Promoting sexual health in transgender and gender diverse adolescents through an online sexuality psychoeducation program for parents: A case study.

We describe the implementation and evaluation of an online sexuality psychoeducation group program for parents of young people attending the transgender and gender diverse outpatient service of a pediatric hospital. The 10 participants completed semi-structured pre- and post-intervention questionnaires assessing: whether they had ever discussed with their children about aspects of sexuality, or had the intention of doing it in the future; the level of knowledge and comfort in speaking about these topics; the perceived level of helpfulness of the intervention; and, by using open-ended items, the topics they considered to be most relevant. After attending the program, parents reported they had started talking with their children about issues which previously had been little or not discussed, such as sexting, sexually transmitted diseases, pregnancy, fertility, abuse, and healthy relationships. Participants reported increased levels of knowledge and comfort in addressing these topics and highlighted the importance of being emotionally available to their children. We discuss implications for future intervention development.

Children with Prader-Willi Syndrome and COVID-19: a longitudinal study of the effect of social re-opening after the lockdown.

BACKGROUND: This study longitudinally investigated mental health indicators, body mass index (BMI), and access to school and health-care services in children with Prader-Willi syndrome (PWS) and community controls (CC) during the first wave of the COVID-19 pandemic. METHODS: The parents of 71 children (34 PWS and 37 CC) aged 6-17 years completed an online questionnaire during the initial COVID-19 lockdown (T0) and the subsequent partial (T1) and full re-opening (T2). We examined access to school and health-care services, BMI, and mental health (DSM-5 Parent/Guardian Rated Cross-Cutting Syndrome Measure) across the three time-points. For BMI and DSM-5 measure, we tested within- (Friedman's ANOVA repeated measures) and between- (robustified linear mixed-models, rLMM) group differences over time. RESULTS: Around 30% of PWS children maintained contact with medical personnel through telemedicine. PWS children kept contact with both teachers and classmates at a lower rate than CC. At all time-points, BMI was higher in PWS than CC. During partial reopening, while children with PWS had a decrease in BMI, CC showed an increase, with a significant interaction time*group interaction. Mental symptoms significantly declined in both groups, although in CC the decrease was greater than in PWS. CONCLUSIONS: PWS children were at a disadvantage during the COVID-19 outbreak for lower access to school than CC. The improvement of mental health in both groups with the reopening confirms the importance of social activities outside the family. The decrease in BMI in the PWS group indicates the positive role of caregivers' monitoring on eating habits of children.

The association of attachment, mentalization and reflective functioning with mental health in gender diverse children and adolescents: A systematic review.

Gender diverse children (here defined as minors under 18) face greater risk for depression, anxiety and suicidality than their cisgender peers. This situation calls for research on protective factors of mental health in this population, and on appropriate therapeutic and supportive interventions. This systematic review aimed at (1) examining literature on the role of attachment, mentalization and reflective functioning in protecting mental health of gender diverse children and identifying the mental health outcomes that have been assessed; and (2) outlining interventions based on attachment, mentalization and reflective functioning that have been proposed. The work was conducted according to the PRISMA guidelines. Fifty-one studies were identified and 9 met the inclusion criteria. Results indicate that, besides a general protective role for mental health, attachment, mentalization and reflective functioning moderate and mediate, through different pathways, (1) the association between gender diversity and emotional/behavioural problems; and (2) the negative effects of minority stress. Mentalization seems to be an individual resilience factor; the capacity of the caregiver to serve as a secure base and validate the internal experience of incongruence of the child promote a healthy psychological development. Three levels of action for interventions were identified: individual, family and community.

Trends in admissions to a child and adolescent neuropsychiatric inpatient unit in the 2007-2017 decade: how contemporary neuropsychiatry is changing in Northwestern Italy.

PURPOSE: Rising levels of psychopathology in the adolescent population have been evidenced in the last few years throughout the Western world. We aim to examine how contemporary neuropsychiatry is changing in Northwestern Italy and how this impacts inpatient services. METHODS: The present research considered the 1177 admissions to a public neuropsychiatric inpatient service in the 2007-2017 decade. The annual percentual change (APC) was analysed for the total admissions, the number of the neurological vs psychiatric admissions, the length of inpatient stay, and the mean age at admission, also accounting for sex differences. The annual trend was also calculated for each diagnosis. RESULTS: The overall number of inpatient admissions decreased significantly (APC = - 5.91), in particular for children under 12 years of age (APC = - 7.23). The rate of neurologic diagnoses significantly decreased (APC = - 26.44), while the length of the inpatient stay (APC = 6.98) and the mean age at admission (APC = 6.69) increased. Among the psychiatric diagnoses, depression significantly rose (APC = 41.89), in particular among female adolescents (APC = 40.30). CONCLUSIONS: These data document a substantial change in the utilization of inpatient neuropsychiatric services for children and adolescents, with a major increase in psychiatric hospitalizations and a parallel decrease in neurological ones. These trends call for greater attention to early preventive intervention in mental healthcare system.

Psychopathological profile in children with Prader-Willi syndrome as compared with autism spectrum disorder.

BACKGROUND: Children with Prader-Willi syndrome (PWS) can present with social deficits and repetitive behaviours that are also encountered in autism spectrum disorder (ASD). This study aimed at ascertaining possible differences in psychopathology between PWS and ASD, with particular attention to obsessional thinking, repetitive behaviours, and impulsivity. METHODS: 71 children, aged 4-15 years: 24 with PWS, 23 with ASD, and 24 community controls, were assessed on two standardized parent-reported questionnaires: the Child Behaviour Check List (CBCL) and the Autism Spectrum Quotient (AQ). Group differences were tested with one-way ANOVA. RESULTS: ASD had higher CBCL internalizing symptom scores (67.50 + 9.09) than PWS (56.62 + 9.02, Cohen's d=1.20). On specific CBCL items, PWS had more obsessionality than ASD, which, in turn, showed more impulsivity than PWS. ASD had higher AQ scores than PWS, with small to medium effect sizes (d's ranging from 0.22 to 0.53). CONCLUSIONS: The PWS phenotype was characterized by intense obsessionality, more marked than in ASD. ASD had greater psychopathology than PWS, especially of the internalizing type. Although limited by the small sample size, this study identifies obsessionality as common feature in PSW. Such symptom, considering the negative impact on daily functioning, requires clinical attention for specific treatment approaches.

A psychological support group for parents in the care of families with gender diverse children and adolescents.

Parenting gender diverse children and adolescents can be a challenging experience, entailing doubts about how to protect and support them during their development. Parental reactions impact on the child's sense of security and well-being. Therefore, when caring for families with gender diverse children, it is important to offer support to parents. In this article we present an experience with a 12-month support group for parents of young people who attended the service for gender identity development at a paediatric hospital. We describe the group structure and methodology, together with the process for evaluating the intervention. At 6-month intervals, parents were asked to indicate the most important topics that had emerged during the monthly sessions. At 12 months, they completed a semi-structured feedback questionnaire about their experience in the group, including possible difficulties encountered. Thematic analysis showed an evolution in time, with participants taking a more complex perspective on gender diversity and the needs of their children, while feeling more able to deal with the uncertainties related to gender identity development. After attending the group, parents reported feeling less lonely, more confident, and better able to communicate with their children. They related these positive changes to the opportunity of sharing experiences and mutual learning. This feed-back provides preliminary evidence that the psychological support group was perceived to be a useful resource by parents of gender diverse young people.