Trayectorias diagnósticas de los trastornos mentales en 10 años de seguimiento de una cohorte de niños y adolescentes / Diagnostic trajectories of mental disorders in a 10-year follow-up cohort of children and adolescents

Los trastornos psiquiátricos en la infancia y adolescencia pueden persistir, cambiar, remitir o aumentar en la edad adulta. Este estudio explora la estabilidad y las trayectorias diagnósticas de 311 niños y adolescentes entre 3 y 17 años hasta la edad adulta. Se encuentra que la estabilidad diagnóstica varía en función de la enfermedad. Los cambios de diagnóstico son más frecuentes en el trastorno de conducta y los trastornos afectivos, mientras que la mayor estabilidad diagnóstica se da en las dificultades del aprendizaje, trastorno de déficit de atención con hiperactividad y trastornos del espectro autista. La remisión completa es más frecuente en los trastornos de ansiedad. Los diagnósticos psiquiátricos tienen implicaciones sociales, emocionales y prácticas. Es necesario adaptar los recursos de salud mental a las necesidades de cada grupo de edad. (AU)

Psychiatric disorders in childhood and adolescence may persist, change, remit or increase in adulthood. This study explores the diagnostic stability and trajectories of 311 children and adolescents aged 3-17 years into adulthood. Diagnostic stability is found to vary according to pathology. Diagnostic changes are more frequent in conduct disorder and affective disorders, while the highest diagnostic stability was found in learning difficulties, attention deficit learning disabilities, attention deficit hyperactivity disorder and autism spectrum disorders. Complete remission is more frequent in anxiety disorders. Psychiatric diagnoses have social, emotional and practical implications. Mental health resources need to be adapted to the needs of each age group. (AU)

In Memoriam: Professor Joseph Biederman's Contributions to Child and Adolescent Psychiatry.

OBJECTIVE: To provide an overview of Joe Biederman's contributions to child and adolescent psychiatry. METHOD: Nine colleagues described his contributions to: psychopharmacology, comorbidity and genetics, pediatric bipolar disorder, autism spectrum disorders, Tourette's and tic disorders, clinical and neuro biomarkers for pediatric mood disorders, executive functioning, and adult ADHD. RESULTS: Joe Biederman left us with many concrete indicators of his contributions to child and adolescent psychiatry. He set up the world's first pediatric psychopharmacology clinic and clinical research program in child adolescent psychiatry. As a young faculty member he began a research program that led to many awards and eventual promotion to full professor at Harvard Medical School. He was for many years the most highly cited researcher in ADHD. He achieved this while maintaining a full clinical load and was widely respected for his clinical acumen. CONCLUSION: The world is a better place because Joe Biederman was here.

Polygenic Variation Underlying Educational Attainment and Attention-Deficit/Hyperactivity Disorder Indexes Behavior Ratings of Executive Functions in Child Psychiatry Outpatients.

OBJECTIVE: We leveraged common genetic variation underlying ADHD, educational attainment (EA) and cognition (COG) to understand the nature of the Behavior Rating Inventory for Executive Functions (BRIEF) and its relationship to academic functioning. METHOD: Participants were 991 youth, ages 7 to 17, consecutively referred for neuropsychiatric evaluation. Polygenic scores (PGS) for ADHD, EA, and COG were related to the BRIEF using regression analyses. Structural equation models were used to examine the associations between the PGS, BRIEF and academic outcomes (math, reading, and special education services [EDPLAN]). RESULTS: After modeling the PGS together, only the EA and ADHD PGS significantly associated with the BRIEF. The BRIEF partially mediated the relationships between EA PGS with math and EDPLAN and fully mediated the relationship between ADHD PGS and EDPLAN. CONCLUSION: Genetic data extend evidence that the BRIEF measures a construct relevant to educational success that differs from what is indexed by cognitive testing.

[Restraint in child psychiatry]. / La contention en pédopsychiatrie.

In child psychiatry, there are significant ethical challenges when patients put themselves at risk or refuse to cooperate in their care. This article illustrates two situations of violence and restraints and looks at how the vulnerability of caregivers can be acknowledged in order to find the best balance between the imperatives of protection and the respect of young inpatients in child psychiatry.

Addressing the Gap in Research Training in Child Psychiatry and Neurodevelopment.

Psychiatric and neurodevelopmental conditions in children are common, often co-occur, and can be highly impairing. Moreover, psychiatric disorders that typically do not fully manifest until adulthood, such as schizophrenia, have their roots in early development, with atypical brain and behavioral patterns arising well before a clinical diagnosis is made. The relevance of brain development to improving outcomes of psychiatric and neurodevelopmental conditions underscores the need to cultivate a pipeline of investigators with the necessary training to conduct rigorous, developmentally focused research.

[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.

Remodeling Broken Systems: Addressing the National Emergency in Child and Adolescent Mental Health.

A national emergency in child and adolescent mental health was declared in the United States in 2021 in the wake of the COVID-19 pandemic. This Open Forum discusses potential solutions to better support child and adolescent mental health by improving or expanding school-based mental health services, child psychiatry access programs, virtual mental health services, and new models of care (e.g., integrated youth services hubs and crisis stabilization units). The success of such programs is dependent on stable funding, strong leadership and accountability, robust and well-trained workforces, systems integration, and attention to health equity.

AACAP's Strategic Plans to Enhance the Diversity of the Child Psychiatry and Child Mental Health Workforce Across all Mission Areas.

The American Academy of Child and Adolescent Psychiatry (AACAP) promotes the healthy development of children, adolescents, and families through advocacy, education, and research. This requires effectively meeting the mental health needs of historically minoritized communities. A diverse clinician workforce is an essential component of meeting those needs. This article will discuss AACAP's strategic plan for diversifying the workforce, this will be done with 3 main points: promoting diversity, equity, and inclusion (DEI) across all mission area, creating a pipeline of child and adolescent psychiatrists, and monitoring DEI activities and progress on an organizational level.

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.

[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.

AI in Child Psychiatry: Exploring Future Tools for the Detection and Management of Mental Disorders in Children and Adolescents.

This article explores the potential of artificial intelligence (AI) in the field of child psychiatry, focusing on screening, detection, diagnosis, therapeutic tools, and research development. In this non-exhaustive review, we will examine the interest of AI applications in intervention contexts such as parent education tools, emotion regulation tools, and cognitive-behavioral therapy tools through interactive applications. The network approach, a branch of machine learning, will also be considered. Some examples of machine learning applications in child psychiatry will be presented. Finally, we address the ethical question of the role of these applications, analyzing whether they represent a real beneficial tool or a potential danger.

Expanding Psychiatric Treatment in Primary Care Settings: Improved Care Through the Wisconsin Child Psychiatry Consultation Program.

The national shortage of child psychiatrists has resulted in the necessity of primary care providers (PCPs) managing increased mental health concerns of youth. The Wisconsin Child Psychiatry Consultation Program (WI CPCP) is one of several programs throughout the United States which provide PCPs with education, consultation, and resource support related to pediatric mental health. To evaluate initial impact of the program, data from 190 pediatricians and family practitioners from the Wisconsin Health Information Organization (WHIO) were analyzed. Enrollment in the WI CPCP was associated with a significant increase in rates of mental health diagnoses within primary care visits. In addition, the number of providers who made any mental health diagnosis increased from 56% of PCPs pre-enrollment to over 99% post-enrollment. These data provide additional support for pediatric psychiatry consultation programs within primary care.

Efectos de la educación emocional en el duelo por la pérdida de un ser querido en la infancia y la adolescencia: una revisión sistemática guiada por las directrices PRISMA / Effects of grief education programs in children and adolescents facing the loss of a loved one: a prisma-driven systematic review

Introducción: Diferentes estudios surgidos desde el año 2020 indican que 5,2 millones de niños y niñas han perdido al menos un progenitor o cuidador como consecuencia de la pandemia de COVID-19. Estos datos ponen de manifiesto la importancia de educar en el duelo a los niños y adolescentes y protegerlos de posibles complicaciones en la elaboración del duelo.Objetivo: Analizar si hasta el momento se han realizado investigaciones que avalúen los efectos de los programas de educación emocional en la elaboración del duelo por la pérdida de un ser querido.Método: Se ha realizado una revisión sistemática siguiendo las directrices PRISMA que ha permitido identificar 8 estudios localizados en las bases de datos PsycInfo, Pubmed, ERIC y Dialnet que cumplían con los criterios de inclusión. Resultados y conclusiones: Los resultados indican que la educación emocional sí influye en la relación que los niños y adolescentes establecen con el duelo, la pérdida y la muerte. Asimismo, la falta de claridad en algunos resultados y el uso de instrumentos no específicos para avaluar el duelo, hace que estos deban ser valorados con precaución y hace aconsejable más investigación que supere las limitaciones de la actual.(AU)

Introduction: Several studies published since 2020 claim that about 5.2 million children have lost at least one parent or parental figure to COVID-19. These data support the importance of grief psychoeducation with children and adolescents as this may be an effective intervention to protect them from eventual complications, such as prolonged grief disorder, posttraumatic stress disorder, or others. Aim: To analyse whether research has been conducted up to date on the effects of grief psychoeducation or emotional education programs on grief processes following the death of a parent or another loved one in children and adolescents. Materials and Methods: A PRISMA-driven systematic review has been carried out using databases PsycInfo, Pubmed, ERIC and Dialnet. 8 studies meeting all inclusion criteria have been identified and analysed.Results and conclusions: Results suggest that emotional education significantly impacts grieving processes in children and adolescents, besides shaping their relationships with bereavement, loss and death. Nonetheless, some of the located study results lack clarity and many studies did not use specific instruments to evaluate grief. This calls for prudence when interpreting positive results and encourages future research that hopefully overcomes limitations identified in previous studies.(AU)

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.

Trastornos de tics e impulso premonitorio: validación de la versión espñola de la «Escala para el Impulso Premonitorio al Tic» en niños y adolescentes / Tic disorders and premonitory urges: validation of the Spanish-language version of the Premonitory Urge for Tics Scale in children and adolescents

Introducción: La mayoría de personas con tics persistentes refiere notar una sensación des-agradable (impulso premonitorio) antes de sufrir un tic. En los últimos a ̃nos, el interés haciaestos fenómenos sensoriales ha aumentado debido al importante papel que tienen en la terapiade conducta. Sin embargo, los instrumentos para evaluarlos aún son escasos. Entre ellos, laEscala para el Impulso Premonitorio al Tic (Premonitory Urge for Tics Scale, PUTS) es el másutilizado. Métodos: Examinamos las propiedades psicométricas y la estructura factorial de la versiónespa ̃nola de la PUTS en una muestra de 72 ni ̃nos y adolescentes con síndrome de Tourette otrastorno de tics persistentes. Analizamos los datos para el total de la muestra y por grupos deedad (ni ̃nos hasta los 10 a ̃nos y mayores de 10 a ̃nos). Resultados: La PUTS obtuvo una buena consistencia interna y correlaciones moderadas entreítems de la escala (excepto en el ítem uno). Se encontró una buena validez divergente, unaadecuada fiabilidad test-retest y una estructura bifactorial (con una dimensión de fenómenosmentales relacionados con el trastorno obsesivo-compulsivo y otra sobre las cualidades y fre-cuencia de los impulsos premonitorios). Estos resultados se replicaron para ambos grupos deedad, excepto la validez divergente y la fiabilidad test-retest que fueron inferiores en el grupode menor edad.(AU)

Introduction: Most people with persistent tics report an unpleasant sensation (premonitoryurge) before the tic. In recent years, interest in these sensory phenomena has increased due totheir important role in behavioural therapy. However, instruments for assessing these sensationsremain scarce. Among the available instruments, the Premonitory Urge for Tics Scale (PUTS) isthe most widely used. Methods: We examined the psychometric properties and factor structure of the Spanish-language version of the PUTS in a sample of 72 children and adolescents with Tourette syndromeor persistent tic disorders. We analysed data from the total sample and by age group (childrenup to 10 years old and children/adolescents over 10). Results: The PUTS presented good internal consistency and moderate correlations betweenitems on the scale (except for item one). Divergent validity was good, test-retest reliabilitywas adequate, and a bifactorial structure was identified (one dimension related to mentalphenomena reported in obsessive-compulsive disorder, and another related to the quality andfrequency of premonitory urges). These results were replicated in both age groups, with lowerdivergent validity and test-retest reliability in the younger group.Conclusions: The Spanish-language version of the PUTS is a valid, reliable tool for assessingpremonitory urges in both children and adolescents, especially after the age of 10.(AU)

[Photographing to advance, the use of photography in psychotherapy]. / Photographier pour avancer, l'utilisation de la photographie en psychothérapie.

The practice of the clinical psychologist in child psychiatry can be a perilous task. His balance, as precarious as it may be, lies in listening to and observing the patient, but also in the use of precious tools of which therapeutic mediations are a part. They allow to experiment a sensory-motor anchorage and bring a multidimensional vision necessary to the comprehension of the subject and his suffering. By creating an intermediary space between the I and the You, the outside and the inside, they determine a place where the psychotherapeutic work can take place.