Editorial: Qualitative contributions to translational science - Practical pointers towards methodological pluralism in child psychology and psychiatry.

Qualitative research is notable by its relative absence from the translational science studies in the field of child mental health and neurodevelopmental conditions in general, and the Journal of Child Psychology & Psychiatry in particular. In this editorial, I argue for a pragmatic integration of qualitative and quantitative methods to speed up the development of new and more effective interventions. I give practical examples of the benefits of qualitative methods at specific points across the discovery - development - implementation translational cycle.

Towards identifying the characteristics of youth with severe and enduring mental health problems in practice: a qualitative study.

A group of youth with severe and enduring mental health problems (SEMHP) falls between the cracks of the child-and-adolescent psychiatry (CAP) system. An insufficient understanding of these youth's mental health problems results in a failure to accurately identify and provide support to these youth. To gain a deeper understanding, the aim of this study is to explore characteristics of youth with SEMHP in clinical practice based on the experiences of youth and clinicians in CAP. This qualitative study consisted of 20 semi-structured interviews with 10 youth with lived experience and 10 specialized clinicians in CAP. Both a thematic and content analysis was conducted to identify, assess, and report themes associated with youth with SEMHP. Themes were individual characteristics such as trauma, masking, self-destructive behavior, interpersonal distrust as well as environmental and systematic characteristics including parental stressors, social isolation and societal stressors, which go beyond the existing classifications. These characteristics profoundly impact youth's daily functioning across various life domains, creating an interactive process, ultimately leading to elusive mental health problems and overwhelming feelings of hopelessness. The authors recommend proper assessment of characteristics in all life domains affected and their perpetuating effect on SEMHP during diagnostics in CAP. Engaging in a dialogue with youth themselves is crucial due to the nature of youth's characteristics, which frequently transcend traditional classifications and may not be immediately discernible. It also requires an integrated care approach, entailing collaborations between educational institutions and mental healthcare providers, and attention to potential indicators of deficits in the healthcare system and society.

Retaining Interest in Child and Adolescent Psychiatry Among General Residency Trainees.

OBJECTIVES: This study aimed to identify factors affecting current general psychiatry residents' interest in child and adolescent psychiatry (CAP) at Lehigh Valley Health Network (LVHN). Furthermore, it aimed to identify areas for improvement in clinical education to address the shortage of child psychiatrists at the institution at the time of this study. METHODS: An electronic anonymous pre-implementation survey was sent to all the current general psychiatry residents at LVHN. It assessed the most important factors for trainees in deciding their career paths into CAP, their comfort level with children and families, and overall CAP and related systems-based knowledge. Interventions based on the survey results were implemented in the LVHN psychiatry residency program. The residents then completed a post-intervention survey to assess the impact of these interventions on their perspectives toward CAP. RESULTS: CAP rotation experience and work with families were strong influencers for general psychiatry residents at LVHN in pursing CAP. Systems-based knowledge was particularly lacking compared to overall CAP knowledge. Educational interventions that were implemented at LVHN led to improvements in residents' sense of competence working with children and families with no net loss of interest in CAP. CONCLUSIONS: Educational modifications enhanced attitudes toward CAP among LVHN general psychiatry residents. Implementing such modifications at other residency programs may be likewise effective in retaining interest in CAP among their general psychiatry residents.

Forensic Psychiatry Education in Child and Adolescent Psychiatry (CAP) Fellowship: Results from a Multi-site Survey.

OBJECTIVE: This study examined the current state of forensic education among child and adolescent psychiatry (CAP) fellowship programs, regarding specific forensic topics, teaching resources, methods, and experiences. The authors aimed to gather and analyze this data to assess the need for additional standardization of forensic psychiatry education in CAP fellowship, such as broader access to resources, and/or inform the development of a standardized curriculum, including milestones, in child and adolescent forensic psychiatry. METHODS: The authors collaboratively developed a survey instrument on child and adolescent forensic psychiatry education, which was then sent to 135 accredited CAP fellowship programs. The items included in the survey instrument were designed based on literature review, expert consensus, and a 1992 American Association of Directors of Psychiatric Residency Training survey on teaching ethics and forensic psychiatry. RESULTS: Completed response data was returned by 25 of the 135 programs surveyed. Complete responses came primarily from academic institutions (52% public, 36% private) with small- or medium-sized programs (1-12 total fellows, 88%; 11-29 faculty members, 56%). Programs reported on CAP forensic rotation sites, faculty members' level of expertise and involvement in forensic CAP, common forensic topics and experiences offered, and programs' attitudes towards specific topics and experiences. CONCLUSIONS: Child and adolescent psychiatrists must gain a clear understanding of the essential components of CAP forensic psychiatry during CAP fellowship, to mitigate discomfort when interacting with the legal system and meet the rising need for forensic CAP expertise across systems and structures impacting youth populations.

Psychiatry trainee experience of working in a child and adolescent eating disorder program.

OBJECTIVES: Eating disorders are serious psychiatric conditions that affect people of all ages. Many psychiatry trainees' first and only experience with eating disorders during training is their Child and Adolescent Psychiatry (CAP) rotation. This study aimed to explore the learning experience of psychiatry trainees working within an Eating Disorder Program (EDP) during their CAP rotation. METHODS: Fifteen trainees who participated in the EDP were recruited to complete an online survey and focus groups; a thematic analysis design was used to identify themes emerging from their responses. RESULTS: Themes emerged from the trainee learning experience of working in the EDP around what they found they learnt, what aided that process, what was difficult, and recommendations for future improvement. CONCLUSIONS: This study provided insight into the trainee experience in an EDP as one example of how trainees can learn about eating disorders and one way that could inform future workforce and training initiatives.

Assessing the Factors Affecting Recruitment to Child and Adolescent Psychiatry Fellowship Programs.

OBJECTIVE: The objective of this pilot study was to sample early career child and adolescent psychiatrists (EC CAP), Child and Adolescent Psychiatry (CAP) fellows, adult residents, and medical students to identify factors affecting recruitment to CAP fellowship. METHOD: A 25-item questionnaire was sent to all adult psychiatry, CAP fellowship, triple-board residency program directors, and coordinators in the US to disseminate to their trainees. Questionnaires also were disseminated via professional groups on social media, and through psychiatry student interest groups to medical students. RESULTS: A total of 369 people responded, of which 315 questionnaires were evaluable. Approximately half of the respondents were CAP fellows or EC CAP. Most decided to pursue a career in child psychiatry during medical school. Forty-three percent owed more than $200,000 in educational debt. The top reasons for pursuing a career in child and adolescent psychiatry included working with children, finding it to be a rewarding career, and finding it intellectually stimulating. A switch to a 1-year fellowship and higher income potential were noted to be factors that may increase consideration for CAP fellowship among those who chose not to pursue it. CONCLUSIONS: The majority of early career child and adolescent psychiatrists were recruited during medical school, motivated by altruistic reasons. Early child psychiatry exposure, a means of addressing physician debt, providing additional incentives in geographically undesirable locations, and improving compensation, is needed to improve recruitment to this specialty.

[Genetic Diagnostics in Everyday Clinical Practice in Child and Adolescent Psychiatry: Indications, Framework Conditions, Hurdles, and Proposed Solutions]. / Genetische Diagnostik im klinischen Alltag der Kinder- und Jugendpsychiatrie ­ Indikationen, Rahmenbedingungen, Hürden und Lösungsvorschläge.

Genetic Diagnostics in Everyday Clinical Practice in Child and Adolescent Psychiatry: Indications, Framework Conditions, Hurdles, and Proposed Solutions Abstract: Health insurance covers medically necessary genetic testing in Germany. Diagnostic genetic testing has become increasingly important for child and adolescent psychiatry (CAP), reflected by the rising number of national guidelines relevant to CAP, including genetic testing in the recommended diagnostic work-up. However, implementation of theses guidelines in routine clinical care is lacking. This article provides a concise overview of the relevance of genetic testing in CAP-related national guidelines. It outlines the legal and financial framework for genetic testing in Germany. Furthermore, it points out barriers to implementation and offers potential solutions. It then provides examples from clinical practice highlighting the potential benefits patients and their family members might have from receiving a genetic diagnosis. The article closes by outlining future CAP-relevant areas in which genetic testing may become clinically relevant.

[The S3 Guideline on the Treatment of Language Development Disorders: Summary of Recommendations]. / Die S3-Leitlinie zur Therapie von Sprachentwicklungsstörungen.

The S3 Guideline on the Treatment of Language Development Disorders: Summary of Recommendations Abstract: The German S3 Guidelines on the Treatment of Developmental Speech and Language Disorders (AWMF: No. 049-015) were published on the AWMF homepage at the end of 2022. The German Society for Phoniatrics and Paedaudiologie coordinated the work and developed the guideline text together with linguists and speech and language therapists. Many scientific medical societies consented to the respective recommendations. For the first time in the German-speaking area, the guideline group reviewed international research results on the treatment of various speech and language disorders and formulated evidence- or consensus-based recommendations for clinical care. The present article summarizes these recommendations and evaluates the guidelines from the perspective of child and adolescent psychiatry and psychotherapy.

The Microbiome in Child and Adolescent Psychiatry.

Recent research has increasingly emphasized the function of the microbiome in human health. The gut microbiome is essential for digesting food and seems to play a vital role in mental health as well. This review briefly overviews the gut microbiome and its interplay with the central nervous system. We then summarize some of the latest findings on the possible role of the microbiome in psychiatric disorders in children and adolescents. In particular, we focus on autism spectrum disorder, attention-deficit/hyperactivity disorder, anorexia nervosa, bipolar disorder, and major depressive disorder. Although the role of microbiota in mental development and health still needs to be researched intensively, it has become increasingly apparent that the impact of microbiota must be considered to better understand psychiatric disorders.

[The controversial election of Amsterdams first professor in child psychiatry]. / De controversiële benoeming van Amsterdams eerste hoogleraar Kinderpsychiatrie.

BACKGROUND: The history of psychiatry is also determined by the choice of full professors. The appointment of mrs. dr. E.C.M. Frijling-Schreuder in 1965 as the first full professor in child psychiatry at the University of Amsterdam was controversial. She was not a psychiatrist. Furthermore, a successful lecturer in child psychiatry was already present at the university for ten years, dr. F. Grewel. AIM: Investigating the motives of the appointment and how it came about. METHOD: Consulting literature and archives. RESULTS: The psychiatry professor at the same university, dr. P.C. Kuiper, put forward dr. Frijling-Schreuder, with whom he was in psychoanalysis at the time. To enable this, an academic sidetrack was created for dr. Grewel – an appointment as professor in orthopedagogy. CONCLUSION: In choosing a professor in child psychiatry at the University of Amsterdam in 1965 a psychoanalytical stance was of more significance than child psychiatric expertise.

[Care and law for young people are constantly developing]. / Zorg en recht voor jongeren volop in ontwikkeling.

BACKGROUND: Child and adolescent psychiatry in the Netherlands is part of the broader field of youth care. International treaties, the Youth Act, child protection measures and various legislation for compulsory care provide the framework within which youth care can be provided. AIM: Clarify the laws and regulations of youth care for young people and describe possible changes in the future. METHOD: Study of laws, reports, and commentaries. RESULTS: Laws and regulations governing care for young people are complex and not always effective. The Youth Reform Agenda, the Future Scenario for Child and Family Protection and the Legal Status of Closed Youth Care Act are recent developments that aim to simplify and improve youth care in the Netherlands. CONCLUSION: The legislation and regulations governing healthcare for young people are rapidly developing. Practice will show whether these changes are really improvements.

[Twenty-five years of child and adolescent psychiatry in the Netherlands: patterns of practice]. / 25 jaar Nederlandse kinder- en jeugd­psychiatrie in de praktijk.

BACKGROUND: The department of child- and adolescent psychiatry of the Dutch Association of Psychiatry has regularly investigated the practice of child- and adolescent psychiatry since 1996. This article reports the results of the 2021 survey. AIM: Investigating the composition and practice of the group of child- and adolescent psychiatrists, with special attention to the effect of the decentralization of child mental healthcare to the municipalities in 2015. METHOD: A postal survey; descriptive analysis of collected data. RESULTS: The number of child- and adolescent psychiatrists remained constant since 2012: 445, with sixty-eight percent women. Eighty percent works in institutional practice. Ten percent holds an interim position. Eighty percent reports an increase in workload. Professional satisfaction is mainly derived from patient care. CONCLUSION: Despite the unrest caused by the decentralization, the number of child- and adolescent psychiatrists remained stable over the last ten years. Since 2021 there have been negative, as well as positive developments. Therefore repetition of this survey in a few years is recommended.

Originalarbeiten / Original Articles. Die partizipative, berufsgruppen- und abteilungsübergreifende Entwicklung eines Ethik- Leitbildes in einer kinder- und jugendpsychiatrischen Klinik: Der Ethik-Kompass der UPKKJ Basel.

The Participatory, Cross-Professional and Cross-Departmental Development of an EthicalMission Statement in a Child and Adolescent Psychiatric Clinic: The Ethics Compass of theUPKKJ Basel Employees in child and adolescent psychiatry navigate a complex field of ethical requirements. At the Clinic for Children and Adolescents of the University Psychiatric Clinics Basel (UPKKJ), these areas of tension were examined in a project that spanned across numerous departments and professional groups. Based on a survey study and a narrative literature review, ethical guidelines were developed: the UPKKJ Ethics Compass. The Ethics Compass highlights various areas such as participation, child welfare, justice and developmental health, which are relevant to the relationships between children, adolescents, parents, and the treatment team. To implement these principles in everyday clinical practice, the Ethics Compass is now regularly used in case work and as a communication aid with external partners. Furthermore, a procedural action plan was developed for collaboration with the Department of Clinical Ethics at the University Hospitals in Basel.

Improving front-line clinician capacity to address depression and bipolar disorder among perinatal individuals: a longitudinal analysis of the Massachusetts Child Psychiatry Access Program (MCPAP) for Moms.

Perinatal mood disorders (PMDs) are common, yet many patients are undertreated. The Massachusetts Child Psychiatry Access Program (MCPAP) for Moms is designed to increase clinicians' willingness to address PMDs. We examined utilization of MCPAP for Moms and associations with PMDs treatment, including the more complex bipolar disorder (BD). Analyses of MCPAP for Moms data examined utilization from 7/2014 to 6/2020 and associated treatment outcomes. Participants were clinicians (n = 1006) in obstetrics/gynecology, family medicine, and pediatrics. Encounters included (1) resource and referrals and (2) psychiatric consultations (program psychiatrist consultation with clinicians or patients). Utilization sub-groups were identified using group-based trajectory modeling. Higher utilization of MCPAP for Moms was associated with increased rates of treating PMDs (incidence rate ratio [IRR] = 1.07, 95% CI: 1.06-1.07). Examining by encounter type, psychiatric consultations resulted in more frequent rates of clinicians treating PMDs than resource and referral encounters. Utilization of direct patient consultation was associated with the greatest increase in rates of clinicians treating BD (IRR = 2.12, 95% CI: 1.82-2.41). Clinicians with highest utilization rates of psychiatric consultations longitudinally had strongest predictive associations with providing direct mental healthcare to patients with BD (IRR = 13.5, 95% CI: 4.2-43.2). Utilization of MCPAP for Moms facilitates clinicians' ability to provide mental health treatment to patients.

[Sensory regulation disorders in child psychiatry]. / Troubles de la régulation sensorielle en pédopsychiatrie.

INTRODUCTION: The processing of sensory information determines the development and growth of a child's abilities. Dysfunction in the processing of sensory stimuli can affect a child's behavior and can disrupt development. Sensory Regulation Disorders are frequently associated with Autism Spectrum Disorder (ASD), with the DSM-5 even including it as a diagnostic criterion. However, they are also observed in other neurodevelopmental disorders. At present, the frequency of Sensory Regulation Disorders in children consulting child psychiatry has never been evaluated, although it seems to be a population at risk. OBJECTIVES: To evaluate the frequency of sensory regulation disorders in children between 3 and 6 years old who first consult a child psychiatrist in Marseille. To determine whether certain reasons for consultation are correlated with the presence of sensory regulation disorders. METHODS: A multicenter cross-sectional study was conducted for four months in Marseille. Sensory regulation disorders were assessed by the second version of Dunn's short sensory profile. RESULTS: Fifty-eight patients were included. A significant difference was found between the frequency of SRT in our primary child psychiatry population and the general population. Subgroup analyses according to the reason for consultation showed that there would be more SRT in the Motor Instability/Inattention, Conduct Disorder and Socialization Disorder subgroups. CONCLUSION: We observed a higher frequency of SRT in the child psychiatry consultation population. SRT could explain, or at least partly participate in, the children's symptomatology. The results are in favor of an early detection of SRT in the population of children consulting child psychiatry. The evaluation of the sensory profiles of these children allows a better understanding of the child's functioning and an adjustment of the intervention and support strategies proposed to the family.

[Crisis consultations in child and adolescent psychiatry in Reims: Cross-sectional study of the population of accompanied minors]. / Dispositif de crise en psychiatrie de l'enfant et de l'adolescent à Reims : étude transversale de la population des mineurs accompagnés.

INTRODUCTION: The crisis consultation unit (CCU) of the child psychiatry department of the Reims University Hospital was created to respond to an increasing demand for rapid interventions with minors. OBJECTIVE: The objective of this study is to observe the characteristics of the population received in this facility and to explore the links between the data, to hypothesize about its specificities. METHOD: We conducted a cross-sectional study of data collected during telephone assessments between June 2016 and January 2018. A univariate analysis was performed using EpiInfo© software and the pvalue.io© statistical interface using R statistical software. A total of 263 telephone contacts were counted. RESULTS: A greater activity of the service is found during the school period. The majority of minors did not have any psychiatric or psychological follow-up at the time of the call. Boys consulted earlier, preferably for externalized disorders. The youngest children are often referred to prevent symptoms following an acute stress. CONCLUSION: Our study allowed us to draw up a sociodemographic profile and to show certain trends observed within the CCU of the child psychiatry department of the Reims University Hospital, in particular the multiplicity of reasons for consultation. At a time when the health crisis is impacting the mental health of the entire population and increasing the time required for treatment, this type of system is particularly relevant to the possible reorganization of the care offered by the CMP. The CCU would make it possible to report the most urgent situations, which would then benefit from specific care (hospitalization, medication, specific consultations).

[Honors granted by the German Society for Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy (DGKJP) and its predecessors]. / Die Ehrungen der Deutschen Gesellschaft für Kinder- und Jugendpsychiatrie, Psychosomatik und Psychotherapie e. V. (DGKJP) und ihrer Vorgängerorganisationen.

Honors granted by the German Society for Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy (DGKJP) and its predecessors Abstract. Abstracts: This research on the "honors" granted by the German Society for Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy (DGKJP) investigated all persons honored by the society from 1950 (following the postwar reestablishment of the society) up through 1990 (German reunification). We explored the adequacy of the honors regarding the professional ethics of the honorees during the NS-regime. Ethics violations included so-called T4-assessments (euthanasia) leading to death, working in "special units" where children were murdered using drugs, or any form of nontherapeutic experiments on humans. The Heinrich Hoffman Medal was first awarded in 1957, with honorary memberships being conferred from 1963 onward. From 1957 to 1990, the DGKJP awarded 19 honorary memberships and 9 Heinrich Hoffman Medal to 27 recipients (one person received both). Of those honored, three were detected as violators of professional ethics. After long internal discussions, the DGKJP had already distanced itself from Elisabeth Hecker (1895-1986), Hans-Alois Schmitz (1899-1973), and Werner Villinger (1887-1961). The ideology shared by these three was formulated by Villinger as the "ineducability" of their child victims because of an "inferiority paradigm." The rejection by the DGKJP went little noticed in public, and until 2021 was only briefly mentioned in the society's newsletter. Eleven honored persons were former members of the NSDAP without demonstrable ethical transgressions; the investigations are still ongoing for three others, whose ethical transgressions have neither been ruled out nor confirmed.

[Encopresis in children, the view of child psychiatry]. / Comment j'explore... L'encoprésie chez l'enfant, le point de vue pédopsychiatrique.

The article aims to provide a state of knowledge in the literature on encopresis in the child psychiatric population. The general definition of the symptom and its analysis are presented according to different approaches. Then, the clinic of encopresis is described according to its specificities. The main associated disorders and psychiatric/psychosocial risk factors are discussed in detail. Regarding patient care, the multidisciplinary approach, including the complementarity with the paediatrician, is essential in a number of cases. Finally, family approach and the impact of trauma would be interesting research perspectives.

L'article a pour objectif de proposer un état des connaissances dans la littérature au sujet de l'encoprésie parmi la population pédopsychiatrique. La définition générale du symptôme et son analyse sont exposées selon différentes approches. Ensuite, la clinique de l'encoprésie est abordée selon ses spécificités. Les principaux troubles associés et les facteurs de risques psychiatriques/psychosociaux sont alors abordés dans le détail. Au niveau de la prise en charge du patient, l'approche multidisciplinaire, dont la complémentarité avec le pédiatre, est primordiale dans un certain nombre de cas. Enfin, l'approche familiale et l'impact des traumatismes constitueraient des perspectives de recherche intéressantes.

New Directions in Child Psychiatry: Shaping Neurodevelopmental Trajectories.

Historically, the field of child psychiatry has lagged behind the field of general psychiatry in terms of research innovations and the availability of empirically supported treatment modalities. However, over the last two decades there has been increasing interest in and research focused on the developmental origins of mental disorders examining both neurobiological and psychosocial etiologies.1 This has catalyzed the field leading to advances in understanding the developmental psychopathology of mental disorders and the generation of novel early interventions that have shown significant promise.2-4 Further, catalyzing this effort is new data demonstrating the powerful impact of psychosocial forces on neurodevelopment. New methodologies and discoveries in the basic areas of early childhood developmental psychology have led to a greater appreciation for the emotional and cognitive sophistication of children in the first three years of life. Advances in methods to understand preverbal children's emotional and attentional responses (through measures of eye gaze and suck for example) as well as observational methods to glean a variety of mental health relevant behaviors early in life (e.g. behavioral inhibition, pro-social behaviors and social motivation) have further elucidated and validated these capacities. In addition, measures of neural function using electroencephalogram and evoked response potentials (EEG/ERP) and functional magnetic resonance imaging (fMRI) as early as the neonatal period, with many analysis methods developed at WUSTL, have further informed this domain providing new insight into early brain and behavioral relationships as well as how intervention impact brain function.5-7.

The Joint Commission on the Mental Health of Children, 1965-1970: Emotional disturbance, race and paths not taken in child psychiatry.

The Joint Commission on the Mental Health of Children (JCMHC) was a sprawling, multidisciplinary project that took shape in the years immediately after the assassination of President John F. Kennedy. Participants included child psychiatrists, educators, psychologists, social workers, philanthropists and other laypeople and professionals interested in the plight of children. While the original inspiration for the JCMHC was to address the potential for violence from disturbed children and adolescents, its findings and recommendations were an indictment of American society itself in which poor children went hungry, minority children were oppressed and there were not sufficient resources dedicated to the mental health of the nation's population of young people. The task forces and committees of the JCMHC spent significantly more time addressing prevention and mental health rather than mental illness. Two years into the work of the JCMHC, the leadership formed a committee to specifically examine issues related to race. The final report, published in popular book form as Crisis in Child Mental Health, arrived after the unraveling of the liberal consensus that had fueled President Lyndon Johnson's Great Society programs. Most of the proposed solutions for government intervention were ignored by the Nixon administration. The focus on mental health and the willingness to take a critical look at the detrimental effects of racism had represented child psychiatry at that time. In the decades that followed, however, child psychiatrists turned away from issues about prevention, race and environment and instead focused on the problems of mental illness in individual children.