Use of Mobile and Wearable Artificial Intelligence in Child and Adolescent Psychiatry: Scoping Review.

BACKGROUND: Mental health disorders are a leading cause of medical disabilities across an individual's lifespan. This burden is particularly substantial in children and adolescents because of challenges in diagnosis and the lack of precision medicine approaches. However, the widespread adoption of wearable devices (eg, smart watches) that are conducive for artificial intelligence applications to remotely diagnose and manage psychiatric disorders in children and adolescents is promising. OBJECTIVE: This study aims to conduct a scoping review to study, characterize, and identify areas of innovations with wearable devices that can augment current in-person physician assessments to individualize diagnosis and management of psychiatric disorders in child and adolescent psychiatry. METHODS: This scoping review used information from the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. A comprehensive search of several databases from 2011 to June 25, 2021, limited to the English language and excluding animal studies, was conducted. The databases included Ovid MEDLINE and Epub ahead of print, in-process and other nonindexed citations, and daily; Ovid Embase; Ovid Cochrane Central Register of Controlled Trials; Ovid Cochrane Database of Systematic Reviews; Web of Science; and Scopus. RESULTS: The initial search yielded 344 articles, from which 19 (5.5%) articles were left on the final source list for this scoping review. Articles were divided into three main groups as follows: studies with the main focus on autism spectrum disorder, attention-deficit/hyperactivity disorder, and internalizing disorders such as anxiety disorders. Most of the studies used either cardio-fitness chest straps with electrocardiogram sensors or wrist-worn biosensors, such as watches by Fitbit. Both allowed passive data collection of the physiological signals. CONCLUSIONS: Our scoping review found a large heterogeneity of methods and findings in artificial intelligence studies in child psychiatry. Overall, the largest gap identified in this scoping review is the lack of randomized controlled trials, as most studies available were pilot studies and feasibility trials.

The Hawai'i Child and Adolescent Psychiatry Resources for Primary Care: An Evidence-Informed Tool to Improve Quality of Care.

Mental health continues to be a significant concern both globally and locally in Hawai'i, with nearly half of all mental illness beginning in childhood or adolescence. A shortage of mental health providers has led to less than a third of patients receiving appropriate and timely care. Primary care providers are often the first-line responders to untreated mental health conditions, but they are often underprepared to address these conditions. To help provide guidance to primary care providers and other first-line responders, a child and adolescent mental health resource manual was developed, that is tailored to Hawai'i. This manual was presented at several pediatric didactic sessions and general conferences to describe its evolution, utility, to elicit feedback, as well as for an initial distribution. While feedback was overall positive, future manual development and strategic updates will be made to insure its suitability and timeliness, while continuing circulation efforts to primary care providers will ultimately benefit a greater proportion of children in need.

Item Response Theory Analysis of the Anxiety and Mood Disorders in Clinic-Referred Children.

There is evidence that the major anxiety and depressive disorders could reflect a single underlying internalization factor. For a group of 1,031 clinic-referred children, the study examined support for this factor, and used the two-parameter logistic model to examine the item response theory properties of the disorders in this factor. For the set of anxiety and depressive disorders, confirmatory factor analysis supported a one-factor model. The two-parameter logistic model analysis indicated that all the internalizing disorders in this factor were strong discriminators of the internalizing dimension. Also, they measured more of the internalizing dimension and with more precision in the upper half of the trait continuum. There was also support for the convergent validity of the internalizing dimension, in that it had large-to-medium effect size correlations with internalizing scores of other measures. The implications of the findings for clinical practice and clinical classification are discussed.

Intervenciones psicoterapéuticas con el entorno de niños con problemas psiquiátricos graves desde un centro de día / Psychotherapeutic interventions with the environment of children with serious mental problems from a day care centre

A través de esta exposición y valiéndome de un caso clínico, me gustaría acercar el trabajo realizado con el entorno familiar de niños con problemas psiquiátricos graves en un centro terapéutico-educativo (AU)

Through this exhibition and availing myself of a clinical case, I would bring the work done with the family environment of children with serious psychiatric problems in a therapeutic-educational center (AU)

Harnessing innovative technologies to advance children's mental health: behavioral parent training as an example.

Disruptive behaviors of childhood are among the most common reasons for referral of children to mental health professionals. Behavioral parent training (BPT) is the most efficacious intervention for these problem behaviors, yet BPT is substantially underutilized beyond university research and clinic settings. With the aim of addressing this research-to-practice gap, this article highlights the considerable, but largely unrealized, potential for technology to overcome the two most pressing challenges hindering the diffusion of BPT: (1). The dearth of BPT training and supervision opportunities for therapists who work with families of children with disruptive behaviors; and (2). The failure to engage and retain families in BPT services when services are available. To this end, this review presents a theoretical framework to guide technological innovations in BPT and highlights examples of how technology is currently being harnessed to overcome these challenges. This review also discusses recommendations for using technology as a delivery vehicle to further advance the field of BPT and the potential implications of technological innovations in BPT for other areas of children's mental health are discussed.

Annual research review: re-thinking the classification of autism spectrum disorders.

BACKGROUND: The nosology of autism spectrum disorders (ASD) is at a critical point in history as the field seeks to better define dimensions of social-communication deficits and restricted/repetitive behaviors on an individual level for both clinical and neurobiological purposes. These different dimensions also suggest an increasing need for quantitative measures that accurately map their differences, independent of developmental factors such as age, language level and IQ. METHOD: Psychometric measures, clinical observation as well as genetic, neurobiological and physiological research from toddlers, children and adults with ASD are reviewed. RESULTS: The question of how to conceptualize ASDs along dimensions versus categories is discussed within the nosology of autism and the proposed changes to the DSM-5 and ICD-11. Differences across development are incorporated into the new classification frameworks. CONCLUSIONS: It is crucial to balance the needs of clinical practice in ASD diagnostic systems, with neurobiologically based theories that address the associations between social-communication and restricted/repetitive dimensions in individuals. Clarifying terminology, improving description of the core features of ASD and other dimensions that interact with them and providing more valid and reliable ways to quantify them, both for research and clinical purposes, will move forward both practice and science.

Annual research review: embracing not erasing contextual variability in children's behavior--theory and utility in the selection and use of methods and informants in developmental psychopathology.

This paper examines the selection and use of multiple methods and informants for the assessment of disruptive behavior syndromes and attention deficit/hyperactivity disorder, providing a critical discussion of (a) the bidirectional linkages between theoretical models of childhood psychopathology and current assessment techniques; and (b) current knowledge concerning the utility of different methods and informants for key clinical goals. There is growing recognition that children's behavior varies meaningfully across situations, and evidence indicates that these differences, in combination with informants' unique perspectives, are at least partly responsible for inter-rater discrepancies in reports of symptomatology. Such data suggest that we should embrace this contextual variability as clinically meaningful information, moving away from models of psychopathology as generalized traits that manifest uniformly across situations and settings, and toward theoretical conceptualizations that explicitly incorporate contextual features, such as considering clinical syndromes identified by different informants to be discrete phenomena. We highlight different approaches to measurement that embrace contextual variability in children's behavior and describe how the use of such tools and techniques may yield significant gains clinically (e.g., for treatment planning and monitoring). The continued development of a variety of feasible, contextually sensitive methods for assessing children's behavior will allow us to determine further the validity of incorporating contextual features into models of developmental psychopathology and nosological frameworks.

Annual research review: conceptualising functional impairment in children and adolescents.

Functional impairment is a key factor in the clinical importance of mental health problems in children. Yet, the nature of impairment and criteria for defining and assessing impairment in childhood disorders has been surprisingly overlooked in much of the literature. The current article examines the extant literature on the conceptualisation, nature and assessment of impairment in childhood disorders. Relations between diagnostic symptoms and functional impairment are discussed together with the influence of impairment on diagnostic decisions and prevalence rates. Several factors influencing impairment in childhood such as culture, development and gender are considered. This article concludes with a discussion of the utility of separating judgements of impairment from specific diagnoses, which is proposed for consideration in the forthcoming DSM-5.

Should the diagnosis of autism be made only on the basis of a standardized test?

This commentary argues that a standardized tool such as Autism Diagnostic Observation Schedule (ADOS) is not always required to make the diagnosis of autism, which can be made by obtaining a thorough history and performing an astute clinical examination as William Osler, founder of John Hopkins School of Medicine, taught or Dr. Leo Kanner practiced.

Combining information from multiple sources for the diagnosis of autism spectrum disorders for toddlers and young preschoolers from 12 to 47 months of age.

BACKGROUND: Purpose of this study was to systematically examine combined use of the Autism Diagnostic Interview-Revised (ADI-R) and Autism Diagnostic Observation Schedule (ADOS) for children under age 4 using newly developed and revised diagnostic algorithms. METHODS: Single and combined use of the ADI-R and ADOS algorithms were compared to clinical best estimate diagnoses for 435 children with autism spectrum disorders (ASD), 113 children with nonspectrum disorders, and 47 children with typical development from 12 to 47 months of age. Sequential strategies to reach a diagnostic decision by prioritizing administrations of instruments were also evaluated. RESULTS: Well-balanced sensitivities and specificities above 80% were obtained for ASD diagnoses using both instruments. Specificities significantly improved when both instruments were used compared to one. Scores that can be used to systematically prioritize administrations of instruments were identified. CONCLUSIONS: The ADI-R and ADOS make independent, additive contributions to more accurate diagnostic decisions for clinicians evaluating toddlers and young preschoolers with ASD. Sequential assessment strategies using the scores identified may be appropriate for some children.

Therapeutic uses of the WebCam in child psychiatry.

OBJECTIVE: The authors provide examples for the use of the WebCam as a therapeutic tool in child psychiatry, discussing cases to demonstrate the application of the WebCam, which is most often used in psychiatry training programs during resident supervision and for case presentations. METHOD: Six cases illustrate the use of the WebCam in individual and family therapy. RESULTS: The WebCam, used during individual sessions, can facilitate the development of prosocial skills. Comparing individual WebCam video sessions can help to evaluate the effectiveness of medication and progress in therapy. CONCLUSION: The WebCam has proven to be useful in psycho-education, facilitating communication, and treating children and families. The applications of this technology may include cognitive-behavioral therapy, dialectical-behavioral, and group therapy.

Prevalencia de síntomas obsesivo-compulsivos en los niños con trastornos del espectro autista / Obsessive-compulsive symptoms in children with autistic disorders

La presencia de síntomas obsesivo-compulsivos en los niños con trastornos del espectro autista parece elevada. Dado que estos pacientes podrían beneficiarse con el tratamiento convencional del trastorno obsesivo-compulsivo, se requiere un importante índice de presunción para la detección de esta comorbilidad.

[Quality of life measurement in child-psychiatry]. / Meten van kwaliteit van leven in de kinderpsychiatrie.

BACKGROUND: Quality of life (QoL) has become an important outcome measure in health care, including in child psychiatry. AIM: To formulate assessment criteria with regard to instruments that are designed to measure QoL in children. METHOD: Literature search, using five key electronic databases. results When selecting an instrument, one has to consider the following aspects: its validity and reliability, the relative dimensions of QoL, its suitability for use with both the child and its parents and its cross-cultural applicability. A number of instruments were found to meet these criteria. CONCLUSION: The Child Quality of Life Questionnaire, the Revidierter Kinder Lebensqualit"atsfragebogen, the tno-azl Children's Quality of Life questionnaire, the Pediatric Quality of Life Inventory, the Child Health Questionnaire and in particular the kidscreen show to be suitable instruments for assessing QoL in children.

An Icelandic version of the Kiddie-SADS-PL: translation, cross-cultural adaptation and inter-rater reliability.

The development of structured diagnostic instruments has been an important step for research in child and adolescent psychiatry, but the adequacy of a diagnostic instrument in a given culture does not guarantee its reliability or validity in another population. The objective of the study was to describe the process of cross-cultural adaptation into Icelandic of the Schedule for Affective Disorders and Schizophrenia for School-Age Children-Present and Lifetime Version (Kiddie-SADS-PL) and to test the inter-rater reliability of the adapted version. To attain cross-cultural equivalency, five important dimensions were addressed: semantic, technical, content, criterion and conceptual. The adapted Icelandic version was introduced into an inpatient clinical setting, and inter-rater reliability was estimated both at the symptom and diagnoses level, for the most frequent diagnostic categories in both international diagnostic classification systems (DSM-IV and ICD-10). The cross-cultural adaptation has provided an Icelandic version allowing similar understanding among different raters and has achieved acceptable cross-cultural equivalence. This initial study confirmed the quality of the translation and adaptation of Kiddie-SADS-PL and constitutes the first step of a larger validation study of the Icelandic version of the instrument.

The Rorschach Ego Impairment Index: prediction of treatment outcome in a child psychiatric population.

In this study, we investigated the treatment utility of the revision of Perry and Viglione's (1991) Rorschach Ego Impairment Index (EII-2) in a sample of 53 child psychiatric inpatients. Parent ratings of symptomatic functioning on the Devereux Scales of Mental Disorders (DSMD; Naglieri, LeBuffe, & Pfeiffer, 1994) were obtained at admission, 30 days postdischarge, and 120 days postdischarge. EII-2 scores correlated with initial symptom elevations on the Critical Pathology at admission. EII-2 scores did not predict short-term response to treatment. However, EII-2 scores demonstrated moderate correlations with long-term outcome and relapse. EII-2 was related to prediction of worsening of symptoms between 30-day and 120-day follow-up as measured by Reliable Change Index scores that were computed for the Externalizing, Internalizing, Critical Pathology, and Total DSMD scales.

Prediction of adolescent and adult delinquency from childhood Rorschach ratings.

Relatively few studies have predicted adolescent or adult delinquency from childhood Rorschach data. Incremental validity of Rorschach measures over other known consistent and more easily obtained predictors has typically not been investigated. We addressed Rorschach data's incremental validity over mother's reports of externalizing behavior and mother-child relations for predicting officially registered adolescent and adult delinquency in a longitudinal study of 122 Swedish men. The Rorschach measures we used were aggregates of blind, prospectively performed, global expert ratings based on a holistic evaluation of protocols. An aggregate of Rorschach-based ratings of ego strength significantly improved the prediction of delinquency in adolescence and adulthood over and above earlier identified best predictors (mother's ratings of mother-child relations and externalizing problem behavior).