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Introduction: The Child and Adolescent PsychProfiler version 5 (CAPP v5, 2014) is a measure for screening 14 common DSM-5 disorders in children and adolescents. The separation of Attention-Deficit/Hyperactivity Disorder (ADHD) and Specific Learning Disorder (SLD) by subtype results in 17 screening scales covering the 14 disorders. Theoretically then, the CAPP v5 should have a 17-factor structure, however, to date no published study has confirmed this. Additionally, there has been no comprehensive evaluation of the reliability and validity of the screening scales in this measure. These were examined across two different studies. Study 1 examined support for the 17-factor model of the parent-report version of the CAPP (CAPP-PRF) in a large group of adolescents from the general community. It also examined the internal consistency reliability and discriminant validity of the factors in this measure. Study 2 examined the validity of these factors in a clinic-referred group of adolescents. Methods: In Study 1, 951 parents completed the CAPP-PRF on behalf of their adolescents [mean (standard deviation) = 14.54 years (1.66 years)]. In Study 2, 173 parents completed the CAPP-PRF on behalf of their clinic-referred adolescent children [mean (standard deviation) = 14.5 years (1.84 years)]. Adolescents also completed a number of measures and tests for the purpose of assessing their behavior, IQ, and academic abilities. Results: The results in Study 1 supported a 17-factor model, and virtually all of the factors in this model showed acceptable reliability (alpha and omega coefficients), and discriminant validity. Study 2 demonstrated good support for the validity of the scales in the CAPP-PRF. Discussion: These findings indicate acceptable psychometric properties for the CAPP-PRF, and its utility for screening the more common DSM-5 disorders in children and adolescents.

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The Participatory, Cross-Professional and Cross-Departmental Development of an EthicalMission Statement in a Child and Adolescent Psychiatric Clinic: The Ethics Compass of theUPKKJ Basel Employees in child and adolescent psychiatry navigate a complex field of ethical requirements. At the Clinic for Children and Adolescents of the University Psychiatric Clinics Basel (UPKKJ), these areas of tension were examined in a project that spanned across numerous departments and professional groups. Based on a survey study and a narrative literature review, ethical guidelines were developed: the UPKKJ Ethics Compass. The Ethics Compass highlights various areas such as participation, child welfare, justice and developmental health, which are relevant to the relationships between children, adolescents, parents, and the treatment team. To implement these principles in everyday clinical practice, the Ethics Compass is now regularly used in case work and as a communication aid with external partners. Furthermore, a procedural action plan was developed for collaboration with the Department of Clinical Ethics at the University Hospitals in Basel.

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The Treatment of Children and Adolescents with Substance-Related Disorders in the German Health Care System - a Quantitative Study This study evaluates the minimum characteristics of OPS code 9-694 for specific treatment in special settings for substance-related disorders in children and adolescents. The research questions to be answered are the extent to which given minimum characteristics and potentials are assessed as practical, up-to-date, needs-oriented and necessary. The survey was conducted using a nationwide online survey in special wards of child and adolescent psychiatric clinics. Given minimum characteristics reflect everyday clinical practice and are assessed as practical, up-to-date and relevant. Nevertheless, setting- and method-specific potential for further development was identified, most of which has already been implemented in the clinics but has not yet been incorporated into the minimum characteristics. The topic has received little research attention to date. The findings of the original study can provide a basis for the optimization and adaptation of minimum characteristics and treatment offers for children and adolescents with substance-related disorders and lead to the further development of the OPS code. A theory-practice transfer tailored to the target group requires the networking of individual players in the help system as well as the health policy discussion and gradual adaptation of the content of given minimum characteristics and potential for change.

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Children and adolescents in rural communities have statistically more unmet mental health needs and fewer mental health resources than their urban counterparts. The rural population is ill-served by the traditional medical model of hyperspecialization and would benefit more from a population-based approach. By embracing the community, including each area's distinct culture, mental health providers can best affect change in these areas. Increased pediatric integration via telepsychiatry, including clear and codified teleprescribing parameters for controlled substances, can reach more rural youth and eliminate current burdens to primary care providers who currently treat most rural mental illness.

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Systems of care (SOC) is a proven and community-based service network addressing the mental health needs of children and families. Child and adolescent psychiatrists play a crucial role in leading SOCs, utilizing skills such as partnership building and strategic planning. Barriers to mental health care, including access issues and stigma, can be tackled through multisector collaboration. Overcoming challenges such as cultural differences and fragmented systems requires effective leadership. In a SOC, core principles involve culturally competent care, evidence-based practices, collaborative decision-making, and smooth transitions of care. Championing these principles fosters a holistic and supportive environment for those facing mental health challenges.

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BACKGROUND: Major depressive disorder (MDD) is highly prevalent in youth. Conventional treatment paradigms primarily involve selective serotonin reuptake inhibitors (SSRIs) and psychotherapy, yet a significant proportion of this population exhibits treatment-resistant depression (TRD). In adults, interventional therapies like Electroconvulsive Therapy (ECT), repetitive Transcranial Magnetic Stimulation (rTMS), and ketamine have shown promise for TRD, but their comparative efficacy remains underexplored in Adolescent and pediatric population. This systematic review and meta-analysis aims to assess the relative effectiveness of ECT, rTMS, and ketamine in treating TRD among adolescents. METHODS: Following PRISMA guidelines, we systematically searched databases for studies of ECT, rTMS, or ketamine for treatment-resistant depression in youth ages 10-24. Three reviewers independently screened for inclusion based on predefined criteria. Included observational and randomized controlled trials reported depression symptoms with measures like HDRS and MADRS in youth treated with ECT, rTMS, or ketamine. Two reviewers extracted data on interventions, patients, and depression symptom outcomes. Chance-adjusted inter-reviewer agreement was calculated. For meta-analysis, we pooled standardized mean differences (SMDs) in depression scores using random effects models and assessed heterogeneity with I2 statistics. RESULTS: Meta-analysis of 10 observational studies examined SMD in depression scores for treatment resistant depression patients treated with ECT, ketamine, or rTMS. Patients treated with ECT had a significantly lower SMD of 1.99 (95 % CI 0.92-3.05, p < 0.001) compared to baseline. Patients treated with ketamine also had a significantly lower SMD of 1.58 (95 % CI 1.04-2.12, p < 0.001). Patients treated with rTMS had the lowest SMD of 2.79 (95 % CI 0.79-4.80, p = 0.006). There was no significant difference between the three groups overall (p > 0.05). Comparative analysis between ECT and ketamine found no significant difference in SMD (p = 0.387). Comparison of ECT versus rTMS found a significant difference in SMD favoring rTMS (p = 0.004). Comparison of ketamine versus rTMS suggested a potential difference in SMD favoring rTMS (p = 0.058). In summary, rTMS resulted in significantly larger reductions in depression scores than ECT, and potentially larger reductions than ketamine. CONCLUSIONS: This meta-analysis illustrates the ability of rTMS, ECT, and ketamine to improve depression in youth. rTMS resulted in the largest improvements, highlighting its potential as a first-line treatment for pediatric treatment-resistant depression given its favorable side effect profile compared to ECT. Further research directly comparing these modalities is needed.

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The burden of obesity, diabetes mellitus and asthma remains a significant public health issue worldwide. These conditions are associated with premature deaths and a reduced quality of life. Primary health care plays a key role in the prevention, detection, and management of noncommunicable diseases in childhood, including diabetes and asthma. Health promotion is crucial for a healthy life from early childhood, preventing from obesity, a sedentary lifestyle, exposure to tobacco smoke, and other risk factors associated to noncommunicable diseases. Asthma and type 1 diabetes mainly begin in childhood; thus, recognition and early detection at the primary health care level are essential. In the long term, management of children with chronic diseases requires regular follow-up and cooperation with a specialized team. Care coordination by the primary health care provider is key for optimal control of the disease and development of the child or adolescent in the physical, emotional, and social spheres. Over-referral for diagnosis and follow-up is associated with unnecessary specialist overload, patient anxiety, and financial burden for the families and the health system. Clear criteria and referral pathways with efficient communication between the professional team members are essential to empower primary health care providers, avoid unnecessary referrals, and optimize the care and quality of life of children and adolescents with chronic diseases. The WHO Pocket book of primary health care for children and adolescents was recently developed to address knowledge gaps and improve the diagnosis and management of children and adolescents at the outpatient level. It dedicates an entire chapter to health promotion and disease prevention with counselling messages addressed to children, adolescents and their families; provides guidance for the diagnosis and management of asthma, diabetes and other chronic diseases; and includes additional considerations for adolescents living with chronic conditions.

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BACKGROUND: The COVID-19 pandemic is associated with increases in child mental health problems, but the persistence of these changes in the post-pandemic era remains uncertain. Additionally, it is unclear whether changes in mental health problems during the pandemic exceed the anticipated increases as children age. This study controls for the linear effect of age in 1399 children, investigating the course of child-reported anxiety, depression, hyperactivity, and inattention symptoms during and after the pandemic, and identifies risk and protective factors that predict these mental health trajectories. METHODS: Children (51% male; ages 9-11 at the first timepoint) provided mental health ratings at three pandemic timepoints (July-August 2020; March-April 2021; November 2021-January 2022) and one post-pandemic timepoint (January-July 2023). Mothers reported pre-pandemic mental health (2017-2019) and socio-demographic factors. Children reported socio-demographic factors, risk (e.g. screen time, sleep), and resilience (e.g. optimism) factors during the first timepoint. RESULTS: Average mental health symptoms increased over time, with more children exceeding clinical cut-offs for poor mental health at each subsequent pandemic timepoint. Growth curve modeling, adjusting for age-related effects, revealed a curvilinear course of mental health symptoms across all domains. Examination of risk and protective factors revealed that pre-existing mental health symptoms and optimism were associated with the course of symptoms. CONCLUSIONS: After considering age effects, children's mental health follows a curvilinear pattern over time, suggesting an initial decline followed by a rising trend in symptoms post-COVID. These findings underscore the continued need for additional resources and timely, evidence-based mental health prevention and intervention for children.

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AIM: Evidence suggests an association between maternal hypothyroidism and risk of attention-deficit/hyperactivity disorder (ADHD) or autism spectrum disorder (ASD) in offspring. We examined the risk of ASD and ADHD in individuals with congenital hypothyroidism (CHT). METHODS: A nationwide population-based cohort study enrolled a total of 1260 children younger than 12 years with a confirmed diagnosis of CHT and no prior diagnosis of any neurodevelopmental disorders, selected from the National Health Insurance Research Database of Taiwan between 1998 to 2013. In addition, 12,600 controls matched for sex, age, and residence were selected. Cox proportional hazards analysis was used to investigate the association among CHT, ASD, and ADHD. RESULTS: Children with CHT were associated with a higher incidence of ASD (7.1‰ vs 1.3‰, P < 0.001) and ADHD (39.7‰ vs 18.7‰, P < 0.001) than the control group. Cox regression analyses demonstrated that children with CHT were associated with elevated risks of ASD (hazard ratio [HR], 4.72 [95% confidence interval (CI), 2.08-10.70]) and ADHD (HR, 2.03 [95% CI, 1.49-2.77]), after adjusting for demographic data and family history of major psychiatric disorders, compared with the control group. CONCLUSION: Children with CHT were associated with approximately a two-fold increased risk of ADHD and a four-fold increased risk of ASD than the control group. Our study highlights the need for future research to elucidate the potential pathophysiology among CHD, ASD, and ADHD.

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Screening tools can help with the identification of intellectual disability, but little is known about who uses them. This study analysed anonymous information from 2691 users of an evidence-based, online, intellectual disability screening questionnaire for children and adolescents (CAIDS-Q) to explore the characteristics of the users and of those being screened. The users were split almost equally between parents/family members (48.6%) and professionals (49.9%), with the majority (63.8%) of the latter group being health staff. Significant differences in the characteristics of the children being screened were found, according to whether the user was a parent/family member or a professional, with the overall pattern suggesting that professionals screened children with greater complexity of needs, but about whom less was known. The screened children had a range of areas of difficulties that are common to those with intellectual disability. Implications for practice are discussed.

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Sleep is a critical component of healthy development, particularly during the formative years from infancy through adolescence. Sleep undergoes continuous change throughout life characterized by frequent awakenings and a high proportion of rapid eye movement (REM) sleep during infancy, changes in sleep architecture, an increase in non-rapid eye movement (NREM) sleep during adolescence, and an eventual decrease in REM sleep in old age. Adequate sleep is therefore essential for cognitive development, especially between ages 10 and 16. Sleep deprivation may negatively affect academic performance, attention regulation, and emotional well-being. Biological factors, such as hormonal changes during puberty, significantly influence sleep patterns, leading to later bedtimes and a tendency for chronic sleep deprivation in adolescents. Environmental factors, including light exposure and screen time, also play a critical role in regulating sleep. This paper examines the evolution of sleep patterns across infancy and adolescence, describing changes in sleep architecture, timing, and regulation. The influence of biological, environmental, and socio-cultural factors on sleep is explored, highlighting how these factors collectively shape sleep behaviors and health outcomes. It also addresses the profound role sleep plays in cognitive development, brain maturation, and emotional well-being. The importance of understanding sleep patterns and their developmental trajectories to address sleep-related issues is emphasized. Promoting healthy sleep from an early age can enhance cognitive and emotional outcomes, contributing to better academic performance and overall well-being in children and adolescents. The findings advocate for further standardized sleep intervention programs globally to prioritize sleep health and support optimal development.

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BACKGROUND: Although previous reviews have examined the relationship between heritage cultural maintenance and mental health outcomes among migrants, none have focussed specifically on migrant adolescents (i.e. those aged 10-24 years). AIMS: To examine (1) the focus, scope and nature of quantitative empirical research investigating heritage cultural maintenance - including linguistic maintenance - and mental health outcomes among migrant adolescents globally and (2) the association between cultural and linguistic maintenance and migrant adolescents' mental health outcomes. METHOD: Following the Arksey and O'Malley methodological framework for scoping reviews, we searched 11 electronic health, medical, social science and language databases from database inception until the search date (6 June 2023), using English search terms. We extracted data from included empirical studies using a template with pre-defined data items, which we present in comprehensive overviews and narrative summaries. RESULTS: Thirty-four studies met our inclusion criteria. We identified considerable heterogeneity between studies regarding their research foci, methodologies, terminologies, outcomes and findings regarding the association between cultural maintenance and mental health outcomes. We specifically identified mixed findings regarding the latter, which cannot be transferred or generalised. CONCLUSIONS: The heterogenous nature of methodologies and outcome measures in the published literature, in addition to a scarcity of research from low- and middle-income countries, have hindered meaningful progress in this field. Efforts to address these issues, and to take adolescent context into consideration, will facilitate a more accurate understanding of how cultural maintenance relates to migrant adolescent mental health, and inform future interventions to improve mental health outcomes.

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BACKGROUND: A global schools-based programme within the Global Campaign against Headache is estimating the burden of headache in children (6-11 years) and adolescents (12-17 years), cluster-sampling the world by conducting national studies in all world regions. Its purpose is to complement population-based studies in adults, adding to knowledge of the burden of headache and informing educational and health policies. This study in Benin was the third in the programme from sub-Saharan Africa (SSA). METHODS: We followed the generic protocol for the global study. In a cross-sectional survey, the child and adolescent versions of the Headache-Attributed Restriction, Disability, Social Handicap and Impaired Participation (HARDSHIP) structured questionnaire were administered to pupils within their classes in 16 schools selected from across the country to be representative of its diversities. Headache diagnostic questions were based on ICHD-3 criteria but for the inclusion of undifferentiated headache (UdH). RESULTS: Very large proportions of pupils were absent on the survey days. The sampled population defined by class registers totalled 11,802 pupils, of whom only 2,488 were present. A further 193 pupils (or their parents) declined the survey. The surveyed sampled (N = 2,295; males 1,156 [50.4%], females 1,139 [49.6%]) included 1,081 children (47.1%) and 1,214 adolescents (52.9%), with a non-participating proportion (193/2,488) of 7.8%. Headache ever was reported by 97.3% of the sample. Age- and gender-adjusted 1-year prevalences, according to responses given, were 53.4% for migraine (almost three quarters of this being probable migraine), 21.3% for tension-type headache, 8.2% for UdH, 1.0% for probable medication-overuse headache (pMOH) and 2.6% for other headache on ≥ 15 days/month (H15+). Both pMOH and other H15 + were substantially more prevalent among adolescents. CONCLUSION: The finding for migraine is anomalous, but, within this series of studies, the same was found in Zambia and similar in Ethiopia, both in SSA. While many cases identified as probable migraine, especially among children, might better have been diagnosed as UdH, the true prevalence of migraine almost certainly exceeds 21%. Regardless of diagnosis, headache is very common among children and adolescents in Benin. The study sounds an alarm with regard to pMOH as a developing problem pre-adulthood.

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Introduction: Professional guidelines recommend that providers routinely monitor children prescribed second-generation antipsychotics (SGA) to reduce the risk of adverse metabolic events associated with the medication. Despite this guidance, many studies show low rates of monitoring compliance. In this study, we interviewed child psychiatrists for their views of possible barriers to monitoring. Methods: Semi-structured qualitative interviews, developed according to the Regehr model of influences upon patient-provider decision making, were conducted with child and adolescent psychiatrists in current practice and recruited by convenience and snowball sampling. Interviews were conducted through internet video meetings and were recorded. Interview data were analyzed following Framework Analysis qualitative methods. Results: We recruited and completed interviews with 17 psychiatrists. Patient-level barriers included travel difficulties, limited family time for health care appointments, patient fear of blood draws, and more. Provider-level barriers included professional judgment versus guideline guidance, perceived family burden, assumption of low-risk, short-term SGA use, and more. Organizational level barriers included lack of organizational mandates or incentives, limited appointment time per patient, lack of care coordination, lack of co-located labs, personnel turnover, and more. Barriers at the social and cultural level include stigma and low health literacy. Conclusion: These practicing prescribers provided a wide range of possible barriers to metabolic monitoring in children and adolescents prescribed SGAs. The next step is to explore which may be present in certain settings, and to pilot quality improvement interventions. Addressing barriers can reduce risk of metabolic disorders arising from long-term use of SGAs in children and adolescents.

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This systematic review aims to report on the use of Statement Validity Analysis (SVA) with minors involved in criminal justice proceedings. We conducted a literature search of six bibliographic databases up to March 2024. Additional searches were performed using citation tracing strategies. Nineteen studies published between 1991 and 2023 were retained. Most were published between 1991 and 2000, mainly in the USA. A scientific gap was observed for 10 years before studies resumed between 2011 and 2022. These 19 studies involved 2931 children; most were girls (n = 2080; 71%). The mean age was 9.4 years (SD = 2.40; min = 2; max = 17.5). Most studies did not mention the nature of the relationship between the child and the alleged perpetrator of sexual violence, three studies involved intra-family violence and six studies involved victims of intra- and extra-family violence. Nearly 75% of the interviewers were trained with SVA methods. Most were mental health professionals (52.6%) or police officers (15.8%). No study used the SVA as a whole, 10 studies used 19 criteria of the Criteria-Based Content Analysis (CBCA), and no study used the Validity Check List (VCL). Most studies performed SVA on interview transcripts (n = 8), and two studies performed their analysis on both verbatims and video. The conclusion of our literature review highlights the methodological weaknesses of these studies and encourages more research about the use of SVA in the judicial field to reduce the risk of misleading the judiciary.

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BACKGROUND: Fetal alcohol spectrum disorders (FASD) are a group of conditions that occur due to prenatal alcohol exposure (PAE), which impacts physical, behavioral, and cognitive ability. The literature demonstrates that healthcare professionals lack knowledge and understanding of FASD, resulting in children and young people (CYP) often getting misdiagnosed with neurodevelopmental disorders or the diagnosis of FASD missed, increasing their risk of experiencing secondary mental health difficulties. Child and Adolescent Mental Health Services (CAMHS) are the commissioned service to diagnose neurodevelopmental conditions and support CYP with mental health difficulties, therefore, it is likely that CYP with probable or diagnosed FASD will present in CAMHS. There is currently no research exploring the awareness and understanding of FASD within these services. METHODS: Constructivist grounded theory was utilized to explore the barriers and facilitators clinicians experience when assessing and supporting CYP with probable or diagnosed FASD within CAMHS. A sample of 12 CAMHS clinicians from an NHS Mental Health Trust situated in the Northeast of England were interviewed. Interviews were transcribed and analyzed and grounded theory techniques were utilized to generate an end model. RESULTS: The end model was developed on a box analogy with four categories. 'Unable to Open the Box' captures barriers CAMHS clinicians experience when exploring FASD, 'Things that Help Open the Box' captures facilitators CAMHS clinicians experience when exploring FASD, 'Asking Others About the Box' captures systemic influences CAMHS clinicians may experience when exploring FASD, and 'Making the Box Easier to Open in Future' captures how we can support CAMHS clinicians moving forward to explore FASD. CONCLUSIONS: This model provides new insights into the barriers and facilitators CAMHS clinicians experience when assessing and supporting CYP with probable or diagnosed FASD, highlighting key clinical implications. Recommendations for future research are outlined to expand the knowledge base for this area.

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The environment influences the way we act, react and adapt to our surroundings whether it is consciously or unconsciously. Though it is widely accepted that multiple interacting systems influence human behaviour and development across the life span, the reality of teasing these factors apart is difficult and challenging. In this brief commentary on Czernine and colleagues' important and timely paper, 'Can a modernised psychiatric unit space reduce the use of coercive measures in child and adolescent psychiatry?', I evaluate and build on the evidence presented by making constructive suggestions on ways of improving the status quo healthcare and treatment conditions for children and adolescents today. The underlying assumption is that by furthering this complex yet important area of research in the field of psychiatry and adjacent disciplines, we can improve existing healthcare systems and processes that are aligned with meeting child and adolescent needs.

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BACKGROUND: Child and adolescent antidepressant use increased post-pandemic, but it is unknown if this disproportionally affected those who develop post-acute sequelae of coronavirus disease 2019 (COVID) or long COVID. This study compared the risk of antidepressant initiation among children and adolescents with long COVID with those who had COVID but did not have evidence of long COVID. METHODS: Our retrospective cohort study of children and adolescents aged 3-17 years at the first evidence of COVID or long COVID from October 1, 2021 through April 4, 2022 was conducted within Komodo's Healthcare Map™ database. The index date was the earliest date of a medical claim associated with a COVID (COVID comparators) or long COVID diagnosis (long COVID cases). The baseline period was six months before the index date. The outcome was antidepressant initiation within twelve months after the index date. Due to the large number of COVID relative to long COVID cases, COVID comparators were randomly selected with a ratio of 2 COVID to 1 long COVID. We used propensity score matching to control for confounding due to imbalances in the baseline covariates. Log-binomial models estimated the relative risk (RR) of antidepressant initiation in the propensity score matched sample. We conducted several sensitivity analyses to test the robustness of our findings to several assumptions. RESULTS: Our child and adolescent sample included 18 274 with COVID and 9137 with long COVID. Compared with those with COVID, a larger proportion of long COVID children and adolescents had psychiatric disorders, psychotropic use, medical comorbidities, were previously hospitalized, or visited the emergency department. In the propensity score-adjusted analysis, the long COVID group had a statistically significant higher risk of antidepressant initiation relative to the COVID comparator (adjusted-RR: 1.40, 95% CI = 1.20, 1.62). Our findings were robust across sensitivity analyses. CONCLUSIONS: The increased risk of antidepressant initiation following long COVID warrants further study to better understand the underlying reasons for this higher risk. Emerging evidence of long COVID's impact on child mental health has important implications for prevention and early interventions.

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Youth with developmental and pre-existing mental health conditions have been particularly vulnerable to declines in psychological functioning during the COVID-19 pandemic. This study aimed to first, analyze service usage within an outpatient child and adolescent psychiatry clinic in the months preceding and during the COVID-19 pandemic, and second, to examine associations with potential protective factors against mental health concerns in a treatment-engaged sample. Service usage was examined using clinic billing data, and reports on protective factors were gathered via parent survey of 81 children ages 6-17 years who received mental health treatment in an outpatient psychiatry clinic during the pandemic. Protective factors were assessed at the individual, family, and community levels, and included children's use of coping strategies, parental resilience, and parents' perceived social supports. Study outcomes, including mental health concerns, mental health emergencies, pandemic-related distress, and social impact of the pandemic, were analyzed via Pearson correlations and simultaneous multiple linear regressions. Findings suggest increased service usage and child coping, parental resilience, and social connectedness as factors associated with fewer mental health concerns in youth with psychiatric concerns during the pandemic. This study lends support for expanding psychiatric services with continued use of telemedicine platforms. Further, findings suggest a mental health benefit to optimizing individual, parental, and community-based resources to enhance children's psychological functioning, particularly for youth with pre-existing mental health conditions.