Clinical Child Psychology and Psychiatry

Embracing complexity, fostering innovation
Christie D
The cost of poverty for child development: The adverse impact on maltreatment, education and mental health outcomes cannot be ignored
Skinner GCM and Kennedy E
This commentary explores the 'cost of poverty' for child development, with particular reference to the current UK context. Specifically, it comments on the adverse impacts of poverty on child mental health, education, and maltreatment.
Psychosocial screening, in-patient care, and disposition planning: Clinicians' perspectives
Chong A, Virk P and Doan Q
Our objective was to explore clinicians' views on the MyHEARTSMAP screening report; whether this report has impacted their patient care, and if so, how. MyHEARTSMAP is a psychosocial self-screening tool for youth to identify mental health concerns.
Cumulative interpersonal risk and suicide ideation/attempts among Chinese early adolescents: Does self-esteem play a moderating role?
Zhao J, Wang Y and Wang X
Suicide among adolescents is a serious global health concern. Previous research has highlighted that interpersonal factors are vital determinants of suicidality. However, little is known about the cumulative effects of interpersonal risks and the protective factors that buffer individuals from developing suicidal tendencies. The present study examined whether linear or nonlinear models best account for the relationship between cumulative interpersonal risk and suicidal ideation and attempts among early adolescents and the protective value of self-esteem in these associations.
Assessment of anxiety symptoms in children and adolescents: Italian validation of the short version of the spence children's anxiety scale for parents
De Caro EF, Delvecchio E, Garofalo C and Mazzeschi C
The assessment of anxiety symptoms in children and adolescents requires a valid and reliable single instrument able to detect various anxiety symptoms early and systematically collect data from other informant such as parents. The present study aimed to test the one-factor structure of the SCAS-P-8 and to examine its psychometric properties and invariance across sex and age in an Italian sample of 769 parents of children and adolescents aged 3-18 years (50.8% females). Confirmatory factor analysis confirmed the one-factor structure of the SCAS-P-8, which showed good reliability and invariance by sex and age. When examining mean differences by sex and age, results showed that female schoolchildren had higher anxiety scores than males and other age groups. A strong correlation with emotional problems demonstrated convergent validity, while discriminant validity resulted from the weak correlations with externalizing symptoms and relationship problems with peers. Overall, findings support the SCAS-P-8 as a valid brief instrument to assess anxiety symptoms in children and adolescents for clinical and research purposes and demonstrate its invariance across sex and age.
Letter to the editor: Eating disorder symptoms among transgender and gender diverse youth seeking gender-affirming care
Stratulat D
Response to a letter to the editor about eating disorder (ED) symptoms among transgender and gender diverse (TGD) youth seeking gender-affirming care
Kramer R, Matthews AL, Conard LA, Lenz KR and Aarnio-Peterson CM
The association of personal, parental, school and community factors with depressive symptoms among a sample of Colombian students of ages 9 to 12 years
Lipps G, Lowe GA, Gibson RC, Fonseca L and Romero-Acosta K
Few studies have examined how the personal characteristics of students, together with factors from their local social environments and communities, affect students living in generally high levels of social disruption. We examined the influence that personal characteristics as well as factors from the local social environments and communities may have on Colombian students' levels of depressive symptoms shortly after the end of the of armed conflict. Data were collected from 710 students attending the fifth grade in a random sample of elementary schools in the province of Sucre in Colombia. Information was gathered on the students' ages and gender as well as characteristics of their parents, school factors, and community factors. A five-level hierarchical regression model was used to determine the extent to which all these variables predicted depression scores, as measured by the Adolescent Depression Rating Scale. While personal, parental, school and community factors were all found to predict depression scores, the category, parental factors had the most impact. That was followed by school factors, community factors and finally personal characteristics. Multiple social and environmental factors were associated with the level of depression experienced by Colombian students.
"Breaking the news"-post-autism spectrum disorder diagnosis group intervention for parents to 6-18-year-old children
Gindi S, Ben Shabbat-Seri M, Nagar-Shimoni H, Gilat I and Leitner Y
This study evaluated the effectiveness of a 3-session group intervention for parents who had received a diagnosis of autism for their child within the past month. The intervention group ( = 41) was compared to Treatment-as-Usual ( = 40): one meeting with a social worker after the diagnosis feedback meeting. Parental stress was evaluated in both groups within a week and then a month after the diagnosis. The findings indicate an increase in the experienced parental stress for the comparison group on all six indices, while in the intervention group there was an increase only on two indices. That is to say, the intervention reduced stress that occurred in the first month after the diagnosis. Further analyses revealed that parent satisfaction with the group intervention was the single most important variable in predicting stress reduction. We argue that parent support groups immediately after their child's diagnosis are effective and important, and probably superior to a single post-diagnosis meeting.
Mental health and resilience in young people on Saint Helena Island
Murphy TL and Nixon E
This study explored the mental health needs and strengths of young people (aged 11-18 years) living on the remote island of Saint Helena (SH). 24 young people and their carers completed standardised inventories assessing mental health and resilience, of whom 15 of the young people and their carers participated in semi-structured interviews enquiring into mental health awareness, contributing factors to young people's mental health and resilience, as well as experience with local mental health services. Descriptive data were reported based on the quantitative measures and thematic analysis was applied to the interview transcripts. A number of young people were found to meet criteria for mental health problems while they showed high levels of resilience. The themes derived from young people's interviews were broadly centred around mental health boosters, including personal successes, social interactions, engagement in pleasurable activities and use of anxiety management strategies; and around limitations of living in SH in terms of limited resources and difficulty in maintaining trust in the community. From the carers, the themes revolved around awareness of mental health needs and strengths in young people, perceived barriers to access support mainly due to apprehensions around stigma and anonymity. Recommendations for improvement of mental health provision are made.
Pediatric emergency mental health presentations during early COVID-19: Comparing virtual and in-person presentations
Stuart J, Sheridan N, Cloutier P, Reid S, Tse S, Spettigue W and Gray C
Increased mental health (MH) needs during the COVID-19 pandemic led to the implementation of a novel pediatric Emergency Department Virtual Care (EDVC) service. Our study aimed to describe the pediatric MH patient population that used EDVC by comparing patient-specific factors of those who obtained services virtually to those seen in-person. This retrospective chart review was conducted at a pediatric hospital in Eastern Ontario. Children and youth (aged 3-17) who received virtual or in-person emergency MH services from May to December 2020 were included. Patient demographics, clinical presentation details and disposition were compared between the virtual and in-person groups. Data was analyzed using descriptive statistics. 1104 youth (96.1%) utilized the in-person ED for MH concerns; 45 (3.9%) used EDVC. In-person youth had a higher level of perceived risk (78.9% vs. 41.9%) and were more likely to present with concerns of depression, suicidal ideation, self-harm, or laceration (46.1% vs. 35.6%). Anxiety/situational crises or behavioural issues were more likely to present virtually. Eight patients (17.8%) were redirected to the ED from EDVC. Several patient-specific factors varied between youth seen in-person or virtually for MH concern. Study results can assist with the design and implementation of virtual MH care platforms.
Insecure attachment styles in adolescents at risk for eating disorders
Naor-Ziv R
The present study examines insecure attachment styles in female adolescents, who are at risk for developing eating disorders. A second goal was to investigate whether attachment styles differentiate between high risk for anorexia and high risk for bulimia. A total of 150 adolescents were divided into four risk groups: High risk for anorexia, high risk for bulimia, medium risk and control group. The attachment styles were assessed using the and the . Anxiety Attachment, but not Avoidance Attachment, was found to characterize those adolescents who are at risk for ED (AN + BN), and especially for those at high-risk for BN. The present results do not support the notion of an avoidance of emotional intimacy, characterizing the avoidant attachment style of those presenting with AN. Preoccupied Attachment style was found to characterize high-risk for BN, but not high-risk for AN, while the Insecure, Fearful, and Dismissing Attachment types did not differentiate between these two high-risk groups. This study highlights the dominant attachment style in adolescents at high risk for developing ED: The Anxiety Attachment style for AN and BN, and the Preoccupied Attachment style for BN but not for AN.
Autism spectrum disorder (ASD) presentations among referrals to a child and adolescent mental health service (CAMHS) inpatient unit in Ireland
O'Connor M, Griffin C, Corrigan J, Somers C, Delaney M and Larkin F
This retrospective chart review aimed to identify the intersection between young people with Autism Spectrum Disorder (ASD)'s needs and CAMHS inpatient service needs. A retrospective chart review was conducted on all referrals to a CAMHS inpatient unit over three years ( = 352). Referrals which specified a formal diagnosis or suspected diagnosis of ASD were identified ( = 111), and basic demographic data were collected. Young people with either a formal or suspected diagnosis of ASD referred to the unit presented with a wide range of co-occurring conditions. Of these young people, 30 were admitted to the unit and only 6 of them were engaged with an ASD specialist service. Young people with diagnosed or suspected ASD were more likely to be admitted if they presented with suicidality. Males with diagnosed or suspected ASD were more likely to have a diagnosis of OCD while females with diagnosed or suspected ASD were more likely to present with eating and feeding disorders and personality development difficulties. Findings highlight the lack of a clear care pathway for young people with co-occurring autism or suspected autism and complex mental health problems.
Stories of absence: Experiences of parental and familial rejection among gender-diverse children and young people
McKay K, Kennedy E, Wright T and Young B
Previous research has demonstrated the positive associations with parental support with better mental health outcomes in gender-diverse young people. However, less is known about what happens within a family structure if an unsupportive parent or family member leaves the family unit and sees the child only on the condition that they present in a way that conforms to their birth gender. This paper will focus on the first interviews with nine families within the wider sample of 39 families in the LOGIC-Q (Longitudinal Outcomes of Gender Identity in Children - qualitative) study who reported they had experienced rejection by a parent or family member after the young person had disclosed their gender non-conformity. These families' narratives are examined through two themes: How rejection impacts visitation, and Moving past the loss of rejection. The families all spoke about how they had adapted to the loss of their family members. They described how any negative impact would have been worse had they stayed living together, or were in contact with, the rejecting family member. Here, it becomes important then to understand the context of why a gender-diverse young person may choose to no longer see a parent or family member.
Parenting a child with attention deficit hyperactivity disorder: Jordanian's perspectives
Harb EM, Obieat HDA and Hamdan-Mansour AM
Raising your child with attention deficit hyperactivity disorder (ADHD) in Jordan is a challenge due to the prevailing behavioral concerns, low availability of specialized care, and generalized feelings of social stigma. This phenomenological study involved twelve Jordanian parents of children aged 4-14 years, all diagnosed with ADHD according to DSM-IV-TR criteria. Participants were recruited through purposive sampling, and semi-structured interviews were conducted. Thematic analysis revealed three key themes: "The Journey through ADHD," in which parents recognized the abnormalities of their children, reported suffering during the diagnosis, and described a wide range of uncertainty regarding the diagnosis and treatments. The second theme was "Disease as part of life," where parents reported the impact on family dynamics and social life. The third theme was "Caregiving burden," reflecting physical and emotional exhaustion and financial burden. Jordanian parents caring for children with ADHD face several challenges, including physical, emotional, economic, and social challenges and limited access to specialized services. Identifying their unique needs and challenges is essential in supporting them, providing appropriate services and resources, and developing policies and guidelines for culturally competent quality services.
Effectiveness of technology-assisted vs face-to-face cognitive behavioural therapy for anxiety and depression in children and young people: A systematic review and meta-analysis
Bevilacqua L, Fox-Smith L, Lampard O, Rojas N, Zavitsanou G, Meiser-Stedman R and Beazley P
Cognitive Behavioural Therapy (CBT) has been proven to be effective for anxiety and depression in children and young people (CYP). Over the past 20 years there have been several attempts at delivering CBT through apps, online software, videogames, but also with a therapist via phone or videoconferencing platforms, with promising results for the "technology-assisted" versions. However, most research, have compared online CBT to waiting lists, and not many studies looked at the effectiveness of face-to-face (f2f) CBT versus technology-assisted CBT.
Hyped-up or meditate: A scoping review of mindfulness-based group interventions for adolescents with attention deficit hyperactivity disorder
Tan L and Jones M
The objective of this scoping review is to evaluate the effectiveness of mindfulness training in improving functioning in adolescents (aged 12-19 years) diagnosed with Attention Deficit Hyperactivity Disorder (ADHD). Previous research has demonstrated that psychological interventions improve functioning in a myriad of domains for individuals diagnosed with ADHD, such as attention training, interpersonal relationships, and social skills. Mindfulness-based interventions (MBI) are indicated as an intervention in attention training. It maybe argued that group based MBI programmes should begin early, for children and adolescents at a time that is critical in their development. Methods and reporting are in line with the PRISMA extension for scoping reviews, the protocol is preregistered in the (Open Science Framework register). The study outcomes included attention, impulsivity, and relationships of adolescents with ADHD. Findings demonstrated preliminary evidence for the use of group-based mindfulness interventions with adolescents continues to be nascent. Although studies reported positive results, the evidence of its effectiveness for adolescents with ADHD is inconclusive, due to limited studies available and the limitations of the study design. This scoping review provides a panorama of MBI for ADHD adolescents.
The impact of the first phase of the COVID-19 pandemic on referral patterns and therapeutic service provision for children and young people's psychosocial distress in a Low-or Middle-Income Country: A service evaluation of routinely collected data from a non-government organisation operating in schools in the Western Cape, South Africa
Wilson E, Loades ME, Human S, Coetzee B, Gericke H and Laning G
In low- and middle-income countries (LMICs), including South Africa, there is a paucity of psychosocial support services. Therefore, services are often provided in schools by non-government organisations like Community Keepers (CK). The COVID-19 pandemic and resultant restrictions meant that children and young people's (CYP) lives changed, negatively affecting their mental health. Further, organisations like CK had to change their working processes.
Cultural interpretations of nonsuicidal self-injury and suicide: Insights from around the world
Westers NJ
Examining change in the mental health of young people with epilepsy following a successful psychological intervention
Nizza IE, Smith JA, Bennett SD, Chorpita B, Cross JH, Heyman I, Moss-Morris R, Blackstone J, Coughtrey AE, Dalrymple E, Shah M, D'oelsnitz A, and Shafran R
Evaluate the cognitive, behavioural and affective processes involved in therapeutic change for young people with epilepsy and mental health difficulties receiving an integrated mental health intervention.
A hospital and community-based violence intervention program for Black & Latino youth and their caregivers
Zinny A, Cohen JA, Sell RL, Gracely E, Rich JA and Corbin TJ
Black and Latino youth are disproportionately affected by trauma from community violence, but to date, few data support the benefit of evidence-based treatments for these youth or of including peer support to engage these youth in mental health services.
The healthy habits questionnaire (HHQ): Validation of a measure designed to assess problematic influential behaviours amongst families of children living with obesity or a risk of developing obesity
Davis BÁ, O'Dwyer C, Keating A, Sharry J, Murphy E, Doran A, Nearchou F and Carr A
The 48-item Healthy Habits Questionnaire (HHQ-48) was developed to (1) monitor positive changes in family lifestyles following engagement in the Parents Plus Healthy Families (PP-HF) parent training programme and (2) be utilised as a standalone measure in clinical settings to identify and track problematic influential behaviours amongst families of children in weight-management services. This study aimed to develop and validate a brief version of the HHQ-48. The scale was administered to a cross-sectional community sample ( = 480), and on two occasions to a control sample ( = 50) and an experimental sample ( = 40) from a randomised controlled trial (RCT) of the PP-HF programme to assess test-retest reliability and sensitivity to change respectively. Exploratory and confirmatory factor analysis showed that a 23-item, 4-factor version of the HHQ (i.e., the HHQ-23) best fit the data. The scale and factor subscales had good internal consistency and test-retest reliability. They also had good concurrent and construct validity shown by significant correlations with another scale that assessed lifestyle issues, and scales that assessed parenting satisfaction, family functioning, and children's strengths and difficulties. The HHQ-23 was sensitive to change following parents completing the PP-HF programme. The HHQ-23 may, therefore, be used to monitor positive changes in family lifestyles following engagement in the PP-HF parent training programme. The HHQ-23 also shows promising potential as a standalone screening measure or as part of a larger battery of screening assessments in paediatric weight-management services.
Stakeholder perspectives on managing the adolescent sleep crisis using a transdiagnostic self-management app for sleep disturbances: A qualitative follow-up study
Lau PH and Carney CE
Sleep problems are diverse and pervasive among the adolescent population. Current sleep health interventions are ill-equipped to address the sleep crisis. We developed DOZE (elivering nline zz's with mpirical Support), which is a self-management evidence-based app for sleep disturbances. In an initial study, we found that DOZE was perceived as an acceptable and effective support for teen sleep. In a qualitative follow-up study, we engaged with students and other stakeholders to understand their experiences with implementing, disseminating, and using DOZE. The study employed a combination of qualitative surveys and semi-structured interviews to students ( = 21) and stakeholders (teachers, social workers, and researchers; = 5), respectively. Reflexive thematic analysis was used to identify themes related to experiences implementing and engaging with the app. Students reported increased sleep regularity and sleep duration after using DOZE. Facilitators included greater integration of the app with school curriculum, timing of implementation, and researcher involvement in supporting knowledge dissemination and engagement. Barriers included worries about phone use at night and normalized poor sleep patterns among adolescents. There is need to identify ways to support implementation and engagement in different communities. Researchers continue to engage with stakeholders to support timely access to sleep health interventions for adolescents.
Exploring psychosocial factors in the functional recovery of children with severe mental disorders: A qualitative content analysis
Ganie AUR, Thirumoorthy A, Jangam KV and John Vijay Sagar K
Severe mental disorders during childhood and adolescence can be chronic and disturbing, and may result in serious impairments in functioning. Research on the influence of such factors in the functional recovery of children diagnosed with severe mental illnesses is scant. This study aims to enhance understanding of the patterns and descriptions of social factors in the optimal functioning of children with severe mental illnesses.
Multiple complex developmental disorder (MCDD): Did we throw the baby out with the bathwater too fast? A systematic review
Zaccaria V, Ardizzone I, Pisani F, Raballo A and Poletti M
Multiple complex developmental disorder (MCDD) manifests as early-onset impairment across different domains. Although it could appear as a transitional condition between autism and childhood-onset schizophrenia, interest in MCDD has progressively waned. This study attempts to discern MCDD current relevance to avoid "throwing the baby out with the bathwater" too fast.
Getting help early: An online mental health self-assessment tool for young people
Fischer A, Smith OJ, Gómez Álvarez P, Wolstein J and Schall U
Online self-assessments are becoming more popular. They can serve as a screening tool for specific conditions or assess mental health more broadly but often lack in depth evaluation.
Primary and secondary trauma in adoptive parents
Duncan M, Fearon P and Woolgar M
Secondary trauma is recognised as one of the negative effects for professionals working with people that have experienced trauma. Research has demonstrated secondary trauma in foster carers but little research has explored trauma symptoms within adoptive parents, facing the emotional impact of parenting a child with adverse early experiences. This study aimed to document the rates of primary and secondary trauma symptoms in adoptive parents. It further explores the association between the extent of current behavioural and emotional challenges and the extent of the child's pre-adoption adverse experiences in predicting parental trauma responses.
Satisfaction in mental health care: Examining psychometric properties of experience of service questionnaire
Bulut Ozer P and Halfon S
Measuring satisfaction with psychological health services is important in clinical settings to evaluate the benefits of treatment. Past research has shown that relationship with therapist is at the core of satisfaction reports. However, measurement tools focusing on patients' psychological health care experiences are rather scarce. The objective of this study is to adapt the Experience of Service Questionnaire (ESQ) Parent form and examine its psychometric properties in a Turkish population. ESQ Parent form was presented to parents ( = 265) of children who have received treatment at a university's psychological counseling center. Child Behavior Checklist (CBCL) was gathered from parents pre- and post-treatment to measure symptomatic gains and investigate their associations with satisfaction with treatment. Confirmatory factor analysis comparing two different constructs showed that the 2-factor structure had a better fit. In addition, participants showing higher therapeutic gains showed significantly higher satisfaction in ESQ. This study is the first to measure satisfaction in psychological health care settings in Turkey, and therefore aims to contribute to a gap in the field. Results indicate a significant association between treatment outcome and satisfaction levels. Also, adapted measurement tool demonstrates adequate reliability and validity scores supporting its use in clinical settings.
"I didn't come here for your judgement" alongside "they understand you and encourage you": Exploring the narratives of young black and mixed-race LGBTQ+ people who have a physical health condition and their experiences within physical health services
Williams N, McParland J, Unadkat S and Huckridge J
Lesbian, gay, bisexual, transgender, and queer or questioning (LGBTQ+) individuals experience health inequalities. Young people living with a health condition are also more likely to experience adverse mental health outcomes. Developing positive identity can help to mitigate the impact of this. Young black LGBTQ+ people have additional barriers to developing positive identity. Current research rarely considers the intersection of these identities for young people despite the discrimination they may face, and the impact this may have on their health. A narrative approach allows these voices to be heard in research. Eight participants were interviewed using a narrative approach. Interviews were analysed using content and thematic narrative analysis. Global summaries of each interview were developed and 'plot lines' emerged from these. A central plot related to identity development, with two plots embedded in these exploring experiences of illness and of healthcare. Participants had positive experiences of healthcare despite encountering stigma. Access to positive role models and being able link in with various communities allowed participants to integrate and accept their identities. A key discussion point in this study is the ways in which healthcare staff could become role models for young LGBTQ+ people and help them to integrate and accept their identities.
Linking heart and mind - lived experiences of parents to children with congenital heart disease and mental health issues
Hejl JL, Hulgaard DR, Rasmussen ASD, Larsen LEN and Rask CU
Children with congenital heart disease are more likely to receive special educational services in schools and have an increased risk of mental health issues. We explored the lived experiences of parents caring for a child with heart disease and concurrent mental health issues in Denmark. Semi-structured interviews with ten parents (age 39-57 years) to these children (age 5-17 years) were analysed using interpretative phenomenological analysis. Three Group Experiential Themes (GETs) were generated from the analysis: The first GET, Parental roles and caring behaviours, described parental struggles of fulfilling their parenting role ideals and experiences with stigmatization of MHI. GET two, Parental reflections on their illness explanations, portrayed how parents utilize different illness explanations to make sense of their child's MHI. GET three, Differences in access to help and support, captured how the CHD affected overall access to mental health support. The results may inform various topics of importance for health professionals to address in their clinical encounters with these families.