搜索结果：Journal of child & adolescent trauma

ABSTRACTBackground: Mental disorders often emerge in childhood, affecting individual development and family functioning. Parents are often responsible for seeking mental health care for their child and thereby encounter structural, emotional, and knowledge-related barriers. For parents of children exposed to traumatic events, additional challenges may arise.Objective: This study aims to investigate parental perceptions of barriers to psychotherapy for their child and to compare perceptions between parents of children with and without traumatic experiences.Methods: Perceived barriers were measured with a self-developed 10-item scale. Online survey was conducted with N&#x2009;=&#x2009;271 parents who had at some point been seeking or receiving psychotherapy for their child. Non-parametric Mann-Whitney-U-tests were performed for several group comparisons: search only (n&#x2009;=&#x2009;63) vs. treatment (n&#x2009;=&#x2009;208); child with (n&#x2009;=&#x2009;71) vs. without traumatic experience (n&#x2009;=&#x2009;200); trauma- (n&#x2009;=&#x2009;54) vs. non-trauma-related reasons for treatment (n&#x2009;=&#x2009;154).Results: Parents reported a moderate level of barriers. The highest agreements were found for waiting time and time investment (Md&#x2009;=&#x2009;4.00; IQR&#x2009;=&#x2009;2.00). Parents of children who had only sought but not received psychotherapy reported greater difficulties in finding adequate treatment (p&#x2009;<&#x2009;.05, r&#x2009;=&#x2009;-0.18). Both if children had experienced a traumatic event and if the reason for therapy was trauma-related, parents reported a significantly higher degree of time investment (p&#x2009;<&#x2009;.05, r&#x2009;=&#x2009;-0.16), the concern that their child might be too burdened (p&#x2009;<&#x2009;.01, r&#x2009;=&#x2009;-0.20) and lack of confidence in professional competence (p&#x2009;<&#x2009;.01, r&#x2009;=&#x2009;-0.19).Conclusions: Structural barriers were reported as most prominent. Trauma exposure of the child may further increase perceived barriers. These findings highlight the need for parental support and trauma-informed guidance. Parents encounter multiple barriers when seeking or engaging in psychotherapy for their child, with structural barriers being most prominent.Children&#x2019;s exposure to traumatic events may further increase the perception of barriers.Trauma-informed training and guidance for parents, improved access to support, improved trauma-focused training for professionals and transparent communication between professionals and parents are needed. Antecedentes: Los trastornos mentales con frecuencia emergen en la ni&#xf1;ez, afectando el desarrollo individual y el funcionamiento familiar. Los padres son con frecuencia los responsables de la b&#xfa;squeda de atenci&#xf3;n en salud mental para sus ni&#xf1;os y por lo tanto se enfrentan a barreras estructurales, emocionales y de conocimiento. Para los padres de ni&#xf1;os expuestos a eventos traum&#xe1;ticos, pueden aparecer otros desaf&#xed;os. Objetivo: Este estudio tiene como objetivo investigar las percepciones parentales de las barreras a la psicoterapia para sus hijos y comparar las percepciones entre los padres de ni&#xf1;os con y sin experiencias traum&#xe1;ticas. M&#xe9;todos: Las barreras percibidas se midieron con una escala de 10 &#xed;tems desarrollada para este estudio. Se realiz&#xf3; una encuesta en l&#xed;nea a N&#x2009;=&#x2009;271 padres que en alg&#xfa;n momento hab&#xed;an buscado o recibido psicoterapia para sus hijos. Se realizaron pruebas U de Mann&#x2013;Whitney no param&#xe9;tricas para varias comparaciones de grupos: solo b&#xfa;squeda (n&#x2009;=&#x2009;63) vs. Tratamiento (n&#x2009;=&#x2009;208); ni&#xf1;os con experiencias traum&#xe1;ticas (n&#x2009;=&#x2009;71) vs sin experiencias traum&#xe1;ticas (n&#x2009;=&#x2009;200): razones para el tratamiento relacionada con el trauma (n&#x2009;=&#x2009;54) vs no relacionas con trauma (n&#x2009;=&#x2009;154). Resultados: Los padres reportaron un nivel moderado de barreras. Los mayores acuerdos se encontraron en el tiempo de espera y la inversi&#xf3;n de tiempo (Md&#x2009;=&#x2009;4.00; IQR&#x2009;=&#x2009;2.00). Los padres de ni&#xf1;os que solo buscaron psicoterapia, pero no la recibieron reportaron mayores dificultades en encontrar un tratamiento adecuado (p&#x2009;<&#x2009;.05, r&#x2009;=&#x2009;&#x2212;0.18). Tanto si los ni&#xf1;os tuvieron experiencias traum&#xe1;ticas como si el motivo de la terapia estaba relacionado con el trauma, los padres reportaron un grado significativamente mayor de inversi&#xf3;n de tiempo, (p&#x2009;<&#x2009;.05, r&#x2009;=&#x2009;&#x2212;0.16), la preocupaci&#xf3;n que su hijo pudiera estar demasiado sobrecargado (p&#x2009;<&#x2009;.01, r&#x2009;=&#x2009;&#x2212;0.20) y la falta de confianza en la competencia profesional (p&#x2009;<&#x2009;.01, r&#x2009;=&#x2009;&#x2212;0.19). Conclusiones: Se reportaron las barreras estructurales como m&#xe1;s prominentes. La exposici&#xf3;n a trauma del ni&#xf1;o podr&#xed;a incrementar aun mas las barreras percibidas. Estos hallazgos destacan la necesidad del apoyo parental y orientaci&#xf3;n especializada en trauma.

Trauma-related symptoms can overlap with core symptoms of ADHD. However, there is limited evidence of exploration of how trauma exposure, particularly trauma burden and trauma type, relates to ADHD and whether these associations differ in their impact on psychosocial functioning compared to neurotypical (NT) children. To examine the associations between trauma exposure, trauma burden and trauma type and ADHD status and to assess whether these factors are differentially associated with behavioral, psychological and social functioning in children with ADHD compared to NT peers. Participants (N&#xa0;=&#xa0;242) comprised of an ADHD (n&#xa0;=&#xa0;141, 58.26%) and a NT group and were a subset of children whose parents completed the adverse childhood experience questionnaire. Behavioral and psychosocial functions were examined using the child behavior checklist. Children with ADHD were more likely to be exposed to trauma and to report higher trauma burden. Exposure to a single traumatic event resulted in a higher trauma burden and higher internalizing and externalizing problems in children with ADHD compared to NT children. They also had higher exposure to events related to household dysfunction, compared to NT children, after adjusting for socio-demographic factors. For trauma type, household dysfunction associated with higher internalizing problems and abuse-related trauma associated with higher internalizing and social difficulties in those with ADHD when compared to NT children with similar trauma exposures. Trauma burden and type can have differential effects on behavioral and psychosocial problems in children with ADHD.

BackgroundADHD is a prevalent neurodevelopmental disorder frequently accompanied by psychiatric comorbidities. While international evidence is well-established, data from South Africa - particularly in younger children - remain limited.AimTo describe psychiatric comorbidities and associated factors in children aged 7-12&#xa0;years with primary ADHD at the Child, Adolescent, and Family Unit (CAFU), Charlotte Maxeke Johannesburg Academic Hospital (CMJAH).MethodsA retrospective cross-sectional record review of children aged 7-12&#xa0;years with primary ADHD at CAFU between January 2020 and December 2022. Data were analysed using SPSS version 26.ResultsOf 573 records screened, 108 were included. The combined subtype was most prevalent (72.2%). Almost all children (95.5%) had at least one comorbidity. The most frequent were generalised anxiety disorder (52.8%), intellectual disability (38.9%), and oppositional defiant disorder (29.6%). Females were more likely to present with oppositional defiant disorder (p = .007) and males with autism spectrum disorder (p = .032). High rates of domestic violence (29.6%), parental substance abuse (33.3%), and parental psychiatric history (30.6%) were documented.ConclusionPsychiatric comorbidities are highly prevalent in South African children with ADHD, exceeding international estimates, and reflect the broader psychosocial context of the setting. Comprehensive, multidisciplinary, and trauma-informed assessments are essential. Attention Deficit Hyperactivity Disorder (ADHD) is one of the most common conditions affecting children. Children with ADHD often struggle with attention, impulsivity, and hyperactivity &#x2014; but many also have other mental health or developmental conditions at the same time. We wanted to find out how common this is among younger children in South Africa, where very little research on this topic has been done. We looked at the medical records of 108 children aged 7 to 12&#xa0;years who were diagnosed with ADHD at Charlotte Maxeke Johannesburg Academic Hospital between 2020 and 2022. We found that almost all of the children (95%) had at least one additional condition alongside their ADHD. The most common were anxiety (found in more than half the children), intellectual disability (affecting about 4 in 10), and oppositional defiant disorder &#x2014; a condition where children persistently argue, defy rules, or act angrily. Interestingly, girls were more likely to have oppositional defiant disorder, while boys were more likely to have autism, which is different from what many international studies have found. We also found that many families in our study were dealing with difficult circumstances, including domestic violence (nearly 1 in 3 families) and parental mental illness or substance use &#x2014; all of which can affect a child&#x2019;s mental health. These findings show that children with ADHD in South Africa are dealing with a heavy load of challenges, many of which may be missed if doctors only focus on the ADHD diagnosis. Children need thorough assessments that look at the whole picture. Schools, families, and health services all have a role to play in identifying these additional difficulties early and getting children the right support before problems become harder to treat.

Autistic traits have been associated with greater risk of childhood trauma and adulthood psychopathology. However, the role that childhood trauma plays in the association among autism, autistic traits, and depression in adulthood is poorly understood. We used a UK-based birth cohort with genotype and phenotype data on autism, autistic traits, childhood trauma, and depression in up to 9,659 individuals prospectively followed up until age 28&#xa0;years. Using mixed-effects growth-curve models, we assessed trajectories of depression symptoms over time according to autism diagnosis, autism polygenic score and trait measures, and explored whether these differed by trauma exposure. We further investigated the association between autism/autistic traits and depression in adulthood using confounder-adjusted logistic regression models and undertook mediation analyses to investigate the relationship with childhood trauma. All autism variables demonstrated increased depressive symptom trajectories between ages 10 and 28&#xa0;years. Social communication difficulties (SCDs) were most strongly associated with a depression diagnosis in adulthood (age 24 OR&#xa0;=&#xa0;1.86; 95% CIs: 1.15-3.01). Trauma and autistic traits combined to further increase depression symptom scores. Mediation analyses provided evidence for direct pathways between autistic traits and increased risk of depression alongside indirect pathways through increased risk of trauma. Autism/autistic traits increase the odds of experiencing childhood trauma and of being diagnosed with depression at ages 18 and 24. Depressive symptom trajectories emergent in childhood persist into adulthood. The combined effect of SCDs and childhood trauma is greater than the individual exposures, suggesting worse depression symptomatology following trauma in individuals with SCDs.

Acquired brain injuries are injuries that occur after birth and are a leading cause of long-term disability and death in children and young adults. They may result from trauma, hypoxia, stroke, infection, or a variety of other causes. Fatigue is one of the most common and underrecognized consequences of pediatric acquired brain injury, often expressed behaviorally rather than verbally. Traditional rehabilitation programs are frequently static and cognitively demanding, limiting engagement and therapeutic outcomes. Extended reality (XR) technologies offer new opportunities to address these challenges by enabling interactive, adaptive, and motivating home therapy environments. However, few XR systems are co-developed with children and therapists, and there is limited knowledge about how to co-design engaging, gamified, XR-based motor rehabilitation solutions that take into account children's fatigue. This study explores why specific gamification and XR design elements facilitate or hinder engagement and effective fatigue response during rehabilitation for children with acquired brain injuries. A qualitative case study approach was employed with a total of 25 participants (22 provided consent), combining co-design workshops, interviews with health care professionals, observational data, and iterative user testing with children ages 8-16, their parents, and the clinical team. Participants who provided consent included 4 children with acquired brain injury (ages 8-16), 4 parents, 4 clinicians, and 10 healthy children involved in early ideation only. The XR prototype was developed using Unity, Cognitive3D, and the Meta Quest 3 headset. Engagement and fatigue related to prototype use were evaluated using subjective measures adapted from the User Engagement Scale and the Virtual and Mixed Reality Fatigue Scale, supplemented by thematic analysis of interview and workshop data. Children demonstrated higher engagement with short, modular XR sessions (3-10 minutes) that included interactive game elements and preserved visibility of their surroundings. Fatigue was identified through behavioral cues such as gaze, posture, and responsiveness. Therapists emphasized the importance of adaptive difficulty, personalization, and simplified environments. A therapist-facing dashboard was developed to visualize behavioral fatigue-related cues, consistent with clinician observation. This qualitative case study provides preliminary insights into how XR-based rehabilitation, when co-designed with children and clinicians, may support engagement and facilitate observation of fatigue-related behaviors in pediatric brain injury contexts. The findings provide design-oriented insights for creating engaging XR home-rehabilitation experiences while accounting for fatigue-related limitations (eg, short, modular sessions; visual grounding; adaptable challenge). The results of our study indicate a need for objective fatigue measurement within XR solutions to adjust content in ways that support both engagement and fatigue considerations. However, fatigue detection was not validated in this study and should be addressed in future research.

Adolescents exposed to natural disasters often develop post-traumatic stress disorder. Despite interest in group-based trauma therapies, the feasibility of the Eye Movement Desensitization and Reprocessing Integrative Group Treatment Protocol among disaster-affected adolescents remains underexplored. This study aimed to evaluate how symptom severity and psychological resilience influence adolescents' perceptions of the feasibility of Eye Movement Desensitization and Reprocessing Integrative Group Treatment Protocol. It also sought to identify key barriers and facilitators affecting adolescents' willingness to participate in such interventions following natural disasters. A total of 120 adolescents aged 13 to 18 years from earthquake- and flood-affected regions participated in a convergent mixed-methods study using stratified purposive sampling to ensure diversity in gender, exposure severity, and location. Participants completed the Revised Child Post-Traumatic Stress Disorder Symptom Scale, the Connor-Davidson Resilience Scale, and a 15-item Feasibility Questionnaire for Eye Movement Desensitization and Reprocessing Integrative Group Treatment Protocol. Quantitative data were analyzed using bivariate correlations and linear regression. Qualitative responses to open-ended questions about perceived barriers and facilitators were analyzed using thematic content analysis. Adolescents with higher levels of post-traumatic stress reported lower feasibility scores (r = -0.47, p < 0.01), while those with higher resilience perceived the intervention as more acceptable (r&#x2009;=&#x2009;0.35, p < 0.01). Significant differences were found in feasibility and resilience based on PTSD severity groups (p = 0.005 and p = 0.036, respectively). Key barriers included emotional dysregulation, confidentiality concerns, and scheduling difficulties. Facilitators included peer support and the presence of structured preparatory guidance. Perceived feasibility of group-based Eye Movement Desensitization and Reprocessing is shaped by trauma severity and resilience. Psychoeducational preparation, logistical flexibility, and attention to emotional safety are essential to support adolescent engagement in post-disaster mental health interventions. This study was not prospectively registered, as it does not constitute a clinical trial. It was conducted as an observational, non-interventional mixed-methods feasibility study assessing adolescents' pre-intervention perceptions of group-based EMDR therapy. No therapeutic outcomes were evaluated, and no participants were assigned to treatment conditions. In accordance with Turkish regulations, observational studies involving human participants require ethical approval but are not subject to mandatory trial registration. Ethical approval was obtained from the Toros University Ethics Committee.

Child marriage continues to be a deeply rooted tradition in some urban Indian communities, such as Sowcarpet, where cultural conventions, economic vulnerability, and patriarchal norms combine to normalize the early marriage of girls between 12 and 18 years of age. This qualitative study employs a descriptive phenomenological approach to analyze the emotional and psychological consequences of child marriage among eight adolescent brides, using snowball sampling and detailed oral accounts to examine child marriage as a form of sexual and psychological abuse. The analysis identifies five key themes, namely, cultural grooming, emotional isolation, postpartum trauma, power imbalance, and silent resistance. The findings reveal that adolescents experience severe psychological distress, including postpartum depression and symptoms of psychosis, highlighting the terror and confusion faced by girls who are emotionally immature yet compelled into motherhood. These experiences disrupt identity formation and contribute to intergenerational trauma, affecting both the girls' development and their children's wellbeing. This article situates these findings within feminist and trauma-informed frameworks, asserting that child marriage constitutes both a developmental injustice and a violation of bodily autonomy. It further calls for reforms aligned with the Sustainable Development Goals 5.3, 4, 10, and 16.

Childhood maltreatment and adolescent mental health problems are unequally distributed, with the highest burdens among marginalised groups including females and those experiencing socioeconomic disadvantage. However, little is known about how the psychological consequences of maltreatment vary across intersecting social positions (e.g., socioeconomically disadvantaged females). Prior quantitative work has largely focused on average differences across a limited number of groups, obscuring non-additive intersectional patterning. Because social realities are structured by overlapping systems of privilege and oppression (e.g., relating to gender, socioeconomic position, ethnicity, age, and place), we leveraged recent methodological advances to address this gap. Accordingly, this study aimed to (i) map inequalities in adolescent emotional problems and the effects of maltreatment across intersectional positions; and (ii) describe the extent to which inequalities in emotional problems reflect additive and non-additive (intersectional) effects. Data were analysed from 19 590 students aged 11-16 years who participated in the OxWell 2023 Student Survey in England, United Kingdom. Within a random-coefficient Multilevel Analysis of Individual Heterogeneity and Discriminatory Accuracy (MAIHDA), individuals were nested in 180 intersectional strata defined by combinations of social positions relating to gender, ethnicity, household poverty, school year group, and school-level deprivation (also entered as additive main effects). Emotional problems (Revised Child Depression and Anxiety Scale; RCADS-11) were regressed on maltreatment exposure (Short Childhood Maltreatment Questionnaire) as the primary effect of interest. Stratum-specific predicted emotional problems and maltreatment effects were estimated, and between-stratum variance was partitioned into additive and residual non-additive components. Maltreatment was associated with higher levels of emotional problems, with stratum-specific increases ranging from&#xa0;+3.20 to&#xa0;+6.14 scale points. Socioeconomically disadvantaged females and individuals who selected 'other' or 'prefer not to say' for gender showed the highest levels of emotional problems and among the strongest maltreatment effects. Between-stratum inequalities in emotional problems were largely accounted for by maltreatment exposure and the additive contributions of the included social positions. However, residual non-additive effects were also evident, particularly among individuals exposed to maltreatment, where 5.25% of between-stratum variance remained unaccounted for by additive effects (compared with 3.46% among those not exposed). In this large community sample of adolescents in England, the detrimental effects of maltreatment on emotional problems appear pervasive but not uniform across intersectional social positions. Applying an intersectional MAIHDA framework suggests that inequalities in adolescent emotional problems largely reflect additive social patterning, with additional non-additive contributions suggestive of intersectional dynamics that are more pronounced with maltreatment exposure. These findings motivate deeper investigation into the social-structural mechanisms that shape vulnerability and resilience in adolescence, and support the need for trauma-informed, equity-focused interventions and policy action to reduce unequal exposure to maltreatment and the contexts that amplify its harms.

Adolescents in Out-of-Home Care (OOHC) often suffer multiple Adverse Childhood Experiences, leading to high rates of distorted Post-Traumatic Cognitions (PTC) and Fear of Compassion (FC). Tailored, evidence-based psychological interventions are essential for this group. This mixed-methods study aimed to design, validate, and empirically evaluate a Internal Family Systems (IFS)-based group intervention for trauma-exposed adolescents in Out-of-Home Care (OOHC). Fifty trauma-exposed adolescents (27 female, 23 male) were purposively selected from 180 OOHC residents and randomly assigned to the IFS (n&#xa0;=&#xa0;25) or control (n&#xa0;=&#xa0;25) group. The IFS protocol was first developed and validated qualitatively via content analysis and expert review. The quantitative quasi-experimental phase utilized a pre-post-follow-up design to assess PTC and FC using standardized measures across three time points. IFS led to significant reductions across all PTC subscales. The strongest and most stable effect was on Negative Self-Cognitions (&#x3b7;2&#xa0;=&#xa0;0.40), while the most immediate change, aligning with IFS theory regarding Protector Parts, was seen in Self-Blame (&#x3b7;2&#xa0;=&#xa0;0.22). FC also decreased significantly, with the largest improvements in FC-for oneself (&#x3b7;2&#xa0;=&#xa0;0.31) and FC-for others (&#x3b7;2&#xa0;=&#xa0;0.27). These effects were maintained at the two-month follow-up. Findings support the effectiveness of the IFS in improving trauma-related cognitive and emotional outcomes. Crucially, the change pattern suggests that IFS promotes recovery by first establishing internal self&#x2011;leadership and self-compassion, which then gradually generalizes to interpersonal relationships. This provides a promising model for structural trauma recovery in vulnerable youth.

This study aimed to identify adverse childhood experiences (ACEs) clusters and investigate the longitudinal relationships between ACEs clusters and their effects on health and health-related quality of life (HRQoL) in Australian children and adolescents. This study used data from the kindergarten cohort of the Longitudinal Study of Australian Children. Latent class analysis was employed to identify ACEs clusters. Generalized estimating equation (GEE) models were used to examine longitudinal associations between ACEs clusters and multiple health outcomes, including general health, mental health, obesity, and HRQoL domains. The study included 3,089 participants contributing 18,534 observations. Three ACEs clusters were identified: low adversity (65.8%), moderate adversity (25.5%), and high adversity (8.7%). Children in the high-adversity cluster had a higher risk of poorer mental health (IRR&#x2009;=&#x2009;1.89, 95% CI 1.85-1.92) and suboptimal general health (OR&#x2009;=&#x2009;1.19, 95% CI 1.17-1.22) compared with those in the low-adversity cluster. Moderate adversity was also associated with elevated risks, although of smaller magnitude. HRQoL scores across social, school, psychosocial, physical, and emotional domains were consistently lower among children exposed to higher adversity. Distinct ACEs clusters were associated with differences in health and HRQoL among Australian children and adolescents. Identifying ACEs patterns provides valuable insights for developing targeted prevention and intervention strategies aimed at mitigating the long-term health and psychosocial consequences of childhood adversity.

Materialistic value orientation, defined as the long-term endorsement of values, goals, and beliefs centered on the importance of acquiring money and possessions that convey status, has been associated with various negative developmental outcomes among adolescents. However, the formation of materialistic values remains insufficiently understood, and research examining the association between adverse childhood experiences (ACEs) and materialistic value orientation is limited, particularly among Chinese adolescents. This study examined the relationships among ACEs, parent-child attachment, and adolescent materialistic value orientation, and explored gender differences in these associations. Data were drawn from a 2022-2023 survey of 11,386 Chinese high school students (mean age = 16.41; 51% boys) using multi-stage stratified sampling across eastern, central, and western China. Participants completed self-report measures of ACEs, parent-child attachment, and materialistic value orientation. Correlation analyses and one-way ANOVAs were used to examine associations among key variables, and regression-based moderated mediation analyses with follow-up simple slope tests were conducted to test the role of parent-child attachment and gender differences. Higher ACE exposure was associated with stronger materialistic value orientation among adolescents. ACEs were associated with greater attachment insecurity and poorer parent-child attachment was also related to higher materialistic value orientation. Gender differences were observed: boys reported higher overall levels of materialistic value orientation, whereas ACEs showed stronger associations with parent-child attachment and materialistic value orientation among girls. These findings suggest that adverse childhood experiences are linked to adolescents' materialistic value orientation and highlight the importance of family relationships in value development. Gender-sensitive approaches may be beneficial, with attention to higher baseline materialistic value orientation among boys and greater sensitivity to family adversity among girls.

Trauma-focused cognitive behavioural therapy (TF-CBT) is the established first-line treatment for paediatric post-traumatic stress disorder (PTSD), but access to evidence-based care remains limited. This study aimed to evaluate the feasibility and acceptability of a therapist-guided, 12&#x2009;week, internet-delivered TF-CBT (iTF-CBT) programme for adolescents with PTSD and to explore preliminary changes in PTSD symptoms. Single-group feasibility trial. Save the Children, Sweden. Twenty-two adolescents (13-17 years, 82% female) with primary PTSD. A 12&#x2009;week, therapist-guided, asynchronous, internet-delivered TF-CBT comprising eight modules and parallel caregiver modules with joint adolescent-caregiver activities. Feasibility measures included recruitment pace, participant retention, treatment adherence (module completion) and therapist time. Acceptability was evaluated through satisfaction, credibility, negative effects and reported adverse events. Within-group changes in PTSD severity using independent evaluator-rated Clinician-Administered PTSD Scale (CAPS-CA-5) and the self-reported Child and Adolescent Trauma Screen 2 (CATS-2) were used as indicators of potential clinical change. Assessments occurred at baseline, during treatment, post-treatment and at 1&#x2009;month follow-up (primary endpoint). Recruitment was completed after 7&#x2009;months of active enrolment. Retention and adherence were high, satisfaction and credibility ratings were favourable, and no intervention-related serious adverse events occurred. Within-group improvements were observed at the primary endpoint, with large reductions on CAPS-CA-5 (Cohen's d=1.27) and CATS-2 (Cohen's d=1.51). At follow-up, 47.6% of participants no longer met criteria for PTSD. Therapist-guided iTF-CBT for adolescents with PTSD was safe, feasible, acceptable and associated with potentially meaningful symptom improvements. These findings support further evaluation in larger, controlled trials to determine efficacy, cost-effectiveness and long-term outcomes. NCT06185244.

Ice hockey is a fast-paced and physically demanding collision sport that carries a high risk of injury, especially concussions and closed head injuries (CHIs). The purpose of this study was to evaluate the frequency, trends, and mechanisms of injury of concussions and CHIs sustained by male ice hockey players in the United States (US). Concussions and CHIs sustained playing male ice hockey presenting to US emergency departments from January 1, 2004 to December 31, 2023 were queried using the National Electronic Injury Surveillance System (NEISS). For each injury, patient demographics, disposition, and mechanism of injury were recorded. National estimates (NEs) were calculated using the NEISS statistical sample weight. Injury trends were evaluated by linear regression modeling. Descriptive epidemiology study. Level 3. A total of 62,070 concussions and CHIs occurred during the study period. From 2004 to 2023, overall injury incidence increased (P&#x2009;=&#x2009;0.06). From 2004 to 2012, there was a significant increase in concussion and CHI incidence (P&#x2009;<&#x2009;0.001) followed by a plateau after 2013. The age group affected most commonly was adolescents (ages 13-19&#x2009;years) (52.3%, NE&#x2009;=&#x2009;32,455). The top 3 mechanisms were head-to-ice contact (28.6%, NE&#x2009;=&#x2009;17,741), head-to-boards contact (22.8%, NE&#x2009;=&#x2009;14,123), and head-to-player contact (15.4%, NE&#x2009;=&#x2009;9575). Head-to-ice contact was the most common mechanism in children (33.6%, NE&#x2009;=&#x2009;5960). Head-to-player reached its highest rate in young adults (21.3%, NE&#x2009;=&#x2009;1567). Falls initiated 33.9% of all concussions and CHIs. The hospitalization rate across the study was 3.4%. Concussions and CHIs sustained from male ice hockey demonstrated a 290% increase from 2004 to 2023, with the child and adolescent populations at greatest risk and head-to-ice contact representing the most common injury mechanism. Focused injury awareness, educational prevention programs, and potential rule changes are essential to decrease the rising incidence of concussions and CHIs in this at-risk patient population.Strength-of-Recommendation Taxonomy (SORT):C-level recommendation.

Nonsuicidal self-injury (NSSI) is common in trauma-exposed adolescents and has been linked to dysregulation of stress-response systems, including the hypothalamic-pituitary-adrenal (HPA) axis. Most existing evidence is based on short-term cortisol measures, whereas hair cortisol concentrations index cumulative HPA axis activity over several months. We therefore investigated hair cortisol concentrations in trauma-exposed adolescents by comparing those with and without recent NSSI. Fifty trauma-exposed adolescents (mean age = 16.02 years; 68% identified as female, 26% as male, and 6% as gender-diverse; 72% were assigned female at birth and 28% male at birth) were recruited. Recent NSSI within the past three months and trauma symptom severity were assessed using clinical interviews. Proximal 3-cm hair segments were analyzed to index cumulative cortisol secretion over the corresponding three-month period. Group differences in hair cortisol concentrations were examined using t-tests on log-transformed values, with additional analyses adjusting for dimensional trauma symptom severity. Trauma-exposed adolescents with recent NSSI (n&#x202f;=&#x202f;23) showed higher hair cortisol concentrations than those without NSSI (n&#x202f;=&#x202f;27; p&#x202f;=&#x202f;.006, Hedges' g = 0.86). These group differences remained significant after adjusting for trauma symptom severity, which was not significantly associated with hair cortisol concentrations. In trauma-exposed adolescents, recent NSSI was associated with elevated cumulative HPA axis activity, indexed by higher hair cortisol concentrations. This finding highlights the relevance of long-term stress-system functioning in adolescents who engage in NSSI and underscores the importance of considering cumulative, rather than solely acute, indices of HPA axis activity in clinical research.

At least half of all American children are impacted by trauma at some time during their lives, including exposures to abuse, violence, poverty, discrimination, and parental illness. Science has repeatedly shown that adverse childhood experiences (ACEs) affect human beings across the full spectrum of growth, development, and well-being. This includes an impact on a person's physiology, physical and mental health, and even their parenting style and ability. Children from marginalized backgrounds or those who experience violence are at a particularly high risk for trauma, while parents with a history of ACEs face unique challenges as adults with their own children. Given their family-centered focus, pediatric providers are uniquely positioned to identify and respond promptly to childhood and/or family trauma; thus, providing trauma-informed care (TIC). TIC is a specific form of medical care that not only assesses and recognizes the effects of trauma on kids but also allows providers to react and respond to traumatic stress on entire families and colleagues. It is a tool that pediatric clinicians can use in practice to improve care and outcomes for children and families. The effective use of TIC requires that clinicians commit to a raised awareness of the effects of adverse childhood experiences, improved education on trauma and effective care, and consistent application of trauma-informed strategies in their own personal practice.

Emotion dysregulation is recognized as a transdiagnostic feature common to child psychopathology. This study examined the unique association between emotion regulation difficulties and specific strategies (suppression, reappraisal) with transdiagnostic symptom domains of attention, externalizing, and internalizing problems in youth. This study also tested for the mediating role of emotion regulation between domains of childhood adversity (family conflict and negative life events) and transdiagnostic symptoms. In a sample of 9,057 children aged 12 to 13 years in the Adolescent Brain Cognitive Development&#x2120; (ABCD) Study (47.21% female), linear mixed-effects models were used to examine the association between emotion regulation difficulties and specific regulation strategies with transdiagnostic symptoms. Follow-up analyses tested replication of findings retrospectively and prospectively. Structural equation modeling was used to test whether emotion regulation mediated the association between childhood adversity (family conflict, negative life events) and symptom severity. The Child Behavior Checklist was used as a continuous measure of symptom severity. Greater severity of emotion dysregulation was associated with severity of each transdiagnostic symptom domain, and these associations were replicated both retrospectively and prospectively. Sex-specific longitudinal patterns emerged for attention and externalizing problems. Emotion regulation difficulties mediated the association between childhood adversity (family conflict, negative life events) and all symptom domains, with strategy-specific patterns emerging only for internalizing problems. These findings have implications for developing targeted interventions to address broad emotion dysregulation as an underlying mechanism of child psychopathology linked to exposure to childhood adversity. This study examined how difficulties in emotion regulation affect child mental health and interact with early life adversity, with a focus on attention, disruptive behaviors, and internalizing problems. Utilizing data from the Adolescent Brain Cognitive Development (ABCD) Study (n=9,057, aged 9-10 years), the authors found that emotion dysregulation was linked to increased symptom severity in children. Sex-specific patterns of disruptive behavior were identified in male participants and internalizing problems in female participants. Emotion regulation difficulties mediated the association between childhood adversity and all mental health symptom domains.

We aimed to explore the relationships between childhood adversity, as assessed by the Childhood Trauma Questionnaire (CTQ) and transcranial magnetic stimulation (TMS) neurophysiological measures of GABAergic and glutamatergic neurotransmission. We hypothesized that elevated CTQ scores would have associations with dysregulated GABAergic and glutamatergic neurotransmission. Adolescents (N&#xa0;=&#xa0;47) aged 12-18&#xa0;years diagnosed with Major Depressive Disorder (MDD) were assessed with the CTQ and TMS neurophysiology measures (n&#xa0;=&#xa0;40) including: Short-Interval Cortical Inhibition (SICI), Long-Interval Cortical Inhibition (LICI), the Cortical Silent Period (CSP), and Intracortical Facilitation (ICF). Spearman partial correlation coefficients, controlled for age, number of failed medical trials and depressive symptom severity were employed to examine potential associations among the CTQ and markers of GABAergic and glutamatergic neurotransmission. A significant positive correlation was observed between ICF-10 and physical abuse (&#x3c1;&#xa0;=&#xa0;0.36276, p&#xa0;=&#xa0;0.0297) suggesting an association with historical physical abuse and increased glutamatergic neurotransmission. Significant negative correlations also emerged between LICI-200 and emotional abuse (&#x3c1;&#xa0;=&#xa0;-0.36047, p&#xa0;=&#xa0;0.0308), emotional neglect (&#x3c1;&#xa0;=&#xa0;-0.42310, p&#xa0;=&#xa0;0.0101), physical neglect (&#x3c1;&#xa0;=&#xa0;-0.35610, p&#xa0;=&#xa0;0.0330), and overall adversity scores (&#x3c1;&#xa0;=&#xa0;-0.515, p&#xa0;=&#xa0;0.0013), suggesting that greater childhood adversity was associated with increased GABA-B mediated inhibitory neurotransmission. This study suggests that childhood adversity may be linked to distinct neurophysiological alterations in adolescents. These findings support the potential of TMS-derived measures as candidate biomarkers for adversity-related psychiatric disorders. Further studies should validate these findings in larger samples with a longitudinal design.

The arrival of a baby and the early years of a child's life represent a critical period for parents, often marked by increased parental stress that can impact both their well-being and the child's development. Although parental stress has been widely studied, no systematic review has yet focused specifically on early childhood. To address this gap, we conducted a systematic review synthesizing evidence on factors examined as antecedents of parental stress during the first three years postpartum. Following PRISMA guidelines, we included 108 quantitative studies published in the past 12 years that investigated variables statistically modeled as predictors of parental stress. Key determinants of parental stress were identified at three levels: (1) at the personal level, internalizing symptoms, adverse childhood experiences, and perinatal negative experiences were related to higher stress; (2) at the relational level, marital satisfaction and coparenting quality were associated with lower stress; and (3) at the contextual level, social support from friends and family served as a protective factor of parental stress, while children's developmental problems served as risk factors. Despite the increasing number of longitudinal studies and the growing inclusion of fathers in research, few studies have focused on participants from social minority groups or from non-Western contexts. These findings may contribute to the development of effective strategies to support families during the early years of parenthood.

Although pediatric thoracic injuries constitute only a small proportion of all childhood injuries, the risk of morbidity and mortality is increased due to the anatomical and physiological characteristics of children. Early diagnosis and timely referral to appropriate centers are critically important, particularly in hospitals with limited advanced imaging, thoracic surgery, and intensive care facilities. This study aims to comprehensively evaluate the interhospital transfer characteristics of pediatric patients with thoracic trauma in Turkey. The patients' age, gender, nationality, referring-receiving province and region, referral time, distance, and ICD-10 codes were retrospectively evaluated. A total of 313 patients were examined (78% male; mean age, 11.2&#x2009;&#xb1;&#x2009;5.8 years). The most common diagnosis was pneumothorax (27.2%). The vast majority of transfers were by road (98.1%), within the province (82.7%), outside working hours (78%), and on weekdays (70.9%). A significant proportion of air transfers were performed during working hours (p&#x2009;=&#x2009;0.023). No significant relationship was found between diagnoses and either the transfer route or the transfer time. The distance was significantly longer for out-of-province transfers (p&#x2009;<&#x2009;0.001). Although significance was detected between the transferring and receiving regions and the direction of transfer, it disappeared in subgroup analyses. Regulating the criteria for the use of air ambulance services is crucial for strengthening national trauma systems, regionalizing pediatric trauma management, and increasing timely access to advanced trauma centers.