Child and Adolescent Mental Health

The use and potential of artificial intelligence for supporting clinical observation of child behaviour
Minnis H, Vinciarelli A and Alsofyani H
Observation of child behaviour provides valuable clinical information but often requires rigorous, tedious, repetitive and time expensive protocols. For this reason, tests requiring significant time for administration and rating are rarely used in clinical practice, however useful and effective they are. This article shows that Artificial Intelligence (AI), designed to capture and store the human ability to perform standardised tasks consistently, can alleviate this problem.
Editorial: Advancing equity, diversity and inclusion through culturally sensitive collaboration and training
Salazar de Pablo G
Staff Perspectives: Why are adolescent inpatients secluded and what causes changes in rates of seclusion on a unit?
Yurtbasi MK, Gordon M, Pavlou C and Melvin G
The use of seclusion in Adolescent Inpatient Psychiatric Units is being heavily scrutinised due to its forceful nature and potential to cause harm. This study aimed to understand staff perspectives on reasons for seclusion in an Adolescent Inpatient Psychiatric Unit.
Commentary: Who gets the credit for "discovering" ADHD and what is the question, really?
Carlson GA
Recognition of hyperactivity, impulsivity, distractibility, and emotional lability as a clinical syndrome is at the heart of identifying whether there is a discoverer of the condition of attention deficit hyperactivity disorder (ADHD). Just as clinics of children diagnosed with ADHD do not capture a homogeneous group of boys and girls, however, history does not either. What different observers/clinicians have chosen to highlight reflects what is important to them and to the times in which they lived. The child/children described by Heinrich Hoffman (of Fidgety Phil fame) and George Still (who highlighted impulsive aggression as a moral defect), for instance, did not come with a list of criteria (with which even now we cannot always agree) to prove unequivocally that they had ADHD. Who cares! It is sufficient that they recognized the importance of certain co-occurring behaviors and shared their observations with us such that we can conclude our clinic's children were recognized by good past observers. ADHD-like children, like the poor, have probably always been with us.
Letter to the Editor: Detecting and treating young people at risk for psychosis is essential, but early intervention for those with a psychotic disorder should be a priority for CAMHS
Alameda L and Conus P
Self-harm, suicidal ideation, depression and peer relationships in transgender and gender diverse adolescents accessing specialist mental health services
Whittle K, Moore E and Stallard P
There are an estimated 25 million transgender and gender diverse (TGD) individuals worldwide, with 1.2%-2.7% of this population being under the age of 18. Community studies describe increased rates of mental health difficulties such as depression, self-harm, suicidal ideation and difficulties with peer relationships for TGD youth over cisgender peers. However, comparatively little is known about the mental health symptomatology of TGD youth attending specialist mental health services (CAMHS) in the UK.
Narrative Matters: When does the history of ADHD not begin?
Smith M
This commentary discusses the history of ADHD and how it can inform contemporary debates about the disorder. It critiques retrospective histories of ADHD, which propose earlier origins for the disorder than match the historical evidence. It concludes by indicating when ADHD did emerge as a distinctive disorder and why it did so.
Debate: How much should nonspecialists be involved in mental health care when resources are limited? A perspective from low- and middle-income countries
Ani C and Omigbodun O
Millions of children and young people (CYP) in low- and middle-income countries (LMICs) have no access to mental health care. This huge treatment gap is primarily due to limited availability of trained mental health professionals. We propose task-sharing as a scalable strategy to expand access to child and adolescent mental health (CAMH) interventions in LMICs. Task-sharing involves using the few mental health specialists in LMICs to train and supervise nonspecialists to provided CAMH interventions. There is strong evidence of clinical and cost effectiveness of task-shared mental health interventions for adults in LMICs and promising evidence for CYP. To succeed, task-shared programmes need to be embedded in a balanced system-wide care setting that includes stakeholder involvement. The existing mental health specialists may require additional training in leadership, supervision, mentoring, service design and evaluation in order to meet the additional expectations of managing task-sharing programmes. The nonspecialists to be trained would need assurances about workload, ongoing supervision, clinical back up for cases that exceed their expertise, certification for their training and career progression. CAMH task-sharing offers good promise for increasing CYP's access to mental health interventions in LMICs. However, planners need to be aware of the important practical, ethical and contextual considerations necessary for success and sustainability.
Debate: How much should nonspecialists be involved in mental health care for children and young people when resources are limited?
Gega L
From the barber-surgeons of the Middle Ages to the digitally enabled clinical interventions of today, the role of nonspecialists in delivering accessible health care remains relevant and important. Their contribution in developing and supporting appropriate interventions and care pathways in the community can make a big difference for the overwhelming majority of children and young people with diagnosable mental health conditions who are not eligible for specialist treatment or do not seek help. Even if resources for specialist services were unlimited, there are independent benefits in involving nonspecialists in mental health care, albeit not without limitations and concerns. The natural shift over time in the boundaries of specialisms, the omnipresence and omnipotence of digital media in our lives and the vision of 'no wrong door' for service users, mean that it is not a question of whether, but of how, nonspecialists should be involved. We need to get past the point of considering them just as alternative providers of mental health interventions and services. Instead, they are best placed to protect children and young people's mental health through ubiquitous everyday actions, which counter the negative and maximise the positive elements in current practices, environments and interactions that influence families and communities.
Debate: How much should nonspecialists be involved in mental health care for children and young people when resources are limited? Working with police forces to improve mental health crisis care for young people
McCulloch A, Eve Z and Parry S
The last few years have seen a mental health crisis for children and young people in the UK, with more young people presenting to services at crisis point. Young people have reported that there is a general lack of support before reaching the point of crisis and police forces in the UK have seen a rise in callouts related to youth mental health problems. We provide an overview of the evidence for joint responses from police and mental health services and highlight the importance of including people with lived experience in the development of crisis services. Most of the available data relates to interventions for adults, with very few studies including children and young people. We outline a new study in the UK aiming to evaluate a joint response for young people experiencing a mental health crisis. Whilst resources for children and young people's crisis services remain limited, joint response models with police forces can help to provide much needed intervention.
Trends in the nonmedical misuse of benzodiazepines and Z-hypnotics among school-aged adolescents (2016-2021): gender differences and related factors
Carrasco-Garrido P, Hernández-Barrera V, Jiménez-Trujillo I, Lima Florencio L, Gallardo Pino C, Yeamans S and Palacios-Ceña D
The misuse of psychotropic medication has increased during the past decade, especially among adolescents. The aim of our study was to describe the prevalence and patterns of the nonmedical use of benzodiazepines (BDZ) and Z-hypnotics among school-aged adolescents through the lens of sex. In addition, we sought to analyze the temporal evolution of the nonmedical use of these drugs during the period 2016-2021.
Debate: Bridging the gap - role of nonspecialists in child and adolescent mental health care
Chachar AS and Mian AI
The first point of contact for patients and families seeking professional help for health problems is often in nonspecialist community healthcare settings that vary widely across the countries in funding sources, resources and support from specialist services. They typically involve general practitioners, family physicians, general and community paediatricians, and nonphysician health workers such as nurses, social workers and public health professionals. This article discusses the role of nonspecialists in addressing the challenges of limited resources in Child and Adolescent Mental Health (CAMH) care services as healthcare systems struggle to meet the high demand. Stakeholders and decision-makers need to reconsider traditional healthcare models and service delivery. Integrating nonspecialist community care can be a potential solution but is beset with ethical, geopolitical, practical and economic challenges. The urgency and complexity of the issue are highlighted, emphasising the need for global discussion around CAMH care.
Debate: How the business model of social media fuels the need for greater moderation
Graham R
The current business model of social media companies is to keep users engaged and on screen, so that data can be obtained from them, and targeted advertisements sold. To maintain user engagement, recommender systems (algorithms) promote content, which can be extreme, and includes mental health content. Extreme mental health content, such as self-harm images, can be pushed to any user and then more and more extreme content can be pushed to them. The normalisation, amplification or glamorisation of harmful content can have negative impacts upon the user, who may struggle to express what is happening online to anyone. In contrast with the views of Zhang et al. (Child and Adolescent Mental Health, 2024, 29, 104), without greater, timely moderation of harmful content, the promotion of self-harm, suicide and eating disorders will continue on social media, with potentially devastating consequences.
Associations between parental socioeconomic status and mental health in Chinese children: the mediating roles of parenting practices
Sun X and Yuan Y
The significance of socioeconomic status (SES) in child mental health is well-established in Western populations; however, there is little evidence on this topic in Chinese populations. The possibility that Chinese families with different SES elicit different parenting practices that cause positive or negative child mental health outcomes warrants further investigation.
Editorial: Socio-economic inequality and child and adolescent mental health
Pickett KE and Wilkinson RG
Editorial: Open science and methods review for Child and Adolescent Mental Health
Spreckelsen TF and Paton LW
This editorial introduces the journal's new open data policy for original articles using quantitative data. It discusses key opportunities from data and code sharing. It further briefly sets out the new methods review that articles which use quantitative analysis will automatically undergo. With both changes we hope to strengthen our review process and contribute to a better evidence base in the field.
Editorial: The Cass Review - implications and reassurance for practitioners
Cass H
This editorial perspective summarises the key findings of the independent review of gender identity services for children and young people commissioned by the National Health Service (NHS) in England (the Cass Review). Although the evidence underpinning endocrine interventions in this group of young people remains weak, there is much that mental health practitioners can do to improve their well-being and support their families. The controversies surrounding this group of young people have disempowered local professionals, who have lost confidence in their ability to provide care for them. The reality is that CAMHS professionals already have all the necessary transferrable skills and with a small amount of top up training, they can make a profound difference to the lives of this vulnerable group, which has been marginalised in our healthcare system.
Debate: More, not less social media content moderation? How to better protect youth mental health online
Russell I
This article challenges Zhang et al.'s claims that social media content moderation is proving detrimental to youth mental health and asserts that greater emphasis on the systemic risks posed by social media platforms is required.
Clinical Research Updates
Kyriakopoulos M, Saraswat C, Snelson L and Stathopoulos M
Commentary: Can a modernised psychiatric unit space reduce the use of coercive measures in child and adolescent psychiatry? A commentary on Czernine et al. (2024)
Wong KK
The environment influences the way we act, react and adapt to our surroundings whether it is consciously or unconsciously. Though it is widely accepted that multiple interacting systems influence human behaviour and development across the life span, the reality of teasing these factors apart is difficult and challenging. In this brief commentary on Czernine and colleagues' important and timely paper, 'Can a modernised psychiatric unit space reduce the use of coercive measures in child and adolescent psychiatry?', I evaluate and build on the evidence presented by making constructive suggestions on ways of improving the status quo healthcare and treatment conditions for children and adolescents today. The underlying assumption is that by furthering this complex yet important area of research in the field of psychiatry and adjacent disciplines, we can improve existing healthcare systems and processes that are aligned with meeting child and adolescent needs.
Letter to the Editor: Addressing the escalating trend of nonmedical use of benzodiazepines and Z-hypnotics among adolescents - a call for gender-sensitive interventions and policy reforms
Wei LC and Chiu HJ