搜索结果：JAACAP open

There is limited evidence-based guidance about how autism diagnostic assessments should be conducted for gender-diverse people. This study aimed to integrate expert knowledge on key clinical considerations for these assessments. A modified Delphi study was conducted. World experts in the field (N = 21) were invited to complete 2 rounds of surveys. Survey one collected open-text responses about key clinical considerations when conducting diagnostic assessments, structured around the DSM-5-TR criteria for autism, across age ranges. Experts were asked to rate the importance of each consideration they listed. A content analysis was conducted to synthesize and collate similar considerations, alongside descriptive statistics of importance ratings. Survey two presented the resulting considerations and mean importance ratings, with experts rerating their importance. Statements rated as at least "important" and that had an SD of less than 1.0 were reported. Round one resulted in 65 individual statements, of which 37 met our definition for reporting. These statements, summarizing expert opinions, were categorized as being general considerations for assessments, linked to the DSM-5-TR autism criteria (A-E), or practical considerations for working with the gender-diverse population. They highlighted areas to be considered during assessments, such as ways in which the features of autism may intersect with gender diversity, and practical considerations for increasing comfort and engagement of gender-diverse individuals undergoing an autism assessment. The summary of expert opinions provides preliminary considerations for clinicians working in this field and for researchers to use as hypotheses for empirical investigations. Gender-diverse people are more likely to be diagnosed with autism or have autistic traits. In this study, the authors conducted surveys of 21 experts in conducting autism assessments in youth from around the world. The authors summarized expert opinion including general considerations for assessment, autism diagnostic criteria, and working with gender-diverse populations.

Transgender and gender diverse (TGD) youth are at high risk for self-injurious thoughts and behaviors (SITB) including suicidal ideation, nonsuicidal self-injury (NSSI), and suicide attempt. We compared total SITB endorsements during a 4-year period among 3 groups: TGD youth with high gender-related social stress (TGD+High-Stress); TGD youth with low gender-related social stress (TGD+Low-Stress); and non-TGD youth. We further identified risk and resiliency correlates of 3 longitudinal SITB trajectories (NSSI, suicidal ideation, and suicide attempt), accounting for gender-related social stress and other known robust risk factors. This study (N = 11,851) used longitudinal data for youth spanning ages 10 to 14 years from the Adolescent Brain Cognitive Development study (release 5.1), of whom 4% were TGD. Analyses of variance were used to compare mean SITB endorsements across groups. Three mixed-effects logistic regressions identified correlates of SITB trajectories during the study. On average, TGD+High-Stress experienced more SITB events than TGD+Low-Stress and non-TGD youth, respectively. Longitudinal results found that TGD compared to non-TGD youth experienced higher NSSI and suicidal ideation risk regardless of gender-related social stress. TGD+High-Stress but not TGD+Low-Stress youth had greater suicide attempt risk than non-TGD youth. Higher psychopathology symptoms and family conflict were associated with higher NSSI and suicidal ideation risk. Only school involvement was protective against ideation and NSSI risk. TGD youth experience higher SITB risk, particularly when facing higher gender-related social stressors at home or school. We urgently need interventions supporting positive connections between TGD youth and their families and peers. Using longitudinal data from the Adolescent Brain Cognitive Development℠ (ABCD) Study (N = 11,851), the authors compared total self-injurious thoughts and behaviors (SITB) among transgender and gender diverse (TGD) youth and non-TGD youth from ages 10 to 14 years. This study found that TGD youth experience higher risk for SITB than non-TGD youth. High gender-related social stress, more mental health symptoms, and family conflict were associated with higher risk of SITB, whereas school involvement was protective against SITB. This study highlights the need for developing interventions that support positive connections between TGD youth and their families and peers.

To identify the depressive profiles of 15-year-old Latinx adolescents who have been school disciplined and school policed, and to provide empirical evidence for the School-to-Patient Nexus (STPN). Data from 813 Latinx adolescents from the Future of Families and Child Wellbeing Study (FFCWS) were used to conduct a latent class analysis to understand the subgroup differences among Latinx adolescents in terms of their school discipline, school policing, and depressive symptoms. Covariates included prior mental health history, demographics, and school connectedness. Three classes of Latinx adolescents were identified: (1) "less school policing"; (2) "no school discipline/low school policing"; and (3) "more school policing." Depressive symptom scores incrementally increased with latent classes. School discipline and school policing influence the depressive symptoms of Latinx adolescents. Compared to the other classes, class 3 indicated that Latina adolescent girls had the highest depressive mean scores, and therefore structural and institutional changes and interventions specifically adhering to the needs of these girls are needed. These findings provide empirical support for the School-to-Patient Nexus, demonstrating how carceral school practices become embodied as mental health outcomes. Although it is known that school discipline and policing can harm the mental health of young people, little is known about how these factors affect Latinx teenagers. Eight hundred thirteen Latinx teenagers were studied to understand how school discipline and policing related to depressive symptoms. Three distinct groups emerged: (1) “less school policing”; (2) “no school discipline/low school policing”; and (3) “more school policing.” Latina girls in the most heavily policed group had the highest depressive scores, raising the question of whether carceral school practices harm the mental health of Latinx youth.

Sleep disturbances have been linked to suicide risk, but few studies have explored these effects during the transition from childhood to adolescence. This study examined whether specific trajectories of sleep disturbance across childhood and early adolescence were associated with greater suicidal thoughts and behaviors (STB) for youth in the Adolescent Brain Cognitive Development&#x2120; (ABCD) Study. Data from 11,864 participants in the ABCD Study&#xae; (Data Release 5.1) were used in this study. Youth STB were assessed by the Schedule for Affective Disorders and Schizophrenia for School-Age Children suicidality module. The Sleep Disturbance Scale for Children measured sleep disturbance. Latent class growth analysis was used to identify sleep trajectories, and Bayesian ordinal regression models were used to examine whether sleep trajectories were differentially associated with STB during 2-, 3-, and 4-year follow-up. Latent class growth analysis identified 3 latent sleep profiles (low-stable, high-decreasing, and moderate-increasing). Sleep profiles with greater disturbance, including both high-decreasing (odds ratio 1.75, 95% CI [1.06, 2.89], p = .030) and moderate-increasing (odds ratio 2.34, 95% CI [1.72, 3.14], p < .001) profiles, were linked to higher likelihood of more severe STB outcomes compared with the low-stable group. This study identified distinct developmental trajectories of sleep disturbance across childhood and early adolescence linked to STB. Specifically, early high sleep disturbances that improved and moderate disturbances that worsened over time were both associated with greater STB severity. Difficulty falling and staying asleep and excessive sleepiness were common in both patterns. These findings highlight the need to identify and address early and/or worsening sleep problems as a potential target for suicide prevention strategies. Analysis Code for: "Sleep Disturbance Trajectories During Childhood and Early Adolescence Associated with Increased Suicide Risk"; https://osf.io/pf49z. Sleep disturbance has been associated with suicidal risk. This study examined whether sleep problems from childhood to early adolescence were linked to suicidal thoughts and behaviors. Using data from over 11,000 youth in the Adolescent Brain Cognitive Development&#x2120; (ABCD) Study, researchers found those with persistent or worsening sleep disturbances, such as trouble falling or staying asleep and daytime sleepiness, were more likely to report suicidal thoughts and behaviors. Early and ongoing sleep problems may be important warning signs for suicide risk and could help guide prevention efforts.

Irritability is among the top reasons for youth mental health referrals worldwide. Cultural factors may affect how irritability manifests and develops; how it is experienced by youth and responded to by their caregivers; and how it is treated. However, the influences of cultural context on irritability have received little systematic investigation. The Cross-Cultural Consortium on Irritability (C3I; https://m.yale.edu/c3i) is an international research network created to increase the limited evidence base on cross-cultural similarities and differences in irritability. By bringing together researchers worldwide, C3I provides an innovative and collaborative approach to address unmet needs and to explore novel research questions regarding cultural variation in irritability. In addition, combining resources and data around the globe helps to produce robust, reproducible, and generalizable results using large mega-data. One important initiative involves pooling existing datasets to support manuscript collaborations. The first 3 such projects focus on cross-cultural comparisons of the following irritability-related topics: boundaries of normative behavior; association with suicidality and self-harm; and informant effects. Another ongoing effort involves conceptualization of irritability across cultures. Other efforts include promoting projects of primary data collection using qualitative and quantitative methods, harmonization across measures, and facilitating/supporting community-based participatory research and engagement. C3I is an innovative, collaborative research structure to build a robust, reproducible, and generalizable evidence base on irritability and its characteristics, including sociocultural influences. This evidence base will facilitate recognition and assessment of irritability and, ultimately, inform development of effective, culturally informed prevention and intervention to benefit the largest possible number of youth and their families. This article describes the Cross-Cultural Consortium on Irritability (C3I), an international network aimed at understanding how culture shapes the presentation, experience, response to, and treatment of irritability in youth. By exploring these cultural influences, C3I seeks to improve recognition, assessment, and development of effective, culturally sensitive prevention and intervention strategies to benefit the largest possible number of youth and their families worldwide.

As of 2021, suicide has increased to the third leading cause of death among children 8 to 12 years of age. Children presenting to the emergency department (ED) for suicide thoughts and behaviors (STB) are at high risk for recurrent behavioral health (BH) concerns. This study leveraged electronic health records (EHR) to identify risk factors for STB and return ED visits. EHR for 920 patients 8 to 12 years of age (N = 1,310 visits) who indicated STB or BH concerns or had a psychiatric consultation in the pediatric ED of a metropolitan hospital were reviewed from 2020 to 2023. Structured data (eg, demographics, diagnoses) were combined with clinician free-text notes. STB were frequently indicated among BH patients (65%). Ingestion was the most common injury cause from acute suicide behavior (71%). Most suicide behavior was linked to family/social triggers (56%); 21% included conflict over social media/technology. Psychosocial factors differentiated STB from other BH cases, including bullying, impulsivity, irritability, sleep, and LGBTQ+ identity (odds ratio = 2.09-6.46). Of the patients, 13% had multiple visits implicating STB. Most subsequent ED returns were within 3 months of discharge (median = 89 days). Prior psychiatric hospitalization was the strongest predictor of ED returns for subsequent STB within 1 year (odds ratio = 3.27). Suicide risk is common among 8- to 12-year-old children seeking psychiatric emergency services. EHR provide critical data for understanding this public health challenge and can guide enhancement of pediatric screenings for suicide risk, including detailed assessment of symptoms (eg, impulsivity, sleep disruption) and psychosocial context (eg, bullying, LGBTQ+ identity). Helping families increase safety around ingestible lethal means remains a key point of intervention. We worked to ensure sex and gender balance in the recruitment of human participants. We worked to ensure race, ethnic, and/or other types of diversity in the recruitment of human participants. One or more of the authors of this paper self-identifies as a member of one or more historically underrepresented sexual and/or gender groups in science. One or more of the authors of this paper received support from a program designed to increase minority representation in science. We actively worked to promote sex and gender balance in our author group. While citing references scientifically relevant for this work, we also actively worked to promote sex and gender balance in our reference list. The author list of this paper includes contributors from the location and/or community where the research was conducted who participated in the data collection, design, analysis, and/or interpretation of the work. Suicide risk is the third leading cause of death for children aged 8 to 12 years. This study examined electronic health records from emergency department encounters of children with suicidal thoughts or behaviors or with behavioral health concerns (N = 920 youth). Ingestion or overdose attempts were the most common injury type (71%). Most suicidal behavior was linked to family/social triggers (56%); 21% involved conflict over social media/technology. The authors also identified multiple psychosocial factors associated with suicidal thoughts and behaviors. Children with prior psychiatric hospitalizations were most at risk for repeated emergency room visits. Helping families increase safety around ingestible lethal means remains essential.

Functional somatic symptoms, which are physical symptoms that cannot be fully explained by any underlying medical condition, run in families. Besides genetic predispositions, parental model behaviors may contribute to the intergenerational transmission of proneness to somatic symptoms. However, studies examining the long-term influences of parental health and illness factors on somatic symptoms in offspring are scarce. Using data from the Lifelines Cohort Study, cross-sectional associations were investigated between parental somatic symptoms, (chronic) medical conditions, health care utilization, medication use, and health literacy-assessed through a questionnaire and professional involvement in health care-and somatic symptoms reported by their adolescent offspring (13-17 years old) using the Somatic Complaints subscale of the Youth Self-Report. Long-term associations were then examined with the same predictors and symptom reports at follow-up in early adulthood. The study included 3,735 mother-adolescent dyads and a subsample of 2,668 mother-father-adolescent triads containing maternal and paternal information. Negative binomial regression analysis was used to examine associations between parental health factors and offspring symptoms. Maternal (chronic) medical conditions and pain medication use were significantly associated with symptom reports of adolescents, particularly girls, in both mother-father-adolescent triads and mother-adolescent dyads. Additionally, in the dyads, mothers' somatic symptoms predicted somatic symptoms in adolescents, especially daughters. Only maternal somatic symptom reports were significantly associated with somatic symptoms of young adult daughters 3 to 4 years later. No significant associations were found for parental health care utilization, health literacy, or fathers' health and illness factors after multiple comparison correction. This study examined various parental somatic health indicators, emphasizing the significant role of maternal health in somatic symptom burden of adolescent children. This influence diminishes as adolescents transition into adulthood. These findings highlight the importance of prioritizing maternal health in clinical interventions to reduce somatic symptoms in adolescents. By focusing on early identification and empowering mothers with health education, health care providers can promote healthier behaviors and potentially reduce the intergenerational transmission of somatic symptom tendencies. Parental factors associated with the persistence of somatic symptoms from adolescence into adulthood; https://osf.io/5htsb/overview. This study explored how parents&#x2019; health, including somatic or physical symptoms, medical conditions, and healthcare utilization, as well as healthcare literacy relate to physical symptoms in their teenagers. Researchers analyzed the Lifelines Cohort Study of Dutch families, which includes 3,735 mother-adolescent pairs, of which 2,688 also have paternal information. Maternal medical conditions and pain medication use were associated with their daughter&#x2019;s somatic symptoms during adolescence and early adulthood. However, paternal health and healthcare utilization showed no clear associations.

Transgender and gender diverse (TGD) people in China have long remained relatively invisible, and research focusing on this population is scarce. This study aimed to analyze and summarize existing evidence to outline the mental health and health care needs of TGD adolescents in China, thereby guiding future health initiatives. Research articles on TGD adolescents in China published in Chinese and English and found on PubMed, Wanfang (in Chinese), and CNKI (in Chinese) databases were examined; 12 articles published between January 1, 2020, and April 1, 2025, were analyzed in the review. TGD adolescents in China frequently experience family and school violence, bullying, and problematic smartphone and internet use. There is a high prevalence of mental health disorders, notably depression and anxiety, as well as high occurrences of self-harm and suicidal behaviors in this population. Furthermore, although there is a pronounced need for hormone therapy, barriers in diagnosis and treatment obstruct TGD adolescents in China from receiving accessible and standard care. Research on the mental health of TGD adolescents in China is lacking. Mental health care for these adolescents requires immediate attention, prioritizing the integration of social and psychological support to improve their mental well-being. Gender education is needed in both family and educational settings to enhance the understanding of gender minority. Development of comprehensive medical services, encompassing both mental health support and hormone therapies, is needed to improve psychosocial function and physiological health of TGD youth. This review examined research studies on mental health conditions and healthcare needs among transgender and gender diverse (TGD) adolescents in China. Findings reveal high rates of depression (39.0%-63.4%), anxiety (22.4%-38.4%), self-harm (24.6%-27.5%), suicidal ideation (31.8%-56.3%), and suicidal behavior (4.2%-16.1%) in this population. Many Chinese TGD youth reported experiencing family and school violence, bullying, and problematic smartphone and internet use. This study shows an urgent need for more accessible psychological support and medical services for this population. Enhancing gender education in families and schools is essential to improve the well-being of TGD youth.

Recreational activities are considered vital for emotional and cognitive health of youth, yet empirical research examining the specific associations between recreational activities and youth behavioral and cognitive outcomes is limited. In this cohort study, interpretable machine learning methods, specifically random forest paired with SHapley Additive exPlanations (SHAP) analysis, were applied to quantify the contribution of each activity to behavioral and cognitive outcomes in the Adolescent Brain Cognitive Development&#x2120; (ABCD) Study baseline data (ages 9-10). Data-driven activity groups were defined by SHAP contribution patterns for behavioral and cognitive outcomes. Engagement in these groups was then tested for association with the corresponding outcomes using linear mixed-effects models in the hold-out sample, both cross-sectionally and longitudinally. Of activities, 14 were identified with more favorable and 8 with less favorable behavioral patterns, and 13 were identified with more favorable and 2 with less favorable cognitive patterns. Activities with more favorable behavioral patterns (eg, skiing/snowboarding) were linked to fewer problems (&#x3b2; = -1.12, p < .001), whereas activities with less favorable patterns (eg, martial arts) were linked to more problems (&#x3b2; = 1.75, p < .001). For cognition, activities with less favorable patterns (eg, football) were associated with lower cognitive scores (&#x3b2; = -1.34, p < .001), whereas activities with more favorable patterns (eg, musical instruments) were associated with higher scores (&#x3b2; = .98, p < .001), and family income moderated this association (p < .001). Recreational activities exhibit distinct patterns of association with cognitive and mental health outcomes. These data-driven findings highlight the importance of considering individual differences and contextual factors when investigating youth engagement in recreational activities. This study used machine learning to examine how different kinds of recreational activities in youth were associated with behavior and cognitive function. Some activities, like music and skiing, were linked to better outcomes, while others showed less positive patterns. In general, access to certain recreational activities was associated with healthier developmental outcomes. These findings merit independent replication and further study.

To demonstrate changes in health care encounters and identify risk factors associated with mental and behavioral health among the pediatric population before, during, and after the COVID-19 pandemic. Using data from Epic Cosmos, an interrupted time series analysis was conducted to examine changes in health care encounters associated with mental and behavioral health between 2017 and 2023 among a national sample of youth (6-17 years old). Logistic regression analyses predicted encounters attributed to mental and behavioral health using sociodemographic variables, and their interactions with the COVID-19 era were followed by post hoc analyses to highlight differences in these visits before, during, and after the pandemic. More than 20 million health care encounters were examined among the pediatric population from 2017 through 2023. Among those records, more than 2 million encounters, approximately 10.3% of the encounters, were attributed to mental or behavioral health diagnoses. During the COVID-19 era, the proportion of encounters increased significantly for every mental and behavioral diagnosis. The most common diagnoses linked with these health care encounters were depression (n = 713,744), anxiety and obsessive-compulsive disorder (n = 682,458), and hyperkinetic disorders and attention-deficit/hyperactivity disorder (n = 607,676). Health care encounters attributed to mental health were more common in older (p < .001), female (p < .001), and White (p < .001) or non-Hispanic or non-Latino (p < .001) youth. COVID-19 era by race and ethnicity interactions was significant (p < .001), which prompted follow-up analyses by era to elucidate race and ethnicity-based trends. In addition to elevated proportion of health care encounters associated with mental health during the pandemic, higher odds of such encounters were consistently demonstrated among White and non-Hispanic youth, suggesting disparities in care based on race and ethnicity. These disparities were relatively consistent, though some inconsistencies were observed based on specific race or ethnicity group and disorder class. We worked to ensure sex and gender balance in the recruitment of human participants. We worked to ensure race, ethnic, and/or other types of diversity in the recruitment of human participants. One or more of the authors of this paper self-identifies as a member of one or more historically underrepresented racial and/or ethnic groups in science. One or more of the authors of this paper self-identifies as a member of one or more historically underrepresented sexual and/or gender groups in science. While citing references scientifically relevant for this work, we also actively worked to promote inclusion of historically underrepresented racial and/or ethnic groups in science in our reference list. This study sought to determine the potential presence of disparities in mental health care before, during, and after the COVID-19 pandemic. The authors analyzed nearly 21 million healthcare visits among the pediatric population from 2017 to 2023, of which 10.3% were related to mental or behavioral health. During the COVID-19 era the proportion of encounters increased significantly across mental health diagnoses. Youth who were White or non-Hispanic or non-Latino were more likely to have encounters relating to mental health, suggesting disparities in care based on race and ethnicity.

Greater peer victimization predicts more internalizing symptoms, particularly among adolescent girls. However, not all adolescents are equally sensitive to peer interactions; rostral anterior cingulate cortex (rACC) reactivity to social cues may mark these differences in sensitivity. rACC activation to social stimuli may mark individuals for whom peer victimization leads to internalizing symptoms; this effect may vary by sex and level of peer victimization. Understanding unique pathways to internalizing symptoms may provide increasing insight into the heterogeneity of emerging internalizing symptoms as well as precision targets for intervention. Participants (n = 1,557; 11-12 years of age) from the Adolescent Brain Cognitive Development (ABCD) Study&#x2120; completed functional neuroimaging and questionnaires. Participants were divided into quartiles of rACC social activation (faces>places) during the Emotional N-back task. Higher quartiles of left, but not right, rACC social activation were associated with higher levels of internalizing symptoms (b = 6.777e-02). In female participants, high rACC social activation related to decreased internalizing symptoms as victimization increased (b = -0.08) compared to female participants with average and low rACC social activation and all male participants. Lateralized rACC social activation may mark sensitivity to internalizing symptoms and peer victimization. At normative-to-low levels of peer victimization, higher rACC social activation marked a particularly vulnerable group to peer victimization. However, in female participants, higher rACC social activation may be protective against high peer victimization, where it decreased the association between peer victimization and internalizing symptoms. The rACC may be a treatment target to reduce internalizing symptoms, but social context is an important factor contributing to heterogeneity. One or more of the authors of this paper self-identifies as a member of one or more historically underrepresented racial and/or ethnic groups in science. One or more of the authors of this paper self-identifies as a member of one or more historically underrepresented sexual and/or gender groups in science. One or more of the authors of this paper received support from a program designed to increase minority representation in science. We actively worked to promote inclusion of historically underrepresented racial and/or ethnic groups in science in our author group. While citing references scientifically relevant for this work, we also actively worked to promote sex and gender balance in our reference list. While citing references scientifically relevant for this work, we also actively worked to promote inclusion of historically underrepresented racial and/or ethnic groups in science in our reference list. The author list of this paper includes contributors from the location and/or community where the research was conducted who participated in the data collection, design, analysis, and/or interpretation of the work. Greater peer victimization predicts more internalizing symptoms, particularly among adolescent girls, and it may be helpful to identify those who are particularly sensitive to peer interactions. The rostral anterior cingulate cortex (rACC) has been shown to play a role in social threats and has been considered a treatment target for depression. Thus, this study examined rACC social activation in 1,557 subjects (11-12 years of age) from the Adolescent Brain Cognitive Development&#x2120; (ABCD) study. Results showed that rACC activation to faces relates to internalizing symptoms, with this relation being modulated by negative peer environments and sex. This suggests the rACC may be a treatment target for internationalizing symptoms, but sex and social context may be important factors to consider.

Growing engagement with digital spaces among children and adolescents increases the risk of negative online experiences (NOE). This study examined the prevalence, risk factors, and reporting barriers for NOE among youth with mental health and neurodevelopmental conditions. A cross-sectional, mixed-methods study between January and July 2023 was conducted using a community-based sample from the Child Mind Institute's Healthy Brain Network. A total of 1,009 youth aged 9 to 15 years (58.4% male; mean age = 11.79 years, SD = 1.71 years) completed a quantitative survey. A subsample (n = 109) participated in a qualitative follow-up involving a 3-day moderated online bulletin board. Of the 1,009 participants, 26.6% experienced NOE in the previous year, with 68.7% reporting multiple incidents; however, 80% did not report them. Factor analyses identified 3 key reporting barriers: reporting process, reporting policy, and emotional barriers. Social aptitude, mental health symptoms, and parenting style predicted youths' likelihood of encountering NOE and key reporting barriers. Qualitative findings indicated that reporting decisions involved assessing malice, perpetrator intent, and NOE type; ambiguity in these areas contributed to reporting uncertainty. This study highlights the gap between the high prevalence and low reporting rates of NOE among youth with mental health and neurodevelopmental conditions. Identified demographic, clinical, and family factors were associated with increased risk of experiencing NOE and the 3 reporting barriers. Findings underscore the need for targeted, developmentally appropriate strategies involving policymakers, technology developers, clinicians, and educators to support safer online environments for at-risk youth. &#x2022; Educate children and families about online reporting processes using developmentally appropriate, clear, and accessible language.&#x2022; Encourage parents to adopt consistent, supportive involvement in their children's online activities, as positive parenting was associated with lower risk and reporting barriers.&#x2022; Address emotional barriers by normalizing help-seeking, validating fears of embarrassment or retaliation, and connecting youth with safe peer or adult support.&#x2022; Collaborate with schools and digital platforms to advocate for user-friendly reporting tools and resources tailored to younger or more vulnerable users. Children with mental health conditions often face bullying or harassment online. This cross-sectional study of over 1,000 youths examined negative online experiences and reporting patterns. Despite negative online experiences being common, few youths reported them. Barriers included not knowing how to report, doubting action would be taken, and feeling strong emotions. These findings may guide families, schools, clinicians, and technology companies in creating safer online spaces.

First-episode psychosis (FEP) in pediatric onset is a pivotal window for preventing chronic disability and optimizing long-term outcomes. Improved understanding of psychosis biomarkers is essential to clarify the pathophysiology, guide individualized intervention, and improve prognostication for patients. We evaluated the glymphatic system (GS) as a potential mechanistic biomarker and assessed whether developmental processes influence GS function and cortical thinning in a cohort of FEP adolescents. We also explored the impact of age on GS function and cortical thinning. A total of 21 FEP patient research participants (PRP) were recruited from a Psychiatry and Behavioral Health unit. The experimental battery included clinical and neuropsychological assessments and a magnetic resonance imaging session in which both T1 and diffusion-weighted sequences were acquired. PRP were compared to a normative set of 42 community control participants (CCP) from the same scanner. Across both groups, analysis along the perivascular space (ALPS), an approximation of glymphatic activity, was generated from the diffusion images, and whole-brain cortical thickness was compared between groups using Freesurfer software and statistical models. Consistent with previous findings, significant and widespread reductions in cortical thickness were evident in the FEP population relative to the CCP. However, in contrast to expectations, ALPS was significantly elevated in PRP, suggesting increased GS functioning. Cortical thinning partially explained ALPS. In contrast to the few published studies in adults with schizophrenia, which have found significant reductions in ALPS, these results suggest that pediatric PRP with FEP have increased activation of the GS. Our findings suggest that this may relate to excessive cortical thinning in some brain regions (a hypothesis that we are currently exploring), although the directionality of this relationship is unclear. These findings may further indicate to a differential GS response in early vs late phases of disease or other differential pathologies related to development or disease phase, and to a differential role of GS and cortical thinning across groups. This study examined the difference in brain waste clearance for adolescents with first-episode psychosis compared to adolescents with no history of psychosis symptoms. The study discusses synaptic pruning as a potential explanation for differences in waste clearance activity.

Suicide is a leading cause of death among youth, yet differences in screening outcomes across demographic groups remain poorly understood. This study examines associations between demographic and clinical characteristics and responses to universal suicide risk and depression screening tools in a pediatric hospital setting. We conducted a retrospective cohort study of 66,225 patients 10 to 26 years of age who were screened with the Ask Suicide-Screening Questions (ASQ) and Patient Health Questionnaire-9 (PHQ-9) across emergency, urgent care, and inpatient settings. Demographic and clinical data were extracted from electronic health records. Response categories to the ASQ and PHQ-9 were analyzed against these factors with frequency and association tests. Positive ASQ screens occurred in 8.5% of patients (1.9% acute positive), with elevated rates among older youth and those assigned female at birth. Hispanic/Latino ethnicity and private insurance were associated with lower-than-expected rates of positive screens, whereas having a military insurance payor and higher Area Deprivation Index scores were associated with increased risk. Depression symptoms were more prevalent than suicidal ideation and showed similar demographic patterns. Demographic and clinical factors are correlated with suicide and depression screening outcomes. These findings highlight opportunities to improve equity in screening practice. 66,225 youths were screened for suicide risk in this study. 8.5% screened positive on the Ask Suicide-Screening Questions instrument. A positive screen was more common among those assigned female at birth, those with military insurance, and those living in disadvantaged areas.

Suicide attempt (SA) risk is especially high among youth with early nonsuicidal self-injury (NSSI) onset and persistent NSSI. Still, few youth experience persistent NSSI, and few attempt suicide. Identifying which youth follow specific NSSI trajectories and which NSSI trajectories are at higher risk for SA has strong potential to inform more targeted early suicide risk identification and prevention. The present study aimed to identify NSSI trajectories, identify characteristics forecasting which NSSI trajectories youth followed, and compare SA risk across trajectories. A subsample of youth (N = 2,524) with at least 1 NSSI event before typical onset was retrospectively identified. Youth were followed for 4 years (ages 9-14 years) using the first 5 annual assessments from the Adolescent Brain Cognitive Development&#x2120; (ABCD) Study (release 5.1). Latent-class growth modeling identified 2 subgroups of youth following distinct NSSI trajectories. The earlier-onset group (15%, mean [SD] age at onset = 9.83 [0.59] years) experienced baseline limited NSSI. The later-onset group (85%, mean [SD] age at onset =11.63 [1.60] years) had moderate risk for more than 1 NSSI endorsement. The later-onset group was significantly more likely to attempt suicide than the earlier-onset group (21% vs. 17% reported &#x2265;1 SAs). Sex, psychopathology, family conflict, and positive parenting predicted group membership and SA risk. SA risk among youth with early-onset or persistent NSSI was high; however, risk was slightly higher for youth with persistent NSSI. Whereas youth and family characteristics may forecast which NSSI trajectories youth follow, clinical implications of this research support children with NSSI are at risk for SA and may need continued monitoring and intervention. Findings support promoting broad public health awareness of SA risk in youth with NSSI. Using longitudinal data from the Adolescent Brain Cognitive Development&#x2120; (ABCD) study, this study aimed to identify factors associated with nonsuicidal self-injury (NSSI) and suicide attempt among youth with at least one NSSI event prior to age 14 (N = 2,524). Youth with later onset of NSSI (mean age 11.63 years) were more likely to report multiple episodes of NSSI and to attempt suicide than youth with earlier-onset NSSI (mean age 9.83 years). Sex, mental health problems, family conflict, and positive parenting were associated with age of onset of NSSI and risk of suicide attempt.

Although aggression in children and adolescents remains a leading cause of seeking mental health services, the nosology of aggression remains underdeveloped. Prior work characterized youth with aggression by using secondary analyses of large research protocol-based data sets, which revealed a profile characterized by high levels of aggression impulsive/reactive (AIR) and symptoms of hyperactivity/impulsivity. The goal of this study was to evaluate whether the AIR profile was present in a clinical sample using similar methodology with novel dimensional measures of AIR. Medical records of patients 4 to 17 years of age who presented with behavior concerns to outpatient, inpatient, and emergency department settings were reviewed. Caregivers completed dimensional measures evaluating symptoms of aggression, mania, depression, and hyperactivity/impulsivity. Latent profile analysis was performed with indicators representing the same 6 content domains as in prior work: AIR, depression, mania, rule-breaking, self-harm, and hyperactivity-impulsivity. A total of 430 patients completed the questionnaires and were included in the analyses. Patients' mean age was 12.52 years, and 53% were female. Four profiles were identified: predominantly AIR with hyperactivity-impulsivity (n = 83) and low mood symptoms; high AIR and high mood symptoms (n = 54); high AIR, mood, and self-harm (n = 56); and moderate overall symptom profile (n = 237). Children with high AIR and hyperactivity-impulsivity symptoms were more likely to be younger and male (mean age, 9.8 years), to have younger ages of onset of aggressive behaviors (mean age, 5.1 years), and to be less likely to have an abuse history. This work further validated the previously described AIR profile in a new cohort of youth presenting for clinical care. Future studies should focus on developing diagnostic criteria for children with AIR. Aggression in children is a leading cause of seeking mental health services. Prior work described a profile of aggression characterized by high levels of aggression impulsive/reactive (AIR) and with symptoms of hyperactivity/impulsivity. This study evaluated whether the AIR profile of aggression was present in a sample of youths presenting with behavioral concerns for mental health treatment (n = 420). This study validated the previously described AIR profile in a new cohort of youth, finding children with high AIR and hyperactivity-impulsivity symptoms were more likely to be younger males (mean age 9.8 years) and have younger onset of aggressive behaviors (age 5.1 years), and were less likely to have an abuse history.

Despite growing concerns about mental health effects of youth digital media use, the frequency of digital media/device-related problems (DMRPs) amid pediatric psychiatric crises is unknown. This study leverages the electronic medical record system of a large pediatric hospital to provide a descriptive analysis of DMRPs associated with pediatric psychiatric crises, including different DMRP subtypes. Consistent with existing research on problematic digital media use, we expected to find greater frequency of presentations involving DMRPs in older adolescents as well as sex-based differences in specific DMRP subtypes. A retrospective chart review was performed examining psychiatric consultation notes from all youth 6 to 17 years of age who presented to the hospital in psychiatric crisis in 2021 or 2022. Age, biological sex, race/ethnicity, and psychiatric diagnoses were recorded from each initial psychiatric consultation note. All encounters were assessed for presence of a DMRP within the presentation, coded under 5 primary subtypes. Relationships between variables of interest and DMRPs were assessed using regression models. There were 3,710 encounters that met inclusion criteria, representing 2,889 unique patients (average age, 13.5 years). Of the total encounters, 711 (19.2%) featured a type of DMRP. Youth with presentations including DMRPs were significantly older in age and more likely to have a mood disorder diagnosis. Compared to male patients, female patients were significantly less likely to present with crises related to device/digital media access and excessive device use, but were more likely to have presented because of high-risk online sexual behaviors/relationships. Our findings support the need to assess for problematic digital media and device use during pediatric crisis evaluations. In addition, demographic differences in crisis presentations that involve DMRPs can guide development of targeted screening recommendations for specific types of problematic digital media/device use. The frequency with which youth psychiatric crises involve digital media/device-related problems (DMRP) remains unknown, as do characteristics of youth who are at higher risk of such crises. This retrospective chart review analyzed 3,710 clinical encounters occurring from 2021 to 2022 at a large tertiary pediatric hospital to estimate the frequency of DMRP in youth presenting with a mental health crisis. Authors found that 19.2% of encounters involved DMRP, and youth presenting with DMRP were older in age and more likely to have a mood disorder diagnosis. Female patients were less likely to present with crises related to device/digital media access and excessive device use but were more likely to have presented due to high-risk online sexual behaviors/relationships. Findings support the need to assess for problematic digital media use during pediatric crisis evaluations and develop tailored interventions.

To evaluate the effectiveness of LGBTQ+ competency training programs for health care professionals and examine the impact of these programs on LGBTQ+ youth suicidal thoughts, behavior, attempts, and risk. This systematic review included quantitative studies that assessed LGBTQ+ cultural competency. Searches of 6 electronic databases yielded 6,317 records and 77 grey literature records (last searched on May 20, 2024); 19 studies met the inclusion criteria. Risk of bias was assessed using Cochrane ROB 2.0 and the Cochrane Robins I tool. Data on study design, sample characteristics, training details, and outcomes were extracted in line with the Cochrane Handbook and Preferred Reporting Items for Systemic Reviews and Meta-Analyses (PRISMA) guidelines. Included studies varied: 13 mixed methods, 4 quasi-experimental, 1 randomized controlled trial, and 1 time series. All studies were conducted in Western countries and involved health care professionals, with varying training formats and durations. Training programs generally improved objective measures of knowledge, skills, and clinical preparedness. However, self-perceived knowledge, attitudes, and comfort levels showed inconsistencies. Only 6 studies addressed health care workers' knowledge of LGBTQ+ youth suicide risk, focusing on general cultural competency rather than suicide risk reduction. None of the studies examined suicide prevention outcomes. Although LGBTQ+ cultural competency training shows improvements in health care professionals' competence, studies are limited by methodological flaws, including reliance on self-assessments, small sample sizes, limited long-term data, high attrition rates, and variable assessment tools. A gap exists in understanding the impact of training on LGBTQ+ youth suicide risk. Future research should explore the association between health care provider cultural competency training and long-term suicide prevention outcomes. Ask for their pronouns, save their life: Exploring the effectiveness of training programs on healthcare competency as a means of suicide prevention in LGBTQ+ youth: A systematic review; https://www.crd.york.ac.uk/PROSPERO/view/CRD42024529991. One or more of the authors of this paper self-identifies as a member of one or more historically underrepresented racial and/or ethnic groups in science. One or more of the authors of this paper self-identifies as a member of one or more historically underrepresented sexual and/or gender groups in science. The authors conducted a systematic review of 19 studies on LGBTQ+ cultural competency training for healthcare professionals to evaluate its potential impact on LGBTQ+ youth suicide risk. Most studies found that training improved providers&#x2019; knowledge and confidence in working with LGBTQ+ youth. However, only 6 studies specifically addressed workers&#x2019; knowledge about LGBTQ+ youth suicidal thoughts, behaviors, attempts, and risks. None of the studies examined whether the cultural competency training influenced outcomes related to suicidal thoughts or behaviors. The findings show a need for more research to understand how this type of training could reduce suicide risk among LGBTQ+ youth.

Restricted repetitive behaviors (RRBs) are prevalent across neurodevelopmental conditions. It has been hypothesized that greater severity of RRBs reflects elevated distress or diminished regulatory capacity. To test these hypotheses, prospective associations between early negative affectivity (NA) and effortful control (EC) and later RRB severity were examined in a transdiagnostic sample of toddlers with and without autism. Participants were 238 toddlers with neurodevelopmental conditions (autism: n = 165; non-autism: n = 73). NA and EC were assessed at time 1 (T1) (mean [SD] age =24.4 [5.2] months) using the Toddler Behavior Assessment Questionnaire or Early Childhood Behavior Questionnaire. At time 2 (T2) (mean [SD] age = 42.2 [7.3] months), severity of RRBs was assessed using the Autism Diagnostic Observation Schedule (ADOS) and Autism Diagnostic Interview-Revised (ADI-R). Multivariate regression models tested whether T1 NA and EC predicted time 2 RRBs, controlling for age, sex, nonverbal developmental quotient, T1 RRBs, and visit year. Higher EC at T1 predicted lower ADI-R RRB scores at T2 (p < .001) but was not associated with ADOS RRB scores (p = .621). Higher EC was associated with ADI-R lower intensity of compulsive adherence to nonfunctional routines or rituals (p = .001), stereotyped repetitive motor mannerisms (p < .001), and preoccupation with parts of objects or their nonfunctional elements (p = .002), but not circumscribed interests (p = .266). T1 NA was not associated with T2 RRBs on either measure. Regulatory and affective traits show differential longitudinal associations with RRBs, highlighting a potential role for EC in their emergence or maintenance. Interpretation of null findings for NA is limited by unmeasured early environmental influences on the development of anxiety. We worked to ensure sex and gender balance in the recruitment of human participants. We worked to ensure race, ethnic, and/or other types of diversity in the recruitment of human participants. One or more of the authors of this paper self-identifies as a member of one or more historically underrepresented racial and/or ethnic groups in science. One or more of the authors of this paper received support from a program designed to increase minority representation in science. We actively worked to promote sex and gender balance in our author group. We actively worked to promote inclusion of historically underrepresented racial and/or ethnic groups in science in our author group. Restricted and repetitive behaviors (RRBs) are common in children with autism spectrum disorder and other developmental conditions. This study examined whether distress or difficulty with attention and behavior regulation predicted later repetitive behaviors. Toddlers prone to distress were not more likely to develop more intense repetitive behaviors later on, while toddlers with lower attentional and behavioral regulation skills were more likely to develop intense repetitive behaviors in preschool.