Variations in Conduct, Attention Deficit Hyperactivity Disorder, Mood and Anxiety Disorders Among Children and Youth from Immigrant, Refugee, and Non-Immigrant Backgrounds in British Columbia, Canada: A Population-Based Study.

There remains limited understanding of population-level patterns of mental disorder prevalence for first- and second-generation immigrant and refugee children and youth and how such patterns may vary across mental disorders. To examine the diagnostic prevalence of conduct, attention-deficit/hyperactivity disorder (ADHD), and mood/anxiety disorders in immigrant, refugee, and nonimmigrant children and youth in British Columbia, Canada. This retrospective, population-level cohort study examined linked health administrative records of children and youth in British Columbia (birth to age 19 years) spanning 2 decades (1996-2016). Physician billings, hospitalizations, and drug dispensations were linked to immigration records to estimate time-in-British Columbia-adjusted prevalence of mental disorder diagnosis among children and youth from immigrant or refugee backgrounds compared with those from nonimmigrant backgrounds. Analyses were conducted from August 2020 to November 2021. The diagnostic prevalence of conduct, ADHD, and mood/anxiety disorders were the main outcomes. Results were stratified by migration category (immigrant, refugee, nonimmigrant), generation status (first- and second-generation), age, and sex. A total of 470 464 children and youth in British Columbia were included in the study (227 217 [48.3%] female). Nonimmigrant children and youth represented 65.5% of the total study population (307 902 individuals). Among those who migrated, 142 011 (87.8%) were first- or second-generation immigrants, and 19 686 (12.2%) were first- or second-generation refugees. Diagnostic prevalence of mental disorders varied by migration category, generation status, age, and sex. Children and youth from immigrant and refugee backgrounds (both first- and second-generation), compared with nonimmigrant youth, generally had a lower prevalence of conduct disorder (eg, age 6-12 years: first-generation immigrant, 2.72% [95% CI, 2.56%-2.90%] vs nonimmigrant, 7.03% [95% CI, 6.93%-7.13%]), ADHD (eg, age 6-12 years: first-generation immigrant, 4.30% [95% CI, 4.10%-4.51%] vs nonimmigrant, 9.20% [95% CI, 9.08%-9.31%]), and mood/anxiety disorders (eg, age 13-19 years: first-generation immigrant, 11.07% [95% CI, 10.80%-11.36%] vs nonimmigrant, 24.54% [95% CI, 24.34%-24.76%]). Among immigrant children and youth, second-generation children and youth generally showed higher prevalence of conduct, ADHD, and mood/anxiety disorders than first-generation children and youth (eg, ADHD among second-generation immigrants aged 6-12 years, 5.94% [95% CI, 5.75%-6.14%]; among first-generation immigrants aged 6-12 years, 4.30% [95% CI, 4.10%-4.51%]). Second-generation refugee children had the highest diagnostic prevalence estimates for mood/anxiety in the 3-to-5-year age range relative to first- and second-generation immigrant and nonimmigrant children (eg, second-generation refugee, 2.58% [95% CI, 2.27%-2.94%] vs second-generation immigrant, 1.78% [95% CI, 1.67%-1.89%]). Mental disorder diagnoses also varied by age and sex within immigrant, refugee, and nonimmigrant groups. These findings show differences in diagnostic mental disorder prevalence among first- and second-generation immigrant and refugee children and youth relative to nonimmigrant children and youth. Further investigation is required into how cultural differences and barriers in accessing health services may be contributing to these differences.

Despite a marked increase in treatment for bipolar disorder among youths, little is known about their pattern of service use. This article describes mental health service use in the year before and after a new clinical diagnosis of bipolar disorder. Claims were reviewed between April 1, 2004, and March 31, 2005, for 1,274,726 privately insured youths (17 years and younger) who were eligible for services at least one year before and after a service claim; 2,907 youths had new diagnosis of bipolar disorder during this period. Diagnoses of other mental disorders and prescriptions filled for psychotropic drugs were assessed in the year before and after the initial diagnosis of bipolar disorder. The one-year rate of a new diagnosis of bipolar disorder was .23%. During the year before the new diagnosis of bipolar disorder, youths were commonly diagnosed as having depressive disorder (46.5%) or disruptive behavior disorder (36.7%) and had often filled a prescription for an antidepressant (48.5%), stimulant (33.0%), mood stabilizer (31.8%), or antipsychotic (29.1%). Most youths with a new diagnosis of bipolar disorder had only one (28.8%) or two to four (28.7%) insurance claims for bipolar disorder in the year starting with the index diagnosis. The proportion starting mood stabilizers after the index diagnosis was highest for youths with five or more insurance claims for bipolar disorder (42.1%), intermediate for those with two to four claims (24.2%), and lowest for those with one claim (13.8%). Most youths with a new diagnosis of bipolar disorder had recently received treatment for depressive or disruptive behavior disorders, and many had no claims listing a diagnosis of bipolar disorder after the initial diagnosis. The service pattern suggests that a diagnosis of bipolar disorder is often given tentatively to youths treated for mental disorders with overlapping symptom profiles and is subsequently reconsidered.

Child and adolescent mental disorders are common disorders with various symptoms, and attracting more attention due to the increasing prevalence. Mental disorders, especially the attention-deficit hyperactivity disorder (ADHD) and the autism spectrum disorder (ASD), have great influence on the development of children and adolescents. Nowadays, the biomarkers from neuroimaging such as magnetic resonance imaging (MRI) have a great importance on the diagnosis of mental disorders, and machine learning has been proved to be very powerful in the processing for neuroimages. Nowadays, many researchers are focusing on the studies of computer-aided diagnosis (CAD) based on machine learning and neuroimaging. In this review, the technical details of machine learning based CAD of child and adolescent mental disorders are briefly introduced, and the research progress in CAD of ADHD and ASD based on machine learning and structural MRI are summarized. These studies showed that many machine learning methods have been used in the diagnosis of child and adolescent mental disorders, but the relevant methods cannot be applied to clinical diagnosis. Further studies should be conducted to improve the diagnostic ability of machine learning methods from multiple perspectives, and provide an objective and reliable tool for the clinical diagnosis of child and adolescent mental disorders. Key words: ADHD; ASD; Structural magnetic resonance imaging; Machine learning

There has been an increased awareness in the diagnosis of mental disorders in people with intellectual disability (ID). The evidence base has demonstrated that people with ID can display the same mental disorders as the general population and that the prevalence of such disorders varies according to the methods used for their assessment and diagnosis. The diagnosis of mental disorders in people with ID is a highly complex process mostly because of the difficulty or inability of some people with ID to express their feelings and symptoms. Hence, many of the diagnostic criteria for mental disorders used in the general population needed to be modified and adapted for people with ID.The National Association for Persons with Developmental Disabilities and Mental Health Needs (NADD) has been among the leading organizations in the U.S. and internationally in providing educational and training programs, support for research projects, and publicizing important clinical and policy issues regarding people with mental disorders and ID.In 2007, the NADD published the Diagnostic Manual – Intellectual Disability (DM–ID; Fletcher, Loschen, Stavrakaki, & First, 2007) as a companion to the American Psychiatric Association's (APA; 2000) manual for psychiatric diagnosis (i.e., the DSM-IV-TR) to assist clinicians in making more accurate diagnoses for people with ID. Approximately ten years later, with the APA's (2013) publication of their updated manual (i.e., the DSM-5), the NADD published the Diagnostic Manual – Intellectual Disability (DM-ID 2): Textbook of Diagnosis of Mental Disorders in Persons with Intellectual Disability (DM-ID 2: Fletcher, Barnhill, & Cooper, 2017) for people with ID, having taken into consideration the changes introduced by the DSM-5.The editors of the DM-ID 2 stated that their book is designed to provide state-of-the-art knowledge of mental disorders for people with ID. The DM-ID 2 was compiled by "a multicentered, multicultural, and multifaceted" (p. 9) collaboration of over 100 clinicians, researchers, and practitioners with expertise in mental disorders and ID who worked in 26 working groups over a period of four years. A chairperson was assigned for each working group. A summary of the main points of the DM-ID 2 has also been published separately (Fletcher, Barnhill, McCarthy, & Strydom, 2016).The DM-ID 2 consists of 27 chapters covering the main psychiatric diagnostic categories that correspond closely to the DSM-5 classification system, with modifications to make them more applicable to people with ID. Chapter 1 describes the most commonly used assessment and diagnostic methods "to assist the reader in understanding the biopsychosocial developmental approach when conducting a psychiatric assessment" with people with ID. Chapter 2 describes "behavioral phenotypes that are associated with genetic disorders, which is intended to aid in the understanding of how a disorder's genotype affects its behavioral phenotype". Both chapters 1 and 2 are informative and comprehensive and present an added value to the publication of the DM-ID 2.The authors of the DM-ID-2 relied upon an expert consensus model in much of their work to overcome the poverty of existing relevant research in the field. Each chapter is based on a systematic critical review of the available literature and follows guidelines for clarity and uniformity.The principal elements of the guidelines for the structure of each chapter include both organizational and conceptual elements (e.g., chapter summary, review of diagnostic criteria, general description of the disorder, summary of DSM-5 criteria, diagnosis in people with ID, comorbidity, application of diagnostic criteria to people with ID, etc.)Variations of the suggested guidelines are evident in several chapters of the DM-ID 2, probably due to the different prevalence of mental disorders in people with ID. Therefore, all of the guidelines were not applicable to all mental disorders. All chapters consist of three main parts: (1) summary of the DSM-5 criteria, (2) review of the literature, and (3) suggestions for applying criteria for people with mild/moderate ID and severe/profound ID.There are important changes in the DSM-5 reflecting developments in research of genetics and neuroimaging, and there is a revised organizational structure, taking into consideration that mental disorders do not always fit entirely within the boundaries of a single disorder, but that some symptoms involve multiple diagnostic categories. The changes in DSM-5 relevant to people with ID include a lifespan approach and the abandonment of the multi-axial method. Other important changes in the DSM-5, that have been adopted for the DM-ID-2, include the amalgamation of autistic disorder, Asperger's syndrome, and pervasive developmental disorder, into one diagnostic category - Autism Spectrum Disorder (ASD). Reactive attachment disorder, disinhibited social engagement disorder, posttraumatic stress disorder (PTSD), acute stress disorder, and adjustment disorder have been combined in the DSM-5 under the diagnostic category trauma- and stressor-related disorders that has also been adopted by the DM-ID 2. Disorders previously referred to as "dementias" are now designated as major or mild neurocognitive disorders by both the DSM-5 and DM-ID 2.A critical change in DSM-5 is that intellectual disability (ID) is included as "a discrete syndrome" with the term Intellectual Development Disorder (IDD) within the diagnostic category of Neurodevelopmental Disorders. The DM-ID 2 adopts the term IDD (in the disability field this abbreviation stands for intellectual and developmental disabilities) but makes a central point that IDD can coexist with other mental disorders. This emphasis of the coexistence of IDD with other mental disorders is an important distinction of the DM-ID 2 from DSM-5, where IDD is frequently an exclusion criterion from the diagnosis of other mental disorders.The inclusion of IDD as a separate category, under the neurodevelopmental disorders of the DSM-5, to affirm that it is a health condition, remains controversial (Bertelli, Salvador-Carulla, & Harris, 2016). The American Association for Intellectual and Developmental Disorders (AAIDD) defines ID as a "disability" and not as a "health condition." The AAIDD definition states that ID is "characterized by significant limitations, both in intellectual functioning and adaptive behavior as expressed in conceptual, social, and practical adaptive skills," and that the disability originates before age 18. (Schalock et al., 2010, p. 1).Another important change in the DSM-5 for the diagnosis of IDD is that it shifts the emphasis from IQ scores to the necessity that the onset should occur "during the developmental period and to include both intellectual and adaptive functioning deficits in conceptual, social and practical domains" (American Psychiatric Association, 2013, p. 33).The DM-ID 2 retains IDD as a separate diagnosis, and in Chapter 4, the complex conceptual issues involved with the diagnostic criteria of Neurodevelopmental Disorders. These issues include a number of overlapping symptoms from other, co-existing, neurodevelopmental syndromes or/and other mental disorders. DM-ID 2 allows some flexibility by stating that clinicians will have to judge how best to modify inclusion, specifiers, and exclusion criteria to apply these diagnostic criteria to people with IDD.Additional changes in the diagnostic criteria covered in the DSM-5 and adopted by DM-ID-2 include the exclusion of Attention Deficit Hyperactivity Disorder (ADHD) from Autism Spectrum Disorder (ASD); the realignment of impulse control and disruptive behavior disorders to the category of Disruptive Mood Dysregulation Disorder (DMD) for people with affect dysregulation and ADHD (previously diagnosed as bipolar disorder) and the creation of trauma- and stressor-related disorders.The DSM-5 diagnostic criteria for major neurocognitive disorder and mild neurocognitive disorder to aid in the diagnosis of dementia have also been modified for people with ID in the DM-ID 2, but some caution is given for the validity of mild neurocognitive disorder in people with ID.The DM-ID 2 aims to assist in the diagnosis of mental disorders for people with ID based on adaptation and modification of the diagnostic criteria of the DSM-5. It is written in a well-organized and methodological style in a field characterized by very difficult and complex issues and concepts. Individual chapters include wide-ranging discussions based on a systematic review of the literature and the extant research evidence on mental disorders among people with ID to support the suggested adaptive diagnostic criteria for people with ID. The term IDD as used in the DSM-5, has been adopted by the DM-ID 2 throughout the publication. The process of developing the DM-ID 2 does not include field trials and does not mention the association with the APA, as was the case with the development of the DM-ID.The acceptance of a psychiatric diagnosis and classification for those with mental disorders, including for people with IDD, serves several purposes, including "medical record keeping, data collection, retrieval and compilation of statistical information, communicating with third parties, such as insurers and governmental agencies, and is the basis for eligibility and reimbursement for psychiatric services" (Sturmey, 1999, p. 4). Standardized diagnosis can also serve as the basis for communication between different professional groups and non-professionals as well as in research contexts. Diagnosis also serves the purpose of providing a summary for multiple presenting symptoms, etiology, and prognosis, and can inform therapeutic interventions. The provision of mental health services for those with ID has undergone profound transformations since the implementation of community care programs (Bouras, Ikkos, & Craig, 2017). Accurate diagnosis is of utmost importance for planning, provision, and delivery of services, monitoring, and evaluation (Bouras, 2017).The publication of the DM-ID 2 is an important resource toward advancing our knowledge of mental disorders in people with ID. Discussion on the relationship of problem behavior known as "challenging behavior" not included in the DSM-5, would have been helpful in the DM-ID 2. The value of the DM-ID 2 remains to be confirmed in clinical practice and research studies that apply the suggested diagnostic criteria. In the future, the publication of an "operational guide" for the DM-ID 2 will serve as a user-friendly tool facilitating diagnosis and treatment for people with ID and mental disorders.

Treatment Controversies in Adult ADHD.

As in many other countries, child psychiatry in China has gradually developed from general psychiatry. In the early days of the profession, child psychiatry was considered as psychiatry for "little adults". Child psychiatry in China has gradually developed and expanded since the implementation of Professor Guotai Tao's child psychiatric services in Nanjing in the 1930s. In particular, the profession has developed rapidly since its affiliation with the International Association for Child and Adolescent Psychiatry and Allied Professions (IACAPAP) in 1998. Child psychiatry has been one of the fastest developing advanced international disciplines over the past 10 years. Pediatric psychiatry mainly focuses on the diagnosis, treatment, and prevention of mental disorders in children, adolescents, and their families. In 1899, the term ''child psychiatry'' (in French) was used as a subtitle in Manheimer 's monograph Les Troubles Mentaux de l'Enfance. The Swiss psychiatrist Moritz Tramer (1882–1963) was probably the first to define child psychiatry, in 1933, in terms of diagnosis, treatment, and prognosis within the medical discipline. In 1934, he founded the Journal of Child Psychiatry (1934–1952), which later became Acta Paedopsychiatrica (1953–1994). The first academic pediatric psychiatry department was established in 1930 at the Johns Hopkins Hospital in Baltimore by Leo Kanner (1894–1981). Since then, the clinical practice, research, and teaching of child psychiatry have gradually developed around the world.1 There have been three stages to the development of children's psychiatry in China. The first is the exploration and development period, which occurred mainly during the 1930s to the 1950s. This period was characterized by the introduction of Western models by experts and the exploratory development of child psychiatric services. Professor Yulin Cheng, Guotai Tao, and Yonghe Ling other professors are the pioneers. The second stage is the initial development period, which occurred from the 1950s to the late 1970s. Child psychiatric clinics and/or wards were established in Nanjing, Shanghai, Beijing, Guangzhou, Sichuan, Hunan and other places and child psychiatric teams were formed. Although there was a pause in the early 1970s, child psychiatric service models continued to be developed. The third period, from the late 1970s to the present, was characterized by rapid progress. The development of child psychiatry has been promoted mainly since the economic reform and opening-up in China, with the transformation of the medical model from a pure biomedical model to a biopsychosocial medical model. Psychiatrists, pediatricians, and psychologists have begun to focus on child mental health and have conducted some interdisciplinary research and practice. Following the establishment of the Nanjing Child Mental Health Research Center, many provinces and cities have established child mental health centers. Psychiatric hospitals or mental health institutes affiliated to major medical universities in Nanjing, Beijing, Hunan, Sichuan, Shanghai and other places have successively established Master's and doctoral training sites for child psychiatry and applied psychology. Relevant disciplines and research institutions such as child health care, behavioral pediatrics, special education schools, and autism training centers have successively joined the ranks of child mental health services. In particular, Professor Guotai Tao founded the Nanjing Child Mental Health Research Center in 1984. In August 1987, the center was appointed by the World Health Organization (WHO) as a scientific research and training cooperation center, and was appointed by the Chinese Ministry of Health (now the National Health Commission) as a child mental health guidance center. Many child psychiatrists and mental health workers have been trained, and academic exchanges have been promoted in China and abroad.2 With the rapid development of disciplines, Chinese child psychiatry has reached an internationally renowned and advanced level. Multidisciplinary participation in child psychiatry is good. For example, the psychology of child development, developmental behavior pediatrics, child neurology, child health care, education, and sociology have begun to attach importance to clinical practice and research on mental health. A growing number of universities and colleges offer degrees for social workers in clinical psychology and childcare. In addition, with more primary care centers in the community, primary care physicians can implement screening and follow-up for children with mental health disorders. However, the primary care providers still need more education and training. To address this problem, the National Health Commission has been advocating multilevel collaboration. Pediatricians and primary care physicians across the country are now being trained in early diagnosis and basic treatment for common mental disorders in children. They are taught to screen patients for signs of developmental disorders by checking, for example, whether a 3-month-old baby's eyes can follow moving objects or whether an 18-month-old child can make eye contact. The problem of the shortage of child psychiatrists has been partially solved.3 Children and adolescent mental health problems are related to a country's development and to global changes. About 20% of children and adolescents worldwide experience mental health disorders. The major challenges for children and adolescents with mental disorders are stigma, isolation, discrimination, and the lack of access to health care and education facilities. Obviously, children and adolescents are vulnerable groups; they have no political power and their mental health problems are complicated. The mental health of children and adolescents requires multisectoral cooperation and the attention of the whole society. In particular, the protection afforded by government actions and policies is crucial. Policies must be designed to ensure that children and adolescents can access even the most basic mental healthcare. However, there are few countries worldwide that provide specific policies for the mental health needs of children and adolescents.4 China has a large population of children. Rapid economic development and social reforms in recent years have had a substantial impact on the mental health of children and adolescents. Increasing social pressures and workers migration, and changes in family planning, have changed traditional family structures and social support systems.3 As part of development and progress within China, the Chinese government has initiated a series of policies and regulations to promote mental health. Some of these policies are aimed at promoting mental health in children and adolescents; for example, "The Law of the People's Republic of China on the Protection of Minors", "The Law of the People's Republic of China on the Protection of the Rights and Interests of Women and Children", "The Law of the People's Republic of China on the Protection of Disabled Persons", "Mental Health Law of the People's Republic of China", and programmatic documents such as the "Healthy China 2030 Planning Outline", "National Program of Outline for Action for Child Development in China (2011–2020)", "Guidelines for the Prevention and Treatment of Attention-Deficit/Hyperactivity Disorder'', ''Guidelines for the Diagnosis, Treatment and Rehabilitation of Children with Autism'', and ''Technical Specifications for Children's Mental Health Care''.5-10 These reflect how the support of national policies has driven the development of child psychiatry. Major national basic and clinical research projects have invested in child psychiatry research, such as the National Natural Science Foundation of China, which has supported national research and development plans in key health areas. Research by a team led by Professor Zhang Dai has demonstrated that FMR1, DISC1, EN2, and SHANK3 genes are related to autism. Studies by a team led by Professor Kun Xia and Jingping Zhao have shown that XRXN1, GRIN2B, RELN, and DAB1 genes may be antecedents of autism. Such research has been published in several high quality academic journals in recent years.11, 12 Some research of the National "12th and 13th Five-Year Plan" scientific and technological support projects led by Professor Yi Zheng, on "The Epidemiological Study of Child Mental Disorders in China" and "Comprehensive Intervention Strategies for Chronic Non-communicable Diseases with Attention Deficit-Hyperactivity Disorder". These show that Chinese child psychiatry has become a discipline supported by the national key research project. Traditional research group in child psychiatry include the team led by Professor Guotai Tao, Jie Lin and Xiaoyan Ke about autism, mental retardation and childhood schizophrenia; team led by Professor Yufeng Wang on attention deficit hyperactivity disorder; team led by Professor Xiaoling Yang and Jing Liu about autism spectrum disorders; team led by Professor Xuerong Li, Linyan Su and Xuerong Luo on epidemiological surveys and tool scales for child mental disorders; team led by Professor Rene Xin, Yasong Du and Wenhong Chen on epidemiological investigation of children's behavior problems and related research on child psychology and family therapy; team led by Professor Shiji Zhang, Yi Zheng, Yonghua Cui and Fan He on tics and related disorders; and team led by Professor Youhe Shan, Lanting Guo and Yi Huang on behavioral scales and tic disorders. The above studies have published valuable articles in academic journals and won many awards. Child psychiatrists need to be dedicated. The treatment of patients with mental illness is difficult and often daunting, and children's mental health disorders are particularly difficult to treat. Treatment of children with autism or mania requires tackling difficult problems and good practice in basic clinical skills. In China, child psychiatrists experience low returns and low income. The number of child psychiatric inpatients and outpatients is constantly increasing, and their treatment often relies on the dedication of child psychiatrists. To treat such patients, there are now more than 10 centers, nearly 1000 beds, and dozens of special education centers, such as autism rehabilitation centers. To care for left-behind children, children infected with AIDS, children affected by natural disasters such as earthquakes, and children with substance abuse and internet addiction, many child mental health workers and full-time child psychiatrists have formed competent national and local emergency response teams. Child psychiatrists are now available to help children to cope with a variety of social disasters, such as the Wenchuan earthquake or the "3.01" terrorist incident in Kunming. The development of modern child psychiatry in China is interlinked with foreign exchange. Since Professor Guotai Tao's studies in the United States in 1940, Chinese child psychiatry has been continuously introducing and incorporating foreign advanced diagnosis and treatment and research concepts. At present, Professor Tao has discussed diagnostic issues with international authoritative experts in foreign journals and participated in the preparation of the 11th revision of the International Classification of Diseases (ICD-11). Professor Tao was the first international participant in efforts to promote the integration of child and adult psychiatry and the popularization of the notion of the lifelong effects of mental illness, such as the Cross-Strait Summit Forum, and domestic and foreign academic institutions and academic exchanges, such as the Asian Society for Child and Adolescent Psychiatry and Allied Professions (ASCAPAP) and the International Association for Child and Adolescent Psychiatry and Allied Professions (IACAPAP). Chinese child psychiatrists have attended and contributed to both of the latter societies. Since the 1930s, older generations of individuals, such as Yulin Cheng, Guotai Tao, and Xueshi Chen, have made substantial contributions to the development of the discipline of child psychiatry. In 1989, Professor Jie Lin set up and led the Child Psychiatric Group of the Chinese Medical Association Psychiatry Branch. Professor Guotai Tao served as a consultant of the Group. Almost at the same time, the Chinese Mental Health Association established the Child and Adolescent Professional Committee, with Xuerong Li as director. Xueshi Chen serves as a consultant. Since then, two academic organizations have held annual meetings or training courses. In 1998, Professor Shiji Zhang, Yi Zheng, and Linyan Su participated in the IACAPAP congress and joined this organization, which is the most highly regarded academic organization in international child psychiatry. Chinese child psychiatry is fully in line with international developments in child psychiatry. In 2003, Professor Yi Zheng and Linyan Su attended the WHO Expert Headquarters "Concern for Children and Adolescents with Mental Disorders" meeting as Chinese representatives. In the same year, Professor Yi Zheng participated in the ASCAPAP congress and was elected as an executive member. In 2004, Professor Yi Zheng was appointed onto the IACAPAP executive committee. Professor Yi Zheng created the Cross-Strait Children's Psychiatry Summit Forum, which is held once every 2 years alternately in the mainland of China and Taiwan province, China. The Forum is now in its ninth session and has promoted the rapid development of the discipline. In 2010, the 19th IACAPAP International congress was successfully held in Beijing. This was the first time that this congress had been held in a developing country. Professor Yi Zheng served as Executive Chairman, and Professor Jing Liu served as Chairman of the organizing committee. Xiulian Gu, Zhu Chen, Wenkang Zhang and the country's main health care officials attended the opening ceremony and delivered speeches. More than 1300 foreign scholars and 500 domestic scholars attended the congress. Yi Zheng was elected onto the ASCAPAP executive committee and was elected Chairman, and Jing Liu was elected Vice-Chairman of ASCAPAP. At the 21st IACAPAP Conference held in South Africa in 2014, Professor Yi Zheng was elected Vice-President of IACAPAP and won the International Child Psychiatry Outstanding Contribution Award, indicating that Chinese child psychiatry has played a major role on the international stage.2 China has a population of more than 1.3 billion individuals, of which 238 million are children younger than 15 years of age.13 Though a nationwide prevalence study is lacking, some regional epidemiological studies show that the prevalence of mental health disorders in children is close to the worldwide prevalence of 20%,14-18 indicating that about 50 million children in China require treatment for mental health disorders. However, there is a scarcity of child and adolescent psychiatrists (CAPs) in China, and there are less than 500 full-time CAPs nationwide. Currently, only a national psychiatrist certification system exists, and there is no child psychiatrist certification system. Instead, students must obtain a postgraduate training certificate or a nationally approved Ph.D. or Master 's degree training certificate to become a child psychiatrist. A recent survey showed that training units for CAPs are mainly concentrated in large and medium-sized cities. Moreover, only a small number of medical personnel in China can diagnose and treat children and adolescents with mental health disorders, and these have insufficient training. Currently available training for child psychiatrists contains insufficient scientific, practical, and problem-solving content. Furthermore, current educational training poorly equips child psychiatrists for subsequent teaching and professional scientific research abilities. Therefore, a greater training focus is needed on more comprehensive qualities and abilities, such as dedication. Although CAPs undertake a long process of training, this mainly comprises postgraduate or doctoral Master's degree training; the national specialized certification system for CAPs has only been piloted in major cities. The CAP training system requires further improvements, and more CAPs are needed.19 China still has a shortage of child psychiatrists. To address this, a new type of multilevel collaboration is currently being implemented. Pediatricians and primary care physicians are also receiving training in child psychiatry. In addition, psychotherapists from other countries have been recruited to help train psychiatrists. China is currently exploring all possible ways to strengthen multilevel collaboration to promote the children's physical and mental health.3 The artificial boundary between children and adults with mental health disorders will be removed: more attention and value will be placed upon the treatment of adult attention deficit–hyperactivity disorder (ADHD), adult autism spectrum disorder (ASD), adult tic disorder, and other issues. Gene diagnosis and classification of child neurological and mental development disorders will become a reality: the detection of genes for susceptibility to ASD, ADHD, tic disorders, child schizophrenia, and child bipolar disorder will become possible. The concept of the supremacy of child mental health will gradually be accepted. More and more studies have confirmed that among the main factors for healthy and successful child developmental, child mental health is of paramount importance. As physical health and nutritional issues have been generally resolved in most parts of China, the impact of mental health on the future success of children will be a core health issue. Therefore, mental health should start with children. The multidisciplinary and multisector nature of child mental health will be further improved: medicine, economics, sociology, and other disciplines will pay close attention to child mental health. In particular, the only-child problem, the problems experienced by elderly parents in raising a second child, the problem of left-behind children, AIDS-infected children, Internet addiction problems, youth suicide, and crime prevention problems will become the focus of social attention. There will be new breakthroughs in early diagnosis and interventions for child mental health disorders: the ICD-11 (containing input from Chinese experts) will soon be released. Early warning indicators for child psychological problems and quantitative assessment techniques for child mental health care will be promoted from the national level to the whole country. Like child vaccination, assessments and interventions for child psychological conditions will benefit every child, which will set a global precedent. Treatment methods for child mental health disorders will be qualitatively improved. In addition to the further optimization of the structure and dosage of antipsychotics, research on functional food will make significant progress, and the use of alternative medicine and traditional Chinese medicine for child mental health disorders will be further clarified. In conclusion, the development of child psychiatry in China is still far behind developed countries, but a golden age of rapid development is approaching. Research on prevention and control of major chronic non-communicable diseases in the Ministry of Science and Technology (No: 2016YFC1306100) None.

ObjectiveUnderstanding differences in outpatient care before and after mental health hospitalization for adolescents from diverse backgrounds is critical to ensuring effective and responsive care. The objective of the current study was to examine outpatient mental health care in the two years before and 30 days after a mental health hospitalization for adolescents from immigrant, refugee and non-immigrant backgrounds.MethodThis retrospective, population-based cohort study, conducted in British Columbia (BC), Canada, analyzed linked health service utilization data (practitioner billings, hospitalizations) and migration records to track outpatient care before and after mental health hospitalization. The study included adolescents (ages 10–18) with an unscheduled/urgent mental health hospitalization between January 1, 2008 and December 31, 2016 (n = 5,314) from a cohort of adolescents in 10 of the largest school districts in BC (between 1996 and 2016). The main analyses examined outpatient mental health visits (e.g., general practitioner/psychiatrist) (i) in the two years before hospitalization and (ii) in the 30 days after discharge. Sub-analyses focused on outpatient visits with psychiatrists.ResultsOverall, 30.4% had no outpatient mental health visit in the two years before hospitalization and 45.1% had none in the 30 days following discharge. First-generation immigrants and refugees and second-generation immigrant adolescents were significantly less likely than non-immigrants to have had an outpatient mental health visit in the two years before mental health hospitalization (aOR1st_gen_immg = 0.79, 95% CI, 0.63 to 0.98; aOR2nd_gen_immg = 0.75, 95% CI, 0.61 to 0.93; aOR1st_gen_ref = 0.40, 95% CI, 0.26 to 0.64). Second-generation immigrant adolescents were significantly more likely than non-immigrants to have had any outpatient mental health visit in the 30 days following hospitalization (aOR2nd_gen_immg = 1.34, 95% CI, 1.09 to 1.65).ConclusionsResults suggest outpatient care before and after mental health hospitalizations is limited for many adolescents in BC and differed by migration background. Implications for meeting standards of care are discussed.Plain Language Summary TitleMental health-related care from a doctor/psychiatrist before and after mental health hospitalization for adolescents from immigrant, refugee, and non-immigrant backgrounds in British Columbia

This paper systematically reviewed the literature from 2002 to 2016 describing the risks of autism spectrum disorder, intellectual disability and attention deficit hyperactivity disorder in children of immigrant and refugee backgrounds. Compared to children of non-immigrant mothers, 10 studies found increased risk of autism and intellectual disability and four studies found increased risk of autism without identifying concomitant intellectual disability. Very high risks were observed if the mother’s country of birth was a developing country or region. One study found higher risk of attention deficit hyperactivity disorder in a sample of children who were refugees. Children of immigrant and refugee backgrounds from developing countries had greater risks of a neurodevelopmental disorder compared to their peers whose mother was locally born.

This article focuses on the social identities of service providers with immigrant backgrounds in Norwegian reception centres for asylum seekers. Migrant service providers who work with migrant clients are often perceived as ‘insiders’ who understand explicit cultural expectations in intra-group interactions with clients. We explore how the insider position of service providers with immigrant backgrounds in accommodation for asylum seekers is experienced, negotiated and constructed in interaction with asylum seekers and Norwegian colleagues. On the one hand, our findings indicate that service providers with immigrant and refugee background, who are very often themselves ex-residents of reception centres, are seen as an asset for the working environment. On the other hand, the professionalism and loyalty of these workers is often questioned, both by the staff and residents. Migrant workers also risk being accused of ethnic favouritism while they try to provide more emphatic and more culturally and linguistically-adjusted service provision. The article is based on interviews with asylum seekers and service providers of immigrant and non-immigrant background.

Diagnosis of Attention Deficit Hyperactivity Disorder by Using MR Imaging and Radiomics: A Potential Tool for Clinicians.

Objective Mental health disorders are prevalent among individuals with intellectual disabilities (ID). However, there is a lack of research on the impact of concomitant autism spectrum disorders (ASD) or attention deficit hyperactivity disorder (ADHD) on the mental health within this population. We aimed to investigate the prevalence of mental health disorders and registered healthcare visits due to self-harm among individuals with ID. Method We used administrative data for all healthcare with at least one recorded diagnosis of mental health disorder or self-harm during 2007–2017 among people with a diagnosis of Down syndrome (DS; n = 1298) and with ID without DS (IDnonDS; n = 10,671) using the rest of the population in Stockholm Region (n = 2,048,488) for comparison. Results The highest odds ratios for a mental health disorder were present in females with IDnonDS (9.01) followed by males with IDnonDS (8.50), compared to the general population. The ORs for self-harm among individuals with IDnonDS were high (8.00 for females and 6.60 for males). There were no registered cases of self-harm among individuals with DS. The prevalence of an anxiety or affective disorder was higher among individuals with ID including DS with concomitant ASD or ADHD. Neighbourhood socio-economic status was associated with a lower occurrence of mental health disorders and self-harm in wealthier areas for all outcomes and for all groups. Conclusions Self-harm and psychiatric comorbidities were common among individuals with ID without DS with an attenuated difference among those with concomitant ASD or ADHD, which calls for attention.

National Variation of ADHD Diagnostic Prevalence and Medication Use: Health Care Providers and Education Policies

FIGURE 1. Changes in cortical thickness provide one measure of brain maturation. A large longitudinal study found that for most areas of cortex, children with attention deficit hyperactivity disorder (ADHD) reach peak cortical thickness several years later than typically developing children, supporting presence of developmental delay. The rate of cortical thinning also differed between the group who continued to meet diagnostic criteria into adulthood (persistent ADHD) and those who did not (remitted ADHD). Areas of cortex in which the rate of thinning correlated with adult symptom level (green, more symptoms associated with more thinning) are approximated on medial and lateral simplified representations of cortex. An earlier study also identified multiple areas in which cortex was thinner in adults with persistent ADHD compared with controls (orange). In addition, this study noted some areas of thicker cortex in remitted ADHD when compared with persistent ADHD (blue).

Suicidality and Self-harm in Adolescents With Attention-Deficit/Hyperactivity Disorder and Subsyndromal ADHD

Background: There is a lack of clinical studies that focus on different psychiatric disorders after trauma and the relationship with migration status.Purpose: To examine differences in psychiatric morbidity in traumatized patients referred to psychiatric treatment in Southern Oslo.Materials and methods: Hundred and ten patients with trauma background attending an outpatient clinic in Southern Oslo were studied. Forty-four of the participants (40%) were ethnic Norwegians, 25 (22.7%) had refugee background and 41 (37.3%) were first- or second-generation immigrants without refugee background. Thorough diagnostic assessment was done by experienced psychiatrists through several structured clinical interviews and self-report questionnaires.Results: Ninety-eight patients (89%) were diagnosed with at least one Diagnostic and Statistical Manual of Mental Disorders, fourth edition, text revision (DSM-IV-TR) disorder. There was a clear difference in the presentation of certain psychiatric disorders between the groups. Ethnic Norwegian patients were more likely to have anxiety disorders: agoraphobia, social phobia and panic disorder than non-refugee immigrant patients. They also had higher rates of alcohol abuse/dependence. Somatoform pain disorder was more common in both the refugee and other-immigrant groups than among the ethnic Norwegian patients. The refugee patients had significantly more major depressive disorder, post-traumatic stress disorder (PTSD) and both co-occurring.Conclusion: Trauma is frequently associated with depression, anxiety disorders, somatoform pain disorder and PTSD in a clinical population. The clinical presentation and comorbidity of these disorders seem to vary significantly between traumatized patients with Norwegian, refugee and non-refugee immigrant backgrounds. After a major trauma, refugees may be at greater risk for both PTSD and depression than other immigrants and the native population.