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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.

Psychological theories emphasize the role of executive function in the mental health of adolescents. Yet, the longitudinal relationship remains poorly understood. This cohort study explored the longitudinal relationship between self-reported executive function and adolescents' mental health and potential gender differences. Data were collected at 3 time points from 8,072 adolescents (11-15 years old) in 84 secondary schools in the United Kingdom, as part of the MYRIAD (MY Resilience In ADolescence) trial (ISRCTN86619085). The longitudinal relationship between adolescents' self-reported executive function (Behavior Rating Inventory of Executive Function, Second Edition [BRIEF-2]) and 4 mental health outcomes-well-being (Warwick-Edinburgh Mental Wellbeing Scale [WEMWBS]), social-emotional-behavioral difficulties (Strength and Difficulties Questionnaire [SDQ]), risk for depression (Center for Epidemiologic Studies Depression Scale [CES-D]), and suicidality (item-based)-was explored using 3 mixed-effects regression models. Model 1 included a composite measure of executive function; model 2 included behavioral, cognitive, and emotional self-regulation; and model 3 included 7 executive function skills. Better executive function (ie, lower BRIEF-2 scores) was associated with better mental health over 1 year (regression coefficient [95% CI]: well-being -0.23 [-0.24, -0.22], social-emotional-behavioral difficulties 0.24 [0.23, 0.24], risk for depression 0.33 [0.32, 0.34], and suicidality 0.02 [0.01, 0.02]). This association weakened over time for all outcomes except suicidality (model 1). Associations were strongest for emotional self-regulation (model 2) and specifically emotional control and planning (model 3). The relative role of other executive function skills (eg, working memory and self-monitoring) differed by outcome and gender. Better executive function was associated with better mental health over time. Potential intervention targets include emotional self-regulation, particularly emotional control and planning. This study used data from 8,072 adolescents (aged 11-15 years) in 84 United Kingdom schools, collected as part of the MYRIAD (MY Resilience In ADolescence) trial, to examine how executive function relates to adolescent mental health outcomes over one year. Young people who reported better executive function were more likely to report better mental well-being, as well as less social-emotional-behavioral difficulties, depression, and suicidality, over time. The relation to mental health outcomes at one year was strongest for better emotional self-regulation, including emotional control and planning, reported at baseline in both boys and girls.

This study examined temporal trends in mental health diagnoses and treatment patterns among children and adolescents across the COVID-19 pre-pandemic, pandemic, and post-pandemic periods in the United States. This retrospective cohort study used the TriNetX U.S. Collaborative Network, including 13.3 million children and adolescents aged 3 to 18 years with health care encounters from October 2018 to December 2022. Using 2 complementary approaches-rolling monthly health care-seeking incidence and treatment-engaged cohorts (≥2 encounters per phase)-we assessed psychiatric diagnoses, psychotropic medication initiation, and psychotherapy use across 3 phases: pre-pandemic (October 2018 to February 2020), pandemic (March 2020 to July 2021), and post-pandemic (August 2021 to December 2022). Analyses were stratified by age, sex, race, and ethnicity. Incidence rates declined sharply during early pandemic lockdowns, rebounded by March 2021, and remained elevated post-pandemic. Compared with pre-pandemic levels, psychiatric diagnoses increased 24%, psychotropic medications 35%, and psychotherapy 26%. Antidepressants had the largest increases (58%-94%), with female children and adolescents showing steeper rises (65%-137%) compared with male children and adolescents (41%-57%). Attention-deficit/hyperactivity disorder (ADHD) medication use also increased, with the greatest rise in preschoolers (147%), whereas male adolescents showed minimal change or decreases. Racial and ethnic disparities persisted. Among treatment-engaged youth, adolescents had higher antidepressant use (32%-36%) and hydroxyzine use (7%-10%), with reduced benzodiazepine use (7%-4%). Substantial and sustained increases in pediatric behavioral health treatment persisted beyond the acute pandemic period, concentrated among female individuals and driven primarily by antidepressant prescribing. These patterns warrant monitoring and targeted interventions to address sex disparities and persistent racial and ethnic inequities. This study examined mental healthcare utilization trends in US children before, during, and after the COVID-19 pandemic. Mental health diagnoses and treatments rose during and after the pandemic, after a drop during the lockdown period of the pandemic. Antidepressant use showed the greatest increase, especially among girls. Attention-deficit/hyperactivity disorder (ADHD) medication utilization also rose, with greatest increase among preschoolers. Racial and ethnic gaps persisted, highlighting the need for targeted support to improve access to care.

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.

Resilience in psychiatry is often defined as the absence of psychopathology following early adversity. Resilience may be better operationalized as a continuous construct reflecting the degree to which individuals are functioning better than would be predicted given their adversity exposure. We used a continuous metric of resilience to predict mental health problems in 2 richly phenotyped samples studied longitudinally, and compared findings to those of conventional grouping approaches. Exposure to early adversity was assessed at baseline (Study I: N = 1,265; Study II: N = 191), and mental health was assessed several times over a decade (9-21 years of age). Resilience was defined as the residual of participants' mental health symptoms accounting for early adversity. We then used generalized additive models to examine mental health symptoms across adolescence as a function of resilience to adversity. Finally, we compared continuous approaches with grouping approaches to assess resilience. In both studies, greater resilience to adversity in childhood predicted fewer mental health problems in adolescence. Although both approaches to modeling resilience predicted unique variance in subsequent mental health symptoms when modeled simultaneously, the grouping approaches identified fewer individuals as resilient than did the continuous approach. A continuous approach to operationalizing resilience significantly predicted mental health symptoms across adolescence. Furthermore, both continuous and categorical operationalizations predicted unique variance in mental health outcomes. Importantly, however, grouping approaches may overlook a significant number of individuals who are, by a continuous assessment, resilient. Determining the optimal approach for identifying resilient individuals should be a priority for mental health research. This study examines how children respond to adversity over time. After assessing early adversity at baseline, the authors assessed resilience in terms of mental health over a decade in two studies of youth (n=1,265 and n=191). In both studies, greater resilience was related to fewer mental health problems over time. The authors also investigated two approaches to assess resilience over time and found that a grouping approach identified fewer individuals as resilient than a continuous approach, suggesting a continuous approach may better identify resilient individuals in mental health research.

To quantify associations between childhood maltreatment and emerging major depressive disorder (MDD) in adolescents/young adults with and without a first-degree family history of bipolar I disorder. A total of 116 youths 14 to 21 years old were classified into a high-risk group (n = 58) based on at least 1 first-degree relative diagnosed with bipolar I disorder and a low-risk group (n = 58) based on no first- or second-degree family history of bipolar disorder. Childhood maltreatment was assessed using the Childhood Trauma Questionnaire-Short Form (CTQ-SF). Psychiatric diagnoses were established with semistructured interviews. Logistic regression tested interactions between childhood maltreatment and familial risk, controlling for age and sex, as predictors of MDD. Half of participants in the high-risk group exhibited current or past MDD compared with 24% of the low-risk group. Regression models showed that each 1-point increase in CTQ-SF total score was associated with a 7% increase in the odds of MDD (odds ratio [OR] = 1.07, 95% CI 1.01-1.17, p = .004). High-risk status conferred approximately 3 times greater odds of MDD vs low-risk status (OR = 3.04, 95% CI 1.14-8.43, p = .03). Each year of age increased risk of MDD by 34% (OR = 1.34, 95% CI 1.09-1.67, p = .01). The childhood maltreatment × familial risk interaction was not significant (p > .6). Childhood maltreatment and familial risk for bipolar I disorder independently increase the risk of MDD. Mitigating either risk factor independently could meaningfully reduce depression risk in at-risk youth. 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. 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. 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. This study investigated associations between childhood maltreatment and development of major depressive disorder (MDD) symptoms in 116 adolescents (ages 14-21 years) with (high-risk [HR]) and without (low-risk [LR]) a first-degree family member diagnosed with bipolar I disorder. Half of HR participants exhibited current or past MDD, compared with 24% of the LR group. The authors also found that higher total trauma questionnaire score, HR status, and older age increased the odds of having MDD. Findings suggest that childhood maltreatment and familial risk for bipolar disorder are associated with major depression risk, highlighting opportunities for screening and early intervention efforts in offspring of adults living with bipolar 1 disorder.

To examine associations between individual adverse childhood experiences (ACEs) and disordered eating behaviors (DEBs) in US youth. In addition, to test mediation and moderation by psychosocial and contextual factors. The study was based on a cross-sectional analysis of 47,617 children 10 to 17 years of age from the 2022-2023 National Survey of Children's Health. Survey-weighted logistic regression estimated ACE-DEB links adjusted for demographics; mediation was assessed with structural equation modeling and moderation with interaction terms. Overall, DEBs were reported for 29% of youth. Household mental illness and economic insecurity showed the strongest and most consistent associations, each paired with 4 or more DEBs. For compensatory weight-control behaviors specifically, adjusted odds ratios were 1.82 for household mental illness and 2.05 for economic insecurity. Depression, anxiety, and food insecurity demonstrated robust mediation effects across a variety of DEB-ACE pairings. Family resilience and ≥4 shared meals weekly reduced DEB odds, but protection weakened with mental illness or financial strain. Bullying victimization raised DEB risk, but this association was attenuated among youth facing racial discrimination. Household mental illness and financial hardship confer broad risk for disordered eating in youth, largely through internalizing symptoms and, in the context of poverty, food scarcity. Family strengths and peer experience can buffer or amplify these risks. Together, these findings highlight the value of trauma-informed and developmentally sensitive assessment of DEBs that consider emotional, nutritional, and family context, including exposure to adversity, to support early identification and prevention in youth. Many teens experience disordered eating, but some are at higher risk than others. This cross-sectional study of over 47,000 youths investigated how childhood hardships related to disordered eating behaviors. Poverty and household mental illness had the strongest links to multiple disordered eating patterns. These patterns were partly explained by depression, anxiety, and food insecurity. These findings may help families and providers identify early risk factors for disordered eating behaviors and offer support and prevention strategies.

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

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

Potential associations between adverse childhood events and disordered eating have been a topic of research interest for decades, often focused on specific types of child abuse.1 More recent research has included a wider variety of adverse childhood events, including parental illness or absence.2 , 3 The idea that such adversity triggers disordered eating has caught the eye of media and has become socially accepted, with films such as To the Bone focusing on a character's struggle with an eating disorder in the wake of her parents' divorce and emotional absenteeism.4 Portrayals like this risk oversimplifying complex situations and individual experiences for dramatic purposes and, without additional work to convey risk, lead the public to believe that disordered eating, or eating disorders, are inevitable outcomes of many adverse childhood events. This makes it important for researchers to better understand, and communicate, how individual adverse childhood events relate to specific disordered eating behaviors, as well as what factors may mediate associations between exposures and outcomes.

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.

This study examined temporal trends in suicide deaths among South Korean children &#x2264;13 years of age from 2013 to 2022 and identified gender-specific patterns for targeted prevention strategies. We retrospectively analyzed national mortality data from Statistics Korea's microdata, covering the period from 2013 to 2022. Suicide deaths among children &#x2264;13 years of age were analyzed using second-order polynomial regression models and Poisson regression to assess temporal trends and population-adjusted incidence rates. Sex-stratified analyses were performed to examine differences between male and female individuals. Model validation revealed an excellent fit between the observed and predicted rates (correlation = 0.97, mean absolute error = 0.04). Over the 10 years, 79 children &#x2264;13 years of age died by suicide (47 male, 32 female), most commonly by hanging (74.7%). The proportion of children <13 years of age among all suicide deaths in individuals <19 years of age ranged from 1.1% to 3.9% annually, with an increasing trend observed since 2020. Poisson regression showed significant annual increases in suicide incidence for both male (incidence rate ratio [IRR] = 1.09, p=0.045) and females (IRR=1.15, p=0.029). Pre- vs. post-2020 analysis revealed a marked increase in female suicide rates (rate ratio = 2.43, 95% CI = 1.23-4.77), whereas male suicide rates remained stable (rate ratio = 0.71, 95% CI = 0.34-1.46). This study demonstrates divergent suicide trends between sexes in children <13 years, with female children showing a steeper increase over the decade. We should consider suicide prevention and intervention strategies in light of sex differences and social factors in cases of suicide among children. Enhanced surveillance systems and developmentally appropriate interventions are crucial for addressing this emerging public health concern in South Korea's youngest population. 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. While citing references scientifically relevant for this work, we also actively worked to promote sex and gender balance in our reference list. There has been a persistent increase in suicide among children younger than 13 years old in several high-income countries during the past decade. This study examined suicide trends among South Korean children under 13 years of age from 2013 to 2022 using national mortality data. Although suicide is rare in this group (79 over the 10-year period), rates have increased, especially among girls, since 2020. This analysis showed that female suicide rates doubled after the pandemic, while male rates remained stable. These results highlight the need for gender-sensitive prevention and better mental health support for young children in South Korea.

The impact of partial hospitalization programs (PHP) for adolescents with mental health difficulties has remained unclear, especially during the COVID-19 pandemic. This study examined changes in mental health symptomatology among youth in an in-person PHP. Specifically, this study examined whether the COVID-19 pandemic or sex moderated the effect of insomnia on irritability, anxiety, depression, and suicidality among youth in an in-person PHP. A retrospective study of 271 adolescents (aged 11-17 years) treated in a PHP before (n = 99) and during (n = 172) the COVID-19 pandemic from January 2019 through December 2021 was conducted. The conditional process moderation path analytic regression model assessed whether changes in insomnia symptoms were moderated by both COVID-19 (pre- COVID-19 and during COVID-19 time periods) and sex. A significant positive linear relationship was observed between changes in insomnia symptoms and changes in depressive, anxiety, and irritability symptoms among female adolescents, both before and during the COVID-19 period. A similar relationship between insomnia and suicidal ideation was observed among female adolescents, albeit only in the pre-COVID period. However, no significant interaction effects were identified between insomnia and group (pre- vs during COVID-19) or between insomnia and sex, suggesting that neither the pandemic nor sex moderated these associations. This study highlights the impact of sleep disturbance on mental health symptoms particularly among female adolescents, in the context of an in-person PHP, both before and during the COVID-19 pandemic. The PHP appeared to be equally effective in managing these symptoms in both the before and during the COVID-19 period. These findings provide a foundation for future research regarding the role of partial hospitalization programs in addressing adolescent mental health during global crises. This study evaluated if the COVID-19 pandemic and sex (assigned at birth) moderated the impact of insomnia on irritability, anxiety, depression, and suicidality in adolescents attending an in-person partial hospitalization program (n = 271). Researchers found a positive relation between changes in insomnia symptoms and changes in depressive, anxiety, and irritability symptoms in female youths before and during the COVID-19 pandemic, highlighting the impact of sleep disturbance on mental health symptoms in adolescents.

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

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.

Irritability is highly heterogeneous and a common challenge in youth clinical services. Albeit transdiagnostic, the diagnostic manuals conceptualize severe irritability differently: the ICD-11 primarily recognizes it as behavioral (oppositional defiant disorder specifier), and the DSM-5-TR, as depressive (core to disruptive mood dysregulation disorder). Irritability is also highly prevalent in, and genetically linked to, neurodevelopmental conditions. It is unclear whether irritability represents a unitary construct or multiple different types. We examined whether distinct behavioral, neurodevelopmental, and depressive irritability types, differentiated by their developmental course, sex-preponderance, clinical, genetic, and environmental covariates, could be observed. Using data from the Avon Longitudinal Study of Parents and Children (female participants: 5,085; male participants: 5,028), we explored sex-stratified irritability latent profiles across 5 time points (&#x223c;ages 7-25 years) for irritability measured with the Development and Well-Being Assessment. We investigated associations with various clinical, genetic, and environmental covariates typifying behavioral, neurodevelopmental, and depressive conditions. We identified 5 irritability profiles similar across sexes (low, child-limited, child/adolescent-limited moderate, child/adolescent-limited high, high-stable) and 2 sex-specific profiles: adolescent-onset (female participants) and fluctuating (male participants). Although most profiles were not distinguished by condition-specific covariates, 2 profiles showed some specificity with neurodevelopmental or depressive conditions: (1) the male high-stable profile was associated with attention-deficit/hyperactivity disorder diagnosis and genetic liability, and autism-like traits, and (2) the female adolescent-onset profile was associated with depression diagnosis and genetic liability, and adolescent/adult stressful life events. Irritability appears to be developmentally heterogeneous. Albeit often transdiagnostic, for some individuals irritability may align with neurodevelopmental or depressive conditions. This could have potential implications for classification and treatment. Exploring Possible Behavioural, Neurodevelopmental and Depressive Types of Irritability, Using a Developmental Approach; https://osf.io/av2s8/. Irritability is highly impairing and linked to different mental health conditions. Using data from the Avon Longitudinal Study of Parents and Children (n = 10,113), the authors characterized irritability in female and male youths. Five irritability profiles common to female and male youths were identified, as well as adolescent-onset irritability in female youths and fluctuating irritability in male youths. Irritability persisting from childhood to adulthood in male individuals was linked to attention-deficit/hyperactivity disorder and autism, whereas adolescent-onset irritability in female individuals was linked with depression.

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.

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.

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