A Scoping Review of the Intersectionality of Autism and Intellectual and Developmental Disability with Social Inequity on Diagnosis and Treatment of Youth.

Objective: To describe how the intersectionality of race, ethnicity, and language with autism and intellectual and developmental disability (IDD) impacts mental health inequities in psychopharmacological management of youth. Method: This was a scoping review in which a series of searches were conducted in PubMed, Web of Science, Google Scholar, and manual review of the articles collected. Results: Although autism and/or IDD increases the risk for poor physical and mental health, social determinants of health such as race, ethnicity, and language account for approximately a third of poor outcomes. Minoritized children with autism/IDD experience significantly greater delays to diagnosis and misdiagnosis and are less likely to receive appropriate services. Access to psychological testing and psychosocial services is often limited by availability, skilled practitioners, a shortage of non-English-language providers or interpreters, and poor reimbursement. Conclusion: The intersectionality of autism and/or IDD with race, ethnicity, and language compounds the health inequities associated with either of these challenges independently.

Dynamic Gender Identities and Expressions: Detransition and Affirming Non-linear Gender Pathways Among Transgender and Gender Diverse Youth.

For some transgender and gender diverse (TGD) youth, exploration of gender identity and expression may be non-linear. Some TGD youth elect to detransition, broadly defined as the cessation or reversal of an already-initiated social and/or medical gender affirmation process. Youths' experiences with detransition appear to be highly heterogeneous, and rates of detransition appear to be quite low. Nevertheless, it is essential that providers facilitate non-judgmental, open-ended discussions about the possibilities of gender identity and gender expression evolution, with a focus on how clinicians will support young people and their families regardless of how their gender trajectory may evolve.

Sexual Health in Child and Adolescent Psychiatry: Multi-Site Implementation Through Synchronized Videoconferencing of an Educational Resource Using Standardized Patients.

Objective: Matters of sexuality and sexual health are common in the practice of child and adolescent psychiatry (CAP), yet clinicians can feel ill-equipped to address them with confidence. To address this gap in training and practice, we developed, implemented, and evaluated an educational module enhanced by videotaped depictions of expert clinicians interacting with professional actors performing as standardized patients (SPs). Methods: We developed an educational resource highlighting common issues of sexual health relevant to CAP practice, including sexual development, psychotropic-related side effects, and sexuality in children with autism. We wrote original scripts, based on which two clinicians interacted with three SPs. Digital recordings were edited to yield 5 clips with a cumulative running time of 20 min. The clips were interspersed during a 90-min session comprising didactic and interactive components. Due to the COVID-19 pandemic, we used synchronous videoconferencing, which allowed content dissemination to several training programs across the country. Results: We recruited 125 learners from 16 CAP training programs through the American Academy of CAP's Alliance for Learning and Innovation (AALI). Routine inquiry into adolescent patients' sexual function was uncommon, reported by only 28% of participants, with "awkward" and "uncomfortable" the most common terms mentioned in reference to the clinical task. The didactic intervention led to measurable improvements after 2 weeks in skills and knowledge (p = 0.004) and in attitudes (p < 0.001). The three items with the greatest improvement were: (a) availability of developmentally tailored resources; (b) comfort in addressing sexual development with underage patients; and (c) with parents or guardians of neuroatypical or developmentally disabled patients (p < 0.001 for each). Conclusions: A sexual health curriculum enriched by video-based examples can lead to measurable improvement in outcomes pertinent to the clinical practice of CAP. These educational materials are available for distribution, use and adaptation by local instructors. Our study also provides proof-of-principle for the use of multisite educational initiatives in CAP through synchronized videoconferencing.

Community attitudes on genetic research of gender identity, sexual orientation, and mental health.

Sex is an important factor in mental health, and a non-binary view of how variation in sex and gender influence mental health represents a new research frontier that may yield new insights. The recent acceleration of research into sexual orientation, gender identity, and mental health has generally been conducted without sufficient understanding of the opinions of sexual and gender minorities (SGM) toward this research. We surveyed 768 individuals, with an enrichment of LGBTQ+ stakeholders, for their opinions regarding genetic research of SGM and mental health. We found that the key predictors of attitudes toward genetic research specifically on SGM are 1) general attitudes toward genetic and mental health research 2) tolerance of SGM and associated behaviors and 3) age of the participant. Non-heterosexual stakeholder status was significantly associated with increased willingness to participate in genetic research if a biological basis for gender identity were discovered. We also found that heterosexual, cisgender participants with a low tolerance for SGM indicated their SGM views would be positively updated if science showed a biological basis for their behaviors and identities. These findings represent an important first step in understanding and engaging the LGBTQ+ stakeholder community in the context of genetic research.

Identity, Conformity, and Nonconformity: A Closer Look.

As clinicians, we have been vigilant to screen for underlying psychopathology in children and adolescents who meet criteria for gender dysphoria (GD) based on the risk these individuals have for developing externalizing and/or internalizing disorders, likely driven by a stigmatizing society. However, we have not paid careful attention to an often overlooked population, namely gender-nonconforming (GNC) children-especially those in community samples-who do not meet criteria for GD per se but who, according to the well-done and thought-provoking study featured in this issue, van der Miesen et al.'s "Behavioral and Emotional Problems in Gender-Nonconforming Children: A Canadian Community-Based Study,"1 appear to share some similar psychiatric vulnerabilities as their peers with GD, with some unique features noted for natal boys versus natal girls. The few studies that have looked at this group of children have relied on clinical samples, which complicates whether the increased rates of psychopathology are in fact due to GNC-related factors versus inherently higher rates of psychopathology in clinical samples. Because of this, previous studies using clinical samples might overestimate the rates of psychopathology in GNC youths. Van der Miesen et al. smartly attempted to avoid that bias by drawing participants from the community and by excluding participants with any previous mental health diagnoses, including GD.1 This study is a refreshing shift, delving into community samples and using a validated measure, the Gender Identity Questionnaire for Children (GIQC), thus allowing comparisons to be made with prior clinical samples.

Longitudinal outcomes for victims of child abuse.

Childhood abuse and neglect (child maltreatment) represent a common and significant public health burden. The consequences of maltreatment can be seen immediately, in the short term and in the long term. Determination of the exact prevalence of childhood maltreatment is difficult, as many cases go unreported; however in reported cases there is an estimated $124 billion annual burden on the US health-care system. The evaluation of potential maltreatment is difficult as many of the initial symptoms are subtle and can be explained with alternative illnesses or injuries. Potential immediate and short-term effects include brain injury, shaken baby syndrome and behavioral regression. The potential long-term sequelae of child maltreatment are explored in detail here and include increased risks of the development of mental health disorders, substance use disorders and chronic physical complaints during development and adulthood. Lastly, the review provides an overview of current treatment approaches for victims of childhood maltreatment.

Depression and Anxiety Symptoms in Children and Adolescents with Autism Spectrum Disorders without Intellectual Disability.

Recent studies have shown that rates of depression and anxiety symptoms are elevated among individuals with autism spectrum disorders (ASDs) of various ages and IQs and that depression/anxiety symptoms are associated with higher IQ and fewer ASD symptoms. In this study which examined correlates of depression and anxiety symptoms in the full school-age range of children and adolescents (age 6-18) with ASDs and IQs ≥ 70 (n=95), we also observed elevated rates of depression/anxiety symptoms, but we did not find higher IQ or fewer ASD symptoms among individuals with ASDs and depression or anxiety symptoms. These findings indicate an increased risk for depression/anxiety symptoms in children and adolescents with ASDs without intellectual disability, regardless of age, IQ, or ASD symptoms.

Juvenile maladaptive aggression: a review of prevention, treatment, and service configuration and a proposed research agenda.

OBJECTIVE: To review prevention programs, psychosocial and psychopharmacologic treatments, and service delivery configurations for children and adolescents with maladaptive aggression. To propose a research agenda for disorders of aggression in child and adolescent psychiatry. DATA SOURCES: Recent empirical studies were reviewed using searches of MEDLINE and PsycINFO (text terms: aggression, antisocial, violence, conduct, oppositional, psychosocial treatment, psychopharmacology, and prevention), relevant books, review articles, and bibliographies. DATA EXTRACTION: Articles met the following criteria: published in an English-language, peer-reviewed journal between 1980 and 2005, included a focus on individuals < 18 years old, and included an outcome measure of relevant significance. STUDY SELECTION: Results of 154 randomized, controlled psychosocial treatment trials, 20 controlled psychopharmacology studies, 4 open-label medication studies, and 2 psychopharmacology meta-analyses were reviewed. RESULTS: Prevention programs show promise for reducing future aggression in at-risk populations. Empirical support is available for the effectiveness of multifocused psychosocial treatments in reducing aggression in children and adolescents. Atypical antipsychotics, lithium, divalproex sodium, and stimulants for conduct problems associated with attention-deficit/hyperactivity disorder have empirical support for reducing aggression in selected patient populations. CONCLUSIONS: Therapeutic nihilism in the treatment of aggressive children and adolescents with conduct problems is no longer warranted. Multifocused psychosocial interventions given early in life to at-risk children have the most support for effectiveness. However, treatments for children who routinely present to the child psychiatrist with already well-established disorders of aggression are neither robust nor well-established. Further research into maladaptive aggression in referred children and adolescents within and across psychiatric diagnoses is important for the field of child and adolescent psychiatry.