Identifying child temperament risk factors from 2 to 8 years of age: validation of a brief temperament screening tool in the US, Europe, and China Appendix excluded from article CC BY licence. All rights reserved

Service- and practitioner-level variation in non-consensual dropout from child mental health services Abstract Non-attendance of mental health service appointments is an international problem. In the UK, for example, the estimated cost of non-attendance in child mental health services is over £45 million (US dollar 60.94 million) per annum. The objective of this study was to examine whether there were service- and practitioner-level variation in non-consensual dropout in child mental health services. This was an analysis of routinely collected data. Service-level variation (as services covered different geographic areas) and practitioner-level variation were examined in N = 3622 children (mean age 12.70 years; SD 3.62, 57% female, 50% white or white British) seen by 896 practitioners across 39 services. Overall, 35% of the variation in non-consensual dropout was explained at the service level and 15% at the practitioner level. Children were almost four times more likely to drop out depending on which service they attended (median odds ratio = 3.92) and were two-and-a-half times more likely to drop out depending on which practitioner they saw (median odds ratio = 2.53). These levels of variation were not explained by levels of deprivation in areas covered by services or by children’s demographic and case characteristics. The findings of the present research may suggest that, beyond service-level variation, there is also practitioner-level variation in non-consensual dropout in child mental health services.

Adolescent self-harm and suicidal behavior and young adult outcomes in indigenous and non-indigenous people Abstract The aim of this study was to examine the associations between self-harm and suicidal behavior in indigenous Sami and non-Sami adolescents and mental health and social outcomes in young adulthood. Data were obtained by linking the Norwegian Patient Registry (2008–2012), the National Insurance Registry (2003–2013), and the Norwegian Arctic Adolescent Health Study, a school-based survey inviting all 10th grade students in North Norway (2003–2005). In total, 3987 (68%) of all 5877 invited participants consented to the registry linkage, of whom 9.2% were indigenous Sami. Multivariable logistic regression was used to explore the associations between self-harm only, suicidal ideation with and without self-harm, and suicide attempts in adolescence (≤16-year-old), and later mental health disorders, long-term medical, social welfare benefit receipt, or long-term unemployment in young adulthood. Self-harm and suicidal behavior in Sami and non-Sami adolescents were associated with increased risk of later mental health disorders, long-term welfare benefit receipt, and long-term unemployment. These associations were attenuated by adolescent psychosocial problems. No major differences between the indigenous Sami participants and their non-Sami peers were found. Young suicide attempters experienced the highest risk, with adolescent suicide attempts being significantly associated with all four adult outcomes after adjustment. Self-harm and suicidal behavior in adolescence are markers of mental health disorders and unfavorable social outcomes in young adulthood, mostly accounted for by adolescent psychosocial problems. In contrast to other indigenous peoples, no indigenous health disparities were found, indicating that the indigenous Sami adolescents were not worse off.

Maternal prenatal thyroid function and trajectories of offspring emotional and behavioural problems: findings from the ALSPAC cohort Abstract Maternal thyroid hormone may have impact on fetal brain development and consequently lead to offspring mental health problems. This study examined the role of maternal prenatal thyroid function on trajectories of offspring emotional and behavioural problems. Data were taken from the Avon Longitudinal Study of Parents and Children. A total of 4839 mother–child pairs were included. Thyroid-stimulating hormone (TSH) levels, free thyroxine (FT4), and thyroid peroxidase antibodies (TPO-Ab) were assessed during the first trimester of pregnancy. Childhood emotional and behavioural problems were assessed using the Strengths and difficulties questionnaire. A group-based modelling approach was used to identify the different trajectories of offspring emotional and behavioural problems reported by parents over four waves of measurement at age 3.5 (42 months), 6.75 (81 months), 9 and 11 years. Multinomial logistic regression was then used to test for an association between hormone levels and class membership. We identified four trajectories of offspring emotional and behavioural problems; normative-decreasing (49.7%), moderate-decreasing (35.7%), moderate-static (8.4%), and high-decreasing (6.2%) trajectory. There were no significant differences in the mean values of mother’s FT4, TSH, and the proportion of mothers with positive TPO-Ab between trajectories. Univariable and multivariable multinomial logistic models showed no association between maternal thyroid function (FT4, TSH, and TPO-Ab) and the trajectories of offspring emotional and behavioural problems. The results of our study show that maternal thyroid parameters in a community population are not associated with trajectories of offspring emotional and behavioural problems.

Specialty training in child and adolescent psychiatry in India Abstract India has a considerable skilled manpower deficit in the area of child and adolescent mental health, given its population and their needs. To address this deficit, in the recent past, various centres in India have begun specialty training in the field of child and adolescent psychiatry with the lead being taken by the National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore. This is a welcome step in the right direction. However, specialty training of this nature cannot exist in a vacuum. There is a need for a comprehensive and cohesive child and adolescent mental health policy which must include adopting certain standards in training in the various sub-specialties of child and adolescent mental health. From this national policy, provisions must be made for a spectrum of care from specialized tertiary care to high-quality community-based care. Dedicated, skilled mental health professionals who will impart training at the highest level as well help train a cadre of specialists (psychiatrists, pediatricians) and non-specialists with various degrees of exposure and training in the field of child and adolescent mental health are the need of the hour to have a stepped model of care. This will go a long way in ensuring effective and equitable distribution of the sparse human resources. Similar issues may operate in other low- and middle-income countries and thus the discussion may be relevant to such populations as well.

Child and adolescent psychiatry training in the USA: current pathways Abstract This manuscript reviews contemporary training in the field of child and adolescent psychiatry in the USA. There are multiple well-defined pathways to becoming a child and adolescent psychiatrist in the USA. The Accreditation Council of Graduate Medical Education oversees child and adolescent psychiatry training programs and ensures that training programs are meeting the appropriate common and program-specific requirements. The American Board of Psychiatry and Neurology ensures that the individual child and adolescent psychiatrist is competent. There is a substantial shortage of child and adolescent psychiatrists in the US, and efforts are being made to increase the number of and accessibility of trained child and adolescent psychiatrists. Child and adolescent psychiatry training in the United Sates is constantly evolving and future directions include increased engagement of medical students and general psychiatry residents, new abbreviated pathways for training, and international collaboration between programs.

Effectiveness of a brief psychotherapeutic intervention compared with treatment as usual for adolescent nonsuicidal self-injury: a single-centre, randomised controlled trial Abstract Although nonsuicidal self-injury (NSSI) is a clinically significant behavior, evidence-based, specific, time-, and cost-effective treatment approaches are lacking. The aim of this study was to compare the efficacies of a brief cognitive-behavioral psychotherapy manual, the Cutting Down Programme (CDP), and treatment as usual (TAU) in the treatment of adolescent NSSI. We conducted a single-centre randomised controlled trial (RCT). Eligible participants were aged 12–17 years engaging in repetitive NSSI (at least 5 times within the past 6 months). We randomly allocated 74 participants to CDP (n = 37) or TAU (n = 37; in a 1:1 ratio). Outcome measures were administered before treatment (T0), directly after CDP or 4 months after baseline evaluation in the TAU group (T1), and another 6 months later (T2; primary endpoint). Primary outcome was a 50% reduction in NSSI frequency within the past 6 months at 10-month follow-up (T2). Regarding the primary outcome, there were no significant differences between the CDP (n = 26; 70.3%) and TAU group [n = 27; 73.0%; χ2(1) = 0.07; p = 0.797]; NSSI frequency within the past 6 months was significantly reduced at T2 [χ2(1) = 12.45; p < 0.001] with no between-group difference [χ2(1) = 0.14; p = 0.704]. However, we found a significant group x point of measurement interaction [χ2(2) = 7.78; p = 0.021] regarding NSSI within the last month indicating at T1. CDP was equally effective and achieved faster recovery compared to a significantly more intensive TAU in treating adolescent NSSI. The CDP could provide a brief and pragmatic first treatment within a stepped-care model for NSSI in routine clinical care. Clinical Trial Registration The trial was prospectively registered in the German Registry of Clinical Trials (https://www.drks.de; DRKS00003605) and is now complete.

Quality of life and self-esteem in 7-year-old children with familial high risk of schizophrenia or bipolar disorder: the Danish High Risk and Resilience Study-VIA 7—a population-based cohort study Abstract It is well established that children with familial high risk of schizophrenia (FHR-SZ) or bipolar disorder (FHR-BP) have a higher risk of developing mental disorders, however, little is known of to what degree the genetic and environmental vulnerabilities affect the quality of life and self-esteem of these children. We aimed to compare the quality of life and self-esteem between children with FHR-SZ or FHR-BP and controls. We used Danish nationwide registers to retrieve a cohort of 522 7-year-old children with FHR-SZ or FHR-BP and controls. Quality of life was assessed with the ‘Health-related Quality of Life Screening Instrument’, KIDSCREEN-27, and the scale ‘Social Acceptance (Bullying)’ from the KIDSCREEN-52. Self-esteem was assessed with the self-report scale ‘I think I am’. Assessors were blind to familial risk status of the children. Children with FHR-SZ displayed lower levels of the general quality of life, as well as lower scores on the ‘Psychological Well-being’ scale and the ‘School Environment’ scale of the KIDSCREEN-27 compared with controls. Both children with FHR-SZ and FHR-BP reported more bullying victimization compared with controls. Children with FHR-SZ reported lower self-esteem on the total scale of ‘I think I am’, as well as on the ‘Skills and talents’, the ‘Psychological well-being’, and the ‘Relationships with others’ subscales compared with controls. The findings of lower quality of life and self-esteem in children with FHR-SZ together with more bullying victimization in both familial high-risk groups call for studies on low risk, early intervention strategies towards this group of vulnerable children.

Effects of perceived stress and resilience on suicidal behaviors in early adolescents Abstract Suicidal behaviors are significant public health issues. The aim of the current study is to examine the effects of perceived stress and resilience on suicidal ideation (SI), plan (SP), and attempt (SA) among early adolescents. A longitudinal study was conducted with data collected from 1035 junior high-school students at baseline and 1-year follow-up. Participants were assessed for suicidal behaviors, resilience, and perceived stress. Logistic regression was performed to analyze for the associations between independent variables and suicidal behaviors. 210 (20.3%) of the participants reported to have SI, 59 (5.7%) had SP, and 49 (4.7%) had SA at baseline. Perceived stress was a strong risk factor (p < 0.001) for SI (OR 1.16–1.18), SP (OR 1.20–1.21), and SA (OR 1.12–1.16) while accounting for different dimensions of resilience. Students with persistent high stress during the 1-year follow-up period had significantly increased risk of SI (OR 7.14–9.64), SP (OR 3.92–6.37), and SA (OR 3.76–3.84) than the persistent low-stress group (p < 0.01). Increased perceived stress scale (PSS) (OR 2.89–3.15) and decreased PSS (OR 2.47) also had a higher risk for SI than persistent low PSS group. Moreover, students with high perceived stress who reported to have higher hope and optimism were less likely to show SI (OR 0.90, p = 0.001) and SP (OR 0.87, p = 0.002) at baseline, and the problem-solving and cognitive maturity mature dimension of resilience showed a significant protective effect on SP longitudinally (OR 0.25, p = 0.003). Perceived stress substantially increased the risk for suicidal behaviors, and moderates the protective effect of resilience on suicide. Considering both risk and protective factors of suicidal behaviors is essential in designing future suicide prevention and intervention programs.

Time spent gaming and psychiatric symptoms in childhood: cross-sectional associations and longitudinal effects Abstract There is sparse knowledge on how the amount of gaming overlaps with—and is longitudinally related to—psychiatric symptoms of ADHD and emotional problems throughout early and middle childhood. In this prospective study of 791 Norwegian children, we investigated the amount of electronic gaming at ages 6, 8, and 10 while also measuring DSM symptoms of such disorders. Cross-lagged longitudinal analyses showed that more ADHD symptoms at age 8 predicted more gaming at age 10, whereas gaming did not predict more psychiatric symptoms, controlled for gender and socio-economic status. Cross-sectional overlaps between gaming and symptoms were marginal but nonetheless increased with each age level. Hence, time spent gaming did not forecast more psychiatric problems at these ages, but children with more ADHD symptoms were more likely to increase their amount of gaming throughout middle childhood. Results indicate that the sheer amount of gaming is not harmful to children’s mental health, but that poorly regulated children become more attracted to games throughout childhood. Findings are discussed in light of the coexistence of problematic gaming and psychiatric problems reported among adolescents and adults, as well as the potential beneficial psychological outcomes from gaming.