severity of psychosis positive, negative, and general symptoms, and lower performance efficiency on executive, spatial memory, complex cognition and social cognition tests. Mediation models showed that association of psychosis scores and GAF were mediated by PSQI and the association between PSQI and GAF was mediated by psychosis scores. Sleep disorders are prevalent in individuals with 22q11.2DS and impact psychiatric manifestation and neurocognitive performance. Results suggest a possible "vicious cycle " whereby disordered sleep is associated with increased psychosis which, in turn, results in worsening sleep, all affecting GAF. Identification of sleep disorders can facilitate appropriate interventions reducing burden of psychiatric symptoms and improving cognition and functioning.