Child Psychiatry Research Articles

Psychiatric characteristics of child survivors after the Kahramanmaraş double earthquake.

The two strongest earthquakes in Turkey for eight decades hit Kahramanmaraş province on February 6, 2023. This study aimed to determine psychiatric complaints, acute stress symptoms, anxiety, depression, and sleep characteristics in children who were treated in a tertiary inpatient pediatric unit after the earthquakes. They were evaluated in the fourth week after the earthquake. Trauma experiences and acute stress disorders were evaluated by child and adolescent psychiatrists, sleep characteristics were examined by the Child Sleep Habits Questionnaire (CSHQ), and the anxiety and depressive symptoms were investigated using the Revised Child Anxiety and Depression Scale (RCADS). Forty-two patients aged 1-17 were included. Trauma experiences and acute stress disorder symptoms were similar for all age groups examined. There were no significant differences in RCADS or CSHQ scores based on age or gender groups. There were significant differences in RCADS scores when the children were grouped as having parental loss or not and, similarly, there were significant differences in sleep anxiety and resistance to bedtime in CSHQ between these children. This research offered baseline findings about psychological outcomes after these earthquakes in child survivors, and it may provide a further basis to assess the effect of psychological interventions after earthquakes. These results may offer a foundation for suitable psychological interventions for children in developing countries.

Psychometric properties and post-hoc CAT analysis of the pediatric PROMIS® item banks anxiety and depressive symptoms in a combined Swedish Child and Adolescent Psychiatry and School sample.

The objective of this study is to assess the psychometric properties and reliability of the Swedish Patient-Reported Outcomes Measurement Information System (PROMIS) item banksfor anxiety and depressive symptoms with item response theory analysis and post-hoc computerized adaptive testing in a combined Swedish Child and Adolescent Psychiatry (CAP) and school sample. Participants (n = 928, age 12-20) were recruited from junior and high schools and Child and Adolescent Psychiatry Clinics in the region of Västerbotten. Unidimensionality, local independence, and monotonicity was tested. We fitted a graded response model to the data and tested differential item functioning (DIF) for sex, age group, sample type, and language (Swedish vs. U.S.). Moreover, a post-hoc computer adaptive testing (CAT) simulation was performed. All analysis were made in R. Unidimensionality, local independence, and monotonicity were acceptable. The graded response model yielded acceptable item fit, discriminative, and threshold values for all items in both item banks. DIF for language (Swedish vs. U.S.) was found for two items from the anxiety and one item from the depressive symptoms item banks. A Stocking-lord transformation was used for the items displaying language DIF, and post-hoc CAT simulations were performed. The post-hoc CAT simulation showed reliability around 0.9 for both Swedish and official U.S. item parameters T-scores calibration from within normal limits to severe anxiety and depressive symptoms. The Swedish pediatric PROMIS item banks of anxiety and depressive symptoms are appropriate to assess mild to severe symptoms of anxiety and depressive symptoms in Swedish school- and CAP samples.

Medication adherence and attitudes in adolescent psychiatry: Key influences.

Adolescents with mental illnesses often struggle with adhering to prescribed medication regimens. This study investigates how patient perceptions influence medication adherence among adolescents with psychiatric disorders. It also examines the role of patient characteristics and medication-related factors on adherence and attitudes. The Pediatric Medication Adherence Scale (PMAS)- 9 questions and the Pediatric Attitude toward Medication Scale (PAMS)- 18 questions, two reliable self-report scales designed for the adolescent population, were used to assess negative adherence behaviors and patients' perceptions of medication. Statistical analysis examined correlations between adherence, attitudes, and patient characteristics. The scales were administered to 288 adolescents with psychiatric disorders, and a significant correlation was found between concern scores and attitudes toward medication (r = 0.886, p < .05). Patients receiving monotherapy demonstrated lower concern scores and more positive attitudes (p < .05). Experiencing side effects was significantly linked to reduced medication adherence and more negative attitudes toward treatment. Patients with eating disorders demonstrated more negative attitudes, while those using antidepressant-antipsychotic combinations demonstrated more negative attitudes than those using stimulants. This study emphasizes the necessity of addressing critical factors that influence medication adherence and attitudes toward psychiatric medication among adolescents with psychiatric disorders. In particular, it highlights the importance of considering concern perception, managing side effects, and evaluating polypharmacy to optimize pharmacotherapy in this population.

Legal requirements for information and their influence on patient satisfaction

The German Patientenrechtegesetz defines, among other things, medical obligations in connection with the provision of information. To date, the extent to which these legal requirements also influence patient satisfaction with information has not been investigated in Germany.The study employed an anonymized patient survey on satisfaction with information, which was recorded using a validated 10-item questionnaire.189 consultations (n=105 female, n=84 male patients) were included in the analysis. 87.8% (n=166) of the patients were undergoing inpatient treatment, 12.2% (n=23) were treated as outpatients. The patients were on average 53.2 years old (standard deviation: 20.3 years, range: 15 to 97 years) and were distributed across the following treatment areas: Anesthesia: n=68; Surgery: n=60; Internal Medicine: n=56; Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy: n=5 patients. Overall, there was a high level of satisfaction with the information provided, which did not differ significantly between the genders. However, patients were more satisfied if they were informed by doctors with German as their mother tongue (p=0.005; d=0.214) or by specialists (p<0.001; d=0.288). The duration of the consultation was significantly positively correlated with patient satisfaction (p=0.002, r=0.211). It was also shown that the physician's level of training (specialist: yes/no) was the most important factor (adjusted odds ratio: 4.48).The requirements of the Patientenrechtegesetz with regard to the comprehensibility and thoroughness of the information conveyed, as well as the proficiency of the medical practitioner, have been demonstrated to foster patient satisfaction. It is thus imperative that sufficient professional competence is always ensured. For medical practitioners whose native language is not German, the utilization of translation programs, pictorial or video-based supplementary materials is recommended to facilitate comprehension and minimize any potential language barriers. Moreover, the duration of the consultation should be tailored to the specific needs of the individual patient in order to optimize satisfaction. In order to achieve this, it would be prudent to ascertain from patients in advance the level of detail they would prefer the consultation to encompass.

Launching a child and adolescent psychiatry training program in Mongolia inspired by Japanese models.

This manuscript details the development and implementation of Mongolia's first official training program for child and adolescent psychiatry (CAP) specialists. This initiative, inspired by and developed in collaboration with Japanese CAP training models, addresses the substantial gap in specialized mental health services for children and adolescents in Mongolia. Our discussion elaborates on the collaborative efforts between the Mongolian National University of Medical Sciences, Nagoya University, and other partnering institutions, reflecting on the initial outcomes and the strategic importance of this program.

Antipsychotic Drug Prescribing in Children Previously Treated With Stimulants for ADHD: A Population-Based Longitudinal Study: La prescription d'antipsychotiques chez les enfants précédemment traités avec des stimulants pour le TDAH : une étude longitudinale basée sur la population.

Stimulant drug treatment in preschool-age children for attention-deficit hyperactivity disorder (ADHD) as well as the concomitant use of antipsychotic drugs is largely unstudied in terms of longitudinal outcomes. We characterized longitudinal patterns of stimulant drug use in children diagnosed for ADHD and analyzed the mental health disorders leading to add-on therapy with antipsychotics. The study population comprised of children and adolescents (age: 0-19 years) in the province of British Columbia (BC), Canada, with at least one dispensing for any psychotropic drug between 1997 and 2017 (N = 144,825). BC health administrative databases were used to identify children with diagnosis for ADHD and dispensings for stimulant and antipsychotic drugs. Longitudinal patterns of drug use and diagnostic codes proximal to the add-on of antipsychotics were assessed. We found that residence in rural regions and lack of child psychiatrists are significantly associated with higher rates of stimulant drug prescription in preschool and early school-age children. Residence in rural regions was also associated with a higher rate for the concomitant use of antipsychotics over the course of stimulant treatment. When comparing children starting stimulant therapy before the age of 6 with those starting therapy after 6 years, we found an 82% increase in the likelihood of antipsychotic add-on in those starting stimulants at younger ages (HR: 1.82, 95% CI [1.63-2.04]). Moreover, children starting stimulant therapy before the age of 6 years had 3.57-fold higher rates of diagnostic codes for specific delays in development (ICD-9 315) in close proximity to the antipsychotic add-on. The question remains whether the add-on of antipsychotics is a consequence of insufficient action of the stimulant in ADHD, or required to ameliorate the adverse effects of the stimulant drug. Our result suggests that care need to be taken in the diagnosis for ADHD in children at the age when entering elementary school.

Engagement in child psychiatry department appointments: An analysis of electronic medical records in one safety-net hospital in New England, USA.

This study examined whether being scheduled in a screening clinic versus scheduled directly with a long-term provider to conduct a mental health intake (MHI) is associated with engagement in child psychiatry services in New England, USA. We used electronic medical record data from one safety-net hospital serving a predominantly low-income and minoritised population. The study sample included 815 youths aged 0 to 25years, referred or scheduled for a MHI between 1 January 2016 and 31 December 2016. We used chi-square and t-tests to examine the association between referral pathways and engagement, logistic regression to understand the relationship between youth's socio-demographic characteristics and referral pathways, and logistic and Poisson regressions to assess potential moderating effects of socio-demographic characteristics on engagement. The mean age of the study population was 12years; 46% were female, and the majority had public health insurance (84%) and lived in high social vulnerability areas (65%). Less than half of the youth attended the first scheduled MHI visit. Those scheduled with the screening clinic were less likely than those scheduled with the provider to ever attend a MHI appointment. Spanish-speakers were more likely to be directly scheduled with a provider (Odds Ratio, OR 0.48; 95% CI: 0.32, 0.73), while those with public health insurance were more likely to be scheduled with the screening clinic (OR 0.56; 95% CI: 0.43, 0.96). Spanish-speaking status and areas social vulnerability scores moderated the relationship between the referral pathway and engagement in psychiatric appointments. The study highlights the need for psychiatric services to evaluate how MHI referral procedures may mitigate barriers to care and facilitate engagement for youth at high risk of not attending psychiatric service appointments.

Coexistence of Neurodevelopmental Disorders (ASD, ADHD) and Neurological Malformations: A Case Study

Introduction: The association of neurodevelopmental disorders and neurological malformations in children is a complex and relatively under-documented phenomenon. Autism spectrum disorder (ASD) and attention deficit hyperactivity disorder (ADHD) can coexist with structural anomalies such as Chiari malformation type 1 (CM-I) and primitive empty sella syndrome (primary ESS). This co-occurrence raises important questions about pathophysiological mechanisms, diagnostic challenges, and therapeutic approaches. We propose to explore this issue through this clinical case. Case Report: We report here the case of a 6-year-old boy, followed in child psychiatry since the age of 3 for ASD. The child presents with language disorder, lack of pointing and gaze fixation, hyperactivity, agitation crises, and sleep disturbances. Brain imaging revealed CM-I and primary ESS. Discussion: Several hypotheses regarding the links between neurological malformations and neurodevelopmental disorders are discussed in the light of the literature, explaining the role of the cerebellum, associated structures, and cerebral hemispheres in the pathophysiology of neurodevelopmental disorders such as ADHD and ASD. Conclusion: The coexistence of neurological malformations, notably CM-I and primary ESS, and neurodevelopmental disorders such as ASD and ADHD is still under-documented in the literature. Further studies are necessary for a better understanding of these links, which could shed light on the etiopathogenesis of these complex cases, to ensure better management of these children and improve their quality of life.

The motives for non-suicidal self-injury among adolescents with psychiatric disorders

BackgroundNon-suicidal self-injury (NSSI) is an intentional act that results in physical damage to one’s body, without the intent to commit suicide. In recent years, self-injurious behaviors, including non-suicidal self-injury (NSSI), have increased, especially among adolescents and young adults. The objective of this study was to investigate the motives for NSSI among adolescents with psychiatric disorders.MethodsAdolescents aged 12 to 18 years including patients admitted to the Department of Child and Adolescent Psychiatry at a state hospital in Babol (northern Iran) and outpatients referring to this center were included in the research. Data collection occurred between February 2021 and September 2021 from a sample of 140 participants. All subjects were given a demographic questionnaire and an inventory of statements about self-injury (Klonsky and Glenn). Moreover, a structured interview was conducted with all to diagnose the nature of the underlying disorder by a child and adolescent psychiatrist.ResultsA total of 140 adolescents with mean age 16.25 ± 1.48 years were assessed. Eighty-five (60.7%) of them were girls. Sixty-five (46.4%) individuals were inpatients and 75 (53.6%) were outpatients; 78 (55.8%) had a history of NSSI and 62 (44.2%) cases had no history of self-injury. The most common method of self-injury was Wounding or cutting a part of the body (n = 56(40.0%)). Attention-deficit/hyperactivity disorder (ADHD) emerged as the most common psychiatric diagnosis among individuals with a history of NSSI. Emotion regulation was the most common motive for self-injury (p = 0.004). The prevalence of self-injury was higher among adolescent girls (p = 0.049). There was no significant relationship between self-injury and inpatient or outpatient status (p = 0.342).ConclusionsOur findings indicate that NSSI in adolescents is not limited to a specific or single motive; instead, multiple factors contribute to its occurrence. NSSI methods can also vary, and all should be considered when examining this behavior.

Acceptance of online therapy for children and adolescents with digital media use disorders: perspectives from child and adolescent psychiatrists and psychotherapists in Germany.

Online therapies have the potential to improve access to psychological services for individuals in need while alleviating the burden on healthcare systems. However, child and adolescent psychiatrists and psychotherapists (CAPPs) rarely integrate these services into their daily practice. This exploratory study investigates CAPPs' acceptance of online therapy, with a focus on treating children and adolescents with digital media use disorders (DMUD). The study aimed to examine attitudes toward online therapy for DMUD treatment and to identify barriers and facilitating factors to its implementation. A cross-sectional online survey (5-10min) was distributed to 1000 members of a German practitioner network, with 142 respondents completing it in full. Attitudes toward online therapy were assessed using adapted versions of the Attitude towards Telemedicine in Psychiatry and Psychotherapy (ATiPP) questionnaire. Barriers and facilitating factors were explored using open-ended questions. Descriptive statistics, correlations, and regressions were used to analyze the closed-ended questions, while responses to open-ended questions were categorized. CAPPs reported considerable experience with DMUD, but less experience with online therapy. Attitudes towards online therapy were generally neutral, with less favorable views on its use for DMUD treatment. Key barriers to implementation in outpatient care included technical challenges, lack of personal contact or control, and concerns about data security. Facilitators included access to adequate technical resources, user-friendly and evidence-based programs, interactive tools, and opportunities for regular face-to-face interactions. The results highlight the need to develop online therapy solutions that align practitioners' needs and acceptance. However, further qualitative and quantitative research with more representative samples is essential for a more comprehensive understanding of this topic.

AACAP on diversity, equity, inclusion, and belonging

The American Academy of Child and Adolescent Psychiatry (AACAP) is dedicated to ensuring equitable access to mental health resources and compassionate care for all children, adolescents and their families, regardless of their ability and identity, and has issued the following statement.

Cognitive disengagement syndrome: The same as or different from attention-deficit hyperactivity disorder? An examination based on biochemical parameters.

The aim of this study was to determine whether there are differences in the biochemical blood parameters between individuals with Cognitive Disengagement Syndrome (CDS) and Attention Deficit Hyperactivity Disorder (ADHD), and to investigate the relationship between vitamin levels and these disorders, as well as their impact on symptom severity. The study included 35 patients with ADHD, 35 patients with both ADHD and CDS, and 35 healthy control subjects who presented to the child and adolescent psychiatry outpatient clinic between January 2022 and 2023, matched for age and gender. Children aged 7-15 were included in the study. Participants were administered a sociodemographic data form, DSM-IV Based Screening and Assesment Scale for Disruptive Behavior Disorders- Parent form (DBSAS-DBD) and the Barkley Child Attention Scale (BCAS). Hemogram parameters, iron, ferritin, Thyroid Stimulating Hormone (TSH), T3, T4, and vitamin levels (B12, folic acid, vitamin D) were analyzed for all participants. Of the participants, 78 (74.3%) were male, and 27 (25.7%) were female. In the analysis, Vitamin B12 and D levels were found to be significantly lower in the ADHD+CDS group compared to both the ADHD group and the control group (p=0.04; p=0.03; p=0.009 p=0.004 respectively). Hemoglobin levels did not significantly differ between the ADHD+CDS group and the ADHD group, but were significantly higher in the ADHD+CDS group compared to the control group (p=0.004). Ferritin levels were significantly lower in both the ADHD+CDS group and the ADHD group (p<0.001; p<0.001, respectively). The significant decrease in vitamin B12 and vitamin D in the CDS+ADHD group may be related to daytime sleepiness and slow cognitive processes in the CDS clinic. Screening for nutritional deficiencies in individuals with CDS may be beneficial for clinical management, and identifying differences in blood parameters of CDS from ADHD will contribute to a better understanding of this clinical condition. This is an exploratory study with a rather small sample size, in which many outcomes were examined. Further studies with larger and more diverse samples will provide a more comprehensive understanding of the biochemical foundations of these two conditions.

Risk Factors and Clinical Predictors of Suicidal Behaviors and Non-Suicidal Self-Injury Among Pediatric Psychiatry Emergency Admissions Pre- and Post-Pandemic: A Retrospective Cohort Study.

Suicidal behavior (SB) and non-suicidal self-injury (NSSI) are significant public health concerns among adolescents. The COVID-19 pandemic may have exacerbated these issues. This retrospective cohort study analyzed data from 341 adolescents (aged 6-18 years) presenting to a Romanian pediatric psychiatry emergency department during the years 2019 (pre-pandemic) and 2022 (post-pandemic). All participants underwent a thorough psychiatric assessment, and, together with their caregivers, were questioned on a wide range of potentially relevant issues, such as family, social, school, and life history factors. Logistic regression and random forest models were used to identify predictors of SB and NSSI. SB was significantly predicted in regression models based on a prior suicidal ideation (OR = 68.410; p < 0.001), having a parent living abroad (OR = 11.438; p = 0.020), depression (OR = 6.803; p < 0.001), and conflicts with peers (OR = 0.325, p = 0.042), teachers (OR = 0.119, p = 0.024), or both (OR = 0.166, p = 0.012). The random forest model featured a slightly different order of the main predictors and highlighted the importance of additional predictors, such as prior suicide attempts, gender, and past non-suicidal self-injury. NSSI was mainly predicted by a history of self-harm (OR = 52.437; p < 0.001), the number of comorbid psychiatric disorders (OR = 1.709; p = 0.003), and conduct disorder (OR = 0.184; p < 0.001), to which are added, according to random forest models, new predictors, such as borderline personality disorder, suicidal ideation, and school performance. Post-pandemic increases were observed in depression, suicidal ideation, and possible psycho-traumatic negative life event exposure. This study underscores the complex interplay of individual, familial, and societal factors influencing adolescent self-harm. Comprehensive interventions are needed, with early intervention crucial for those with a history of self-harm. Further research using prospective designs is recommended.

The American Academy of Child and Adolescent Psychiatry (AACAP) has issued a Call for Papers for its Annual Meeting

The American Academy of Child and Adolescent Psychiatry (AACAP) has issued a Call for Papers for its Annual Meeting

How Do Psychiatry Residents View Their Training in Spain? A Mixed-Method Survey.

Efforts to improve psychiatry training must incorporate residents' assessment of their training. This study sought to collect the opinion of residents about the program that has been in force in Spain since 2008, until the current transition to a new plan. The authors conducted an online survey of psychiatry residents in Spain, asking about their formative and working conditions. Based on previous research and the national training programme, it was distributed electronically to resident representatives of the National Board of Psychiatry. This descriptive, cross-sectional study used a mixed-methods (quantitative and qualitative) approach, following standard procedures for data analysis. A total of 109 residents from 67 training units responded to the survey. The average score for satisfaction with their training was 6.84 (standard deviation (SE) = 2.4; the maximum possible score was 10). Psychotherapy was considered the area with the greatest need for improvement, while the rotations that participants would most like to be extended were child psychiatry and addictions. It was reported that rotation durations established by the national programme were not fulfilled in 38.5% of cases, while the required direct supervision for first-year residents was not fulfilled in 77.1% of cases. Regarding working conditions, 47.7% of the residents reported that they exceeded the maximum working time established by European law. Psychiatry residents in Spain perceive certain areas of their training as deficient, especially those related to psychotherapy and clinical supervision, and they consider that their working time is excessive. The approval of the new training programme opens up an interesting opportunity for improvement.

Care-studies in adolescent psychiatry

The Fondation santé des étudiants de France offers inpatient psychiatric care for adolescents or young adults with stabilized psychiatric disorders compatible with schooling. This arrangement requires the close collaboration of a psychiatric care unit and an educational team from the French Ministry of Education. The admission process involves a careful assessment of each case file to refine the medical indications. Despite its advantages, such as care in a protected environment and small classes, it faces logistical challenges when patients come from far away, and difficulties in maintaining external partnerships due to staff shortages in adolescent psychiatry.

Employing Emotional Virtual Characters for Teaching in Child and Adolescent Psychiatry

Employing Emotional Virtual Characters for Teaching in Child and Adolescent Psychiatry Abstract: Communication and interaction are central to teaching child and adolescent psychiatry, with practical exercises often needing more access to actual patients or actors. Virtual reality (VR) offers an innovative solution by enabling simulation-based learning. With the help of computer-generated, interactive characters, students can practice repeatedly and in a standardized way how to conduct a medical interview and acquire communication skills. Initial tests with students show a high level of acceptance and believability despite the need for optimization of the voice input and the student's desire to use such new technology in teaching in the future. The next step will be to evaluate the benefits of the VR application regarding learning success and the influence of the teaching method on motivation and enjoyment of learning.

The place of social networks in the daily lives of caregivers in adolescent psychiatry

Social networks play an important role in the daily lives of adolescents, even when they are hospitalized in a child psychiatric ward. While they enable them to establish and maintain relationships, and can ease emotional tensions, they can also increase their sense of malaise. Many hospitalized young people report digital harassment, revenge porn or exposure to harmful or even dangerous content. Many hospital wards prohibit the use of cell phones and social networking sites, which nevertheless remain a key part of their care. It is important to support young patients in their use of social networks, andto teach them how to behave safely.

The diagnostic conundrum of late-onset developmental regression in child psychiatry: case series.

Developmental regression in children, in the absence of neurological damage or trauma, presents a significant diagnostic challenge. The complexity is further compounded when it is associated with psychotic symptoms. We discuss a case series of ten children aged 6-10 years, with neurotypical development, presenting with late-onset developmental regression (>6 years of age), their clinical course and outcome at 1 year. A comprehensive clinical evaluation, laboratory investigations and neuroimaging ruled out any identifiable neurological cause. Mean age at regression was 7.65 (s.d. 1.5) years and mean illness duration was 10.1 (s.d. 8.5) months. The symptom domains included regression (in more than two domains - cognitive, socio-emotional, language, bowel and bladder incontinence), emotional disturbances, and hallucinatory and repetitive behaviours. Response to treatment was gradual over 6 months to 1 year. At 1-year follow-up, nine children did not attain pre-regression functioning, and residual symptoms included not attaining age-appropriate speech and language, socio-emotional reciprocity and cognitive abilities. These cases demonstrate a unique pattern of regression with psychiatric manifestations, distinct from autism spectrum disorder and childhood-onset schizophrenia. The diagnostic dilemma arises from the overlap of symptoms with childhood disintegrative disorder (CDD), childhood-onset schizophrenia and autism. This study underscores the diagnostic intricacies of this clinical presentation and highlights the need for longitudinal follow-up to unravel the transitions in phenomenology, course and outcome. For severe manifestations such as developmental regression, where the illness is still evolving, considering CDD as a non-aetiological and transitory/tentative diagnosis would aid against premature diagnostic categorisation and provide scope for ongoing aetiological search.

Predictive accuracy of the Violence Risk Assessment Checklist for Youth in acute institutions: A prospective naturalistic multicenter study.

Acute health and social services for children and adolescents often struggle with youth aggression and violence. Early identification of violence risk during institutional stay can help prevent violent incidents. As such, this study assessed the predictive accuracy of the Violence Risk Assessment Checklist for Youth (V-RISK-Y) aged 12-18 in two different juvenile settings providing 24-hour services for youth. Institutions were included from child and adolescent inpatient psychiatry and residential youth care under child protective services. A prospective, naturalistic observational study design was employed. V-RISK-Y was administered for youth admitted to four acute inpatient psychiatric units and four acute residential youth care institutions. Incidents of violence and threats during the youth's stay were registered by institutional staff. In total, 517 youth were included in analyses, 59 of whom were registered with at least one incident of violence or threats during their stay. Area under curve (AUC) and logistic regression analyses were used to assess predictive accuracy and validity of V-RISK-Y. For the overall sample, V-RISK-Y had good predictive accuracy, and the sum score of V-RISK-Y significantly predicted registered violent incidents. Stratified analyses indicated good predictive accuracy of V-RISK-Y for the inpatient units, but not for the residential youth care institutions. Findings imply that V-RISK-Y is accurate in identifying violence risk for youth admitted to inpatient psychiatric units but has limited predictive accuracy in residential youth care institutions. Future research should explore approaches to correctly identify violence risk in residential care settings.