To compare the short-term efficacy and tolerability of second-generation antipsychotics (SGAs) versus placebo for schizophrenia-spectrum disorders in children and adolescents using pairwise meta-analysis of randomized trials, and to summarize prospective long-term evidence. We pooled acute double-blind randomized controlled trials (RCTs) (≤12 weeks; participants ≤19 years; Diagnostic and Statistical Manual of Mental Disorders [DSM]/International Classification of Diseases [ICD] schizophrenia-spectrum) with random-effects models. Efficacy was change in Positive and Negative Syndrome Scale (PANSS) or Brief Psychiatric Rating Scale [BPRS] total score, expressed as standardized mean difference (SMD) versus placebo. Short-term tolerability was defined as adverse event-related outcomes and expressed as risk ratios (RRs) for potentially drug-related treatment-emergent adverse events (TEAEs) versus placebo. Trials without a placebo arm and long-term prospective studies were synthesized narratively. Seventeen acute RCTs were identified; ten were placebo-controlled and entered pooling (agents: olanzapine [OLZ], risperidone [RSP], asenapine [ASP], aripiprazole [APZ], brexpiprazole [BRX], blonanserin [BNS], quetiapine [QTP], lurasidone [LUR], paliperidone [PAL], ziprasidone [ZPD]); seven head-to-head or open-label trials were not pooled. Placebo-referenced efficacy favored several agents: OLZ -1.12 [-1.44 to -0.81], RSP -0.93 [-1.22 to -0.63], BNS -0.50 [-0.89 to -0.11], ASP -0.41 [-0.65 to -0.17], APZ -0.37 [-0.61 to -0.13], BRX -0.34 [-0.61 to -0.07], QTP -0.33 [-0.61 to -0.06], LUR -0.31 [-0.54 to -0.08], PAL -0.25 [-0.57 to -0.07], and ZPD -0.06 [-0.31 to -0.19]. For tolerability, most drugs showed numerically higher TEAE risk versus placebo with wide confidence intervals (typical RR ≈ 2-3); APZ showed a statistically higher risk (RR 2.34 [1.42-3.86]), whereas the point estimate for LUR was below 1 (0.47 [0.18-1.17]). One randomized maintenance study and 12 open-label extensions were reviewed narratively and were not meta-analyzed. Several SGAs produce short-term symptom reductions versus placebo in children and adolescents with schizophrenia-spectrum disorders, with heterogeneity in TEAE risk across agents. Evidence for long-term maintenance and continuation remains limited, underscoring the need for adequately powered randomized continuation trials to guide sustained treatment in this population.

Disruptive mood dysregulation disorder (DMDD), along with other internalizing disorders, is associated with greater impairment in youth with attention-deficit/hyperactivity disorder (ADHD). However, it remains unclear whether DMDD is associated with differences in treatment course and outcomes among youth with ADHD and comorbid internalizing disorders. Using real-world data, this study compared treatment patterns and clinical outcomes among youth with ADHD and internalizing disorders with and without comorbid DMDD. A retrospective cohort study analyzed electronic health records from the TriNetX U.S. Collaborative Network, including 340,225 youth aged 6-18 years with ADHD and at least one internalizing disorder (major depressive disorders or anxiety disorder), of whom 25,580 (7.5%) had comorbid DMDD. Outcomes included treatment patterns and clinical outcomes. Propensity score matching and Cox proportional hazards models adjusted for confounding were used to estimate relative risks (RR), adjusted hazard ratios (aHR), and 95% confidence intervals (CI) over 1 year. Youth with ADHD, internalizing disorders, and DMDD exhibited greater psychiatric comorbidity and higher healthcare utilization than those without DMDD. They received more ADHD medications, with a marked shift toward nonstimulants (RR 1.73, 95% CI 1.69-1.77), and other psychotropic medications, including antidepressants, antipsychotics, and mood stabilizers (RR range 1.36-3.02). New central nervous system (CNS) stimulant prescriptions did not differ between youth with and without DMDD. Compared with nonstimulants, CNS stimulants were associated with lower risks of all adverse outcomes-including suicidal ideation/attempts, inpatient hospitalization, emergency visits, and subsequent antipsychotic or mood stabilizer initiation-in youth both with and without DMDD (aHR range 0.33-0.73). Comorbid DMDD adds clinical complexity among youth with ADHD and internalizing disorders, influencing treatment patterns toward nonstimulants and other psychotropics. Despite this shift, CNS stimulants were associated with the most favorable outcomes across cohorts.

The demand for children and adolescent mental health crisis services has risen dramatically in recent years, yet evidence on real-world implementation models remains limited. Rapids is a community-based crisis intervention service developed within Lambeth Children and Adolescent Mental Health Services (CAMHS) at South London and Maudsley NHS Foundation Trust. The primary aim of this study was to examine how clinical presentations, risk profiles, and service outcomes changed over time among children and adolescents accessing Rapids over a 6-year period. We also aimed to describe the characteristics of individuals accessing Rapids. This service evaluation used routinely collected clinical data from all children and adolescents up to 18 years who accessed Rapids between January 1, 2019, and December 31, 2024. Sociodemographic, diagnostic, pharmacological, and risk-related variables were evaluated. Diagnoses were coded using International Classification of Diseases, 10th Revision (ICD-10) criteria. Descriptive and inferential analyses were conducted to assess changes in clinical presentations and service outcomes. In total, 325 children and adolescents were included (mean age = 15.5 years, 61.8% females, 64.6% non-White). Anxiety disorders (29.5%), depressive disorders (42.2%), and autism spectrum disorder (33.5%) were the most common diagnoses. Inpatient admissions increased (1.5%-5.8%, p = 0.043), and high risk to self also rose notably (19.5%-31.7%, p < 0.001). Referrals accepted to adult services decreased significantly over time (38.5%-16.8%, p < 0.001). Diagnostically, eating disorders increased (3.7%-10.0%, p = 0.032), whereas emotionally unstable personality disorder traits decreased (14.1%-7.4%, p = 0.049). Rapids has evolved into an established model of crisis care within CAMHS, addressing acute needs through timely community-based interventions. We observed meaningful temporal changes in the clinical acuity, diagnostic profile, and service use outcomes of young people presenting to our community-based CAMHS crisis service. Our findings support the feasibility and scalability of intensive community-based crisis care and highlight the need for sustained investment in culturally responsive, multidisciplinary service models.

Emotion dysregulation (ED) is the inability to modulate the intensity and quality of emotional responses. It is strongly associated with psychopathology among youth, carries significant morbidity and predicts long-term impairments. Data on ED are limited among nonclinical populations. This study aims to estimate the prevalence of ED and to identify its demographic and clinical correlates in children. Data from the Adolescent Brain Cognitive Development study, N = 11,878 children (ages 9-10), were analyzed. ED was measured using cutoff scores of ≥180 and <210 on the sum of the Attention, Aggression, and Anxious/Depressed subscales of the Child Behavior Checklist. Demographic and socioeconomic variables, sleep-related variables and physical activity levels, screen time use, and psychopathology were examined as correlates. 9.9% of participants screened positive for ED (moderate 8.4%, severe 1.5%) with a male predominance (60.9% and 64.8% of those who screened positive for moderate and severe ED, respectively). Moderate ED was associated with parental education (adjusted odds ratio [aOR] = 0.716 for graduate university degree vs. bachelor's degree, p = 0.004). Financial hardships such as inability to afford food (aOR = 1.389, p = 0.012) and medical/dental services (aOR = 1.271, p = 0.035) were correlated with moderate ED, while severe ED was associated with lower perceived neighborhood safety (aOR = 1.583, p = 0.024). Psychiatric disorders (current and past), including mood, anxiety, post-traumatic stress, and behavioral disorders, suicidal/homicidal thoughts/behaviors, self-harm, and sleep disturbance, were linked to both moderate and severe ED, while psychosis was linked to severe ED (aOR = 2.873, p < 0.001). Psychiatric disorders, socioeconomic factors, and sleep disturbances are important correlates of ED. Findings highlight the importance of early screening for ED and call for the implementation of emotion regulation skills during childhood as a strategic, evidence-based preventive intervention focus.

Irritability, a form of emotion dysregulation, is a transdiagnostic symptom cutting across internalizing and externalizing problems. Clinical practitioners and parents have expressed concerns about the potential negative impact of screen use on irritability in youth. Despite the significant concerns, no studies have examined the association between screen usage and irritability and its directionality. Using a novel temporal network approach, this study investigated bidirectional associations between irritability and screen time across different activities in preadolescents. We used data from the Adolescent Brain and Cognitive Development (ABCD) study. Data from baseline, 1-year, and 2-year follow-ups were included (N = 8979, baseline mean age = 9.5 years, 49.1% females). All data used in the study were collected from 2016 to 2019. At each timepoint, time spent on different screen activities was self-reported by youth using the ABCD Youth Screen Time Survey, and irritability was measured using parent-rated Child Behavior Checklist. The cross-sectional Gaussian Graphical Model showed that irritability was negatively associated with time spent on video streaming at Year 2. The temporal network, estimated by Graphical Vector Autoregressive Model, revealed bidirectional associations between irritability online chatting. Specifically, online chatting predicted decreases in irritability over time, whereas irritability predicted increased time spent on online chatting. Additionally, watching TV and using social media were both associated with subsequent increases in irritability. Results controlled for co-occurring attention-deficit/hyperactivity disorder, anxiety, and depressive symptoms. These findings suggest a bidirectional association between irritability and online chatting. TV watching and social media unidirectionally predicted increased irritability. These associations highlighted the importance of monitoring screen use patterns as both potential behavioral symptoms and modifiable risk factors in interventions targeting emotion dysregulation. More research is needed to better understand how various screen activities and contents and adolescents' motives to use them are linked to irritability.

Cognitive disengagement syndrome (CDS) is associated with internalizing symptoms, emotion regulation (ER) difficulties, daytime sleepiness, and impulsivity; however, their interrelations in adolescents with subthreshold attention-deficit/hyperactivity disorder (ADHD) remain underexamined. This study aimed to evaluate the relationships between CDS, ADHD symptoms, ER problems, daytime sleepiness, trait impulsivity, and internalizing symptoms and to determine the mediating roles of ER problems and daytime sleepiness. This cross-sectional, clinic-based study included 144 treatment-naïve adolescents (12-18 years) referred for inattention and/or hyperactivity/impulsivity complaints. Parent-reported measures (Conners Parent Rating Scale-Revised-Short Form (CPRS-R-SF); Child and Adolescent Behavior Inventory-Sluggish Cognitive Tempo Scale [(CABI-SCT]) and adolescent self-reports (Pediatric Daytime Sleepiness Scale [PDSS], Revised Child Anxiety and Depression Scale-Child Version [RCADS-CV], Difficulties in Emotion Regulation Scale-Short Form [DERS-16], Barratt Impulsiveness Scale-Brief) were administered. Pearson correlations with Bonferroni-Holm correction and structural equation modeling were performed. The CPRS ADHD index and CABI-SCT served as predictors, DERS-16 and PDSS as mediators, RCADS-CV-Total as the outcome, and trait impulsivity, sex, and socioeconomic status were included as confounders. CDS showed moderate-to-high correlations with ADHD indices and significant associations with all internalizing domains except separation anxiety. CDS and daytime sleepiness were moderately correlated, and both were significantly associated with ER difficulties. Trait impulsivity correlated with CDS, ER problems, and internalizing symptoms. CDS was associated with internalizing symptoms through an indirect pathway involving ER difficulties, whereas daytime sleepiness did not a significant mediating effect. Trait impulsivity significantly predicted CDS, ADHD symptoms, ER difficulties, and daytime sleepiness, supporting its role as a shared vulnerability factor. CDS symptoms appear more closely related to ER difficulties and internalizing symptoms than subthreshold ADHD symptoms in clinically referred adolescents. ER problems may represent a key mechanism linking CDS to internalizing psychopathology. Routine assessment of CDS symptoms, ER skills, and sleep-related problems may facilitate early identification of at-risk youth. Interventions targeting ER skills and sleep-related processes may represent potential targets for future interventional research, and that longitudinal studies using multimethod assessments are needed to clarify causal pathways.