Epistemological Misunderstandings of the German Federal Court of Justice in Criminal Cases Regarding the Null Hypothesis: Verification in the Credibility Assessment The article deals with the decision of the German Federal Court of Justice (Bundesgerichtshof, BGH) in criminal matters regarding credibility assessment dated 30 July 1999 (1 StR 618/98, BGHSt 45, 164). Regarding criminal matters, the BGH formulated specific requirements for credibility assessments based on two published scientific expert reports. We analyzed conflicting postulates of scientific theory in the expert reports and the reception of these principles in the BGH judgment by examining the original quotes. Given the central importance of this BGH decision, we analyzed the original expert reports for their epistemological content. The BGH formulated the scientific approach of starting from the assumption that the statement is untrue - the so-called "null hypothesis". In doing so, it referred to Popper's deductivism, albeit without addressing the rules of hypothesis testing. Based on the second expert report, which argues for inductive.

In 2018, Herwig Czech (2018, 2020) and Edith Sheffer (2018) accused Hans Asperger of complicity in the Nazi child euthanasia program also because of his participation in the Gugging Commission. We reviewed all documents related to the Commission to clarify Asperger's role. The Commission consisted of officials from Vienna and Lower Danube and had the primary task of determining which children admitted to Gugging could attend an auxiliary school. As part of the investigations, a group of children was also diagnosed as incapable of learning and developing normally based on a list prepared by Gugging's Director. According to two documents prepared for the Commission, these children were to be assigned to the "Aktion Jekelius". The two authors imply that "Aktion Jekelius" was a cover term for the murder of these children and was known as such. However, this designation was communicated only within the Reich Governor's Office in Lower Danube. According to the available documents, there is no indication that Hans Asperger, as a member of the Vienna delegation, knew about "Aktion Jekelius" and its hidden murderous intentions. He therefore had no reason to refuse to participate in the Commission. Analysis of the subsequent transfers of children to Spiegelgrund showed no direct connection with the Commission's activities.

Current State of Research on Surf Therapy and its Possible Application as an Intervention for Adolescent Depression Depression is one of the most common mental health disorders experienced in adolescence. Because of its high prevalence rates and significant impact on affected individuals, alternative and complementary interventions are being explored. In recent years, physical activity has received increasing attention as a form of treatment. Current reviews highlight the potential benefits of this therapeutic approach in reducing depressive symptoms. Surf therapy is an innovative approach in the field of physical activity that additionally utilizes the therapeutic effects of the ocean. It combines surfing with structured exercises to promote mental and physical well-being. Internationally, surf therapy is already being applied to children and adolescents dealing with mental health problems as well as to adults diagnosed with conditions such as depression and posttraumatic stress disorder. Initial studies suggest positive effects of surf therapy in terms of symptom reduction, although the research is limited and requires further investigation. We present our pilot study investigating the feasibility and effectiveness of surf therapy for the treatment of adolescent depression in Germany.

Adolescents with Gender Incongruence - Special Case Constellations Adolescents with gender incongruence and gender identity variants have a high rate of accompanying mental disorders, such as depression, autism spectrum disorders, or eating disorders. Yet, the interaction between gender incongruence, gender dysphoric distress, and accompanying mental disorders is complex and varies considerably from case to case. We need an individualized approach and careful professional assessment to help those affected and their guardians make informed decisions regarding possible treatment steps in complex case constellations. Maintaining careful process support and planning of the treatment steps can help to resolve blocked development processes in adolescents with gender incongruence and accompanying psychological disorders or in young people with unstable gender identity development.

The situation of patient's relatives is still not broadly studied in psychiatry. Their needs are often overlooked. We developed a digital questionnaire concerning the patient's sociodemographic, disease-related, and family-related data and had the patient's therapist fill it out. The patients included ( = 1766) were persons hospitalized on a selected date. One-third of patients had at least one relative with mental illness, prior treatment, or need for treatment. The main diagnoses in relatives were affective, substance use, and somatoform disorders, often in concordance with their index patient. Teenage patients had the most affected relatives. The therapists of the minors included were better informed about their familial situation, whereas the therapists of the 30-59-year-olds knew the least. The comparably lower rate of affected relatives in adults stems most likely from underassessment and needs further investigation.

Recommendations for the Medical Treatment of ADHD in Comorbid, Substance-Related Disorders: Statement of the Joint Addiction Commission of the German Child and Adolescent Psychiatric Society and Associations Attention-deficit/hyperactivity disorder (ADHD) and substance use disorder (SUD) often occur together in adolescents. The available guidelines give the group of children and adolescents with ADHD and comorbid SUD little consideration. The Joint Addiction Commission of the German Child and Adolescent Psychiatric Society and Associations has drawn up a statement with treatment recommendations intended to provide orientation as a best-practice approach. Early treatment with stimulants in adolescents with ADHD and SUD may.

As a vulnerable group, minors require special protection in studies. For this reason, researchers are often reluctant to initiate studies, and ethics committees are reluctant to authorize such studies. This often excludes minors from participating in clinical studies. This exclusion can lead to researchers and clinicians receiving only incomplete data or having to rely on adult-based findings in the treatment of minors. Using the example of the study "Computer-Assisted Risk Evaluation in the Early Detection of Psychotic Disorders" (CARE), which was conducted as an 'other clinical investigation' according to the Medical Device Regulation, we present a line of argumentation for the inclusion of minors which weighs the ethical principles of nonmaleficence (especially regarding possible stigmatization), beneficence, autonomy, and fairness. We show the necessity of including minors based on the development-specific differences in diagnostics and early intervention. Further, we present specific protective measures. This argumentation can also be transferred to other disorders with the onset in childhood and adolescence and thus help to avoid excluding minors from appropriate evidence-based care because of insufficient studies.

Digital Beacons of Hope? The Challenges and Potentials of Digital Health Applications for Children and Adolescents with Mental Disorders in Germany With the Digital Healthcare Act, Germany has taken a decisive step toward promoting high-quality, evidence-based digital health applications (DiHAs). Presently, there is a significant gap in the provision of mental health services throughout Germany, particularly regarding children and adolescents and especially in the aftermath of the COVID-19 pandemic. DiHAs as low-threshold, location- and time-independent additional mental health services - may offer a way to address this situation. Particularly in the emerging generation of digital natives, there is a high demand for digital mental health services. However, despite the rapidly growing supply of DiHAs for adults, there is a lack of approved DiHAs for children and adolescents with mental disorders. Rather, the demand for care is left to the unregulated market of diverse internet- and mobile-based interventions; early studies have questioned the evidence base, safety, and quality. This discrepancy arises from various specific challenges and risks that reduce incentives to develop DiHAs for this particularly vulnerable target group, including (1) limited evidence, (2) high complexity in study execution, (3) high complexity in the development of applications, (4) poorly researched specific risks, and (5) high regulatory requirements. This article discusses these challenges and risks and outlines the perspectives for a high-quality, safe, and evidence-based digital mental healthcare for children and adolescents.

The S3 Guideline on the Treatment of Language Development Disorders: Summary of Recommendations The German S3 Guidelines on the Treatment of Developmental Speech and Language Disorders (AWMF: No. 049-015) were published on the AWMF homepage at the end of 2022. The German Society for Phoniatrics and Paedaudiologie coordinated the work and developed the guideline text together with linguists and speech and language therapists. Many scientific medical societies consented to the respective recommendations. For the first time in the German-speaking area, the guideline group reviewed international research results on the treatment of various speech and language disorders and formulated evidence- or consensus-based recommendations for clinical care. The present article summarizes these recommendations and evaluates the guidelines from the perspective of child and adolescent psychiatry and psychotherapy.

When Old People Suffer Because of the Sex of the Young: A Commentary on Korte, A. & Tschuschke, V. (2023). The Media's Stranglehold on Sturm und Drang - The Sorrows of Generation Z Regarding Sex and Gender In their article "Sturm und Drang im Medien - Die Leiden der jungen Generation am eigenen Geschlecht" in the für Kinder- und (volume 51, issue 5), our colleagues Korte and Tschuschke address the question of the extent to which the increase in gender identity deviations among adolescents "also results from upheavals the cultural landscape and, above all, in media technology." The authors look critically at the planned German "Self-Determination Law," the social transition of children and adolescents, the so-called puberty blockade, and hormone therapy in adolescents and justify their preference for a gender-critical over a transaffirmative therapy approach. Although the article introduces some interesting hypotheses from the perspective of cultural studies and philosophy (among others), it may contribute to uncertainty among colleagues in treating trans*people because of its trans-critical tone. This stems from linguistic devices, misleading and erroneous quotations, and incomplete or incorrect descriptions of facts. This contribution therefore takes a critical look at the article by Korte and Tschuschke, using critical linguistic analysis and examining the facts, data, and sources cited by the authors. It encourages our colleagues to engage in a joint treatment process with gender-dysphoric children and adolescents while exploring the sizeable intermediate area between "gender-critical" and "transaffirmative" attitudes, which the authors Korte and Tschuschke barely touch on in their article.

Recent research has increasingly emphasized the function of the microbiome in human health. The gut microbiome is essential for digesting food and seems to play a vital role in mental health as well. This review briefly overviews the gut microbiome and its interplay with the central nervous system. We then summarize some of the latest findings on the possible role of the microbiome in psychiatric disorders in children and adolescents. In particular, we focus on autism spectrum disorder, attention-deficit/hyperactivity disorder, anorexia nervosa, bipolar disorder, and major depressive disorder. Although the role of microbiota in mental development and health still needs to be researched intensively, it has become increasingly apparent that the impact of microbiota must be considered to better understand psychiatric disorders.

The Operationalized Psychodynamic Diagnostic of Children and Adolescents (OPD-KJ-2) in Everyday Clinical Practice with the Plämobox: Applicability and Interrater Reliability The OPD-CA2 manual for assessing psychodynamic aspects in children and adolescents is well established in clinical practice. However, publications regarding its reliability and validity are limited to (1) adolescents, (2) the structure of the first version of the manual and not to the comprehensive revision of the OPD-CA2, (3) the axes "structure" and (partly) "conflict" but not the axis "relationship," and (4) missing applicability in everyday clinical practice. The present study comprised 42 children aged 6-12 years (age level 2 of the OPD-CA2), with and without mental illness, and assessed them using two randomly assigned raters. We assessed them using a low-structured diagnostic symbol game with miniature figurines and objects based on videotapes. We also tested the interrater reliability of the OPD-CA2 axes. The overall assessment of structure and the assessment of the four subdimensions succeeded with good to very good agreement. We could also determine the presence of relevant conflict dynamics with very high agreement, while not recognizing specific conflicts in the clinical sample. Our assessment of the items of the relationship axis shows a low level of agreement. Overall, we can confirm the reliability of the OPD-CA2 for everyday clinical assessment in the younger age groups. Finally, we discuss which factors contribute to the heterogeneous picture.

Sports and Physical Exercise Therapy in the Treatment of Mental Health Issues in Children and Adolescents Mental disorders are among the most common chronic diseases in childhood and adolescence in Germany and worldwide. The health benefits of a physically active lifestyle during adolescence are well documented. Furthermore, a growing body of evidence suggests a positive impact of physical activity on mental health and emotional well-being. Longitudinal studies also show an association between physical activity and reduced risk of developing a mental disorder. Therefore, therapeutic exercise plays an important role in child and adolescent psychiatry. High-quality randomized-controlled trials are needed to substantiate the described effects.

Is Physical Activity a Treatment Option for ADHD? Physical activity as an option for the prevention and treatment of psychiatric disorders is increasingly becoming the focus of research. In particular, because of improvements in cognitive functioning, attentional performance, impulsivity, and hyperactivity, physical exercise could be a promising treatment option for attention deficit hyperactivity disorder (ADHD). In this narrative review, we present and evaluate the current state of research on exercise effects in children and adolescents as well as in adults with ADHD. While studies of the short-term effects of a single bout of physical activity indicate robust effects on attention and inhibitory control, results on the impact on further symptoms of ADHD as well as in adults are mixed. Randomized controlled trials of longer-term physical activity are scarce and show high heterogeneity. Nevertheless, they are encouraging for further research in this area.

Beyond NICE: Updated Systematic Review on the Current Evidence of Using Puberty Blocking Pharmacological Agents and Cross-Sex-Hormones in Minors with Gender Dysphoria The suppression of physiological puberty using puberty-blocking pharmacological agents (PB) and prescribing cross-sex hormones (CSH) to minors with gender dysphoria (GD) is a current matter of discussion, and in some cases, PB and CSH are used in clinical practice for this particular population. Two systematic reviews (one on PB, one on CSH treatment) by the British National Institute for Clinical Excellence (NICE) from 2020 indicated no clear clinical benefit of such treatments regarding critical outcome variables. In particular, these two systematic NICE reviews on the use of PB and CSH in minors with GD detected no clear improvements of GD symptoms. Moreover, the overall scientific quality of the available evidence, as discussed within the above-mentioned two NICE reviews, was classified as "very low certainty" regarding modified GRADE criteria. The present systematic review presents an updated literature search on this particular topic (use of PB and CSH in minors with GD) following NICE principles and PICO criteria for all relevant new original research studies published since the release of the two above-mentioned NICE reviews (updated literature search period was July 2020-August 2023). The newly conducted literature search revealed no newly published original studies targeting NICE-defined critical and important outcomes and the related use of PB in minors with GD following PICO criteria. For CSH treatment, we found two new studies that met PICO criteria, but these particular two studies had low participant numbers, yielded no significant additional clear evidence for specific and clearly beneficial effects of CSH in minors with GD, and could be classified as "low certainty" tfollowing modified GRADE criteria. The currently available studies on the use of PB and CSH in minors with GD have significant conceptual and methodological flaws. The available evidence on the use of PB and CSH in minors with GD is very limited and based on only a few studies with small numbers, and these studies have problematic methodology and quality. There also is a lack of adequate and meaningful long-term studies. Current evidence doesn't suggest that GD symptoms and mental health significantly improve when PB or CSH are used in minors with GD. Psychotherapeutic interventions to address and reduce the experienced burden can become relevant in children and adolescents with GD. If the decision to use PB and/or CSH is made on an individual case-by-case basis and after a complete and thorough mental health assessment, potential treatment of possibly co-occurring mental health problems as well as after a thoroughly conducted and carefully executed individual risk-benefit evaluation, doing so as part of clinical studies or research projects, as currently done in England, can be of value in terms of generation of new research data. The electronic supplement (ESM) 1 is an adapted and abreviated English version of this work.