CHILD PSYCHIATRY & HUMAN DEVELOPMENT

No Way Out? Cognitive Rigidity and Depressive Symptoms Associated with Suicidal Thoughts and Behaviors in Autistic Youth
Reid M, Clawson A, Ratto A and Rich BA
Research has found increased premature mortality among autistic individuals, with suicide being one of the most common causes of premature death in autistic youth. This study aimed to fill literature gaps related to suicidal thoughts and behaviors (STB) in autistic youth by exploring the clinical predictors of suicidal ideation (SI) and suicidal and/or self-injurious behavior (SSIB) in 404 autistic youth from a clinic database. Consistent with prior literature, STB were elevated in autistic youth compared to general population rates. Self-reported suicidal ideation and behaviors were increased in autistic youth assigned female at birth. Caregivers reported greater SI in older autistic youth as compared to younger youth. Logistic regression analyses showed that elevated depressive symptoms and greater cognitive rigidity significantly increased the likelihood of SI in autistic youth. Results have important implications for understanding factors that increase the risk for suicidal ideation and behaviors in autistic youth and informing the development of responsive interventions.
Welcoming 2025: Striving for Improved Treatment Access
Storch EA and Cheng J
Risk and Protective Effects of Need for Approval on Self-Injury in Adolescent Girls
Clapham RB, Ye Z, Somerville LH, Miller AB, Giletta M, Hastings PD, Slavich GM, Nock MK, Prinstein MJ and Rudolph KD
The goal of this research was to expand theoretical models of adolescent suicide by exploring whether individual differences in adolescent girls' need for approval (NFA and NFA) contribute to risk for, or protection against, self-injurious thoughts and behaviors (SITBs). We examined these novel hypotheses in a series of concurrent and longitudinal analyses in two samples of adolescent girls (Study 1: N = 89, M = 16.31 years, SD = 0.84, 67.4% White; Study 2: N = 229, M = 11.80, SD = 1.80, 49.8% White). Hierarchical linear and logistic regressions revealed that NFA was generally associated with higher risk for SITBs, whereas NFA generally had a protective effect against SITBs; moreover, the strength of these associations depended on the extent to which girls engaged in rumination. Together, these results suggest that encouraging girls to develop diverse foundations for their sense of self-worth beyond peer judgements may protect against SITBs.
Psychometric Validation of the New Misophonia Screening List-Child and Youth and AMISOS-Y (Dutch Child- and Parent-Report Versions) for Assessing Misophonia in Youth
Rappoldt LR, Kan KJ, Dalmeijer L, Rutten SA, van Horen R, van der Pol MM, de Wit C, Denys D, Vulink NCC and Utens EMWJ
Misophonia is a recently identified disorder of decreased sound tolerance that often originates in childhood. Currently, there is a lack of validated questionnaires for screening and assessing misophonia severity in children/adolescents. This paper presents an iterative validation process of two innovative (parallel child-/parent-reported) questionnaires: the Misophonia Screening List-Child and Youth for screening, and the Amsterdam Misophonia Scale-Youth (AMISOS-Y) for assessing misophonia severity in youth. After instrument refinement, we performed ROC curve, reliability, and principal component analyses, and assessed concurrent, convergent and divergent validity, on a combined sample (aged 8-18; clinical sample N = 94 youth, 95 parents; control group screening N = 197 youth, 56 parents; control group AMISOS-Y N = 192 youth, 55 parents). Both questionnaires were unidimensional and displayed excellent psychometric properties (α = 0.95-0.96). Future replication studies are needed in community and clinical samples to contribute to a unified diagnostic framework. Trial registered 09/2021: NL-OMON20775.
Contributions of Attachment and Cognitive Functioning on ADHD Symptoms in Children
Wylock JF, Borghini A, Delvenne V and Slama H
ADHD is a neurodevelopmental disorder with multifactorial origins. Several studies have shown that parent-child attachment impacts the expression of ADHD symptoms, while others have highlighted the influence of cognitive impairments on ADHD symptoms. However, few studies have simultaneously examined the respective contributions of child attachment and cognitive functions to ADHD, which is the aim of this study. We included 45 children with ADHD from a university hospital and 44 typically developing children from regular schools. Child attachment was evaluated using a self-report questionnaire, the French Attachment Security Scale (ASS-Fr), and a narrative interview, the Cartes pour l'évaluation de l'Attachement et de la Mentalisation chez l'Enfant (CAME). Cognitive assessment involved both objective and subjective measures. Perceived attachment security to both parents and disorganized attachment were significantly associated with ADHD symptoms, but these relationships were mediated by externalizing symptoms and executive function difficulties. The relationships between attachment and ADHD symptoms are indirect and mediated by the presence of externalizing symptoms and executive function impairments.
Somatic Symptoms in a Population-Based Sample from Childhood to Adolescence: Stability and Concurrent and Longitudinal Predictors
Pardej SK, Waschbusch DA, Calhoun SL and Mayes SD
The present study investigated group and individual stability and predictors of somatic symptoms from childhood to adolescence in a population-based sample. 259 youth were evaluated at 6-12 years (M 8.1) and 8 years later (M 15.2). Sixteen somatic symptoms from the parent-rated Pediatric Behavior Scale were used for analyses, in addition to psychopathology subscales. Most somatic symptom prevalence rates decreased from childhood to adolescence. Group mean scores were relatively stable over time. Individual stability for the absence of somatic symptoms in childhood and adolescence was high, yet individual stability for the presence of somatic symptoms at both time points was low. Most symptoms remitted for the majority of youth. New cases in adolescence were common. Significant correlates of childhood and adolescent somatic symptoms varied. Longitudinal predictors were childhood somatic symptoms and adolescent medication status. Childhood psychopathology scores did not predict the total adolescent somatic symptom score.
Is Bedtime Procrastination Related to Multidimensional Sleep Health? Evidence from Samples of Different Educational Stages (Aged 10-25) in China
Zhang Y, Ye H, Cai Y, Chen F, Huang M, Li M, Yu Z, Chen H, Wang X, Jia R and Fan F
Bedtime procrastination has been associated with poorer sleep health, but evidence for this association is not sufficient. This cross-sectional study aimed to investigate the relationship between bedtime procrastination and multidimensional sleep health among students at different educational stages (from elementary school to college) in China, and further examine the moderating role of psychological distress in the procrastination-sleep health link. A total of 3539 students (M = 15.6 [2.9] years) completed an online survey between December 17 and 31st, 2023. Sociodemographics, bedtime procrastination, chronotype, psychological distress, and sleep health indicators were assessed. Binary logistic regression was used to estimate the association of bedtime procrastination with sleep health. The moderating effects of psychological distress were examined using the Process macro. The results showed that, from elementary school to college, scores of bedtime procrastination displayed a gradually increasing trend. Greater bedtime procrastination across different educational stages was related to poorer sleep health, including satisfaction, alertness, timing, efficiency, and regularity. However, there was no significant association between bedtime procrastination and sleep duration among elementary, middle, and high school students. Moreover, the moderating effect of psychological distress was observed among middle and high school students. The negative association between bedtime procrastination and total sleep health was attenuated in students with high psychological distress than in students with low psychological distress. The findings underscore the importance of early prevention and intervention strategies targeting bedtime procrastination.
Exploring the Utility of the Limited Prosocial Emotions Specifier for Subtyping Conduct Problems and Oppositional Defiant Problems: A Multi-informant Study
Elhami Athar M
This study aimed to assess the clinical utility of the "Limited Prosocial Emotions" (LPE) specifier in subtyping conduct problems (CP) and oppositional defiant problems (ODP) among two samples including 1203 parent-child dyads and 1,937 school-attending youths in Iran. The prevalence of LPE across the entire sample, as well as subsamples of youths with clinically elevated levels of CP and ODP, were examined. CP + LPE individuals scored significantly higher than CP-Only youths on several measures of externalizing psychopathology and depression, although these findings were not fully consistent across informants. Several anticipated differences in measures of aggression and antisocial behavior were not found. Also, no significant group differences were observed between the ODP + LPE and ODP-Only groups concerning externalizing and internalizing psychopathology. In the total sample, youths with LPE scored significantly higher in measures of externalizing and internalizing psychopathology than those without LPE, though the magnitude of these differences was in small ranges. Overall, the findings provide only limited support for the clinical utility of the LPE specifier for CP and none whatsoever for ODP.
Executive Functioning, Family Accommodation, and Treatment Response in Youth with OCD and Comorbid ADHD in a Partial Hospital Program
Killion B, Marklin M, O'Connor E, Freeman JB, Cain GH, Walther M and Benito KG
Few studies have examined differential treatment response, rates of familial accommodation (FA), and executive functioning (EF) in youth with OCD vs. OCD + ADHD, particularly in a partial hospital program (PHP). The current study includes 138 youth diagnosed with OCD only and 102 youth diagnosed with OCD + ADHD in a PHP setting for a total sample of 240 youth (and their families). Families and clinicians completed several measures assessing child and parent variables of interest. Findings of ANCOVA analyses suggest poorer treatment response and EF in children with comorbid OCD + ADHD compared to their counterparts with OCD only. No significant differences emerged between groups in baseline levels of symptom severity, functional impairment, or FA. Given the high rate of comorbidity between OCD + ADHD, clinicians and researchers should be aware of the need to modify treatment approaches for children with comorbid OCD + ADHD and/or weaker EF performance.
A Psychometric Evaluation of the Parenting Anxious Kids Rating Scale (PAKRS-PR) in a Sample of Families with Clinically Anxious Children
DiFonte MC, Sain KS and Tolin DF
The Parenting Anxious Kids Rating Scale-Parent Report (PAKRS-PR) measures five types of anxiogenic parenting. The present study aimed to extend the previous psychometric evaluation of the PAKRS-PR to a treatment-seeking sample and examine sensitivity to change over 15 sessions of cognitive behavioral therapy. The sample included 383 parent-child dyads presenting to treatment at a specialty outpatient clinic. Cronbach's α was acceptable for the PAKRS-PR Total scale and several subscales, although the Accommodation/Beliefs and Warmth/Support subscales were in the unacceptable/questionable range. Convergent validity was found to be mixed with the closest relationship between anxiety severity and the Accommodation/Beliefs, Warmth/Support, and Conflict PAKRS-PR subscales. Additionally, the PAKRS-PR Total score and subscales changed significantly throughout treatment, but were not associated with treatment response or child- or clinician-rated treatment outcome measures. Overall, the current findings demonstrate some support for the psychometric properties of the PAKRS-PR; however, further refinement of the PAKRS-PR at the item-level is recommended to further strengthen the measure.
Elementary School Teachers' and Counselors' Decisions on Referring Students for Evaluation: The Impact of ADHD Traits, Achievement, and Giftedness
Tamsut A, Asadi H, Sinai GN, Saka N and Pollak Y
The present study examined the effect of ADHD-related traits, academic-achievement level, and giftedness label on elementary school teachers' and counselors' referral recommendations for assessment. 532 teachers and counselors were presented with one of 12 vignettes describing a hypothetical pupil. Participants were asked to report the likelihood they would refer the pupil for ADHD diagnosis and address them during a high-level interdisciplinary school-team meeting (HISTM). High ADHD-related traits (effect size 0.359) and low academic-achievement (effect size 0.070) and their interaction were significantly related to a higher likelihood of referral. Further analysis revealed that lower academic achievement was related to a higher likelihood of referral only when ADHD-related traits were not indicated (p < .005). The status of giftedness label was not found to be significant (p > .05). These findings indicate that mainly ADHD-related traits and, to a lesser degree, low academic-achievement influence teachers' decisions to refer pupils for ADHD diagnosis and address them in HISTM.
Toddler Screen Time: Longitudinal Associations with Autism and ADHD Symptoms and Developmental Outcomes
Hill MM, Gangi DN and Miller M
Greater screen time is associated with increased symptoms of autism spectrum disorder (autism), attention-deficit/hyperactivity disorder (ADHD), and lower scores on measures of development in preschool-aged community samples. In the current longitudinal study, we examined screen time differences at 18 months of age based on clinically-defined outcomes (i.e., Autism, ADHD Concerns, Comparison) determined at age 3-5 years in a genetically-enriched sample based on family history, along with prospective associations between toddler screen time and preschool autism/ADHD symptoms and developmental achievement. Participants (n = 82) included children at high and low familial likelihood for autism and ADHD. Children with Autism and ADHD Concerns outcomes experienced significantly more screen exposure at 18 months than children without autism or elevated symptoms of ADHD. Greater screen time at 18 months was also associated with preschool symptoms of autism and ADHD and lower developmental achievement across the sample. Preschoolers with neurodevelopmental challenges experienced more screen exposure earlier in development than same-age peers, increasing potential for negative developmental impacts.
Validity of Cognitive Disengagement Syndrome with Mother and Father Ratings of Brazilian Children: Replication of Northern Hemisphere Findings in South America
Belinati G, Moura M, Becker SP and Burns GL
Although the Child and Adolescent Behavior Inventory (CABI) cognitive disengagement syndrome (CDS) scale has demonstrated validity relative to the CABI attention-deficit/hyperactivity disorder-inattention (ADHD-IN) scale with parent ratings of youth from North America, Europe, East Asia, and Central Asia, no study has evaluated the validity of the 15 symptom CDS scale with children from South America. Our purpose was to examine for the first time the validity of the CABI CDS scale with Brazilian children. Latent variable modeling procedures were used to examine the validity of CDS scores. Mothers and fathers completed measures of CDS, ADHD-IN, ADHD-hyperactivity/impulsivity (HI), anxiety, depression, and academic impairment on 366 Brazilian children (M = 8.64, SD = 1.39, 53.3% females). First, the CDS symptoms showed strong internal validity with the ADHD-IN symptoms. Second, within and across sources, ADHD-IN showed stronger first-order and unique associations than CDS with ADHD-HI, whereas CDS, especially across sources, showed stronger first-order and unique associations than ADHD-IN with anxiety and depression. CDS and ADHD-IN were similarly associated with academic impairment. This study is the first to support the validity of CABI CDS scores with Brazilian children, thus replicating the findings in North America, Europe, East Asia, and the Central Asia in South America.
A 10-year Longitudinal Study: The Relationship between Adverse Childhood Experiences, Mental Health Indicators, and Binge Eating Symptoms among Emerging Adults
Schwartz A, Navarro MC and Salamon R
Although binge eating symptoms (BE) can contribute to worsened mental and physical health, little is known about factors associated with binge eating across the lifespan, hindering prevention and treatment. To investigate if there is an association between adverse childhood experiences (ACEs), adolescent and adult mental health conditions, and BE symptoms among young adults. One hundred and thirty-one junior high-school students participated in a series of assessments and 10 years later, 100 of these individuals participated in a follow-up assessment. Linear regression models were performed to estimate the association between ACEs, adolescent and emerging adult self-esteem, depression, and anxiety symptoms, and emerging adult BE symptoms. Among the sample, 26% had 1 ACEs, 18% had 2 ACEs, and 41% had ≥ 3ACEs. After adjusting for age, sex, and current mental health, there was a positive association between ACEs and increased levels of BE symptoms (β = 0.37, SE = 0.19, CI=(0.03; 0.7), p =.0485). Higher levels of emerging adult depression and anxiety symptoms (β = 0.02, SE = 0.01, CI=(0.01; 0.04), p =.0020) but not self-esteem (β = 0.04, SE = 0.05, CI=(-0.06; 0.14,) p =.4253), were associated with BE symptoms. Parental mental health, a parent experiencing a mental illness during the participant's childhood, was the only individual ACE associated with BE symptoms (β = 0.84, SE = 0.40, CI = 0.04, 1.64, p =.0409). Cumulative ACEs and emerging adult anxiety and depression symptoms were associated with BE symptoms. Findings indicate that ACEs, anxiety, and depression symptoms contribute to BE symptoms, highlighting the importance of screening for ACEs and mental health conditions. Persons struggling with BE symptoms may have co-occurring conditions, of which a traditional treatment for BE may not suffice.
Relations Between Academic and Behavioral Adaptations: The Antecedent Effects of Executive Function
Cao X and Yan N
Using a large sample (n = 1163) from the National Institute of Child Health and Development Study of Early Child Care and Youth Development, the Random Intercept Cross-Lagged Panel Model was employed to unpack the between-person and within-person aspects in the relations between children's academic performance and externalizing/internalizing behaviors during primary school and examined the predictive role of early executive function. Results showed that the reciprocal relations between state-level fluctuations in children's behavioral problems and academic performance were largely unsupported. Children with more advanced early executive function were found to have better academic performance and fewer behavioral problems throughout primary school, supporting the antecedent role of early executive function. These findings suggest that fostering executive function skills early on could be a key strategy for improving both academic outcomes and behavioral adjustment in children.
Correction: The Predictive Role of Preschool Children's Attachment on Social Competence, Anxiety, Aggression and Self-Control: Peer Relationships as a Mediator
Akyol NA, Güney Karaman N, Yılmaz A and Essau C
Predictors of Suicidal Thoughts and Attempts among School-Going Thai Adolescents: A Sex-Specific Structural Equation Modelling Analysis
Dadras O
Adolescent suicide is a growing public health concern in Thailand. Identifying predictors of suicidal behaviors is essential for targeted prevention strategies. Using Structural Equation Modeling, this study explores the predictors of suicidal thoughts and attempts among a sample of 5657 Thai adolescents in grades 7-12, typically representing the age group 13-17 years, with nearly equal proportions of males (47%) and females (53%) participants. Data from the Thailand Global School-based Student Health Survey (GSHS) 2021 were analyzed. Explanatory Factor Analysis (EFA) identified key constructs, followed by SEM stratified by sex to examine relationships between constructs and suicidal behaviors. Reliability and validity were assessed using Cronbach's α and SEM fit indices. EFA identified five constructs: current substance use, history of violence, experiences of bullying, parental awareness, and poor mental health. SEM revealed poor mental health as a significant predictor for both sexes. Substance use, experiences of bullying, and a history of violence predicted suicidal behaviors in females. Parental vigilance was only a protective factor for males. The findings underscore the importance of gender-specific interventions and comprehensive mental health support to address the unique vulnerabilities of Thai adolescents, reducing suicidal thoughts and attempts.
Caregiver Psychopathology, Resilience, and Their Associations with Social-Emotional Challenges of Young Children Affected by Armed Conflict in Colombia
Hein S, Ponguta LA, Flores JM, Londoño Tobón A, Johnson INS, Larran J, Ortiz Hoyos AM, Gómez O, González Ballesteros LM, Castellanos Roncancio CA and Leckman JF
We examined the social and emotional challenges (SEC) of young children and the mental health of their caregivers in areas affected by armed conflict and displacement in Colombia. Anxiety, depression, and PTSD symptoms were assessed in 1,133 caregivers. Caregivers also reported on the SEC of their children aged 21-53 months. A subsample of 487 caregivers (43%) completed a resilience self-report measure. Caregivers reported substantial levels of psychopathology ranging from 12.84% of caregivers with elevated anxiety levels, 24.5% who scored above the cutoff on the PTSD measure, and 44.7% who screened positive for depression. Correlations (r) between child SEC and caregiver psychopathology ranged from 0.15 to 0.33. The association between caregiver depression and child SEC was more substantial for boys (B = 0.56) than girls (B = 0.22). We also found that girls whose caregivers reported elevated levels of psychopathology and low levels of caregiver resilience received the highest ratings of caregiver-reported SEC. The importance of caregiver-child resilience-focused psychosocial support is discussed.
The Role of Parental Involvement in the Development of Prosocial Behavior in Young Children: An Evolutionary Model Among Colombian Families
Prada-Mateus M, Obando D, Sandoval-Reyes J, Mejía-Lozano MA and Hill J
Prosocial behavior is a relevant indicator of children's socio-emotional development linked to decreased conduct and emotional problems. The present study aimed to identify cross-sectional direct effects of parental involvement on prosocial behavior in three-time assessments at ages 3, 5, and 7 years, to identify carryover effects of the study constructs, and to identify the evolution of these effects over time. A sample of 235 Colombian families participated at t0, 220 at t1, and 145 at t2 by completing self-reported questionnaires for prosocial behavior using the Strengths and Difficulties Questionnaire and the Alabama Parenting Questionnaire for parental involvement. Using PLS-SEM path modeling, we found that the contribution of parental involvement to prosocial behavior was significant in the three assessments. Carryover analyses indicated that initial levels of parental involvement and initial levels of prosocial behavior predict later levels. Using multigroup analysis, we tested significant changes in the path coefficients of direct effects, finding nonsignificant results. For carryover effects, we found changes in parental involvement between t0/t1 and t1/t2. Finally, t-test analyses were used to identify changes in the construct's means over time, finding significant changes between parental involvement at t1 and t2. No mean differences were found for prosocial behavior. Results from this study highlight the relevance of parental involvement during childhood for maintaining children's levels of prosocial behavior and reducing the risk of socio-emotional problems. Preventive approaches for these problems should include parents' training on parental involvement from age 3.5 years or earlier.
The Predictive Role of Preschool Children's Attachment on Social Competence, Anxiety, Aggression and Self-Control: Peer Relationships as a Mediator
Akyol NA, Güney Karaman N, Yılmaz A and Essau C
The main purpose of this study is to examine the predictive role of preschool children's attachment on social competence, anxiety, aggression, and self-control of 5-year-old children (60-71 months), and to test the mediating effect of peer relationships in this model. A total of 309 children participated in the study. The data of the study were collected through the teacher checklist of peer relationships, the social competence and behavior evaluation scale-30, the self-control rating scale which the teacher filled out, and the doll story completion task which the researcher used during the application process. Path analysis was used to explain the direct and indirect relationships between the variables, and a Sobel test was also used to determine the mediational role of peer relationships. The results showed that peer relationships had a mediating effect on parental attachment between anxiety, anger, social competence, and self-control. This study shows that the reflections of insecure attachment experienced in the first years of life can be reduced by peer relationships and the reflections of secure attachment can be strengthened by peer relationships.
Sports-Related Concussion Among Physically Active Adolescents in the Southeastern United States: Effects on Mental Health During the Pandemic
Fogarty K, Song J, Counts T, Grajo N, Pracht D and Diehl D
Sports-related concussions (SRC) pose risks to young people's physical and mental health. During the COVID-19 pandemic, we studied linkages between youths' SRC experiences and internalizing problems (depression, self-harm, and suicidality) among a representative sample in Southeastern state (n = 4,668 total, n = 547 reported SRC experience). Logistic regressions indicated significant associations between youths' SRC experiences and depression (AOR = 1.32, p < .05), suicidality (e.g., attempted suicide AOR = 2.68, p < .001), and self-harm (AOR = 1.97, p < .001) while controlling for being bullied or teased, gender, age, race, and COVID-19's mental health impact. Contrary to prior findings: (1) SRC associations with self-harm and suicide attempts were consistent across genders; and (2) African American students with SRC were significantly more likely to experience depression, self-harm, suicide planning, and attempts than peers without SRC. Results indicated mental health resilience post-concussion for Latinx youth. Implications advocate population-specific health promotion measures that address vulnerabilities and protective factors while emphasizing SRC education for parents, coaches, and young athletes for timely psychological evaluation and support.