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

Protocol MelatoSom-Kids-PTSD: sleep disturbances in children and adolescents with post-traumatic stress disorder (PTSD) - a randomized double-blind placebo-controlled trial to investigate the efficacy of paediatric prolonged-release melatonin

Introduction: Sleep disorders in the insomnia spectrum, as well as nightmares, are among the most sensitive and persistent symptoms in children with post-traumatic stress disorder (PTSD). There is currently no reference treatment or specific pharmacological treatment recommendation on the management of sleep disturbances in children and adolescents suffering from PTSD, despite the fact that they have a significant effect on daytime functioning and overall mental health of children as well as on family's health and quality of life. In this respect, paediatric prolonged-release melatonin (PedPRM) has shown significant beneficial effects on insomnia disorders in children with autism spectrum disorders and positive effects on anxiety and depressive symptomatology. Our study will be the first randomized controlled trial to examine the efficacy of PedPRM melatonin on sleep disorders in children and adolescents with PTSD, as well as on PTSD symptoms, associated daytime functioning and overall mental health in these children and their caregivers.Methods/design: The MelatoSOM-Kids-PTSD study (French national hospital-based clinical research programme) will be a multi-centre prospective double-blind placebo-controlled parallel group clinical trial investigating the efficacy of paediatric prolonged-release melatonin to alleviate sleep disturbances in children and adolescents with PTSD (120 participants recruited over a 24-month period). The experimental group will be treated with active prolonged-release melatonin over 13 weeks (PedPRM). The control group will receive a placebo. The primary endpoint will be the difference in sleep diary derived total sleep time after 13 weeks of treatment in the PedPRM group versus placebo group. Secondary endpoints will be the differences in objective sleep quality parameters and daytime functioning before and after treatment, in children with PTSD and their caregivers.Discussion: This paper describes the MelatoSOM-Kids-PTSD protocol, which will evaluate the effectiveness of melatonin, a treatment that has already demonstrated an excellent benefit-risk ratio in the paediatric population over 4 years.

Differences in hair cortisol to cortisone ratio between depressed and non-depressed adolescent women

Research on stress has demonstrated that the hypothalamic-pituitary-adrenal (HPA) axis contributes to major depressive disorder in youth. Hair glucocorticoids are key biological markers of chronic stress. We assessed group differences in hair cortisol and cortisone concentrations, and the cortisol/cortisone ratio between depressed adolescent women and a non-depressed comparison group. Further, within the depression group, we explored the contribution of symptom severity and clinical correlates of depression in relation to glucocorticoid concentrations. Hair samples of three centimeters for 74 adolescent women (41 in the depression group and 33 in the comparison group), aged between 12 and 19 years old, were analyzed. Depressive and anxiety symptoms were measured using the Beck Youth Inventory II and clinical correlates of depression were measured using the Childhood Trauma Questionnaire-Short Form and the Borderline Personality Features Scale for Children. No significant differences emerged between the depression group and the comparison group on hair cortisol or hair cortisone concentrations. However, groups differed significantly on the cortisol/cortisone ratio, a proposed proxy of 11-beta-hydroxysteroid dehydrogenase activity, with a higher ratio for the depression group. Within the depression group, neither symptom severity nor clinical correlates were associated with glucocorticoid concentrations. Although cross-sectional, our findings highlight the importance of future studies to test whether the group difference found in cortisol/cortisone ratio is the result of alterations in 11-beta-hydroxysteroid dehydrogenase enzymes (type 1 or 2) activity. Further research is thus needed to clarify the role of these enzymes in major depressive disorder in youth and to develop more targeted intervention strategies.

The relationship between parenting behavior, suicidal ideation, and suicide attempt across two population-based samples of adolescents

We examined the relationship between parenting, suicidal ideation (SI), and the transition from SI to suicide attempt (SA), and whether parenting behaviors moderate the associations of genetic liability for SA and/or painful and provocative events (PPEs) with SA risk. Participants included 6153 adolescents (48.3 % female, Mage at baseline = 9.47 years, followed over 3 years) from the Adolescent Brain Cognitive Development Study (ABCD) and 5942 adolescents (52.1 % female, Mage at baseline = 15.55 years, followed over 1 year) from the National Longitudinal Study of Adolescent to Adult Health (Add Health). We used logistic regression to test associations between parenting and SI/SA. Genetic liability and PPEs were included as potential predictors of SA. In ABCD, higher parental acceptance and monitoring were associated with lower risk for SI (odds ratios [ORs] = 0.7-0.9, ps < .01) but not SA (ORs = 0.9, ps > .05). Non-suicidal self-injury and parental knowledge of child SI were associated with elevated risk for SA (ORs = 2.6-2.8, ps < .01), but their interaction was non-significant (OR = 0.9, p = .85). In Add Health, maternal support was related to reduced SI risk (OR = 0.8, p < .01), but paternal support, and both parents' involvement and presence at home, were not (ORs = 0.9-1.0, ps > .05). Several PPEs were associated with higher SA risk (ORs = 1.3-2.0, ps < .05). These findings suggest that the parent-adolescent relationship may be more relevant to SI, rather than the transition from SI to SA.

Dimensional foundations toward a novel nosology addressing comorbidity: Preadolescent syndrome profiles

OBJECTIVE

Traditional categorical systems for diagnosing psychopathological symptoms, such as the DSM-5, face limitations including high comorbidity rates and insufficient support for transdiagnostic treatment protocols. Dimensional, person-centered approaches can address these limitations by focusing on cross-cutting psychiatric symptoms.

METHOD

This study leverages data from the Adolescent Brain Cognitive Development℠ Study (ABCD Study®) to develop dimensional models of preadolescent psychopathology, focusing on a large, diverse sample of youths aged 9-10. We used latent profile analysis (LPA) on Child Behavior Checklist (CBCL) syndrome scales collected from an elevated symptomatology subsample to delineate subgroups for targeted interventions.

RESULTS

Four distinct profiles emerged: "Mildly Elevated" and "Highly Elevated" (on both internalizing and externalizing), "Moderately Elevated - Rule-Breaking," and "Moderately Elevated - Internalizing & Thought Problems." These profiles differed significantly across sociodemographic, neurocognitive, and life experience characteristics. The "Highly Elevated" group showed the highest levels of risk, including greater trauma exposure and higher rates of parental psychopathology. In contrast, the "Mildly Elevated" group demonstrated lower levels of risk factors and higher fluid intelligence compared to the other groups. The two Moderately Elevated profiles were largely similar across most risk indicators, though the Internalizing & Thought Problems group had a slightly higher proportion of parents with a college education.

CONCLUSIONS

These profiles offer the beginnings of a foundation for classifying symptom co-occurrence and highlight the need for developmentally specific nosologies to improve risk detection and intervention strategies. Future research should further validate these profiles and explore their stability across developmental stages to inform targeted interventions.

Brief Report: Sensory Features Associated with Autism After Controlling for ADHD Symptoms

BACKGROUND

Sensory processing differences are reported both in children with ADHD and in children with autism. Given the substantial overlap between autism and ADHD, the current study examined which sensory features were uniquely predictive of autistic traits after controlling for ADHD symptoms, age, IQ, and sex in a sample of children and adolescents with autism aged 6-17 years.

METHODS

The sample included 61 children and adolescents with autism. The Sensory Profile was used to examine Dunn's quadrant model (seeking, sensitivity, avoiding, registration), ADHD symptoms were measured using hyperactivity and attention problems BASC-2 T-scores, and autistic traits were measured using the AQ.

RESULTS

After controlling for age, IQ, sex, and ADHD symptoms, Dunn's sensitivity quadrant predicted autistic traits.

CONCLUSIONS

Findings provide insight into the phenotype of autism and ADHD. Sensory sensitivity may be unique to autism over and above elevated ADHD symptoms that are commonly seen in this population.

Longitudinal stability of mood-related resting-state networks in youth with symptomatic bipolar-I/II disorder

Bipolar disorder (BD) is characterized by temporal instability of mood and energy, but the neural correlates of this instability are poorly understood. In previous cross-sectional studies, mood state in BD has been associated with differential functional connectivity (FC) amongst several subcortical regions and ventromedial prefrontal cortex. Here, we assess whether BD is associated with longitudinal instability within this mood-related network of interest (NOI). Young people with BD-I/II were scanned 4-6 times and healthy controls (HC) were scanned 4 times over 9 months. Following preprocessing of 20-min resting-state scans, we assessed across-scan correlation of FC, focusing on FC between regions previously associated with BD mood state. Utilizing Bayesian models, we assessed the relationship between diagnostic group and within-person, across-scan correlation, adjusting for motion, time-of-day, and inter-scan interval; prediction intervals (PI) are reported. In a sample of 16 youth (11 BD, 5 HC; 16.3-23.3 years old) with 70 scans (50 BD, 20 HC), across-scan NOI stability was higher within- than between-person (0.70 vs. 0.54; p < 0.0001). BD (vs. HC) within-person scan-pairs showed lower NOI stability (mean -0.109; 95% PI -0.181, -0.038), distinguishing BD vs. HC with excellent accuracy (AUC = 0.95). NOI instability was more pronounced with manic symptoms (mean -0.012; 95% PI -0.023, -0.0002) and in BD-II (vs. BD-I; mean -0.071; 90% PI -0.136, -0.007). Results persisted after accounting for medications, comorbidity, and sleep/arousal measures. Within this pilot sample, BD is characterized by less within-person stability of a mood-related NOI. While preliminary, these results highlight a possible role for precision imaging approaches to elucidate neural mechanisms underlying BD.

Elevated serum angiotensin ii levels in children and adolescents with anxiety disorders

PURPOSE

Angiotensin II peptide is implicated in oxidative stress, neuropathology, and the serotonergic system. We investigated the serum angiotensin II levels in non-medicated children and adolescents with anxiety disorders.

MATERIALS AND METHODS

Thirty-nine children and adolescents diagnosed with anxiety disorders and thirty-five controls participated in this study to investigate the potential association between anxiety disorders and serum angiotensin II levels. Parents of the participants completed the RCADS-P parent version to assess their children's anxiety and depression levels.

RESULTS

Higher serum angiotensin II levels were found in individuals with anxiety disorders compared to the control group. We found that social phobia, panic disorder, low mood (major depressive disorder), and generalized anxiety disorder subscale scores on the RCADS-P were significantly correlated with angiotensin II levels.

CONCLUSIONS

We found that children and adolescents with anxiety disorders had higher serum angiotensin II levels. The current findings align with previous research on the role of angiotensin II in other mental health conditions. Further research is necessary to elucidate its role in anxiety disorders.

Functional connectivity anomalies in medication-naive children with ADHD: Diagnostic potential, symptoms interpretation, and a mediation model

OBJECTIVE

To identify reliable electroencephalography (EEG) biomarkers for attention deficit/hyperactivity disorder (ADHD) by investigating anomalous functional connectivity patterns and their clinical relevance.

METHODS

Resting-state EEG data were collected from 74 children aged 6-12 (33 unmedicated ADHD; 41 typically developing). Functional connectivity was quantified using the imaginary part of coherency (ICOH). Machine learning (ML)-based support vector machine (SVM) modeling, regression, and mediation analyses linked connectivity features to symptom severity and diagnostic classification.

RESULTS

Children with ADHD exhibited beta (β) band hypo-connectivity in frontal regions (Fp2-F4, Fp1-Cz, F7-Cz) and theta (θ) band hyper-connectivity in left parietal-central networks (C3-P7, P3-P7, etc.). An SVM classifier achieved an average area under the curve of 0.89 using three connectivity features. Left parietal θ band hyper-connectivity (C3-P7) correlated with both inattention and hyperactivity/impulsivity and mediated their interrelationship.

CONCLUSIONS

ADHD is characterized by disrupted frontoparietal connectivity, with θ band hyper-connectivity in sensory-integration networks potentially compensating for impaired frontal regulation.

SIGNIFICANCE

These findings highlight C3-P7 θ band connectivity as both a diagnostic and mechanistic biomarker, providing novel target for neurofeedback therapies and enhancing the differential diagnosis in neurodevelopmental disorders.

How does SES influence the brain circuitry for literacy? Modeling the association between SES, oral language, white matter integrity, and reading

Reading is pivotal for educational and occupational success, hence, understanding the factors contributing to reading skill variation is a major educational objective. Although cognitive and neurobiological factors that influence reading are well documented, the contributions of environmental factors, such as socioeconomic status (SES), fiv to reading-related neurobiology are relatively understudied. Studies have shown that SES predicts reading and the integrity of reading-related white matter tracts; however, the direct and indirect contributions of SES to reading via white matter integrity remain undifferentiated. Further, while oral language (both phonological awareness [PA] and vocabulary) has been positively associated with both SES and reading, only a few studies have attempted to model the SES-reading association via oral language, and none of them included white matter integrity. The current study closes these gaps by using Structural Equation Modeling in a large sample of children from the Healthy Brain Network biobank, testing the (in)direct paths by which SES (parental education) influences reading through oral language and white matter integrity. Results reveal an effect of SES on reading that is indirectly affected by oral language, though not by white matter integrity. These findings reinforce the role of oral language skills as a key pathway linking SES and reading.

Neuroanatomical landscapes: Delineating the cortical signatures of pediatric major depressive disorder and bipolar disorder

Pediatric mood disorders, including Major Depressive Disorder (MDD) and Bipolar Disorder (BD), exhibit overlapping symptomatology and complex neurodevelopmental trajectories, necessitating a comprehensive investigation of their neuroanatomical underpinnings. This study aimed to characterize structural brain differences in children with MDD and euthymic BD using high-resolution structural magnetic resonance imaging (MRI). A total of 51 children (aged 10-14 years) were categorized into MDD, euthymic BD, and typically developing (TD) controls. Utilizing advanced surface-based morphometry, we examined four cortical features: fractal dimension, gyrification, sulcal depth, and cortical thickness, to delineate disorder-specific and shared neuroanatomical alterations. Additionally, we explored the interaction between white matter volumetrics and these surface-based metrics to assess its modulatory role in structural brain differences. Our results revealed significant cortical alterations, with distinct and overlapping patterns in both MDD and BD. The findings demonstrated disruptions in cortical complexity, folding patterns, and sulcal morphology, particularly in regions implicated in emotion regulation and cognitive processing. These structural variations provide critical insights into the neurodevelopmental alterations associated with pediatric mood disorders. By integrating multiple morphometric parameters, this study offers a comprehensive framework for understanding the neuroanatomical changes in MDD and BD, contributing to more precise diagnostic biomarkers. The results underscore the importance of incorporating surface-based morphometry and white matter interactions in future research to refine early diagnosis and targeted interventions for mood disorders in children.

Psychiatric Polygenic Risk Scores and Week-by-Week Symptomatic Status in Youth with Bipolar Disorder: An Exploratory Study

Introduction: Prior studies have demonstrated that, in both adults and youth, bipolar disorder (BD) is a polygenic illness. However, no studies have examined polygenic risk scores (PRSs) in relation to the longitudinal course of mood symptoms in youth with BD. Methods: This study included 246 youth of European ancestry with BD (7-20 years old at intake) from the Course and Outcome of Bipolar Youth study and Centre for Youth Bipolar Disorder. Mood symptom severity was assessed at intake and, for 168 participants, prospectively for a median of 8.7 years. PRSs for BD, schizophrenia (SCZ), major depressive disorder (MDD), and attention-deficit/hyperactivity disorder (ADHD) were constructed using genome-wide summary statistics from independent adult cohorts. Results: Higher BD-PRS was significantly associated with lower most severe lifetime depression score at intake (β = -0.14, p = 0.03). Higher SCZ-PRS and MDD-PRS were associated with significantly less time spent in euthymia (SCZ-PRS: β = -0.21, p = 0.02; MDD-PRS: β = -0.22, p = 0.01) and more time with any subsyndromal mood symptoms (i.e., any mania, mixed, or depression symptoms; SCZ-PRS: β = 0.15, p = 0.04; MDD-PRS: β = 0.17, p = 0.01) during follow-up. PRSs for BD and ADHD were not significantly associated with any longitudinal mood variable. Conclusions: This exploratory analysis was the first to examine psychiatric PRSs in relation to the prospective course of mood symptoms among youth with BD. Results from the current study can serve to guide future youth BD studies with larger sample sizes on this topic.

Do meaningful dimensions of childhood adversity exist? Data-driven evidence from two prospective cohort studies

BACKGROUND

There is not yet a consensus on the best way to conceptualise adverse childhood experiences (ACEs). We used data-driven methods across two populations to examine (a) if there were meaningful dimensions underlying ACEs and (b) whether dimensions were differentially associated with increased risk of adolescent psychopathology.

METHODS

Participants were 18,539 British children from the UK Millennium Cohort Study (MCS) and 11,876 American children from the US Adolescent Brain Cognitive Development Study (ABCD). A wide range of ACEs (e.g., abuse, neglect, parental psychopathology, peer victimisation) were measured prospectively from infancy to mid-adolescence using interviews and questionnaires. Internalising and externalising symptoms were assessed with child and/or parent reports during adolescence.

RESULTS

Our preregistered exploratory factor analysis revealed four latent dimensions in the MCS (parental threat, deprivation, victimisation, and parental discipline) and ABCD (parental threat, deprivation, victimisation, and traumatic events). All dimensions except deprivation were associated with increased risk for internalising and externalising symptoms. Over and above the other dimensions, victimisation was more strongly associated with internalising (MCS β = .34, 95% CI 0.33-0.36; ABCD β = .11, 95% CI 0.10-0.13) and externalising (MCS β = .31, 95% CI 0.30-0.33; ABCD β = .13, 95% CI 0.11-0.15) symptoms.

CONCLUSIONS

Across two distinct populations, we found that ACEs can be captured by common underlying dimensions of parental threat, deprivation, and victimisation, as well as additional sample-specific dimensions. Our findings expand dimensional theories of childhood adversity by suggesting that in addition to threat and deprivation, victimisation is a distinct dimension of adversity that has the strongest associations with adolescent psychopathology.

Neighborhood opportunity and response to psychotherapy in anxious youth

Early adversity is a well-documented risk factor for anxiety disorders in youth; few studies, however, have examined how exposure to adversity influences treatment outcomes. Emerging research suggests that systemic inequities can affect the efficacy of frontline psychotherapies. The effects of structural disadvantage and, in particular, neighborhood-level features on treatment outcomes for pediatric anxiety are largely under-studied. The current study aimed to examine the impact of neighborhood opportunity on children's response to cognitive behavioral therapy (CBT). A total of 202 youth aged 8-17 years (Mage = 12.030, 56 % F) with a diagnosed anxiety disorder completed 8-12 weeks of exposure-based CBT. Neighborhood disadvantage was quantified using the Child Opportunity Index (COI), and treatment response was measured via the Pediatric Anxiety Rating Scale (PARS) at baseline, post-treatment, and a 6-month follow-up assessment. Following treatment, anxious youth exhibited a significant 31.523 % reduction in symptoms. Across all scoring dimensions of the COI (socioeconomic, education, and health & environment), neighborhood disadvantage did not reliably predict treatment response. These findings suggest that when provided access to high-quality, evidence-based psychotherapy, youth from lower opportunity neighborhoods achieve comparable outcomes to their more advantaged peers. Taken together with prior research, this study suggests that structural disadvantage at the neighborhood level is not a robust predictor of treatment outcomes in the context of pediatric anxiety. These findings raise the possibility that equitable access to treatment could, in certain circumstances, mitigate the negative effects of systemic neighborhood-level inequities on mental health outcomes, underscoring the importance of expanding the availability of treatment services.

Historia natural de la distonía mioclónica asociada a variantes de SGCE en niños y adolescentes

Children and adolescents with SGCE-myoclonus dystonia showed a progression of motor symptoms during a mean follow-up of 4 years. Patients developed a significant increase in the severity of axial and limb myoclonus, as well as dystonia during writing. Consequently, patients reported a marked decline in their speech, writing, and walking abilities. Up to 74% of patients had a psychiatric diagnosis, most commonly anxiety, obsessive-compulsive disorders, and attention-deficit/hyperactivity disorder.

Sleep Disturbances, ADHD, and Self-Harm Among Youth

OBJECTIVE

Previous studies have linked ADHD with self-harm, but the processes underlying this association are not fully understood. This research aims to investigate the role of sleep disturbances as a potential pathway between ADHD diagnosis and self-harm behaviors.

MATERIALS AND METHODS

The study included 90 youth aged between 11 and 18 years, divided into two groups: a case group of 45 youth diagnosed with ADHD and a control group of 45 youth without ADHD. Both groups completed the Inventory of Statements About Self-Injury to evaluate self-harm behaviors and the Sleep Disturbance Scale for Children to assess sleep disturbances. A path analysis was conducted to examine whether a significant proportion of the association between ADHD and self-harm was shared with sleep disturbances, while controlling for gender, youth education, family income, maternal education, and overall anxiety and depression scores.

RESULTS

An ADHD diagnosis was significantly associated with sleep disturbances (β = .62, p < .001) and self-harm behaviors (β = .35, p = .03). Additionally, sleep disturbances were significantly linked to self-harm (β = .51, p = .002) and played a significant role in the association between ADHD and self-harm (indirect effect β = .32, p = .001).

CONCLUSION

These findings suggest that sleep disturbances account for a substantial proportion of the shared variance in the association between ADHD and self-harm. While the cross-sectional design limits causal interpretations, these results highlight the importance of addressing sleep issues in clinical care for ADHD to potentially reduce self-harm risks and improve outcomes for at-risk youth.

Natural history of SGCE-associated myoclonus dystonia in children and adolescents

AIM

To investigate the natural progression of SGCE-associated myoclonus dystonia from symptom onset in childhood to early adulthood.

METHOD

Myoclonus and dystonia were monitored using rating scales in two cohorts of participants from Spain and the Netherlands. Individual annualized rates of change were calculated and longitudinal trends were assessed using Bayesian mixed models. Psychiatric features were evaluated cross-sectionally in the Spanish cohort.

RESULTS

Thirty-eight patients (21 males, 17 females) were evaluated at a mean age (SD) of 10 years (4 years 7 months; range 2-21 years) and 14 years 2 months (4 years 8 months; range 4-25 years). We observed a significant worsening of action myoclonus, global dystonia, and dystonia during writing (mean annual increases of 1.356, 0.226, and 0.518 in the Unified Myoclonus, Burke-Fahn-Marsden, and Writer's Cramp Rating Scales respectively). Accordingly, participants perceived a significant worsening in their speech, writing, and walking abilities. Twenty-six of 32 participants suffered from anxiety (n = 13), obsessive-compulsive disorder (n = 9), and attention-deficit/hyperactivity disorder (n = 8).

INTERPRETATION

This study demonstrates that, unlike in the adult population, myoclonus dystonia syndrome in childhood and adolescence follows a progressive course that can be debilitating in the early stages of life. These findings, along with a high prevalence of psychiatric symptoms, highlight the need for early therapeutic interventions to prevent long-term motor and psychological sequelae.

Psychiatric Comorbidities in Pediatric Restless Leg Syndrome

Recent research reported an association between pediatric Restless Leg Syndrome (RLS) and psychiatric disorders, in particular attention-deficit hyperactivity disorder in which shared symptoms, such as restlessness and difficulty concentrating, can make differential diagnosis challenging. Comorbidities with depression and anxiety, present in adults, have to be considered in children. Behavioral and psychosomatic disorders and autism can be associated with RLS. Both neurobiologic mechanisms and clinical implication could explain the several comorbidities. In clinical practice, pediatric RLS patients should be evaluated for the presence of psychiatric disorders to tailor multidisciplinary intervention and integrated treatment.

Family Accommodation in Pediatric Obsessive-Compulsive Disorder: Investigating Prevalence and Clinical Correlates in the NordLOTS Study

Family accommodation (FA) involves the actions taken by family members, particularly parents, to accommodate a child´s obsessive-compulsive disorder (OCD) symptoms, reducing distress or impairment. This behavior may maintain compulsive and avoidant behavior, preventing corrective learning or habituation. This study aims to investigate the prevalence and factors influencing FA in a large Scandinavian sample of children with OCD. We assessed 238 children using standardized diagnostic interviews, OCD symptom severity assessments and questionnaires evaluating functional impairment and internalizing and externalizing symptoms. FA was measured using the Family Accommodation Scale, a 12-item clinician-rated interview. Our results confirmed a high frequency of accommodation, with approximately 70% of primary caregivers reporting some accommodation daily and 98% at least once per week. FA was associated with increased OCD symptom severity, contamination/cleaning symptoms, internalizing and externalizing behavior, and functional impairment. Linear regression analysis showed that high levels of FA are specifically associated with lower age, higher OCD symptom severity, parent-reported impairment, internalizing, and externalizing symptoms. A path analysis revealed that FA partially mediated the relationship between OCD severity, externalizing symptoms, and child's age, highlighting the role of FA in the progression of OCD and related symptoms. The findings emphasize the importance of evaluating FA before initiating treatment and specifically addressing it during the therapeutic process.

Children With Sydenham Chorea and Psychiatric Disorders Had Variable Long-Term Outcomes and Required Multidisciplinary Management

AIM

Sydenham chorea (SC) is a globally significant, post-streptococcal, childhood neuropsychiatric condition that is rare in western Europe. This retrospective single-centre study focused on children with neuropsychiatric features of SC.

METHODS

Participants were recruited from neuropsychiatry referrals to a regional paediatric neurology department in Glasgow, Scotland, from 2009 to 2012. Interviews established the course of SC and the children's medical and family histories. Semi-structured psychiatric interviews explored current and past episodes of psychopathology.

RESULTS

We studied 12 children (seven girls) with a mean age of 13 (range 10-15) years, and an average of six (range 4-10) years after their SC symptoms began. Before they displayed symptoms, seven children had been suspected or diagnosed neurodevelopmental problems and four had separation anxiety. Their physical symptoms were often debilitating. Psychopathology was most severe during their first episode and SC diagnoses were sometimes delayed. Educational problems were frequent. Multiple psychiatric conditions were diagnosed in 11 children and anxiety and attention deficit hyperactivity disorder were the most common. Relapses occurred in nine cases. Additional services that were accessed included cardiology, rheumatology, physiotherapy, occupational therapy and speech therapy. Medication included prophylactic penicillin and symptomatic treatment.

CONCLUSION

Children with SC and psychiatric disorders had variable long-term outcomes and required multidisciplinary management.

Caught in the Web of the Net? Part I: Meta-analyses of Problematic Internet Use and Social Media Use in (Young) People with Autism Spectrum Disorder

This article examined the internet and social media usage among (young) individuals with autism spectrum disorder (ASD). Two meta-analyses were conducted to quantify (1) the relation between ASD/autistic traits and problematic internet use (PIU, which included generalized PIU, problematic gaming, excessive smartphone use), and (2) the relation between ASD/autistic traits and social media use. The results of our first meta-analysis-comprising 46 studies and 42,274 participants-revealed that people with ASD or higher levels of autistic traits showed higher levels of PIU, with an average effect size of r = 0.26 (95% CI [0.21, 0.31]). The second meta-analysis-consisting of 15 studies and 7036 participants-indicated that people with ASD or higher levels of autistic traits were less involved on social media platforms as compared to their typically developing counterparts, with the average effect size being r = - 0.28 (95% CI [- 0.38, - 0.18]). The quality of the research on PIU and social media in persons with ASD was critically evaluated and possible directions for future research on this topic are discussed.

Evaluation of Ocular Parameters in Newly Diagnosed Obsessive-Compulsive Disorder Children With Eye-Rubbing Compulsion

PURPOSE

To determine the ocular structural changes in obsessive-compulsive disorder (OCD) children with eye-rubbing compulsion.

METHODS

Participants recruited at the child and adolescent psychiatry clinic were evaluated for the OCD diagnosis. All patients underwent imaging with Scheimpflug corneal topography (Sirius, CSO, Italy), Tomey EM-4000 specular microscopy (Nagoya, Japan), and Lenstar LS 900 (Haag-Streit AG, Switzerland) optical biometry.

RESULTS

Both naive OCD and healthy control groups consisted of 40 patients. Mean cylindric diopter, coma, and trefoil values were significantly higher in the right eyes of OCD children. (P = .043, .024, and .028, respectively). Besides, lens thickness, total ocular aberrations, and high ocular aberrations (P = .014, .040; .027, .038; and.020, .013, in right and left eyes, respectively) were bilaterally higher in OCD children.

CONCLUSION

Eye rubbing and mechanical trauma were proposed as risk factors for ocular structural changes. Early evaluation of corneal topographic parameters such as CylD, coma, and trefoil aberrations in newly diagnosed OCD children might assist in preventing future corneal ectatic diseases.

Gaze behavior, facial emotion processing, and neural underpinnings: A comparison of adolescents with autism spectrum disorder and conduct disorder

BACKGROUND

Facial emotion processing deficits and atypical eye gaze are often described in individuals with autism spectrum disorder (ASD) and those with conduct disorder (CD) and high callous unemotional (CU) traits. Yet, the underlying neural mechanisms of these deficits are still unclear. The aim of this study was to investigate if eye gaze can partially account for the differences in brain activation in youth with ASD, with CD, and typically developing youth (TD).

METHODS

In total, 105 adolescent participants (NCD = 39, NASD = 27, NTD = 39; mean age = 15.59 years) underwent a brain functional imaging session including eye tracking during an implicit emotion processing task while parents/caregivers completed questionnaires. Group differences in gaze behavior (number of fixations to the eye and mouth regions) for different facial expressions (neutral, fearful, angry) presented in the task were investigated using Bayesian analyses. Full-factorial models were used to investigate group differences in brain activation with and without including gaze behavior parameters and focusing on brain regions underlying facial emotion processing (insula, amygdala, and medial prefrontal cortex).

RESULTS

Youth with ASD showed increased fixations on the mouth compared to TD and CD groups. CD participants with high CU traits tended to show fewer fixations to the eye region compared to TD for all emotions. Brain imaging results show higher right anterior insula activation in the ASD compared with the CD group when angry faces were presented. The inclusion of gaze behavior parameters in the model reduced the size of that cluster.

CONCLUSIONS

Differences in insula activation may be partially explained by gaze behavior. This implies an important role of gaze behavior in facial emotion processing, which should be considered for future brain imaging studies. In addition, our results suggest that targeting gaze behavior in interventions might be potentially beneficial for disorders showing impairments associated with the processing of emotional faces. The relation between eye gaze, CU traits, and neural function in different diagnoses needs further clarification in larger samples.

Prevalence and determinants of orthorexia nervosa among Turkish adolescents

PURPOSE

Given the prevalence and diversity of eating issues among adolescents, understanding the epidemiological aspects of orthorexia nervosa (ON) in this demographic, along with identifying associated clinical factors, sociodemographic traits, eating habits and parental attitudes, holds paramount importance both clinically and scientifically. This study aimed to ascertain the prevalence of ON among Turkish high school adolescents aged 14-18 and explore potential correlates of this clinical condition.

METHOD

In the initial phase, 1784 adolescents completed the Data Form, Orthorexia Nervosa Inventory (ONI) and Parent Style Scale (PSS), while their parents filled out the the parental version of the revised Child Anxiety and Depression Scale (RCADS). Subsequently, clinical interview and The Kiddie-Schedule for Affective Disorders and Schizophrenia for School Aged Children, Present and Lifetime Version (KD-SADS-PL) were conducted with 9 adolescents with high risk for ON to assess comorbidities.

RESULTS

The study revealed ON prevalence of 0.5%, with 0.3% in boys and 0.6% in girls. Rural residency, dietary supplement use, and pet ownership correlated with higher ONI scores (p = 0.022, p = 0.002, p = 0.042 respectively). OCD and panic disorder symptoms (B = 0.307, p < 0.001 and B = 0.165, p = 0.018 respectively), increased BMI, and anxiety scores were associated with elevated ONI scores. Authoritarian parenting was significantly related to ONI total scores (B = 1.69, p = 0.018).

CONCLUSION

This study significantly contributes to the literature by delineating the prevalence of ON in adolescents, identifying associated risk factors, elucidating psychopathological associations of orthorexic symptoms, and identifying the relationship between parenting styles and ON. Such insights into the factors influencing ON can aid in demystifying its nature.

Teachers predict ADHD more accurately than parents: findings from a large epidemiological survey

OBJECTIVE

Observational reports of parents and teachers might conflict in the diagnostic process of pediatric Attention-Deficit/Hyperactivity Disorder (ADHD). This study investigates the diagnostic accuracy of parents and teachers in identifying ADHD in children, focusing on the influences of parental education level, child gender, and age.

METHODS

Data were derived from the Turkish Epidemiological Survey in Childhood Psychopathologies, encompassing 5,830 children aged 6-13 years. ADHD diagnoses were determined using a semi-structured interview and impairment ratings from both parents and teachers. Both groups completed the ADHD Rating Scale-IV to identify ADHD-related symptoms. Diagnostic accuracy was evaluated by comparing sensitivity, specificity, positive predictive value, and negative predictive value across informants. Parental education was categorized into lower (LEL) and higher education levels (HEL).

RESULTS

Teachers exhibited significantly higher diagnostic accuracy (93.7%) compared to parents (89.9%, p < 0.001), a trend consistent across gender and age groups. Teachers predicted ADHD in girls (95.2%) with greater accuracy than boys (92.1%), and similar patterns were observed for parents (girls: 92.0%, boys: 88.0%, p < 0.001). Parents with HEL demonstrated better diagnostic performance (91.3%) than those with LEL (89.4%, p < 0.05), though both were outperformed by teachers. Accuracy slightly declined in older children (10-13 years), but the differences were statistically insignificant.

CONCLUSION

The findings highlight teachers' superior ability to predict ADHD, likely due to their comparative observational advantages in structured settings. Parental education and child gender also influenced diagnostic performance. These results underscore the importance of incorporating teacher reports into diagnostic protocols while addressing socio-educational disparities to improve parent-reported accuracy.

Major depressive disorder in children and adolescents is associated with reduced hair cortisol and anandamide (AEA): cross-sectional and longitudinal evidence from a large randomized clinical trial

Pediatric major depressive disorder (MDD) represents a leading cause of disability worldwide in children and adolescents, while its underlying pathophysiology remains largely elusive. The endocannabinoid system (ECS) and the hypothalamus-pituitary-adrenal (HPA) axis are considered intertwined regulatory systems crucially implicated in the pathophysiology of depressive disorders. This study explores the cross-sectional and longitudinal association between the ECS, specifically anandamide (AEA), and the HPA axis with its main effector cortisol and MDD status and severity in children and adolescents. Utilizing data from the omega-3-pMDD trial, a phase III Randomized Clinical Trial assessing the efficacy and safety of omega-3 fatty acid supplementation in pediatric MDD, we examined hair AEA and cortisol concentrations in 110 children and adolescents aged 8-17 years, with MDD. Associations between MDD, symptom severity and hair AEA and cortisol concentrations were explored across four measurement time points (baseline, week 6, 24 and 36). Additionally, 127 healthy children and adolescents were examined once to enable cross-sectional comparisons between MDD cases and healthy controls. Baseline comparisons for the 237 children and adolescents showed lower cortisol and AEA levels in hair of children and adolescents with MDD compared to healthy controls. Longitudinal multi-level analysis over all time-points further corroborated negative longitudinal associations between hair cortisol and depressive symptoms in children and adolescents with MDD. Taken together, reduced baseline AEA and cortisol levels emerge as robust biomarker in depressed youth, while the negative longitudinal association between hair cortisol and depression symptoms might provide useful for therapy monitoring purposes. These results hold implications for early detection, diagnosis, and therapeutic response prediction in pediatric MDD.

Behaviour ratings of executive functions in adolescents with ADHD: correlation with core symptoms and functional impairment measured by multiple informants

BACKGROUND

Executive functional deficits (EFDs) are very common in patients with Attention Deficit/Hyperactivity Disorder (ADHD). Behavioural ratings of executive functions have high ecological value but vary between informants and observational settings. Objectives of this study were to describe correlations between ratings on behavioural executive functions, ADHD symptoms and functional impairment between different informants.

MATERIALS AND METHODS

The study includes 100 adolescents aged 14-18 with ADHD still experiencing clinically impairing symptoms despite standard treatment. Ratings of EFDs were obtained from teachers, parents and self-reports. Parents and adolescents also rated core symptoms of ADHD and functional impairment. A clinician assessed overall global functioning. The relationship between measures and informants were analysed using Pearson correlations.

RESULTS

There was a significant, strong, positive correlation between all measures reported by the same informant. The overall correlation was small to medium between teacher reported EFDs and both core symptoms of ADHD and functional impairment as reported by parents and adolescents. There was a significant negative correlation between clinicians' assessment of global functioning and ratings of EFDs by all informants.

CONCLUSIONS

We found that EFDs were strongly correlated both with higher levels of core symptoms of ADHD, and higher level of functional impairment as reported by the same informant. We also found, in line with previous research, that ratings of symptoms and impairment differs between informants and settings. Our findings underline the importance of multiple informants in both assessment and treatment planning.

Psychopathological Comorbidities in Children and Adolescents with Feeding and Eating Disorders: An Italian Clinical Study

OBJECTIVES

Feeding and eating disorders (FED) represent a major public health issue and are the second leading cause of death among psychiatric conditions in children and adolescents. Psychopathological comorbidities play a significant role in the onset and persistence of FED, yet research on their underlying structure remains limited. This study explores the psychiatric comorbidities associated with FED, focusing on common etiopathogenetic factors and their clinical implications.

METHODS

Data were retrospectively collected from the Italian Regional Center for FED in the Emilia-Romagna Region between June 2023 and April 2024. Diagnoses were assigned following DSM-5 criteria using the Italian version of the semi-structured K-SADS-PL diagnostic interview. Principal component analysis (PCA) was performed to identify latent psychological dimensions underlying FED psychopathology, retaining five components based on the scree plot. Additionally, an analysis of covariance (ANCOVA) was conducted to examine differences in factor scores across FED subtypes, while adjusting for potential confounders.

RESULTS

Seventy-two participants were included (mean age: 14.6 years; mean BMI: 18.3 kg/m2; male-to-female ratio: 1:8). Diagnoses were distributed as follows: 63.9% anorexia nervosa (AN), 13.9% other specified feeding and eating disorder (OSFED), 6.9% avoidant restrictive food intake disorder (ARFID), 4.2% binge eating disorder (BED), 4.2% unspecified feeding and eating disorder (UFED), and 2.7% bulimia nervosa (BN). All participants met the criteria for at least one psychiatric comorbidity. Identified psychopathological clusters include the following: (1) mood disorders (66.5%); (2) anxiety disorders (87.5%); (3) obsessive-compulsive and related disorders (47.2%); (4) neurodevelopmental disorders, i.e., attention-deficit/hyperactivity disorder (ADHD) (30.5%); (5) disruptive and impulse-control disorders (13.9%); and (6) psychotic symptoms (40.3%). No instances of tic or elimination disorders were detected. Conduct disorder was more prevalent among UFED, BED, and BN patients compared to other FED (p = 0.005), and moderate/severe ADHD was associated with higher body mass index (BMI) (p = 0.035). PCA revealed distinct psychological dimensions underlying FED, while ANCOVA indicated significant differences in factor scores across FED subtypes, supporting the presence of shared transdiagnostic mechanisms.

CONCLUSIONS

This study highlights the complex interplay between FED and psychiatric comorbidities, emphasizing the need for early intervention and personalized treatment approaches. The dimensional structure identified through PCA suggests that common psychopathological factors may drive FED development, and ANCOVA findings support their differential expression across FED types. Future research should further investigate these transdiagnostic mechanisms to optimize clinical care.

Longitudinal Development of Neurocognitive Functioning and Gray Matter Volume in Youths With Recurrent Psychosis Spectrum Symptoms

BACKGROUND AND HYPOTHESIS

Neurodevelopmental risk-factor models of psychosis highlight the importance of early developmental deviations in the emergence of psychosis. However, few longitudinal studies map neurodevelopment and neurocognitive trajectories across age in preclinical psychosis. We investigated longitudinal trajectories in neurocognition and brain volume in a community cohort of adolescents with recurrent psychosis spectrum (PS) symptoms, tracking their development into young adulthood compared to their typically developing (TD) peers.

STUDY DESIGN

Utilizing the Philadelphia Neurodevelopmental Cohort, we analyzed data of 231 youths aged 8-30 with at least one follow-up assessment, including 88 with PS.

STUDY RESULTS

Individuals with PS showed similar developmental trajectories but demonstrated significant impairments in executive functioning (t = -2.81, q = 0.010), memory (t = -2.34, q = 0.019), complex cognition (t = -3.72, q = 0.001), social cognition (t = -2.73, q = 0.010), motor (t = -2.50, q = 0.015), and general cognition (t = -3.20, q = 0.004). Lower cortical (t = -2.46, P = .014) and subcortical (t = -2.41, P = .016) gray matter volume in the recurrent PS group compared to the TD group were documented with age-related group differences becoming less pronounced by young adulthood. Further analyses revealed age-by-group interactions (qs < 0.05) observed in a few temporal and frontal regions, with differences between groups at earlier ages.

CONCLUSIONS

These findings suggest that recurrent PS symptoms are linked to early neurocognitive and brain structure deficits, highlighting the need for interventions to reduce psychosis risk and support healthy neurodevelopment.

Joint resting state and structural networks characterize pediatric bipolar patients compared to healthy controls: a multimodal fusion approach

Pediatric bipolar disorder (PBD) is a highly debilitating condition, characterized by alternating episodes of mania and depression, with intervening periods of remission. Limited information is available about the functional and structural abnormalities in PBD, particularly when comparing type I with type II subtypes. Resting-state brain activity and structural grey matter, assessed through MRI, may provide insight into the neurobiological biomarkers of this disorder. In this study, Resting state Regional Homogeneity (ReHo) and grey matter concentration (GMC) data of 58 PBD patients, and 21 healthy controls matched for age, gender, education and IQ, were analyzed in a data fusion unsupervised machine learning approach known as transposed Independent Vector Analysis. Two networks significantly differed between BPD and HC. The first network included fronto- medial regions, such as the medial and superior frontal gyrus, the cingulate, and displayed higher ReHo and GMC values in PBD compared to HC. The second network included temporo-posterior regions, as well as the insula, the caudate and the precuneus and displayed lower ReHo and GMC values in PBD compared to HC. Additionally, two networks differ between type-I vs type-II in PBD: an occipito-cerebellar network with increased ReHo and GMC in type-I compared to type-II, and a fronto-parietal network with decreased ReHo and GMC in type-I compared to type-II. Of note, the first network positively correlated with depression scores. These findings shed new light on the functional and structural abnormalities displayed by pediatric bipolar patients.

Developing brain asymmetry shapes cognitive and psychiatric outcomes in adolescence

Cerebral asymmetry, fundamental to various cognitive functions, is often disrupted in neuropsychiatric disorders. While brain growth has been extensively studied, the maturation of brain asymmetry in children and the factors influencing it in adolescence remain poorly understood. We analyze longitudinal data from 11,270 children aged 10-14 years in the Adolescent Brain Cognitive Development (ABCD) study. Our analysis maps the developmental trajectory of structural brain asymmetry. We identify significant age-related, modality-specific development patterns. These patterns link to crystallized intelligence and mental health problems, but with weak correlations. Genetically, structural asymmetry relates to synaptic processes and neuron projections, likely through asymmetric synaptic pruning. At the microstructural level, corpus callosum integrity emerged as a key factor modulating the developing asymmetry. Environmentally, favorable perinatal conditions were associated with prolonged corpus callosum development, which affected future asymmetry patterns and cognitive outcomes. These findings underscore the dynamic yet predictable interactions between brain asymmetry, its structural determinants, and cognitive and psychiatric outcomes during a pivotal developmental stage. Our results provide empirical support for the adaptive plasticity theory in cerebral asymmetry and offer insights into both cognitive maturation and potential risk for early-onset mental health problems.

The moderating role of hippocampal volume in the association between emotional abuse and peer victimization in adolescents with major depressive disorder

Given its vicious cycle of victimization, early life adversity (ELA) in childhood may be associated with peer victimization during adolescence. Both ELA and peer victimization have been suggested to be major risk factors for depression. Volumetric alterations in the hippocampus implicated in stress sensitivity have been reported in individuals with ELA and peer victimization. This cross-sectional study examined the moderating role of hippocampal volume in the association between ELA and peer victimization in adolescents with major depressive disorder (MDD). The sample included 78 adolescents with MDD (age M (SD) = 14.92 (1.54) years, 56 females). The Early Trauma Inventory-Short Form and Peer Victimization Scale were used to assess participants' ELA and peer victimization, respectively. High-resolution structural T1 images were obtained using a Siemens 3T magnetic resonance scanner. Whole hippocampal volumes were segmented and calculated using the FreeSurfer 6.0. Correlation and moderation analyses were also performed. Emotional abuse, a type of ELA, was significantly correlated with peer victimization after controlling for age and sex. The association between emotional abuse and peer victimization was moderated by bilateral hippocampal volume in adolescents with MDD after controlling for age, sex, and intracranial volume. Additionally, the association between emotional abuse and peer victimization was stronger when the bilateral hippocampal volumes were larger. Our findings partially supported the concept of a vicious cycle of victimization, which may be a critical aspect of depression in adolescents. Furthermore, the moderation results suggested that hippocampal volume plays an important role in the victimization cycle in adolescents with MDD.

Barriers, facilitators and potential solutions to implementing Kiddie Schedule for Affective Disorder and Schizophrenia (KSADS) screening tool at Muhimbili National Hospital in Dar es Salaam, Tanzania

BACKGROUND

Attention Deficit Hyperactivity Disorder (ADHD) affects 5% of adolescents globally. ADHD increases the child's risk for adverse outcomes, including school failure, juvenile delinquency, substance abuse, and increased sexual risk behaviors. ADHD can be diagnosed in children using the Kiddie Schedule for Affective Disorders and Schizophrenia (KSADS). Semi-structured or structured diagnostic interviews, such as the KSADS-Present and Lifetime (PL) version by Kaufman and colleagues, are the gold standard in diagnosing psychiatric disorders like ADHD. Nevertheless, KSADS-PL is not used in routine clinical practice in Tanzania. There is no research exploring barriers and facilitators to use of KSADS-PL in resource limited areas including Tanzania. The study aimed to uncover barriers, facilitators and possible solutions related to psychiatric care providers' routine use KSADS-PL at the Muhimbili National Hospital (MNH) in Dar-es-Salaam, Tanzania.

METHODS

Between July and October 2019, we conducted semi-structured interviews that focused on providers' perceptions of facilitators, barriers, and solutions regarding KSADS-PL integration into routine clinical practice, data were analyzed data using a qualitative thematic approach informed by the Consolidated Framework for Implementation Research (CFIR).

RESULTS

Limited knowledge and lack of training about KSADS-PL represented the most mentioned perceived barrier for providers. Some providers reported inadequacy of both human and material resources, high workload, and limited physical space at the clinic. Facilitators included readiness for KSADS-PL implementation, and providers' desires for uniform and standardized ways of detecting ADHD. Suggested solutions included involving hospital leaders, support for provider training, increasing staff, making KSADS-PL tools readily available, utilizing an online version of the tool, creating departmental standards, maximizing space at the clinic, and reorganizing clinic flow.

CONCLUSION

Findings suggest a need for innovative implementation science solutions such as multifaceted educational strategies focusing on ongoing trainings and supervisions to increase clinical knowledge, reorganizing clinic flow to increase the quality and duration of patient‑provider interaction, as well as role shifting and other planning strategies that may address barriers like understaffing.

Functional brain changes related to adverse childhood experiences and the presence of psychopathology

Research suggests that associated changes in brain function may underlie the vulnerabilities for psychopathology following adverse childhood experiences (ACEs). In addition to the ACEs themselves, the development of trauma symptoms following ACEs may also contribute to psychopathology. The present study investigates how exposure to certain ACEs, specifically child maltreatment, and trauma symptoms both individually and combined, influence the presence of psychopathology in a sample of adolescents. Participants were 52 adolescents between the ages of 12-14 years recruited from New Hanover County Health and Human Services (NHC-HHS). Further, this study seeks to identify functional brain changes with electroencephalography (EEG) that may impact psychopathology in youth. While child maltreatment and trauma symptoms were not associated, results indicated that frontal and central EEG alpha power, but not alpha asymmetry, were associated with an increased likelihood of experiencing psychopathology in adolescents, with higher alpha power reflecting lower cortical activation. The results of this study suggest that certain changes in patterns of neural activity may be candidates for psychopathology prevention in adolescents.

Prospective Associations Between Structural Brain Development and Onset of Depressive Disorder During Adolescence and Emerging Adulthood

OBJECTIVE

Brain structural alterations are consistently reported in depressive disorders, yet it remains unclear whether these alterations exist prior to disorder onset and thus may reflect a preexisting vulnerability. The authors investigated prospective adolescent neurodevelopmental risk markers for depressive disorder onset, using data from a 15-year longitudinal study.

METHODS

A community sample of 161 adolescents participated in neuroimaging assessments conducted during early (age 12), mid (age 16), and late (age 19) adolescence. Onsets of depressive disorders were assessed for the period spanning early adolescence through emerging adulthood (ages 12-27). Forty-six participants (28 female) experienced a first episode of a depressive disorder during the follow-up period; 83 participants (36 female) received no mental disorder diagnosis. Joint modeling was used to investigate whether brain structure (subcortical volume, cortical thickness, and surface area) or age-related changes in brain structure were associated with the risk of depressive disorder onset.

RESULTS

Age-related increases in amygdala volume (hazard ratio=3.01), and more positive age-related changes (i.e., greater thickening or attenuated thinning) of temporal (parahippocampal gyrus, hazard ratio=3.73; fusiform gyrus, hazard ratio=4.14), insula (hazard ratio=4.49), and occipital (lingual gyrus, hazard ratio=4.19) regions were statistically significantly associated with the onset of depressive disorder.

CONCLUSIONS

Relative increases in amygdala volume and temporal, insula, and occipital cortical thickness across adolescence may reflect disturbances in brain development, contributing to depression onset. This raises the possibility that prior findings of reduced gray matter in clinically depressed individuals instead reflect alterations that are caused by disorder-related factors after onset.

Brain Responses During Face Processing in Conduct Disorder: Considering Sex and Callous-Unemotional Traits

Functional magnetic resonance imaging (fMRI) studies of conduct disorder (CD) have mostly been limited to males. Here, we examined whether male and female youth with CD showed similar or distinct alterations in brain responses to emotional faces, using a large, mixed-sex sample of youths with CD. We also investigated the influence of callous-unemotional (CU) traits. Brain responses to angry, fearful, and neutral faces were assessed in 161 CD youths (74 females) and 241 typically-developing (TD) youths (139 females) aged 9-18 years. Categorical analyses tested for diagnosis effects (CD vs. TD and CD with high [CD/HCU] vs. low [CD/LCU] levels of CU traits vs. TD) and sex-by-diagnosis interactions. When processing faces in general (all faces versus baseline), youths with CD exhibited lower amygdala responses compared to TD youths, which appeared driven by the CD/HCU subgroup. Sex-by-CU subgroups interactions were identified in the amygdala (CD/LCU females

Effectiveness of emotion-focused skills training (EFST) for parents: A randomized controlled trial investigating remission of mental health diagnosis and symptom reduction in children

OBJECTIVE

Emotion-focused skills training for parents (EFST) is a parental guidance intervention aimed at strengthening emotional bonds between parent and child and improve children's mental health. In this randomized controlled trial (RCT), EFST was compared to treatment as usual (TAU) in a Norwegian public outpatient clinic for child and adolescent mental health. The hypothesis was that EFST would be equal or superior to TAU in effectiveness on remission of diagnoses and symptomatic change for children.

METHOD

Seventy-two clients were randomly assigned to an EFST intervention or an integrative family-based intervention (TAU). The main outcome measure was the semi-structured diagnostic interview Schedule for Affective Disorders and Schizophrenia (K-SADS-PL), administered at pretreatment and after three months. The secondary outcome was the DSM-IV version of the Strengths and Difficulties Questionnaire (SDQ). Bayesian statistical methods, including clinically informed priors, were used to compare the effectiveness of the two interventions.

RESULTS

Forty-four percent (15 of 34 clients) attained diagnostic remission in the EFST condition compared to 26 percent (10 of 38 clients) in TAU. The proportion of symptomatic decline was equivalent in both conditions.

CONCLUSION

The results support the hypothesis that EFST was equal or superior to TAU in effectiveness in a public outpatient setting.

The measurement of self-regulation in the Adolescent Brain Cognitive Development (ABCD) Study

To facilitate future research on self-regulation and related brain-behavior associations, we aimed to establish a psychometric model of self-regulation in the largest open neuroimaging dataset to date, the Adolescent Brain and Cognitive Development (ABCD; https://abcdstudy.org/). Given the measures adopted in the ABCD study, we tested three theoretically defensible and applicable psychometric models of self-regulation. The dual-process theory provided the framework for postulating the models to be tested. This theory states that successful self-regulation occurs in case of a balanced state between bottom-up 'hot' and top-down 'cool' processes in favor of achieving goals. Based on the results, we recommend a measurement model with three correlated first-order factors: Hot, Cool and Executive Functions. The model successfully predicted academic achievement both at the time of self-regulation assessment and two years later, and its robustness across smaller samples was confirmed. Given its factorial and predictive validity, we recommend the adoption of the established model for future research on self-regulation and its neural correlates based on the ABCD dataset. Given the measures adopted in the ABCD study, a theoretically desirable bifactor model with a general self-regulation factor and nested Hot and Cool factors cannot be reliably established.

Methylation profile scores of environmental exposures and risk of relapse after a first episode of schizophrenia

Both genetic and environmental factors have been found to play a significant role in psychosis relapse, either independently or through their synergistic interaction. Recently, DNA methylation (DNAm) has been proposed through the calculation of methylation profile scores (MPS). The aim of the present study is to evaluate the association of MPS as a surrogate marker of the biological impact of early stressful life events (including stressful intrauterine conditions and obstetric complications, childhood adversity and toxic habits), with the risk of schizophrenia (SCZ) relapse. 91 participants from a cohort of first-episode schizophrenia (FES) patients with less than five years of evolution were classified as non-relapse (patients who had not experienced a relapse after 3 years of enrollment) or relapse (patients who relapsed during the 3-year follow-up). As inclusion criteria, patients fulfilled Andreasen's criteria of symptomatic remission. Genome-wide DNA methylation (DNAm) was profiled and fourteen MPS reflecting environmental exposure were constructed including both early stressful life events (including stressful intrauterine conditions and delivery issues, childhood adversity) and toxic habits. Increased levels of MPS reflecting gestational diabetes (p = 0.009), hypertensive disorders during pregnancy (p = 0.004), pre-eclampsia (p = 0.049), early preterm birth (p = 0.030), childhood adversity abuse (p = 0.021) and all childhood adversity (p = 0.030) were significantly associated with an increased risk of relapse. Our study suggests that changes in specific methylation patterns may represent one of the biological mechanisms linking early stressful life events to an increased risk of relapse.

Empirically Determining Binge/Purge Frequency Thresholds for Differentiating Anorexia Nervosa-Restricting Subtype vs. Binge-Purge Subtype

OBJECTIVE

While research supports differentiating anorexia nervosa into binge-purge (AN-BP) vs. restricting (AN-R) subtypes, DSM-5-TR does not provide a specific threshold of binge and/or purge episodes that constitutes an AN-BP vs. AN-R diagnosis. Our review of the literature suggests that cutoffs used for defining AN subtypes are rarely reported and, when reported, are highly heterogeneous. Inconsistent subtyping protocols limit generalizability and understanding of AN-R and AN-BP differences.

METHOD

The present study used structural equation modeling (SEM) trees to empirically determine the frequency of binge eating and/or purging that best differentiates AN subtypes. We then compared empirically determined groups on characteristics frequently found to differ between subtypes. Participants were 731 adolescents and adults with AN (94% female, Mage = 20, 72% clinically diagnosed with AN-R) in a partial hospitalization program who completed assessments of AN and comorbid symptoms at intake.

RESULTS

SEM tree analyses yielded four subgroups: past-month binge/purge frequency 0 (AN-R; n = 396); frequency 1-3 (AN-BP1; n = 101); frequency 4-15 (AN-BP2; n = 130); and frequency > 16 (AN-BP3; n = 98). AN-R differed from higher frequency groups on 14/22 clinical characteristics, AN-BP1 differed from higher frequency groups on 11/22 clinical characteristics, and AN-BP2 differed from higher frequency groups on 2/22 clinical characteristics.

CONCLUSIONS

Findings suggest that one binge eating and/or purge episode in the past month provides adequate distinction between subtypes. These findings indicate that the DSM's definition of AN-BP may need to be revised to specify that the presence of any binge eating or purging, rather than "recurrent" binge eating or purging, is sufficient for subtyping AN.

Probing Neurophysiological Processes Related to Self-Referential Processing to Predict Improvement in Adolescents With Depression Receiving Cognitive Behavioral Therapy

BACKGROUND

Cognitive behavioral therapy (CBT) is a gold-standard approach for treating major depressive disorder in adolescents. However, nearly half of adolescents receiving CBT do not improve. To personalize treatment, it is essential to identify objective markers that predict treatment responsiveness. To address this aim, we investigated neurophysiological processes related to self-referential processing that predicted CBT response among female adolescents with depression.

METHODS

At baseline, female adolescents ages 13 to 18 years (N = 80) completed a comprehensive clinical assessment, and a self-referential encoding task was administered while electroencephalographic data were recorded. Baseline electroencephalographic data were utilized to identify oscillatory differences between healthy adolescents (n = 42) and adolescents with depression (n = 38). Following the baseline assessment, adolescents with depression received up to 12 weeks of CBT. Baseline differences in electroencephalographic oscillations between healthy adolescents and those with depression were used to guide CBT prediction analysis. Cluster-based event-related spectral perturbation analysis was used to probe theta and alpha event-related synchronization (ERS)/event-related desynchronization (ERD) response to negative and positive words.

RESULTS

Baseline analyses showed that, relative to the healthy adolescents, adolescents with depression exhibited higher levels of frontal theta ERS and greater posterior alpha ERD. Multilevel modeling identified primary neural pretreatment predictors of treatment response: greater theta ERS in the right prefrontal cortex after the onset of negative words and lower alpha ERD in both the right prefrontal cortex and posterior cingulate cortex. ERS and ERD associations with treatment response remained significant, with baseline depressive and anxiety symptoms included as covariates in all analyses.

CONCLUSIONS

Consistent with prior research, results highlighted that relative to healthy adolescents, adolescents with depression are characterized by prominent theta synchronization and alpha desynchronization over the prefrontal cortex and posterior cingulate cortex, respectively. Cluster-based event-related spectral perturbation analysis also identified key mechanisms underlying depression-related self-referential processing that predicted improved symptoms during the course of CBT. Ultimately, a better characterization of the neural underpinnings of adolescent depression and its treatment may lead to more personalized interventions.

Beyond the Window of Risk? The Dutch Bipolar Offspring Study: 22-Year Follow-Up

OBJECTIVE

Adolescent offspring of parents with bipolar disorder (BD) are at high risk to develop BD and other psychopathology, yet how this risk continues into middle adulthood remains unknown. This study aimed to determine the window of risk for BD and other psychopathology in offspring of parents with BD followed from adolescence into adulthood.

METHOD

This study reported on the 22-year follow-up assessment of the Dutch Bipolar Offspring Study, a fixed cohort study of 140 participants established in 1997. Offspring (n = 100; mean [SD] age = 38.28 [2.74] years) of parents with bipolar I disorder or bipolar II disorder were assessed at baseline and 1-, 5-, 12-, and 22-year follow-up.

RESULTS

No new BD onsets occurred since the 12-year follow-up (lifetime prevalence = 11%-13%; bipolar I disorder = 4%; bipolar II disorder = 7%). Lifetime prevalence of any mood disorder was 65%; for major depressive disorder, prevalence was 36%; and for recurrent mood episodes, prevalence was 37%. Prevalence of major depressive disorder more than doubled in the past decade. Point prevalence of any psychopathology peaked between 20 and 25 years (38%-46%), subsiding to 29% to 35% per year after age 30. Overall, 71% of offspring contacted mental health services since the last assessment.

CONCLUSION

The risk for homotypic transmission of BD in offspring of parents with BD is highest during adolescence. The heterotypic risk for mood disorder onset and recurrences continues over the life course. Severe mood disorders are often preceded by milder psychopathology, emphasizing the need for early identification and interventions. This study allows for better understanding of the onset and course of mood disorders and specific windows of risk in a familial high-risk population.

PLAIN LANGUAGE SUMMARY

This longitudinal study followed 100 offspring of parents with bipolar disorder, finding that they are at increased risk to develop mood and other disorders themselves. The window of risk, in terms of age of onset for mood disorders is still unclear. The 22-year follow-up of the Dutch Bipolar Offspring Study shows the highest risk for occurences of bipolar disorder was during late adolescence (11-13%) while the risk for onset and recurrences of other mood disorders continues into middle adulthood (65% and 37%, respectively).

Applicability and Psychometric Properties of General Mental Health Assessment Tools in Autistic People: A Systematic Review

In recent years, there has been a proliferation of instruments for assessing mental health (MH) among autistic people. This study aimed to review the psychometric properties of broadband instruments used to assess MH problems among autistic people. In accordance with the PRISMA guidelines (PROSPERO: CRD42022316571) we searched the APA PsycINFO via Ovid, Ovid MEDLINE, Ovid Embase and the Web of Science via Clarivate databases from 1980 to March 2022, with an updated search in January 2024, to identify very recent empirical studies. Independent reviewers evaluated the titles and abstracts of the retrieved records (n = 11,577) and full-text articles (n = 1000). Data were extracted from eligible studies, and the quality of the included papers was appraised. In all, 164empirical articles reporting on 35 instruments were included. The review showed variable evidence of reliability and validity of the various instruments. Among the instruments reported in more than one study, the Aberrant Behavior Checklist had consistently good or excellent psychometric evidence. The reliability and validity of other instruments, including: the Developmental Behavior Checklist, Emotion Dysregulation Inventory, Eyberg Child Behavior Inventory, Autism Spectrum Disorder-Comorbid for Children Scale, and Psychopathology in Autism Checklist, were less documented. There is a need for a greater evidence-base for MH assessment tools for autistic people.

Safety and Efficacy of Brexpiprazole in the Treatment of Irritability Associated with Autism Spectrum Disorder: An 8-Week, Phase 3, Randomized, Double-Blind, Placebo-Controlled Trial and 26-Week Open-Label Extension in Children and Adolescents

Introduction: The effective management of irritability is a key need in young people with autism spectrum disorder (ASD). We evaluated the efficacy and safety of brexpiprazole in children and adolescents with irritability associated with ASD. Methods: This was an 8-week, phase 3, randomized, double-blind, placebo-controlled trial (NCT04174365) and 26-week, open-label extension (OLE, NCT04258839) of brexpiprazole (0.25-3 mg/day based on body weight) in children and adolescents (5-17 years) with a diagnosis of ASD, score ≥18 on the Aberrant Behavior Checklist-Irritability (ABC-I) subscale, and score ≥4 on the Clinical Global Impressions-Severity scale. Results: Of the 119 randomized participants (brexpiprazole = 60, placebo = 59), 104 completed double-blind treatment, and 95 enrolled and 70 completed the OLE. Similar reductions in mean ABC-I subscale score were seen in both groups (least-squares mean ± standard error reduction from double-blind baseline of -10.1 ± 1.3 with brexpiprazole vs -8.9 ± 1.3 with placebo). Thus, the primary endpoint did not show a significant treatment effect (LS-mean [95% confidence interval] treatment difference: -1.22 [-4.49, 2.05], p = 0.46) and the hierarchical efficacy analysis ended at this point. At the end of the OLE, participants had a mean ± SD reduction from open-label baseline of -6.1 ± 8.2 in ABC-I subscale score. During double-blind treatment, 51.7% participants treated with brexpiprazole had ≥1 treatment-emergent adverse event (TEAE) versus 35.1% with placebo; no severe or serious TEAEs were reported. The only potentially treatment-related TEAE that occurred in ≥5% of participants was somnolence (12.1% for brexpiprazole vs 5.3% for placebo). During the OLE, the most commonly reported TEAE was increased weight (n = 13, 13.7%). Conclusions: Treatment with brexpiprazole did not demonstrate significant efficacy versus placebo for the treatment of irritability associated with ASD. The safety profile was consistent with that observed in adult and adolescent patients with schizophrenia.

Suicidal Ideation, Clinical Worsening and Outcomes among Child Participants in Trauma-Focused Treatment

Research on clinical trajectories of children with suicidal ideation (SI) and clinical worsening (CW) during cognitive behavioral therapy (CBT) for childhood trauma is limited. The current study utilized secondary data from a randomized clinical trial comparing Trauma-Focused CBT versus Stepped care CBT to examine (1) clinical profile and outcomes of children with SI, recurrent thoughts of death/dying, and past attempts; and (2) clinical worsening during treatment and difference in outcomes. Children (ages 4-12) and their parents (N = 183) participated and 132 completed treatment. Interviews assessing SI, thoughts of death/dying, past attempts, and number/type of trauma were conducted with children (ages 7-12) and parents. Outcome measures (baseline and post-treatment) completed by parents included child posttraumatic stress symptoms, impairment, and internalizing and externalizing problems and an independent evaluator rated overall severity. Children (ages 7-12), parents and therapists completed ratings during treatment that indicated CW. Results did not differ by treatment group; thus, the pooled sample was used. Children with SI at baseline had higher severity than children without. For completers, no children (n = 14) with SI at baseline had SI at post-treatment. Child (n = 3) and therapist (n = 5) ratings of CW were low. Eighteen children (13.64%) were rated as CW by parents. Most ratings occurred at the beginning of treatment. Children with therapist ratings of CW had higher internalizing problems. Findings suggest that children with SI and CW can improve from trauma-focused CBT. More research is needed on the clinical trajectory of children with SI and trauma, and on clinical tools to monitor CW. Clinical trial registration information: https://clinicaltrials.gov : NCT02537678.

A Multi-Method Examination of Peer Functioning in Children with and without Cognitive Disengagement Syndrome

OBJECTIVE

Cognitive disengagement syndrome (CDS) includes excessive daydreaming, mental confusion, and hypoactive behaviors that are distinct from attention-deficit/hyperactivity disorder inattentive (ADHD-IN) symptoms. A growing number of studies indicate that CDS symptoms may be associated with ratings of social withdrawal. However, it is important to examine this association in children specifically recruited for the presence or absence of CDS, and to incorporate multiple methods including direct observations of peer interactions. The current study builds on previous research by recruiting children with and without clinically elevated CDS symptoms and using a multi-method, multi-informant design including recess observations and parent, teacher, and child rating scales.

METHOD

Participants were 207 children in grades 2-5 (63.3% male), including 103 with CDS and 104 without CDS, closely matched on grade and sex.

RESULTS

Controlling for family income, medication status, internalizing symptoms, and ADHD-IN severity, children with CDS were observed during recess to spend more time alone or engaging in parallel play, as well as less time involved in direct social interactions, than children without CDS. Children with CDS were also rated by teachers as being more asocial, shy, and socially disinterested than children without CDS. Although children with and without CDS did not differ on parent- or self-report ratings of shyness or social disinterest, children with CDS rated themselves as lonelier than children without CDS.

CONCLUSIONS

Findings indicate that children with CDS have a distinct profile of peer functioning and point to the potential importance of targeting withdrawal in interventions for youth with elevated CDS symptoms.

Social anxiety moderates the association between adolescent irritability and bully perpetration

BACKGROUND

Preliminary work suggests anxiety moderates the relationship between irritability and bullying. As anxiety increases, the link between irritability and perpetration decreases. We hypothesize that any moderation effect of anxiety is driven by social anxiety symptoms. We sought to explicate the moderating effect of anxiety, while clarifying relations to other aggressive behaviors.

METHODS

A sample of adolescents (n = 169, mean = 12.42 years of age) were assessed using clinician rated assessments of anxiety, parent reports of irritability and bullying behaviors (perpetration, generalized aggression, and victimization). Correlations assessed zero-order relations between variables, and regression-based moderation analyses were used to test interactions. Johnson-Neyman methods were used to represent significant interactions.

RESULTS

Irritability was significantly related to bullying (r = .403, p < .001). Social, but not generalized, anxiety symptoms significantly moderated the effect of irritability on bully perpetration (t(160) = -2.94, b = -.01, p = .0038, ΔR2 = .0229, F(1, 160) = 8.635). As social anxiety symptoms increase, the link between irritability and perpetration decreases.

CONCLUSIONS

Understanding how psychopathology interacts with social behaviors is of great importance. Higher social anxiety is linked to reduced relations between irritability and bullying; however, the link between irritability and other aggression remains positive. Comprehensively assessing how treatment of psychopathology impacts social behaviors may improve future intervention.

Differences in Head Motion During Functional Magnetic Resonance Imaging Across Pediatric Neuropsychiatric Disorders

Background

Robust correction for head motion during functional magnetic resonance imaging is critical to avoid artifact-driven findings. Despite head motion differences across neuropsychiatric disorders, pediatric head motion across a range of diagnoses and covariates has not yet been evaluated. We tested 4 preregistered hypotheses: 1) externalizing disorder diagnoses will associate with more head motion during scanning; 2) internalizing disorder diagnoses will associate with less motion; 3) among children without attention-deficit/hyperactivity disorder, externalizing disorders will associate with more motion; and 4) among children with attention-deficit/hyperactivity disorder, comorbid internalizing disorders will associate with less motion.

Methods

Healthy Brain Network data releases 1.0-7.0 (n = 971) were analyzed in a discovery phase, and additional data released by February 29, 2024 (n = 437) were used in confirmatory analyses. Linear mixed-effects models were fitted with in-scanner head motion as the dependent variable. Binary independent variables of interest assessed for the presence or absence of externalizing or internalizing disorders.

Results

The confirmatory sample did not show significant associations between head motion and externalizing or internalizing disorders or support for the preregistered hypotheses. Across samples, there was a consistent interaction between age and neurodevelopmental diagnoses such that age-related decreases in head motion were attenuated in children with neurodevelopmental disorders.

Conclusions

Head motion remains an important confound in pediatric neuroimaging that may be associated with many factors, including neuropsychiatric symptoms, age, cognitive and physical attributes, and interactions among these variables. This work takes a step toward parsing these complex associations, focusing on neuropsychiatric diagnoses, age, and their interaction.

Maternal Inflammatory Proteins in Pregnancy and Neurodevelopmental Disorders at Age 10 Years

IMPORTANCE

Maternal inflammation during pregnancy has been associated with an increased risk of neurodevelopmental disorders (NDDs), such as attention-deficit/hyperactivity disorder (ADHD) and autism, and cognitive deficits in early childhood. However, little is known about the contributions of a wider range of inflammatory proteins to this risk.

OBJECTIVE

To determine whether maternal inflammatory proteins during pregnancy are associated with the risk of NDDs and executive functions (EF) in middle childhood and to identify protein patterns associated with NDDs and EF.

DESIGN, SETTING, AND PARTICIPANTS

This was a 10-year follow-up cohort study of the Danish Copenhagen Prospective Studies on Asthma 2010 mother-child birth cohort, using plasma samples collected at week 24 in pregnancy, where 92 inflammatory proteins were assessed. NDDs and EF were assessed in the offspring at age 10 years, between January 2019 and December 2021. Mother-offspring dyads with available maternal prenatal inflammatory proteins during pregnancy and offspring NDD psychopathology data at follow-up were included. Data analyses took place between December 2023 and August 2024.

EXPOSURES

Levels of 92 inflammatory proteins from panel collected at week 24 during pregnancy.

MAIN OUTCOMES AND MEASURES

Categorical and dimensional psychopathology of NDDs (primary outcome) and EF (secondary outcome).

RESULTS

A total of 555 mothers (mean [SD] age, 32.4 [4.3] years) and their children (285 male [51%]) were included. The principal component analysis showed that higher levels of maternal inflammatory proteins depicted in principal component 1 were associated with a higher risk of any NDD (OR, 1.49; 95% CI, 1.15-1.94; P = .003), particularly autism (OR, 2.76; 95% CI, 1.45-5.63; P = .003) and ADHD with predominantly inattentive presentation (OR, 1.57; 95% CI, 1.05-2.39; P = .03). The single protein analysis showed that 18 of 92 proteins reached false discovery rate (FDR) 5% significance after adjustment. Vascular endothelial growth factor A, C-C motif chemokine ligand, CD5, interleukin 12B, fibroblast growth factor-23, and monocyte chemoattractant protein-1 emerged as top proteins associated with risk of NDDs. The sparse partial least squares approach identified 34 proteins associated with any NDD, and 39 with ADHD with predominantly inattentive presentation. There were no associations with EF after FDR correction.

CONCLUSIONS AND RELEVANCE

The maternal inflammatory proteome during pregnancy was associated with NDDs risks in offspring at age 10 years. Further research is warranted to elucidate the specific pathways involving these proteins during pregnancy that could be targeted with prevention strategies to reduce risk of NDDs in children.

Intersectional marginalized identities as predictors of time until first reported suicide attempt among preadolescent youth using survival analysis

BACKGROUND

Suicide attempts and deaths among children are increasing in the United States, yet suicide in this preadolescent population remains understudied. A clearer understanding of which youth experience early onset of suicidal behavior is crucial for predicting risk and identifying youth best suited to early intervention. This paper examines how intersectional marginalized identities may predict the onset of suicidal behaviors among preadolescent youth.

METHODS

The Adolescent Brain and Cognitive Development (ABCD) Study is a prospective cohort study with annual assessments of youth ages 9 and 10 and their caregivers. Lifetime suicide attempts and preparatory suicidal behaviors were assessed annually. Survival models examined overall trends and demographic differences in the onset of suicidal behaviors.

RESULTS

The final sample included 11,223 participants (mean age = 9.9 years old, SD = 7.5 months). 5,280 (47%) reported a minoritized racial/ethnic identity, and 1,410 (12.6%) were categorized as sexual or gender minorities. 208 suicide attempts and 143 instances of preparatory suicidal behaviors were reported across the study period. An interaction effect was found such that youth who hold multiple minoritized identities (i.e., sexual and gender minority youth from minoritized racial/ethnic backgrounds) were at elevated risk for onset of both suicide attempts (HR = 2.97, 95% CI = 1.59-5.56, p = .001) and preparatory suicidal behaviors (b = 3.09, 95% CI = 1.38-6.93, p = .006).

CONCLUSIONS

Intersectional marginalized identities were associated with earlier onset of suicide attempts and preparatory suicidal behaviors. Findings suggest that early interventions for minoritized youth may be important to reduce the rapidly increasing suicide rate among preadolescent youth.

Epidemiological study of DSM-5 mental disorders: National mental health survey of Korea - child and adolescent 2022

Effective mental health policies for children and adolescents rely on accurate evaluations of psychiatric disorder prevalence; however, no nationally representative epidemiological studies on psychiatric disorders among children and adolescents have been conducted in South Korea. This study examined the prevalence and socio-demographic factors of mental disorders among Korean children and adolescents aged 6-17 years using web-based DSM-5 diagnostic tools, the computerized version of the Kiddie Schedule for Affective Disorders and Schizophrenia. Between September 2022 and February 2023, 142 interviewers visited houses with tablet PCs in each national census tract by stratified cluster sampling (N = 6275; response rate: 59.94 %). The lifetime prevalence of mental disorders, combining past and current rates, was 16.1 % overall. The highest psychiatric disorders were anxiety disorders (9.6 %), followed by disruptive, impulse control, and conduct disorders (4.4 %), and eating disorders (1.7 %). Substance use disorder among adolescents was 3.1 %, adolescent depressive disorder was 1.5 %, and childhood ADHD was 0.6 %. Parental education and household income influenced mental disorders. This first national-level prevalence can help improve our understanding of child and adolescent mental health in Korea and inform early detection and intervention efforts.