Editorial Perspective: Rethinking child and adolescent mental health care after COVID-19.

While COVID-19 pandemic has allegedly passed its first peak in most western countries, health systems are progressively adapting to the 'new normality'. In child and adolescent mental health services (CAMHS), such organizational envisioning is needed to cope with the foreseeable psychological effects of prolonged social isolation induced by nation-wide public health measures such as school closure. CAMHS need to ensure flexible responses to the psychopathological consequences of evolving societal dynamics, as dramatically actualized by the unexpected COVID-19 pandemic. This would imply (a) shifting the focus of intervention from symptom reduction and containment of acute crises in a comparatively small number of severe cases to a broader preventive strategy, guided by a gradient of increasing intensity and specificity of treatment; (b) promoting smooth access pathways into services and encouraging participation of families; (c) adopting a transdiagnostic staging model to capture the developmental fluctuations from subsyndromal to syndromal states and back, with related changes in the intensity of the need of care; and (d) implementing digital tools to encourage help-seeking and compliance by digitally native youth.

A 15-year follow-up of former self-harming inpatients in child & adolescent psychiatry - a qualitative study.

Purpose: Self-harm is common among adolescents, and is even more frequent among psychiatric populations. The aim of this study was to increase knowledge and understanding of different aspects of life for adults who, when adolescents, had engaged in severe self-harm during inpatient stays.Material and methods: Individual semi-structured interviews were held with seven former inpatients with a history of severe self-harm during inpatient stay in their adolescence. The interviews were analysed using a qualitative method, and the results were described in the form of categories and sub-categories.Results: Five categories, with 16 sub-categories, were found to be related to the former patients' experiences of their lives. At the time of the interviews, the subjects were in their early thirties and had no ongoing self-harm. In childhood they had experienced a dysfunctional relationship with one or both of their parents, and self-harm was one of several destructive behaviours. Friendships outside the unit were difficult during adolescence. Soon after admission to the psychiatric inpatient unit, relationships with other patients became important and contributed to them wanting to stay at the unit. Meaningful relationships and being part of a social context with healthy expectations were seen as important factors for stopping self-harm at a later stage. The subjects' experiences of their life today ranged from not enjoying it to accepting their current situation.Conclusion: These findings are based on a small sample, but they indicate the importance of relationships and the social context in contributing to and then ending self-harm.

The prevalence of childhood mental disorders in different habitations: are we underestimating their prevalence in rural areas?

Background: Recently, the number of epidemiological studies of child psychiatry has increased, but most of these studies focus on children living in city centres. Unfortunately, one-third of the global population lives in rural areas, and various habitations exist in cities, including city centres and slums. Moreover, despite having a high risk for psychopathology development, individuals who have symptoms but fall outside the limits specified for diagnoses due to having fewer symptoms than those mentioned in diagnostic systems and individuals who do not fulfil the impairment criteria listed in diagnostic systems are not addressed in these studies.Aim: The purpose of this study was to understand the prevalence of DSM-IV childhood psychiatric disorders and subthreshold psychiatric problems from middle-class city centres, city centres in slums, towns and village areas of Turkey with a nationally representative sample using a state-of-the-art methodology.Methods: In total, 1080 children were randomly selected from second and third grades for the study's sample. A structured diagnostic interview was applied.Results: The overall prevalence of psychiatric disorders was 8.4% (n = 91); 7.2% (n = 78) of the children were subthreshold cases. The general prevalence of psychiatric disorders was higher among children living in villages with respect to all the other human settlement areas included in the study.Conclusions: Although global urbanisation foregrounds the mental health of children living in cities, children in rural areas may have a greater risk of developing a mental disorder. This study confirmed that an equal amount of children fell outside of the diagnosing limits.

Building Child and Adolescent Psychiatry Expertise in Ghana Through Training and Knowledge Dissemination: a Review of the Initial Collaboration Stages, Opportunities, and Challenges.

PURPOSE OF REVIEW: Improving child and adolescent mental health (CAMH) is a priority worldwide. The majority of children with psychiatric conditions in low-middle-income countries (LMIC), like Ghana, receive no treatment due largely to limited resources and few CAMH training opportunities. The Komfo Anokye Teaching Hospital (KATH) and University of Michigan (UM) established a partnership to expand CAMH training for general psychiatrists in Ghana. Lessons learned from the early stages of the collaboration can serve as an adaptable roadmap for similar efforts to expand CAMH training in LMIC. RECENT FINDINGS: Previous articles have discussed global academic partnership, training, and capacity building programs; however, early challenges, opportunities, and preparatory stages involved in creating a mutually beneficial collaboration aimed at improving child psychiatry expertise in a LMIC are under explored in the global mental health literature. This article seeks to fill that gap by using examples to highlight unique considerations for institutions in the initial stages of establishing their global partnership. The early stages of a global partnership can impact the success of the collaboration. Collaborations should be bi-directional, sensitive to local culture, and flexible and establish achievable sustainable goals.

Parents in adult psychiatric care and their children: a call for more interagency collaboration with social services and child and adolescent psychiatry.

BACKGROUND: A parental mental illness affects all family members and should warrant a need for support. AIM: To investigate the extent to which psychiatric patients with underage children are the recipients of child-focused interventions and involved in interagency collaboration. METHODS: Data were retrieved from a psychiatric services medical record database consisting of data regarding 29,972 individuals in southern Sweden and indicating the patients' main diagnoses, comorbidity, children below the age of 18, and child-focused interventions. RESULTS: Among the patients surveyed, 12.9% had registered underage children. One-fourth of the patients received child-focused interventions from adult psychiatry, and out of these 30.7% were involved in interagency collaboration as compared to 7.7% without child-focused interventions. Overall, collaboration with child and adolescent psychiatric services was low for all main diagnoses. If a patient received child-focused interventions from psychiatric services, the likelihood of being involved in interagency collaboration was five times greater as compared to patients receiving no child-focused intervention when controlled for gender, main diagnosis, and inpatient care. CONCLUSIONS: Psychiatric services play a significant role in identifying the need for and initiating child-focused interventions in families with a parental mental illness, and need to develop and support strategies to enhance interagency collaboration with other welfare services.

[50 years specialty for child and adolescent psychiatry in Germany. History, current situation, and future perspectives]. / 50 Jahre Facharzt für Kinder- und Jugendpsychiatrie in DeutschlandGeschichte, Gegenwart und Zukunftsperspektiven 1.

50 years specialty for child and adolescent psychiatry in Germany. History, current situation, and future perspectives Abstract. Abstracts: Method: Review of the historical background and implementation of an independent medical specialty "child and adolescent psychiatry" (CAP) in Germany. Results: The implementation of an independent specialty for CAP in 1968 was crucial for the progressive further development of the discipline. The Enquête Commission "Psychiatry" of the Federal Government, followed by the Model Program "Psychiatry", the Staff Regulations for Psychiatry, the Agreement on the Social Psychiatry and the Psychotherapy Act have had significant impact on the care for psychiatrically ill children and adolescents and their families. This led to an institutional anchoring of new structures, covering three of the four leading principles of the Model Program, namely integration into medicine, community-based and appropriate care. Equality of psychiatric patients with other patient groups has, nevertheless, not yet been achieved and is still to be claimed. Current and future challenges are: (1) The realistic evaluation of new research methods and epochal trends and elimination of opposites, (2) the establishment of future-oriented research initiatives, (3) the intensive promotion of clinical and scientific staff members, and (4) a renewed attention for the subjective perspective of the illness. Conclusions: The implementation of an independent specialty "child and adolescent psychiatry" was an important stimulus for the further development of the discipline. Essential demands for the future will be: the integration of CAP into the curriculum for medical students and the promotion of young researchers within the scope of regional and supra-regional projects.

[Transitional and Adolescent Psychiatry in Austria: A Pilot Study on the Attitudes of Experts]. / Transitions- und Adoleszenzpsychiatrie in Österreich: Eine Pilotuntersuchung zur Sicht von Expert(innen).

Transitional and Adolescent Psychiatry in Austria: A Pilot Study on the Attitudes of Experts Abstract. OBJECTIVE: This pilot study establishes baseline data on the current situation of transitional processes in Austrian psychiatry. We sought to gather information on the specific problems and needs occurring during the transition of mentally ill adolescents from child and adolescent to adult psychiatry. METHOD: Professionals (psychiatrists, psychologists, psychotherapists) working in child and adolescent psychiatry and adult psychiatry (N = 86) were assessed by means of an online survey concerning their experience with the transition of young adults. RESULTS: Almost all of the subjects queried (98.8 %) considered the current system inappropriate, and the majority (70.9 %) thought that patients would not tolerate transition from youth to adult psychiatric institutions very well. Only 16.3 % reported having a structured transition protocol at their workplace. Further 83.7 % expressed the need to improve collaboration between adolescent and adult psychiatry. CONCLUSIONS: This sample of Austrian healthcare professionals describes large deficits regarding transitional issues in psychiatry. There is an urgent need to establish structured protocols for transition, especially since experiences occurring during this vulnerable period are crucial to the mental health of young people later in life.

[History and current challenges of paediatric psychiatry in maternity units]. / Historique et défis actuels de la pédopsychiatrie en maternité.

The legal framework of mother-baby care has evolved over the last thirty years driven by innovative programmes put in place by hospital health professionals. Liaison in perinatal care lies at the crossroads of different temporalities and treatment objectives, and requires constant dialogue between the liaison caregivers and those in maternity. The aim is to form a holding environment facilitating the establishment of an adapted response to the complexity of the clinical situations encountered.

Special population - child and adolescent psychotherapy.

OBJECTIVES: First, to outline the paradigm change of the past 20 years that has transformed the theory and practice of child and adolescent psychodynamic psychotherapy; second, to update aspects of the current Practice Parameters for Psychodynamic Psychotherapy with Children to align with the paradigm change driven by the principles of regulation theory, relational trauma and repair, and the critical need for clinicians' self-care in trauma informed psychotherapy. CONCLUSION: The emerging neuroscience-driven paradigm of psychotherapy poses challenges for the child and adolescent psychotherapist: to embrace the new conceptual reference points as organising principles leads to an urgent need to rethink traditional diagnostic formulations and time-honoured techniques for intervention. Our child patients and their families are entitled to benefit from the translation of the new research evidence from attachment regulation theory to clinical psychotherapy. Our clinical psychotherapy should sustain the 'best-interest-of-the-child' standards for well-being while also heeding Frances Tustin's warning for therapists to avoid the 'perpetuation of an error' by overlooking recent developments from allied fields in developmental psychology and the neurosciences.

Editorial: Looking beyond the horizon--innovation in child psychology and psychiatry.

As readers will no doubt be well aware, the Journal of Child Psychology and Psychiatry dedicates an entire issue, once a year, to state-of-the-art authoritative reviews of research on some of the central issues in our field.(1) I like to think that in doing so we have been quietly undertaking a giant Pavlovian conditioning experiment: every year, as the spring flowers start to blossom (in the northern hemisphere at least), the nucleus accumbens of child psychologists and psychiatrists around the world begin to glow in anticipation of intellectual reward.

Modelling trajectories of psychosomatic health complaints in children and adolescents: results of the BELLA study.

Psychosomatic health complaints (PHC) can significantly impair psychosocial development of children and adolescents and are therefore of considerable interest in health sciences and public health surveillance. Questions addressed the type of function that describes individual trajectories best, potential differences between these, and corresponding predictors from the perspective of both children and their parents. Based on the German population-based and representative BELLA cohort sample, 2,857 children and adolescents between 7 and 17 years of age at baseline were analysed over a period of 3 years with yearly follow-ups using mixed growth curve analyses. PHC were measured in accordance with the health behaviour in school-aged children-symptom checklist. The mean level of PHC was rather low, slightly lower for the parent report than for the self-report and significantly different between subjects. Concerning the parent report, the 2-year course is best described by a slowly increasing linear trend that decelerates somewhat over time. The increasing linear trend was more pronounced in the self-report from 11 to 17 years of age, but was significantly different for each subject and correlated with baseline scores. Trajectories could be explained by known predictors, most importantly by mental health problems of the child or adolescent. The results confirm the findings of previous studies and provide representative data about the individual short-term development of PHC in children and adolescents in Germany.

[Structural quality in inpatient and daycare child and adolescent psychiatry- indicators for planning future staff ratios for the era following the Psychiatry Personnel Act]. / Strukturqualität in der stationären und teilstationären Kinder- und Jugendpsychiatrie.

The German Psychiatry Personnel Act, which went into effect in 1990, has led to a decrease in the number of child and adolescent psychiatry inpatient beds, to a decrease in the length of stay, and to an increase in inpatient psychotherapy. Today, this act is outdated~ for a number of reasons, such as changes in the morbidity of the population, the rising number of emergencies, and new professional standards such as documentation. In addition, new legal provisions and conventions (like the UN Convention on the Rights of the Child) necessitate a complete reevaluation. Child and adolescent psychiatry needs a normative act to enable the necessary implementation. Many different rationales are available to support the debate.

[Treatment of sleep disorders in children with a psychiatric diagnosis]. / Le développement d'une approche clinique pour les troubles du sommeil en pédopsychiatrie.

OBJECTIVES: Health sciences suffer from insomnia: experts too often concentrate their efforts on the wake state. Fortunately enough, some of them have taken the road towards the "Dark Third of Life": sleep. This article gives an historical account of the development of the first Canadian sleep disorders laboratory and clinic specifically and selectively designed for children and adolescents with a psychiatric diagnosis. It then stresses the importance of sleep in children bearing a psychiatric diagnosis and summarizes therapeutic strategies. METHODS: Data-on-file and selective review of literature. RESULTS: An innovative scheme matching sleep psychologists and psychiatrists with expertise in neurodevelopmental disorders led to the creation of a sleep research laboratory on mental health disorders. The initial research projects on the sleep and dreams of patients with schizophrenia and persons with autism are summarized. The Sleep Disorders Clinic for Children and Adolescents was then created at the Hôpital Rivière-des-Prairies, leading to much needed activities focused on youth. Indeed, sleep disorders show a high prevalence in children with a psychiatric diagnosis and the literature shows that these children have an increased sensitivity for diurnal effects of poor sleep. The main sleep-relevant issues at stake are reviewed, including the high frequency of sleep disorders in pedopsychiatric patients. Clinical challenges are described and the operating mode of the Sleep Disorders Clinic is illustrated. CONCLUSION: Sleep disorders and their effects on daytime functioning need to be assessed in children with a psychiatric diagnosis in order to generate a full clinical picture. Appropriate tools and know-how are readily available in order to achieve this goal.

Monday-Morning Quarterbacking: A Senior Analyst Uses His Early Work to Discuss Contemporary Child and Adolescent Psychoanalytic Technique.

Contemporary child and adolescent psychoanalytic technique has evolved and changed a great deal in the last thirty years. This paper will describe the analysis of an adolescent girl from early in the author's career to demonstrate the ways in which technique has changed. The clinical material presented highlights six areas in which contemporary child and adolescent analysts practice and/or understand material and the clinical process differently than they did thirty years ago: (1) the contemporary perspective on mutative action, (2) the contemporary emphasis on mental organization, (3) the developmental lag in integrating the structural model, (4) the child analyst's multiple functions, (5) the child analyst's use of countertransference, and (6) the child analyst's work with parents. The author discusses how he would work differently with the patient now using his contemporary perspective. But he also wonders what might have been lost by not working in a more traditional manner, in particular the opportunity to analyze the patient's hypersensitivity to feeling hurt and mistreated so directly in the transference.

The future of genomics for developmentalists.

The momentum of genomic science will carry it far into the future and into the heart of research on typical and atypical behavioral development. The purpose of this paper is to focus on a few implications and applications of these advances for understanding behavioral development. Quantitative genetics is genomic and will chart the course for molecular genomic research now that these two worlds of genetics are merging in the search for many genes of small effect. Although current attempts to identify specific genes have had limited success, known as the missing heritability problem, whole-genome sequencing will improve this situation by identifying all DNA sequence variations, including rare variants. Because the heritability of complex traits is caused by many DNA variants of small effect in the population, polygenic scores that are composites of hundreds or thousands of DNA variants will be used by developmentalists to predict children's genetic risk and resilience. The most far-reaching advance will be the widespread availability of whole-genome sequence for children, which means that developmentalists would no longer need to obtain DNA or to genotype children in order to use genomic information in research or in the clinic.