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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.

Brief adaptations of existing rating scales may have advantages for research and clinical practice. This study examined the relative performance and psychometric properties of the 5-item Brief Children's Depression Rating Scale-Revised (BCDRS-R5) in the context of a placebo-controlled clinical trial. The present study evaluated the internal consistency, scale dimensionality, relative performance in identifying remission and response, and sensitivity to change of the BCDRS-R5 in outpatients (N = 296) 12 to 17 years of age with major depressive disorder enrolled in a randomized, double-blind, placebo-controlled parallel group trial of the selegiline transdermal patch. The Cronbach coefficient alpha of the BCDRS-R5 ranged from 0.679 at baseline to 0.866 at week 12. A 1-factor solution for the BCDRS-R5 is suggested by the principal component analysis. The BCDRS-R5 demonstrated good accuracy in detecting response and remission. The BCDRS-R5 has good performance and is sensitive to change in symptom severity over 12 weeks of treatment, with either medication or placebo, when compared with the longer, standard CDRS-R17. Phase IV:Safety and Efficacy of EMSAM in Adolescents With Major Depression; https://clinicaltrials.gov/study/NCT00531947. We actively worked to promote sex and gender balance in our author group. We actively worked to promote inclusion of historically underrepresented racial and/or ethnic groups in science in our author group. While citing references scientifically relevant for this work, we also actively worked to promote sex and gender balance in our reference list. While citing references scientifically relevant for this work, we also actively worked to promote inclusion of historically underrepresented racial and/or ethnic groups in science in our reference list. Brief adaptations of clinical rating scales may help streamline research and measurement-based care. This study examined data from a prior clinical trial of selegiline for adolescents with depression (N = 296). The goal was to study the performance of a brief, 5-item version of the Children’s Depression Rating Scale–Revised (BCDRS-R5). This rating scale appeared to have similar properties as compared to the standard 17-item Children’s Depression Rating Scale–Revised (CDRS-R17) from which the BCDRS-R5 was derived. This study is the first psychometric validation of the BCDRS-R5 in the context of a placebo randomized controlled trial for adolescents with major depressive disorder. Results suggest the brief scale has good performance and is sensitive to change in symptom severity over time.

Pediatric anxiety constitutes a serious public health concern. Cognitive behavioral therapy (CBT) is a gold standard treatment, preferred by families over pharmacological options, but barriers limit CBT accessibility. Modern CBT formats include varying levels of therapist involvement and differential technologies to overcome barriers, but little is known about their effectiveness in typical care settings, as well as in pediatric care. The Kids Formats of Anxiety Care Effectiveness study For Extending the Acceptability and Reach of Services (Kids FACE FEARS) trial addresses these gaps. The Kids FACE FEARS trial was a multisite, pragmatic randomized trial comparing therapist-led CBT (telehealth, office-based, or hybrid) with guided internet-based CBT (self-administered/self-paced, with minimal therapist support) for treating anxiety in youth (7-18 years old) identified in pediatric care. English- and Spanish-speaking families were enrolled from high-volume, urban pediatric health care sites affiliated with major medical centers in 4 metropolitan regions. This article describes the study's rationale, treatment conditions, participant recruitment, assessment schedule/strategy, and provider training/consultation. Recent innovations have expanded CBT delivery options for pediatric anxiety. This is the first multisite randomized trial directly comparing CBT formats that draw on differential levels of therapist involvement and modes of technology. Sampling and study design features poise the Kids FACE FEARS trial to be one of the largest and most diverse/representative controlled trials of CBT for pediatric anxiety. In the context of evolving CBT delivery options, trial findings can inform patient-centered decision making and help tailor treatment selections for underserved youth with anxiety. Kids FACE FEARS Comparative Effectiveness Research; https://clinicaltrials.gov/study/NCT03707158. Cognitive behavioral therapy (CBT) is a “gold standard” treatment for youth anxiety, but barriers limit CBT accessibility. This study protocol describes novel ways of improving access in the Kids Formats of Anxiety Care Effectiveness study For Extending the Acceptability and Reach of Services (Kids FACE FEARS) trial—a multisite randomized trial comparing two CBT formats (ie, therapist-led CBT and guided internet-based CBT) with different levels of technology and therapist involvement. This study focused on English- and Spanish- speaking youth with anxiety in urban pediatric sites affiliated with major medical centers. Findings may better inform treatment recommendations in pediatric settings.

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℠ (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 ≥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℠ (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.

With rising prevalence of mental disorders, especially among underserved and under-resourced youth, mental health workforce shortages are evident across the United States. This study aimed to assess the feasibility, acceptability, and pilot implementation of a multicomponent career development program, the Youth Mental Health Academy (YMHA), for structurally marginalized youth-including underrepresentation based on race/ethnicity, disability, sexual orientation/gender identities, socioeconomic challenges, parents/caregivers without college degree, geographic isolation, foster care/juvenile legal system involvement, or having a parent/caregiver in the military. Structurally marginalized high school students interested in mental health careers were encouraged to apply. Students completed baseline and post-program assessments and weekly acceptability ratings. Program feasibility was assessed via attendance, recruitment, and retention rates. A total of 135 students enrolled in the YMHA pilot. Participants were ethnoracially diverse-51.9% Hispanic/Latinx, 30.4% Asian/Asian American, 14.1% Black/African American, 3.7% Middle Eastern, and 3.7% White; 68.9% identified as female. Approximately 40% met criteria for socioeconomic challenges (eg, Federal Free and Reduced Lunch eligibility), 15% had histories of foster care or juvenile legal involvement, and about 7% reported a chronic condition/disability. Of participants, 92% (n = 125) completed the first summer program with high attendance (>75% days attended), and 87.4% (n = 118) completed a second summer internship. High acceptability was maintained throughout. After the 14-month program, 82.9% of students indicated interest in pursuing mental health careers. High acceptability, retention, and engagement indicate that the YMHA program is a promising approach to diversifying the mental health workforce. A large-scale study is needed to examine the scalability and sustainability of this model. We worked to ensure sex and gender balance in the recruitment of human participants. We worked to ensure race, ethnic, and/or other types of diversity in the recruitment of human participants. We worked to ensure that the study questionnaires were prepared in an inclusive way. Diverse cell lines and/or genomic datasets were not available. One or more of the authors of this paper self-identifies as a member of one or more historically underrepresented racial and/or ethnic groups in science. 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 self-identifies as living with a disability. 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. 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. The Youth Mental Health Academy (YMHA) is a 14-month career development program for high school students from underrepresented backgrounds to explore careers in mental health. This study enrolled 135 students from diverse backgrounds (51.9% Hispanic/Latinx, 30.4% Asian/Asian American, 14.1% Black/African American, 3.7% Middle Eastern, and 3.7% White; 15% with history of foster care or juvenile legal involvement) who were interested in mental health careers to participate in the program. Most students who participated stayed engaged (92%) and found the program helpful, and 82.9% indicated interest in pursuing mental health careers. This type of program may be a promising approach to diversifying the mental health workforce.

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.

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&#x2120; (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.

Care for transgender and gender diverse (TGD) young people is among the most contested and scrutinized areas of modern medicine,1 partly related to differences in sociocultural conventions across regions, heterogeneity within TGD populations, and inconsistent research definitions.2 Evidence of appropriate care is difficult to derive from randomized controlled trials, and rigorously designed observational studies remain crucial.3 The same data are often interpreted in support of or opposition to specific gender-related care practices (eg, puberty blocker use in adolescents diagnosed with gender dysphoria),4 , 5 as such interpretations are frequently swayed by ideological and political forces. In many Western regions, current debates also concern the external validity of applying accumulated evidence to shifting populations amid significant secular trends-notably the marked increase in TGD-identifying youth. Importantly, comprehensive understanding of gender-related care needs and service approaches extends beyond medical considerations to encompass psychological, sociocontextual, and legal aspects. This means that appropriate gender-related care must also tackle the unique social realities of each region and jurisdiction. Despite ongoing efforts to harmonize evidence and practice globally, most contributors to the World Professional Association for Transgender Health Standards of Care Version 8 are from North America and Western Europe.4 To address disparities worldwide, evidence syntheses and tailored knowledge mobilization in underrepresented regions, especially regions undergoing rapid societal transformation, are essential for developing and delivering care that genuinely responds to local needs.

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.

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.

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.

Postpartum depression (PPD) is a major mental health issue and affects up to 1 in 5 women with significant downstream consequences for cognitive and social-emotional health of children. Effective treatments for PPD exist but are not always accessible or acceptable to new mothers. One such treatment is selective serotonin reuptake inhibitors (SSRIs). This study investigated the role of SSRI medication use in the developing mother-infant relationship. Participants were enrolled in this longitudinal study when their infants were 2 to 6 months old. Of the 67 mothers included in the sample, 25 were healthy controls, 25 were diagnosed with PPD and chose not to initiate SSRI treatment, and 17 were diagnosed with PPD and chose to take an SSRI. Self-report measures of depression, parenting-related stress, and bonding; an observational measure of mother-infant interaction quality; and salivary oxytocin were collected across 2 visits spaced 3 months apart. Although depression symptoms decreased across both PPD groups from visit 1 to visit 2, mothers in the SSRI group reported greater improvements in the quality of their relationship with their infant. Ratings of observed maternal sensitivity and dyadic interaction quality were consistently high across groups and ages. However, infants of mothers with PPD did not show expected gains in observed social engagement over this period. Our results, though preliminary, suggest that SSRI use is associated with improvements in perceived mother-infant relationship quality, above and beyond what is explained by depression symptoms. However, potential impacts of maternal depression on infant social development remain. Postpartum depression is a common experience for new mothers that can have long-term impacts on mothers and their babies. This study considered whether medication use (selective serotonin reuptake inhibitors) helped to improve the mother-infant relationship. Researchers found that new mothers who chose to treat their depression with medication (n = 17) felt more bonded to their babies at 3-month follow-up than mothers who chose not to treat with medication (n = 25). This was in spite of no observed difference in mother-infant play. These results suggest promise for medication beyond reducing depression symptoms in mothers.

Harsh parenting and childhood externalizing behaviors can form bidirectional, reinforcing dynamics that set the stage for adverse outcomes. In community samples, little is known about contextual factors that moderate this bidirectionality; we examined household chaos as a key candidate. Using the United Kingdom's Millennium Cohort Study (MCS; 17,115 families), we tested moderation by chaos of pathways between main-carer reports of harsh parenting and externalizing behaviors over child ages 3, 5, and 7 years. Findings supported the mutual nature of parent and child behaviors through childhood. Despite 2-year intervals, there was also evidence for interactions between chaos and harsh parenting in predicting later externalizing problems, and between externalizing problems and chaos in predicting later harsh parenting. As hypothesized, perceptions of high chaos in the home exacerbated associations between harsh parenting and later externalizing problems. Unexpectedly, children's externalizing problems had a weaker influence on harsh parenting in the context of higher chaos (or, indeed, a stronger influence in low-chaos homes). Acknowledging our anticipated small effect sizes, several interpretations are discussed. For example, parents perceiving higher chaos may filter out the excessive stimulation of their children's externalizing problems and be less reactive to them, or lower home chaos may reflect a need for calm and control in parents who are particularly reactive to their children's externalizing behaviors. Negative, reinforcing parent-child dynamics are seen outside clinical contexts over time. Exploring moderators of this bidirectionality may offer a nuanced understanding of family processes that hold the key to prevention and intervention. Parents and children influence each other&#x2019;s behavior over time. Understanding how the family home environment strengthens or weakens these patterns may inform ways to mitigate long-term conflictual cycles in the family. Analyzing the UK Millennium Cohort Study (MCS, 17,115 families), this study found that household chaos (eg, disorganization, lack of routine, and sense of rush rather than calm) may change the mutual association between parental harshness and child externalizing behavior over time. The results suggest complex dynamics between parent and child behavior, particularly in the context of household chaos.

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.

Suicide rates among Black youth have been rising at an alarming rate, with a 54% increase between 2018 and 2022. This study investigated sociodemographic, suicide-related, clinical, and interpersonal risk and protective factors of lifetime (cross-sectional) and 6-month (prospective) suicide attempt in a large sample of Black youth who visited the emergency department. Data from 1,719 Black youths (girls = 1,046 [61%], mean [SD] age =14.98 [1.66] years) were obtained from the Emergency Department Screening for Teens at Risk for Suicide (ED-STARS) Study 1 cohort recruited from 13 nation-wide pediatric emergency departments (Pediatric Emergency Care Applied Research Network [PECARN]). Among 784 youths selected for follow-up interviews based on level of suicide risk, 616 (78.6%) participated in 3- and/or 6-month follow-up interviews. Univariable logistic regression models examined cross-sectional and longitudinal relations between sociodemographic, suicide-related, and other clinical and interpersonal risk and protective factors and suicide attempt. A multivariable logistic regression model predicting follow-up suicide attempt was examined. Cross-sectional and follow-up univariable models found that gender identity, sexual minority status, suicidal ideation/behavior, nonsuicidal self-injury, hopelessness, depression, agitation, anxiety, sexual abuse history, level of impairment, connectedness (family, peer, school), and impulsivity predicted suicide attempt. The final multivariable model included lifetime suicidal behavior, baseline suicidal ideation in the past week, impulsivity, and all forms of connectedness (area under the curve = 0.91, 95% CI 0.87-0.95) as predictors of suicide attempt, although impulsivity and social/school connectedness were nonsignificant predictors that were retained for improved fit indices. Our findings highlight the importance of suicide-related factors, hopelessness, functional impairment, sexual and gender minorities, and connectedness at baseline in predicting future suicide attempts in Black youth. Future work should incorporate race-related risk and protective factors. Suicide rates among Black youth are climbing at an alarming rate. This study examined which array of factors predicted suicide attempts 3-6 months later among 784 Black youth who visited the emergency department through follow-up interviews. Results identified several factors that predicted suicide attempts, including sexual and gender minority identity, prior suicidal experiences, and feeling hopeless, amongst others. Feeling connected to family, peers, and school reduced the likelihood of attempting suicide.

Psychopathology shows changes in behavioral manifestation across development, that is, heterotypic continuity. However, research has paid little attention to how to account for heterotypic continuity when examining the development of psychopathology. This longitudinal study accounted for heterotypic continuity of multiple psychopathology dimensions by using developmental scaling to place multi-informant ratings of children's behavior problems onto the same scale to chart children's trajectories. The study examined children's (N = 231) development of 3 psychopathology dimensions-externalizing, internalizing, and thought-disordered-using different measures across 7 timepoints from 3 to 7.5 years of age. Psychopathology dimensions were assessed by mother-, father-, and teacher/caregiver-report. We compared 3 assessment approaches: the common items, upward/downward extension, and construct-valid items approaches. We compared 2 scoring approaches: mean scoring and developmental scaling. Developmental scaling aims to place scores from age-differing measures onto the same scale. We compared their accuracy, for externalizing problems, in terms of criterion validity with respect to observations of compliance and attention to task. Using different measures across ages (ie, construct-valid items approach) was the most accurate assessment approach-modestly more accurate than using the common items or upward/downward extension-in terms of criterion validity with respect to observations of compliance and attention to task (r diff = 0.07-0.13). Developmental scaling was the most accurate scoring approach, modestly more accurate than average scores (r diff = 0.03-0.17). Using (1) age-differing measures to account for heterotypic continuity and (2) developmental scaling to link scores from the different measures onto the same scale may enable studying development of psychopathology across the lifespan. We worked to ensure sex and gender balance in the recruitment of human participants. We worked to ensure race, ethnic, and/or other types of diversity in the recruitment of human participants. We worked to ensure that the study questionnaires were prepared in an inclusive way. School readiness study: https://osf.io/jzxb8. Behavioral health problems manifest differently as children age. This study examined manifestations of 3 dimensions of behavioral health problems from ages 3 to 7.5 years (N = 231). The authors found that using different measures and scaling across ages was the most accurate way to assess behavioral health problems as children age.

The pathophysiology of attention-deficit/hyperactivity disorder (ADHD) is complicated by high rates of psychiatric comorbidities; thus, delineating unique vs shared functional brain perturbations is critical in elucidating illness pathophysiology. We investigated resting-state functional magnetic resonance imaging (rsfMRI)-complexity alterations among children with ADHD, oppositional defiant disorder (ODD), and obsessive-compulsive disorder (OCD), respectively, and comorbid ADHD, ODD, and OCD, within the cool and hot executive function (EF) networks. We leveraged baseline data from 9- to 10-year-old children in the Adolescent Brain and Cognitive Development (ABCD) Study. Data for children who singularly met all DSM-5 behavioral criteria for ADHD (n = 61), ODD (n = 38), and OCD (n = 48), respectively, were extracted, alongside data for children with comorbid ADHD, ODD, OCD, and/or other psychiatric diagnoses (n = 833). Data for a control sample of age-, sex-, and developmentally matched children were also extracted (N = 269). Voxel-wise sample entropy (SampEn) was computed using the LOFT Complexity Toolbox. Mean SampEn within all regions of interest (ROIs) of the EF networks was calculated for each participant. Hierarchical models with generalized estimating equations compared SampEn of comorbidity-free and comorbid ADHD, ODD, and OCD within the EF networks. SampEn was reduced in comorbidity-free ADHD and ODD in overlapping regions of both EF networks compared with the healthy controls, including the bilateral superior frontal gyrus, anterior/posterior cingulate gyrus, and bilateral caudate (Wald statistic = 5.682-10.798, p < .05, and Benjamini-Hochberg [BH] corrected), with ADHD additionally affected in the right inferior/middle frontal gyrus and bilateral frontal orbital cortex (Wald statistic = 7.231-9.420, p < 0.05, and BH corrected). Among comorbid presentations, the presence of ADHD symptomatology was associated with significantly lower SampEn in every ROI (z = -3.973 to -2.235, p < .05, and BH corrected). ADHD and ODD shared common impairments underlying the EF networks in the comorbidity-free presentations, with ADHD showing more widespread complexity reduction. When ADHD co-occurred with other psychiatric disorders, the reduction in SampEn extended beyond the regions affected in comorbidity-free ADHD, indicating that comorbidities amplify neural complexity deficits. In contrast, no significant SampEn alterations were observed in OCD, whether presented alone or in combination with ADHD. Attention-deficit/hyperactivity disorder (ADHD) and its comorbidities may be better understood by examining differences in the brains of those with ADHD versus ADHD with other psychiatric diagnoses. Using data from the Adolescent Brain and Cognitive Development&#x2120; (ABCD) study, this study compares the resting-state fMRI executive function networks in 9- to 10-year-old children. Researchers found ADHD and oppositional defiant disorder (ODD) shared common impairments in the comorbid-free presentations, with ADHD showing more widespread reductions in functional brain complexity. When ADHD co-occurred with other psychiatric disorders, the reduction in complexity extended beyond the regions affected in comorbid-free ADHD, indicating that comorbidities amplify deficits in neural complexity. In contrast, no significant complexity alterations were observed in obsessive-compulsive disorder (OCD), whether presented alone or in combination with ADHD.

Transdiagnostic dimensional approaches have advanced our understanding of psychiatric comorbidity and developmental continuity, but have rarely been applied to investigate links between neurodevelopmental (eg, attention-deficit/hyperactivity disorder, autism) and other psychiatric conditions. Building on recent research delineating a transdiagnostic "neurodevelopmental spectrum," we examined longitudinal associations between this spectrum in late childhood and other psychiatric dimensions in early adolescence, and the role of environmental and lifestyle factors as potential mediators of these associations. In 11,875 children from the Adolescent Brain Cognitive Development&#x2120; (ABCD) Study, we extracted neurodevelopmental, externalizing, internalizing, detachment, and somatoform dimensions at ages 10, 11, and 12 years through confirmatory factor analysis of Child Behavior Checklist items. Using linear mixed models, we tested prospective associations between the neurodevelopmental spectrum at age 10 years and other psychiatric dimensions at ages 11 and 12 years. Mediation models examined whether environmental (eg, family conflict, school involvement) and lifestyle (eg, sleep problems, screen use) factors at age 11 mediated these associations. Strong longitudinal associations emerged between the neurodevelopmental spectrum and all other psychiatric dimensions (&#x3b2; = 0.417-0.641, p < .001). Sleep problems were the most consistent mediator, accounting for 12% to 29% of these associations. Most results remained significant after multiple testing corrections and adjusting for covariates, mediators, and psychiatric dimensions at baseline. Our transdiagnostic dimensional approach revealed that neurodevelopmental traits prospectively predict elevations in major psychiatric symptom dimensions during the transition to adolescence. Sleep problems emerged as a key lifestyle factor underlying these associations and a promising target for transdiagnostic prevention programs to improve mental health outcomes in this population. There has been limited research using transdiagnostic dimensional approaches to understand the link between neurodevelopmental (eg, attention-deficit/hyperactivity disorder, autism) and other psychiatric dimensions. Using data from the Adolescent Brain Cognitive Development&#x2120; (ABCD) study, this study examining 11,875 children&#x2019;s Child Behavior Checklist items shows that children with high neurodevelopmental traits show increased risk for a wide range of other psychiatric symptoms at ages 11 to 12 years. By examining environmental and lifestyle factors underlying these associations, this study found that poor sleep plays a key role in driving this risk. These findings inform future intervention and prevention strategies to improve mental health outcomes in youth with neurodevelopmental traits.

Few evidence-based social cognitive interventions are available to autistic youth as they navigate their complex, socially demanding teenage years. Building from pilot research using neuroplasticity-based targeted cognitive training, CICADAS (Care Improving Cognition for ADolescents on the Autism Spectrum), a digital application (app) designed to prime the brain for socio-affective learning, was developed. In a randomized active-controlled trial with 3 comparison arms, CICADAS was evaluated as a stand-alone program and as an augmentation to evidence-based PEERS (Program for the Education and Enrichment of Relationship Skills). Recruiting from clinics providing PEERS, 62 adolescents (11-18 years old) with confirmed autism were enrolled. Adolescents scheduled to start PEERS were assigned using block randomization to PEERS + CICADAS (n = 22) and PEERS + Active Control (n = 21) groups. A third comparison group (n = 19) comprised adolescents who used the app as a stand-alone intervention (CICADAS only). In addition to in-app performance metrics, data were collected from social, behavioral, and cognitive assessments (self-report/parent-report measures) at preintervention (baseline), postintervention (16 weeks), and follow-up (32 weeks) sessions. Significant effects of group, time, and group &#xd7; time interaction were found on multiple measures collected longitudinally. For example, on the Pediatric Quality of Life Inventory, PEERS + CICADAS participants showed significant psychosocial health improvements (F = 6.862, p = .002) over the study timeline compared with trend level gains in the CICADAS only (F = 2.150, p = .122) and PEERS + Active Control (F = 1.917, p = .153) groups. Whereas all participants improved from baseline on the Social Responsiveness Scale, 2nd Edition (F = 11.038, p < .001), only the PEERS + CICADAS group gained significantly (F = 3.786, p = .026) on the social cognition subscale across all 3 time points. Our data demonstrate the potential of CICADAS as a stand-alone intervention and suggest that engaging with the adaptive app (vs static active control) conferred an additional advantage to autistic teens participating in PEERS. Care Improving Cognition for ADolescents on the Autism Spectrum (CICADAS); https://www.clinicaltrials.gov/study/NCT04562688. Youth with autism have few options for social cognitive support. To address this gap, researchers developed Care Improving Cognition for ADolescents on the Autism Spectrum (CICADAS), an adaptive cognitive training app designed to prime the brain for social cognitive learning. This study tested CICADAS by pairing the digital app with the Program for the Education and Enrichment of Relationship Skills (PEERS), one of the few well-established group-based social skills programs. This study of 62 adolescents (11-18 years) with autism compared groups using CICADAS alone, PEERS alone, or the combination. Data collected pre-/post-intervention showed gains from CICADAS used alone, but particularly as an enhancement to PEERS. Results suggest the digital tool may be a useful stand-alone or augmenting program for improving social cognition in youth with autism.