Child Mental Health Services Research Articles

Elements of Communication Competence in Encountering Traumatized Adolescents in Substitute Care

Adolescents who need both child welfare services and mental health interventions have usually experienced various traumatic events in their early lifespan. The purpose of this study is to identify the elements of communication that can either empower traumatized adolescents in their rehabilitation process or become an obstacle in their recovery. The data consist of interviews of 19 young adults with a substitute care background. Their experiences of communication with welfare professionals in child welfare and mental health services during adolescence are analysed using the method of content analysis in a framework of communication competence that is outlined with four elements: cognitive, affective, behavioural and ethical. The role of communication is crucial while helping the adolescents. The trauma-informed capabilities of welfare professionals should be strengthened. Future research is needed on the processes, enabling the voice of this vulnerable clientele to be heard, here and in previous stages of services.

Nurses’ Perceptions of Telephone Triage in Child and Adolescent Psychiatric Services – An Enhanced Critical Incident Technique Study

In Sweden, units managed by nurses specialised in counselling and telephone triage, have been developed within the Child and Adolescent Mental Health services (CAMHS). This study has a qualitative design and illuminates the nurses’ perceptions of what helps or hinders their assessments and telephone triage. The Enhanced Critical Incident Technique was utilised, eight nurses were interviewed in depth, to identify factors influencing triage. The study is the first to provide a comprehensive description of helpful and hindering factors while performing telephone triage. It illuminates telephone triage in Swedish CAMHS settings and provides insights how to enhance and implement this practice.

A qualitative analysis of child and family complaints related to child mental health services.

Little is known about issues of patient-reported problems, in particular within psychiatric services for children with mental ill health. Child and family complaints related to child mental health services can be analyzed and discussed in light of the universal human right to health and healthcare. Therefore, the aim of this study was to analyze child and family complaints related to child mental health services. A retrospective, descriptive design was used. Child and family complaints were analyzed with a qualitative thematic analysis. The findings were described in three themes describing lack of access to care, inadequate communication between services and children with mental ill health and their families, and lack of clarity of who is responsible for care, leading to neglect of children's needs. These issues place a huge responsibility on parents or relatives. Better communication within mental health services, and better collaboration with other services such as school and social services, could limit children's suffering. Healthcare services with named professionals who specialize in child mental health and provide continuity in care, are required. General human rights principles should guide planning and care of children.

Debate: Neurodiversity, autism and healthcare.

We are at a time of unparalleled flux in our understanding of what autism is and now to respond to it, including our understanding of the role of clinical services. For any clinician working in the context of child development and child mental health services, the majority experience is probably of overwhelming demand, and then perhaps confusion. Referrals for neurodevelopmental conditions, and particularly autism, have become an increasing proportion of UK CAMHS referrals in recent years-with the consequent lengthening of wait times extending to years, sometimes equivalent to the whole length of a child's life up until that point. Services are struggling to develop response strategies to meet user frustration, a task not helped by the fact that most interventions in current use have no good evidence of effectiveness. Consequently, a plethora of local approaches and initiatives have developed. In this article I address these clinical and related issues. I discuss current different uses of the term autism, the relation to intellectual disability, and introduce a conceptualisation of autism as emergent and transactional, which is consistent with current developmental and intervention science. This could bridge between neurodiversity and clinical perspectives and implies a framing of early intervention support that has strong clinical trials evidence and provides the basis for a rational and pre-emptive evidenced care pathway, which I describe.

Parent and Carer Skills Groups in Dialectical Behaviour Therapy for High-Risk Adolescents with Severe Emotion Dysregulation: A Mixed-Methods Evaluation of Participants' Outcomes and Experiences.

There is an established evidence-base for dialectical behaviour therapy for adolescents (DBT-A) in the treatment of young people with severe emotion dysregulation and related problems, including repeated self-harm and suicidal behaviours. However, few studies have reported on parental involvement in such treatments. This study aims to explore the outcomes and experiences of participants of a dedicated skills group for parents and carers embedded within an adapted DBT-A programme in the United Kingdom. This study was conducted within a specialist outpatient Child and Adolescent Mental Health Services (CAMHS) DBT programme in the National Health Service (NHS) in London. Participants were parents and carers of adolescents engaged in the DBT-A programme. Participants attended a 6-month parent and carer skills group intervention and completed self-report measures relating to carer distress, communication and family functioning, at pre-intervention and post-intervention. Following the intervention, semi-structured interviews were also completed with a subgroup of participants to explore their experiences of the skills group and how they perceived its effectiveness. Quantitative and qualitative methods were used to analyse the data collected from participants. Forty-one parents and carers completed the intervention. Participants reported a number of statistically significant changes from pre- to post-intervention: general levels of distress and problems in family communication decreased, while perceived openness of family communication and strengths and adaptability in family functioning increased. A thematic analysis of post-intervention interviews examining participant experiences identified six themes: (1) experiences prior to DBT; (2) safety in DBT; (3) experiences with other parents and carers; (4) new understandings; (5) changes in behaviours; and (6) future suggestions. Parents and carers who attended a dedicated DBT skills groups, adapted for local needs, reported improvements in their wellbeing, as well as interactions with their adolescents and more general family functioning, by the end of the intervention. Further studies are needed which report on caregiver involvement in DBT.

Diagnostic trajectories of mental disorders in children and adolescents: a cohort study.

Mental disorders in children and adolescents may follow different trajectories, such as remission, change of diagnosis, or addition of two or more comorbid diagnoses, showing a heterotypic pattern. This study aims to describe the main diagnostic trajectories across a broad range of mental disorder diagnostic categories, from childhood to adolescence and from adolescence to young adulthood in a clinical population. A prospective study was conducted among a clinical sample of children and adolescents who were aged 3-17years at the face-to-face baseline interview. Electronic health records of these participants were reviewed 10years later. The diagnostic stability over time was examined using the kappa coefficient, and factors associated with stability were explored using simple logistic regression. The study included a sample of 691 participants. The kappa coefficient for diagnostic stability across all diagnoses was 0.574 for the transition from childhood to adulthood, 0.614 from childhood to adolescence, and 0.733 from adolescence to adulthood. Neurodevelopmental diagnoses had the highest stability. Factors associated with higher diagnostic stability included family history of mental disorders, receiving psychopharmacological treatment, and symptom severity at baseline. We found a variable diagnostic stability across different diagnoses and age categories. The different life transitions represent complex periods that should not be overlooked from a clinical standpoint. An appropriate transition from child and adolescent mental health services to adult mental health services may have a positive impact on children and adolescents with mental disorders.

Understanding healthcare services response to technology - assisted child sexual abuse: A freedom of information study

BackgroundThe reported rates of technology-assisted child sexual abuse (TA-CSA) have increased in the last decade. It is unclear how services are currently responding to cases of child sexual abuse that involve an online element. ObjectiveThe aim of this study is to understand the current framework of support offered by National Health Service (NHS) UK Child and Adolescent Mental Health Services (CAMHS) and Sexual Assault Referral Centres (SARC) for cases involving TA-CSA. This includes understanding if a services' current assessment tools refer to TA-CSA, whether interventions address TA-CSA, and assessing what training for TA-CSA is offered to practitioners. SettingSixty-eight NHS Trusts with either an affiliated CAMHS or SARC. MethodA Freedom of Information Act request was sent to NHS Trusts. Under this Act, the Trust had 20 working days to respond to the request, which included 6 questions. Results86 % Trusts (42 CAMHS and 11 SARC) responded to the request. Of the responses, 54 % CAMHS and 55 % SARC offer relevant training to practitioners. 59 % CAMHS and 28 % SARC provide tools for their initial assessment that reference online life. No Trust provided a clear treatment approach for TA-CSA, with 35 % CAMHS and 36 % SARC responding that treatment would address the mental health needs of the young person. ConclusionsThere is a need for a nationwide understanding of how to clearly define TA-CSA in policies and how to approach TA-CSA during an initial assessment. Further, a consistent approach on how to equip practitioners with tools to support individuals who have experienced TA-CSA is urgently needed.

Clinicians’ perceptions of the mental health needs of young people in alternative provision educational settings: An exploratory qualitative analysis

ABSTRACT It is estimated that 1 in 2 young people who are educated in Alternative Provision (AP) educational settings have social, emotional and mental health difficulties. However, the extent to which the mental health needs of these young people are currently being met by Child and Adolescent Mental Health Services (CAMHS) is less clear. In this qualitative study, semi-structured interviews were conducted with 15 CAMHS practitioners who had worked with young people educated in AP settings to explore secondary health care service engagement. We analysed the data using thematic analysis. Findings suggest that young people educated in AP settings have complex mental health needs for which they are currently not receiving adequate support, due to shortcomings within AP schools and numerous external barriers to care. Implications for clinicians and service commissioners include a need for further integration between CAMHS and education services, and better quality support across AP settings.

Service Users Experience in the Use of Tele-Psychiatry in Child and Adolescent Mental Health Services in NHS Orkney

Aims/BackgroundNear Me is a tele-psychiatry platform for conducting video consultation appointment in Child and Adolescent Mental Health Services (CAMHS) in NHS Orkney (NHSO). This model of consultation was introduced in NHSO CAMHS during the COVID-19 pandemic. The performance in offering effective clinical intervention in the domains of quality of care will determined through the experiences of both users and providers of care in this respect.To assess the perception and experiences of service users (clinicians, patients and their families) on the use of Near Me in NHS Orkney Child and Adolescent Mental Health Services by applying the domains of quality of care as a measure. To enable all stakeholders (policy planners, users and providers) to identify gaps and barriers in the use of Near Me and to inform change in practice.MethodsA survey was developed using the Telehealth Usability Questionnaire which is a validated tool to generate responses on the key domains of quality of care measures of appropriateness, reliability, access, timeliness, usefulness, effectiveness, interaction, quality, efficiency, safety, satisfaction and possibility of future use for both users and providers of care.The survey was made available on social media platforms including websites and online adverts for clinicians, patients and their families in Orkney to complete for a period for 10 weeks.Results28 responses were received with 14 completed responses (6 staffs & 8 patients and families) and 14 uncompleted responses (4 staffs and 10 patients & families).A mean rank test was applied to appropriately evaluate the responses received.Over 50% of respondents show high level of satisfaction in the use of tele-psychiatry services in all domains of quality of care in Orkney NHS CAMHS.Access, timeliness and safety are highly positively rated by both clinicians and service users.Improvement in network connections, improved coordination and understanding of technology will enhance the service.Better understanding of the handling of technical problems in tele-psychiatry services should be addressedReduction of in-person interactions was identified by some respondents as concern.Conclusion/recommendationTele-psychiatry is highly useful and accepted as revealed by the survey but network connections for the Near me platform needs to be improved. Face to face consultations should not be discounted and should be available where possible for better engagement.As the first survey of the use of tele-psychiatry in NHS Orkney, this study will serve to establish a baseline for future evaluation of tele psychiatry services in NHS Orkney CAMHS.

A Service Evaluation of Referrals to Sheffield Community Child and Adolescent Mental Health Services (CAMHS) by Ethnicity and Areas of Deprivation

AimsTo investigate disparities in the number and outcome of referrals to Sheffield Community Child and Adolescent Mental Health Services from different ethnic groups and areas of deprivationMethodsThe authors reviewed the the 2021 census data for Sheffield and grouped Sheffield into 3 areas of deprivation (low, medium, and high) based on Index of Multiple Deprivation (IMD 2019 Rank).Reasons and outcome of referrals to Sheffield Community CAMHS for the months of March and April 2022 were analysed by ethnicity and deprivation,ResultsOur study shows that, compared to their white counterpart, Black and Asian children and young people (CYP) were markedly under-represented in CAMHS referrals, whilst CYP of mixed ethnicities were over-represented. Of this group, Asian and mixed ethnicity CYP were less likely to have referrals accepted. Similarly, CYP from areas of high deprivation were also less likely to be accepted into the community CAMHS service. While anxiety was the most common reason for referral, CYP from areas of high deprivation were 3 times more likely to be referred for behavioural difficulties than CYP from areas of low deprivation.ConclusionOur study highlighted that black ethnicities are disproportionately underrepresented in CAMHS referrals. Furthermore, children and young people from an Asian background are not only underrepresented in the number of referrals but also in the proportion of referrals accepted. Similarly, it is reported that CYP from deprived backgrounds are more likely to experience barriers to accessibility to mental health services, and this was also evident from our evaluation.Black and Asian CYP continue to be under-represented in CAMHS services as are CYP from deprived communities. However, these ethnic groups present the highest reported mental health difficulties at adulthood. More research is therefore needed in this area, to identify the specific barriers to accessing mental health care in Sheffield Community CAMHS, so as to allow the provision of culturally appropriate mental health services for the ethnic and high derivation groups.

“When an Elephant Has Its Foot on the Tail of a Mouse…” Trauma-Focused Court Preparation Interventions for Sexually Abused Child Witnesses

Background: This paper addresses the issue of court preparation in a lower middle-income country with recently enacted child sexual abuse (CSA) legislation and almost no precedence of standard child witness training packages or protocols. Aims & methods: Taking into consideration the potential impact of the adversarial system on children and the legal system’s concerns regarding the risk of contamination of evidence and based on assessment and analysis of children’s mental health concerns and consequent capacities for testimony, it describes a set of court preparation interventions designed for a group of vulnerable, sexually abused children from a childcare institution. Results: In recognition of the heightened challenges to their competency to testify in court, the paper highlights the importance of developmental and trauma-focused considerations, particularly in the context of children with adverse childhood experiences, and consequently the role of child mental health service providers in the practice of child forensic psychiatry in the context of CSA. Conclusions: It concludes by challenging established assumptions that tend to underlie court preparation programs for child witnesses and by making recommendations for additional considerations to be incorporated into child witness training in order to enhance child witness competency and child mental health and well-being and to augment victim-oriented procedural justice aspects for vulnerable witnesses in the adversarial justice system.

Emotional and behavioral outcomes among youths with mental disorders during the first Covid lockdown and school closures in England: a large clinical population study using health care record integrated surveys

PurposeEmotional and behavioral problems in children and young people (CYP) have increased over the pandemic. Those with pre-existing mental disorders are more vulnerable but have been understudied. We investigated emotional and behavioral outcomes in this population; differences across diagnostic groups; and social, educational, and clinical determinants.MethodsWe invited 5386 caregivers and CYP (aged 5–17) under child mental health services pre-pandemic to complete an online survey on CYP’s emotional/behavioral symptoms and pandemic-related circumstances, and integrated responses with clinicodemographic information extracted from electronic health records. We compared four parent-rated outcomes (total emotional/behavioral scores and emotional/behavioral changes as compared to before the pandemic) across the three most common diagnostic groups in our population (Attention Deficit Hyperactivity Disorder (ADHD), Autism Spectrum Disorder (ASD) and emotional disorders (EmD)). We then estimated the association of clinicodemographic and pandemic-related characteristics with emotional/behavioral outcomes.ResultsA total of 1741 parents (32.3%) completed the survey. Parents of CYP with ADHD or ASD reported more behavioral difficulties (t(591) = 5.618 (0.001); t(663) = 6.527 (0.001)); greater emotional deterioration (t(591) = 2.592 (0.009); t(664) = 4.670 (< 0.001); and greater behavioral deterioration (t(594) = 4.529 (< 0.001); t(664) = 5.082 (< 0.001)) as compared to the EmD group. Those with ASD and EmD showed more emotional difficulties than ADHD (t(891) = − 4.431 (< 0.001); t(590) = − 3.254 (0.001)). Across diagnoses, poor parental mental health and challenges with education were most strongly associated with worse outcomes.ConclusionsWithin our clinical population, CYP with ADHD/ASD were the most adversely affected during lockdown. Enhancing clinical service provision that tackles parental stress and supports education may help mitigate the impact of future restrictions.

Impact of COVID-19 Pandemic on Outpatient Child and Adolescent Mental Health Service at a Tertiary Care Hospital of Pakistan

Objective: to determine the impact of COVID-19 on mental health care service provision and the pattern of morbidity presenting to out-patient child psychiatry services in Pakistan.&#x0D; Study Design: Cross-sectional study.&#x0D; Place and Duration of Study: Child and Adolescent Mental Health Unit, Institute of Psychiatry, Rawalpindi Pakistan, Medical university, from Jan 2019 to Dec 2020.&#x0D; Methodology: Hospital records for the years 2019 and 2020 were used to get data on the total number of Out-Patient Department (OPD) visits in both years, and Departmental OPD records were used to extract data on all new patients.&#x0D; Results: Two thousand two hundred thirty-two OPD visits were recorded in 2019 versus 536 in 2020, a 76% decline. Eight hundred fifty-six new patients were seen in 2019 vs 259 in 2020. The detailed OPD record analysis revealed that the predominant age group reporting was adolescents in both years. 377(44%) patients reported with behavioural problems in 2019 vs 138(53.3%) in 2019. Pharmacological management plans were used in 138(16.1%) in 2019 vs 66(25.5%) in 2019. Common Diagnoses seen in both years were not significantly different, (p=0.087). OPD records were found to have an increase in the “not mentioned category”, thus reflecting declined quality of record keeping.&#x0D; Conclusion: The COVID-19-related lockdown and pandemic led to a sharp decline in out-patient visits and deterioration and record-keeping quality. The number of children and adolescents presenting with behavioural problems increased, but the common diagnoses remained similar.Keywords: COVID-19, Child and adolescent mental health service, Child psychiatry, Pandemic, School closure.

CAMHS Clinician Attitudes to Borderline Personality Disorder in Adolescence Across Scotland.

Child and Adolescent Mental Health Service (CAMHS) clinicians have been reported to hold negative views toward the diagnosis of borderline personality disorder (BPD) in adolescence. We aimed to reevaluate with the expectation that recent advances have nurtured more positive attitudes. One hundred ninety clinicians working across CAMHS in Scotland completed a 16-item electronic survey of attitudes to BPD, derived from the Attitudes and Skills Questionnaire. Eighty-three percent of psychiatrists, 72% of nurses, and 37% of psychologists surveyed agreed that BPD is a valid diagnosis in adolescence, and 92%, 74%, and 44%, respectively, were willing to make this diagnosis. CAMHS clinicians were more optimistic compared with clinicians working in adult mental health services. CAMHS clinicians' responses may indicate increased acceptance of BPD in the adolescent population. There is a thirst for workforce education and training. Consideration should be taken to actively move the focus of identification and diagnosis of BPD into CAMHS rather than the current culture of late diagnosis.

Exploring changes in family functioning when a child participates in a School‐Based Filial Therapy program

AbstractChild focus is a central construct within Bowen family systems theory (Bowen theory). A clinical implication is that mental health treatment focusing on a child may unwittingly reinforce the operation of child‐focused processes, which undermine rather than enhance child well‐being. The concept of child focus in Bowen theory presents significant implications for professionals working in school settings and in fields such as children's mental health, which are inherently child‐focused. Bowen theory is the guiding theoretical framework for School‐Based Filial Therapy (SBFT). SBFT is a play therapy intervention that was initially established in remote and outer‐regional New South Wales, Australia in response to the low availability of children's mental health services and the significant barriers associated with caregiver engagement in children's mental health treatment. It involves trained school personnel facilitating therapeutic play sessions with children experiencing emotional–behavioural problems. The intervention occurs on school grounds, during school hours, and children's family members do not participate in the intervention. This mixed‐methods study examines the impact of children's participation in SBFT upon family functioning. Interviews with caregivers (n = 10) of children who participated in 10 SBFT sessions were analysed using content analysis. Quantitative data were collected using the Differentiation of Self Inventory – Short Form and Visual Analogue Scale – Family Functioning. A Wilcoxon signed rank test was used to analyse the pre‐ and post‐data. Qualitative outcomes indicated changes in the categories of child functioning, caregiver functioning, and extended family functioning, whilst child‐focused processes remained dominant but changed in intensity and valence following SBFT.

Exploring the workplace well-being of staff at a new integrated community mental health service for children and young people

Background There is a lack of research into the workplace well-being of community mental health professionals. Given children and young people’s increasing needs for mental health support in the wake of the coronavirus disease 2019 pandemic, it is timely to explore the workplace well-being of community mental health teams.Aim To explore the workplace well-being of staff working in a new integrated community mental health service for children and young people.Method Eleven mental health professionals from a range of disciplines took part in the study. The 11 participants completed an online questionnaire and the Professional Quality of Life (ProQOL) scale, which measures levels of compassion satisfaction, burnout and secondary traumatic stress. Three of them also took part in an individual semi-structured interview.Findings Participants felt hopeful and optimistic about the future of the service, felt supported by managers and peers, and wanted to enhance their skills to meet children and young people’s increasingly complex needs within the constraints of a service offering brief interventions. Participants displayed high levels of compassion satisfaction, low levels of burnout and particularly low levels of secondary traumatic stress.Conclusion Emotionally supportive leadership, a culture of continuous learning and peer support may reduce the uncertainty felt by community mental health staff about a new service and create optimism about the future, which may in turn contribute to workplace well-being.

Improving Collaboration Between Youth Peer Support Workers and Non-peer Colleagues in Child and Adolescent Mental Health Services

The involvement of youth peer workers (YPSWs) in child and adolescent mental health services (CAMHS) stimulates hope, destigmatization, and more culturally and developmentally appropriate support. Nevertheless, the collaboration between YPSWs and non-peer colleagues remains challenging, as it requires services to embed a new type of expert into practice. To stimulate the involvement of YPSWs in practice, this study reports on 27 semi-structured interviews with YPSWs and non-peer colleagues to provide insight into the barriers and facilitators in the collaboration process. The study took place in the Netherlands. A total of 10 interviews with YPSWs, and 17 interviews with non-peer colleagues in different healthcare occupations in CAMHS were conducted. Overall, the participants perceived relatively more barriers compared to facilitators in the collaboration process. Barriers to operate efficiently with YPSWs in multidisciplinary teams included: condescending attitudes and professional stigma towards YPSWs; concerns for YPSW boundaries; bureaucratic and clinical language usage by non-peer colleagues; conflicts due to different sets of expertise; and, lack of role clarity and guidelines for YPSWs. To improve the partnership between YPSWs and non-peer colleagues, participants described the importance of supervision and monitoring of YPSW activities. Moreover, participants also stressed the need for clear guidelines, and introduction and evaluation sessions to facilitate the collaboration process. While YPSWs seem to be an asset to CAMHS, there are a number of barriers to overcome. To overcome these barriers, organizational commitment, supervision (especially from peer colleagues), flexibility by non-peer colleagues, training non-peer staff to support YPSWs, and consistent evaluation of the implementation of YPSWs in services is recommended.

Impact of Maternal Mental Illness on the Mothers and the Children: A 7-9 Years Follow-Up Study

The Psychiatry Research and Motherhood (PRAM) study is a cohort of 300 pregnant women (and their babies), half of whom had a mental disorder (major depression or bipolar disorder) in their personal history or during pregnancy. Mothers were assessed in pregnancy, and both mothers and babies were assessed in the first year postpartum; additional data is currently been collected as follow-up of these mothers and their children again, now that children are aged between 7 and 9. Our published findings show that women who suffer from a mental disorder, even if preceding pregnancy, have difficulties in the interaction with their infant in the first year of life, which then continues to be present 7-9 years later. In fact, in analysing the data at age 7-9 that we have so far, we have found that when compared with children in the control group, children born from mothers who were depressed in pregnancy showed higher levels of non-secure attachment, indicating difficulties in their relationship with the mothers. 23% of these children were also referred to child and adolescent mental health services compared to only 8% of children in the control group. Cortisol secreted in saliva during a stressor task was more pronounced in the children born from depressed mothers; furthermore, female children within this group demonstrated reduced performance at cognitive tests of memory and attention. The data we've collected indicates that mental health problems measurable in children at around the age of 7-8 can be predicted by maternal depression during pregnancy, or a difficult mother-infant interaction in the first year of life.

Amygdala Response to Fear in Boys With Conduct Problems Following Parent Training: Considering Heterogeneity

Conduct problems (CPs) in childhood, such as conduct disorder and oppositional defiant disorder, are among the most prevalent mental health disorders in childhood and a leading cause for referral to child and adolescent mental health services ( 1 Fairchild G. Hawes D.J. Frick P.J. Copeland W.E. Odgers C.L. Franke B. et al. Conduct disorder. Nat Rev Dis Primers. 2019; 5: 43 Crossref PubMed Scopus (152) Google Scholar ). The 2019 Global Burden of Disease Study found that for the 0- to 14-year-old age category, CPs have now become the leading cause of burden among mental disorders, in terms of both disability-adjusted life years and years lived with disability ( 2 GBD 2019 Mental Disorders CollaboratorsGlobal, regional, and national burden of 12 mental disorders in 204 countries and territories, 1990-2019: A systematic analysis for the Global Burden of Disease Study 2019. Lancet Psychiatry. 2022; 9: 137-150 Abstract Full Text Full Text PDF PubMed Scopus (502) Google Scholar ). Crucially, various prospective longitudinal studies have shown that the negative outcomes observed in youth persist into adulthood and cover a similar range of domains. Importantly, the worst outcomes in adulthood are experienced by those whose CP symptoms persist ( 1 Fairchild G. Hawes D.J. Frick P.J. Copeland W.E. Odgers C.L. Franke B. et al. Conduct disorder. Nat Rev Dis Primers. 2019; 5: 43 Crossref PubMed Scopus (152) Google Scholar ). SEE CORRESPONDING ARTICLE ON PAGE 50 SEE CORRESPONDING ARTICLE ON PAGE 50 Selective Amygdala Hypoactivity to Fear in Boys With Persistent Conduct Problems After Parent TrainingBiological PsychiatryVol. 94Issue 1PreviewParenting interventions reduce antisocial behavior (ASB) in some children with conduct problems (CPs), but not others. Understanding the neural basis for this disparity is important because persistent ASB is associated with lifelong morbidity and places a huge burden on our health and criminal justice systems. One of the most highly replicated neural correlates of ASB is amygdala hypoactivity to another person’s fear. We aimed to assess whether amygdala hypoactivity to fear in children with CPs is remediated following reduction in ASB after successful treatment and/or if it is a marker for persistent ASB. Full-Text PDF Open Access

Adequacy of Children's Psychopharmacology Services: Variations by Race and Clinical Characteristics.

An expert consensus approach was used to determine the adequacy of children's psychopharmacology and to examine whether adequacy varied by demographic or clinical characteristics. Data were from the baseline interview of 601 children, ages 6-12 years, who had visited one of nine outpatient mental health clinics and participated in the Longitudinal Assessment of Manic Symptoms study. Children and parents were interviewed with the Kiddie Schedule for Affective Disorders and Schizophrenia and the Service Assessment for Children and Adolescents to assess the child's psychiatric symptoms and lifetime mental health services use, respectively. An expert consensus approach informed by published treatment guidelines was used to determine the adequacy of children's psychotropic medication treatment. Black children (compared with White children; OR=1.84, 95% CI=1.53-2.23) and those with anxiety disorders (vs. no anxiety disorder; OR=1.55, 95% CI=1.08-2.20) were more likely to receive inadequate pharmacotherapy; those whose caregivers had a bachelor's degree or more education (vs. those who had a high school education, general equivalency diploma, or less than high school education; OR=0.74, 95% CI=0.61-0.89) were less likely to receive inadequate pharmacotherapy. The consensus rater approach permitted use of published treatment efficacy data and patient characteristics (e.g., age, diagnoses, history of recent hospitalizations, and psychotherapy) to assess adequacy of pharmacotherapy. These results replicate findings of racial disparities reported in previous research using traditional methods to determine treatment adequacy (e.g., with a minimum number of treatment sessions) and highlight the continued need for research on racial disparities and strategies to improve access to high-quality care.