BACKGROUND:Irritability is a common and impairing feature of childhood psychopathology and is increasingly conceptualized as comprising tonic (persistent irritable mood) and phasic (reactive temper outbursts) components. Although these dimensions show partially distinct behavioral correlates, it remains unknown whether they map onto separable neural mechanisms. This study examined whether tonic and phasic irritability show differential associations with neural activation and connectivity during reward processing in early childhood. Early childhood is a critical period for investigation because impairing irritability can first be reliably identified and tonic and phasic components are already distinguishable. METHODS:Participants were 160 children (mean age = 6.17 years, SD = 0.50; 52.5% female) recruited from the community using an irritability-enriched screening design. Caregiver-reported tonic and phasic irritability were assessed at screening using the Tonic and Phasic Irritability Scale (TAPIS). Children completed a developmentally adapted reward task during functional magnetic resonance imaging (fMRI). Whole-brain activation and generalized psychophysiological interaction connectivity analyses examined interactions among tonic irritability, phasic irritability, and task condition (reward vs. no reward; hit vs. miss), controlling for demographic covariates. RESULTS:Tonic and phasic irritability interacted to predict neural activation and connectivity across frontostriatal and limbic networks during reward anticipation and feedback. Tonic irritability was associated with greater reward-related neural differentiation primarily when phasic irritability was low, whereas this differentiation was attenuated at higher phasic irritability. Independent effects also emerged, with tonic irritability linked to altered ventral striatal connectivity during nonreward and performance failure contexts, and phasic irritability associated with increased amygdala-prefrontal and striatal-cingulate differentiation between reward and nonreward conditions. CONCLUSIONS:Findings provide novel evidence that tonic and phasic irritability correspond to partially dissociable neural processes as early as early childhood. Parsing irritability into chronic versus reactive components may refine neurodevelopmental models and inform more targeted intervention approaches.
BACKGROUND:Studies that used complex statistical analyses provided some evidence to support the utility of differentiating between variants of callous-unemotional (CU) traits. Yet, no study has tried to identify these variants using a method that closely resembles applied clinical work. This study, therefore, tested if these variants can be found in individuals with DSM-5 defined conduct disorder (CD) and DSM-5 defined CU traits. METHODS:Participants were 288 male adolescents (Mage = 16.94) with a CD diagnosis. Using a diagnostic interview to assess the DSM-5 CU specifier ("with limited prosocial emotions (LPE)") and a well-established self-report anxiety questionnaire, participants were assigned to mutually exclusive groups, including groups that were low in anxiety (CD + LPE - ANX or "primary variant"; n = 145) or high in anxiety (CD + LPE + ANX or "secondary variant"; n = 27). These two groups were compared in individual and environmental characteristics as measured via questionnaire measures and experimental tasks. RESULTS:Relative to the CD + LPE - ANX group, the CD + LPE + ANX group scored higher on psychopathic trait dimensions, affective empathy, depressive symptoms, negative urgency, bodily awareness of emotions, emotional maltreatment, and sexual abuse. No group differences emerged in antisocial behavior, aggression, emotion recognition accuracy, and treatment engagement. CONCLUSIONS:Findings tentatively suggest that self-reported anxiety can be used to identify variants of youth who have CD and LPE diagnoses and that the CD + LPE + ANX captures a group of youth with multiple and complex needs.
BACKGROUND:Many autistic preschoolers experience heightened emotion dysregulation and rely heavily on parents for co-regulatory support, which may be compromised by elevated parenting stress. METHODS:We examined secondary outcomes of a randomized trial (ClinicalTrials.gov - NCT03459625) to assess downstream effects of parent stress-reduction interventions (MBSR vs. Psychoeducational Support) on emotion dysregulation in autistic children with diverse developmental and behavioral profiles (N = 117). We also explored cross-method, cross-context correspondence between parent report of children's regulatory tendencies and observational ratings derived from independent and dyadic parent-child problem-solving tasks. RESULTS:Parent-reported child dysregulation and observed dyadic dysregulation decreased significantly across groups, with reduced parenting stress predicting decreased parent-reported dysregulation. Conversely, observed child independent dysregulation remained relatively stable. Meaningful multimethod associations were identified. CONCLUSIONS:Results suggest important collateral benefits of parenting stress reduction during the sensitive postdiagnostic period and highlight the sensitivity and utility of parent-reported and observed dyadic dysregulation as trial outcomes, including the new Emotion Dysregulation Inventory-Young Child. Implications for conceptualization and measurement of emotion dysregulation in autism are discussed, as are considerations for optimizing environmental supports.
BACKGROUND:Attention-Deficit/Hyperactivity Disorder (ADHD) is highly heritable; thus, parents and children frequently experience ADHD-related impairments. Parent ADHD is associated with poorer developmental and treatment outcomes for children with ADHD, in part due to executive functioning and emotion regulation difficulties that interfere with parenting and treatment follow-through. Few studies have evaluated multi-modal, family-based approaches that directly address both parent ADHD and parenting to ultimately improve child outcomes. METHODS:We compared a telehealth-delivered, integrated behavioral parent training program (I-BPT) alone or preceded by a parent stimulant medication titration (PSM + I-BPT) for parents with ADHD (N = 120; 25% fathers; 27% Black/African-American; 11% Hispanic) and their 3-8-year-old, stimulant-naïve children. I-BPT dually targeted parenting and parent ADHD and was implemented by providers in urban pediatric clinics. TRIAL REGISTRATION:ClinicalTrials.gov identifier NCT04240756; Treating Parents with ADHD and Their Young Children Via Telehealth: a Hybrid Type I Effectiveness-Implementation Trial. Registered at https://clinicaltrials.gov/study/NCT04240756 on 01/21/2020. RESULTS:Children whose parents received PSM + I-BPT showed significantly steeper declines in Clinical Global Impressions ratings than those receiving I-BPT alone (d = 0.37; p = .001). Parents receiving PSM + I-BPT also demonstrated faster reductions in their own CGI-S ratings (d = 0.33) and reported greater improvements in inconsistent discipline (d = 0.22) and positive parenting (d = 0.24). Self-reported punitive parenting and observed parenting behaviors improved similarly across I-BPT groups. CONCLUSIONS:PSM + I-BPT led to benefits on parent and child clinical severity and targeted parenting skills compared to I-BPT without parental ADHD medication; broader parenting improvements occurred across both I-BPT conditions. Addressing parent ADHD pharmacologically may enhance the effectiveness of parenting interventions for multiplex ADHD families.
BACKGROUND:Hyperactivity is a core symptom of childhood attention deficit hyperactivity disorder (ADHD), yet no population-based studies have compared objective and subjective hyperactivity measures across the school day. METHODS:This study used data from N = 6,518 seven-year-olds in the Millennium Cohort Study. Physical activity was objectively measured using actigraphy every 15 min (Monday-Friday), and hyperactivity was assessed via parent and teacher Strengths and Difficulties Questionnaire ratings, analysed both as continuous (0-10) and binary (≥7; possible ADHD) scores. The association between actigraphy and hyperactivity were assessed via repeated ANOVAs throughout the day, accounting for sex and linear regressions during three school lessons (Lesson 1: 9.00-9.45 am Lesson 2: 11.00-11.45 am and Lesson 3: 1.15-2.00 pm). The effect sizes and standard errors were compared between morning and afternoon lessons. RESULTS:Continuous ratings from both parents and teachers were positively associated with objective activity across the school day (effect sizes = .015 and .008, respectively, both pFDR < .001). For teacher ratings, associations with continuous hyperactivity were significantly stronger in Lessons 2 and 3 than in Lesson 1 (Z = 3.24, pFDR = .005; Z = 2.80, pFDR = .020, respectively). CONCLUSIONS:These results illustrate how objective activity measurement can augment subjective assessments by capturing richer behavioural patterns in naturalistic educational settings.
BACKGROUND:Children with fetal alcohol spectrum disorder (FASD) have difficulties with functioning in daily life, emotions and behaviour. Evidence for FASD-specific parenting interventions is scarce, with few randomised trials of FASD-specific parenting interventions published to date. The Salford Parents' and Carers' Education Course for Improvements in FASD outcomes in Children (SPECIFiC) is a co-designed, seven-session psychoeducation programme co-delivered online. The aim was to evaluate feasibility outcomes of recruitment, retention and acceptability, as well as candidate efficacy outcomes to establish primary outcomes for a definitive trial. METHODS:A two-arm randomised feasibility trial compared SPECIFiC with treatment as usual (TAU). Parents or carers (n = 119) of children (4-16 y) with a confirmed or probable FASD diagnosis were randomised 1:1 to intervention or TAU. Outcomes included parenting stress (Parenting Stress Index-Short Form, PSI-4-SF), parenting self-efficacy (Tool to Measure Parenting Self-Efficacy, TOPSE), child behavioural difficulties (Strengths and Difficulties Questionnaire, SDQ) and parent mental health (Depression Anxiety Stress Scale, DASS-21; Clinical Outcomes in Routine Evaluation, CORE-OM). Health economic analysis used the Client Service Receipt Inventory (CSRI) and quality of life using EuroQol (EQ-5D-5L). Analyses followed an intention-to-treat principle. The trial is registered at www.isrctn.com (ISRCTN14483801). RESULTS:Recruitment (41%) and retention (85%) met prespecified feasibility thresholds, and satisfaction was high. Parenting stress did not differ significantly between groups (adjusted mean difference - 3.89, 95% CI -11.1 to 3.32). No clear between-group differences were observed for child behaviour, parental mental health or quality of life outcomes. Parenting self-efficacy improved in the intervention group relative to treatment as usual (adjusted mean difference 24.9, 95% CI 5.43-44.4; Cohen's d = .80). The cost per participant ranged from £227-£302. Fidelity checks confirmed consistent delivery. CONCLUSIONS:SPECIFiC demonstrated feasibility and acceptability and showed a promising signal for improving parental self-efficacy. A definitive trial is warranted to determine clinical and cost-effectiveness.
Preventive interventions frequently find positive effects that were not the original targets of the intervention, called crossover effects. This review aimed to catalog crossover effects of family-centered prevention programs (FCPP). The authors searched prevention program registries, screened 2,556 prevention programs (including duplicates across registries), and reviewed 166 programs against inclusion criteria. Of these 24 FCPPs with crossover effects were cataloged. Seven crossover domains (internalizing, externalizing, suicidal thoughts and behaviors, physical health, academics, high-risk sexual behaviors, and parental depression) were reviewed. Fourteen of the 24 reviewed programs yielded evidence of significant main effects on at least one crossover domain, with several yielding evidence across multiple crossover domains. Understanding the full breadth and reach of preventive interventions, including crossover effects, can increase efficiency and cost-effectiveness of prevention strategies. Most programs reviewed reported more than one crossover effect, and many others are encouraged to test the data for additional benefits. New data harmonization techniques can assist with low base-rate outcomes and smaller subgroup restrictions. Finally, more mechanistic and longitudinal investigations are needed to effectively leverage the FCPPs with the most widespread crossover effects.
Diagnoses play vital roles in child and adolescent mental health services and research. They facilitate accurate communication, selection of appropriate interventions and estimation of prognosis. Receipt of a diagnosis can generate relief and improved understanding for many families. However, a diagnosis can also lead to feelings of loss or serve as a focus for stigma. Difficulties are magnified when public discourse generates and propagates misunderstandings. These include a failure to appreciate that current diagnostic categories are syndromes (clusters of symptoms and signs) that lack distinct biological signatures or clear demarcation from healthy variation. Even within a single diagnosis, heterogeneity and developmental change are typical. Whilst diagnoses are important, scientists and practitioners need to be able to describe to the public that mental ill health does not consist of a set of distinct diagnostic categories and that many diagnoses lie on a spectrum of severity including less severe psychopathology that cannot be equated with a clinical diagnosis. This perspective emphasises the appropriateness of stepped care, where intensity of treatment, provision of diagnosis and specialist involvement vary across the spectrum.
BACKGROUND:This study aimed to compare the effects of atomoxetine (ATX) and methylphenidate (MPH) on emotional dysregulation (ED) in children with attention deficit/hyperactivity disorder (ADHD), and to explore potential neural correlates underlying treatment-related changes. METHODS:A total of 152 children with ADHD were randomly assigned to receive ATX (n = 76) or MPH (n = 76). After individualized dose titration, participants received a stable dose for 4 weeks. Emotional lability (EL) was the primary outcome, while emotion regulation strategies, ADHD symptoms, and overall illness severity were secondary outcomes. Mixed-effects linear models were applied to examine group differences across three time points (baseline, post-titration, and endpoint). Resting-state functional MRI data were acquired at baseline and endpoint and analyzed using whole-brain functional connectivity (FC) analysis with six amygdala subregions as seeds. TRIAL REGISTRATION:ChiCTR2200062905; approved on August 23, 2022. RESULTS:In both ATX and MPH groups, EL scores decreased significantly over time (β = -1.54, p < .001), with treatment effects in a similar range and no statistically significant between-group difference (MPH: d = -1.46; ATX: d = -0.93). After controlling for ADHD symptom improvement, treatment effects remained significant (β = -0.75, p < .001), suggesting that EL improvement was not solely accounted for by ADHD symptom reduction. Increased FC between the right basolateral amygdala and left orbital middle frontal gyrus (r = -0.46, p = .043), and between the left superficial amygdala and left middle cingulate cortex (r = -0.48, p = .031), was associated with EL changes and remained significant after controlling for ADHD symptom changes. No significant changes were found in self-reported emotion regulation strategies. CONCLUSIONS:ATX and MPH both alleviate ED in children with ADHD, and these effects are not solely accounted for by improvements in ADHD symptoms. Increased amygdala-centered FC may be associated with medication-related ED improvements.
Carroll et al. (Journal of Child Psychology and Psychiatry, 2025, 66, 1065) conducted a Delphi study, which synthesized responses across a range of participants to arrive at a consensus definition of dyslexia. The study contributes to understanding important considerations in this field from the perspective of a panel of stakeholders. In this article, we make the case for an alternative approach to defining and ultimately identifying dyslexia. Our proposed definition is developed through a critical examination of issues raised in the Delphi study and of approaches that emphasize cognitive processes, the use of intellectual assessment, and discrepancy-based concepts of dyslexia. In the end, our definition focuses on core academic skill difficulties and prioritizes effective prevention and intervention for students with or at risk for dyslexia.
BACKGROUND:Negative outcomes of psychological treatments for pediatric posttraumatic stress disorder (PTSD) have been underresearched. Although reporting has increased over the years, a comprehensive systematic review and meta-analysis is lacking. METHODS:We conducted a preregistered systematic review and meta-analysis (PROSPERO ID: CRD42020206290) and followed PRISMA guidelines. MEDLINE, PsycInfo, Web of Science, and PTSDpubs were systematically searched from inception to May 13, 2025. Eligible studies were randomized controlled trials (RCTs) of psychotherapies for pediatric PTSD with ≥10 participants per arm. Two independent coders extracted data and assessed risk of bias. RESULTS:Seventy-two RCTs (N = 5,677) met inclusion criteria. Of these, 69, 6, and 19 reported the incidence of all-cause dropout, deterioration of PTSD, and adverse events, respectively. Most trials (74%) investigated trauma-focused cognitive behavioral therapy (TF-CBT). Random effects meta-analysis showed that 7.87% of patients (95% CI, 4.07-12.55; I2 = 82%) dropped out, with no significant difference relative to passive controls (RR = 1.04, 95% CI, 0.64-1.69; I2 = 53%). Less than 0.01% (95% CI, 0.00-2.39; I2 = 0%) of patients reported deterioration after TF-CBT, compared to 1.26% (95% CI, 0.00-8.13; I2 = 40%) of passive controls. Limited data prohibited isolated review of other treatments. The incidence of adverse events during psychological treatments was also uncommon (0.29%, 95% CI, 0.00-2.67; I2 = 34%) and similar to passive controls (1.14%, 95% CI, 0.00-8.02; I2 = 84%). CONCLUSIONS:Psychological treatments for pediatric PTSD-with most accumulated evidence for TF-CBT-appear safe and acceptable for the vast majority of children and adolescents with PTSD, which is encouraging for clinical practice. Reporting on deterioration and adverse events was scarce, limiting statistical power. Negative outcomes should be routinely assessed in clinical practice and future research, using validated measures and clearly defined constructs. Future work should distinguish serious adverse events and adverse events.
In the fields of child psychology and psychiatry, countless environmental factors have been identified as correlates of children's health and development, yet each of these generally accounts for a small proportion of variance. The unaccounted-for variation in a model may be due to measurement error, random variation, model misspecifications or unmeasured predictors. The search for predictors traditionally viewed as being quite distal in children's social ecology has rapidly expanded over the past decade. For example, concerns regarding the impact of climate change on planetary health have been accompanied by research directly assessing the impact of climate-related environmental stressors on the health and well-being of children and youth. In this space, factors such as ambient heat exposure and air pollution during sensitive windows of development have recently been incorporated into studies examining children's mental health and neurodevelopment. In this perspective paper, we discuss the results of two such papers published in the journal, one each focused on heat exposure (Cuartas et al., 2026) and air pollution (Oh & Song, 2026) in relation to children's neurodevelopmental outcomes. Drawing on large international samples and using diverse methodologies, these studies show several small but consistent associations with a range of child outcomes, thus providing compelling initial evidence of the effects of these climate-related environmental stressors on development. Still, many unanswered questions remain related to the generalizability and reliability of findings, the domains of development most impacted, and the specific factors that may either exacerbate or mitigate the effect of these stressors. With considerable practice and policy implications, we argue for continued work in this area using diverse samples, robust measurement tools, and integration of developmental theories that will move beyond simple associations to help capture the complex mechanisms underlying these associations.
BACKGROUND:Sexual and gender minority youth (SGMY) often experience discrimination and stigma related to their sexual orientation or gender identity. This increases their vulnerability to HIV, poor mental health outcomes, including suicide, and low uptake of HIV prevention through bidirectional causal relationships that suggest integrating mental health support with HIV prevention. This study evaluates the impact of three intervention strategies (automated text messages, online peer support, and coaching) on secondary mental health outcomes among SGMY. METHODS:From May 2017 to August 2019, 895 SGMY (40% Black, 29% Latino) ages 16-24 years were enrolled in Los Angeles and New Orleans via 13 community sites and social media. Participants were randomized to: (a) automated text-messaging and monitoring (AMM), (b) AMM plus online peer support (AMM + PS), (c) AMM plus strengths-based coaching by telehealth or in-person by near-peers (AMM + C), or (d) all three interventions (AMM + PS + C). The interventions targeted HIV risk reduction primary outcomes and mental health and substance secondary outcomes. Assessments occurred over 24 months (70%-90% retention). Multivariate regressions compared interventions' efficacy on depression, anxiety, and mental health services use using intent-to-treat models stratified by high risk mental health (HRMH; n = 342; 38% with history of suicide attempts or psychiatric hospitalization) and low risk mental health (LRMH; n = 553; 62%). RESULTS:Participants reported mild anxiety and depression symptoms over time. At baseline, HRMH youth had more symptoms and greater service use than LRMH peers. Both outcomes significantly declined over time across groups. The two coaching arms were associated with an increased number of times receiving mental health specialist services among LRMH compared to HRMH youth. CONCLUSIONS:While over a third of SGMY (38%) reported past mental health events, recent symptoms of anxiety and depression were mild. Interventions did not significantly reduce symptoms or stabilize mental health service use, though coaching promoted greater services utilization among LRMH youth.
BACKGROUND:Adolescent depression is heterogeneous, yet many studies rely on aggregate symptom scores that may obscure meaningful differences in symptom presentation. Latent class analysis (LCA) offers a person-centered approach for identifying symptom subgroups, but few studies have examined depressive symptom classes longitudinally with attention to social determinants of health (SDoH). This study identified depressive symptom classes among youth with depression and/or suicidality, examined demographic, clinical, and socio-ecological correlates of class membership, and evaluated changes in psychological outcomes over 6 months. METHODS:Participants were 1,825 youth ages 8-20 years who screened positive for depression, endorsed suicidal thoughts or behaviors, or were receiving treatment for depression. Baseline Patient Health Questionnaire for Adolescents (PHQ-A) item responses were used to identify latent classes of depressive symptoms. Associations between class membership and sociodemographic characteristics, trauma exposure, health-related social needs, treatment barriers, anxiety, suicidality and resilience were examined using chi-square tests and analyses of variance. Mixed-effect models evaluated changes in clinical symptoms and resilience across 6 months of follow-up. RESULTS:A five-class solution was identified: Somatic Symptoms (15.6%), No Symptoms (12.4%), Mild Symptoms (20.5%), Moderate Symptoms (27.8%), and High Symptoms (23.5%). Classes differed significantly by sex, trauma exposure, interpersonal safety concerns, treatment barriers, anxiety severity, suicidality, and resilience. In contrast, household income and basic resource insecurities did not differ significantly across classes. Longitudinally, depressive symptoms, anxiety, and suicidality showed significant time-by-class interactions; however, within- and between-class effect sizes were generally small. Resilience did not exhibit differential changes across classes. CONCLUSIONS:Depressive symptom classes among youth with depression or suicidality demonstrate distinct clinical and socio-ecological profiles, highlighting meaningful heterogeneity beyond symptom severity alone. Person-centered approaches may improve characterization of adolescent depression and inform more tailored assessment and intervention strategies. Future longitudinal research should examine the stability of these classes and predictors of transitions between symptom classes.
BACKGROUND:Anorexia Nervosa (AN) has been linked to altered self-regulatory control processes and maladaptive habitual avoidance behavior. Both goal-directed and habit systems may be relevant to AN, in which restrictive eating behavior can appear highly deliberate and increasingly automatic over time. A previous fMRI study identified behavioral and neural markers hinting at heightened self-regulatory control ('overcontrol') during an avoidance habit task in acutely underweight adolescents and young women with AN. Extending this research to recovered individuals with a history of AN (recAN), we aimed to clarify whether these findings persist and can be seen as trait vulnerabilities. METHODS:A sample of 40 recAN and 40 pairwise age-matched healthy control (HC) participants carried out a three-phase experimental paradigm including (1) training of goal-directed response-outcome behavior, (2) training of avoidance stimulus-response pairings, and (3) a test of habitual response interference. Our fMRI analysis strategy focused on capturing training-related changes in neural activity related to reinforcement learning processes. RESULTS:Analyses of main effects of task confirmed expected behavioral and fMRI results. However, unlike previous findings of greater activation in frontoparietal control regions in young acutely underweight patients with AN during the establishment of avoidance behavior and of higher task performance, all behavioral task measures, region-of-interest fMRI, and follow-up whole-brain analyses yielded no group differences between recAN and HC. CONCLUSIONS:Our findings of intact avoidance habit learning after recovery from AN suggest that correlates of overcontrol previously observed in acutely underweight individuals with AN may reflect state-dependent rather than persistent trait markers of the disorder.
BACKGROUND:Sensory over-responsivity (SOR) is highly prevalent and impairing in autism spectrum disorder (ASD). SOR has been associated with sensory-limbic hyperresponsivity and reduced prefrontal top-down regulation during sensory stimulation. There are few evidence-based treatments for SOR, but cognitive reappraisal, an emotion regulation strategy, has been shown to reduce negative feelings through activation of frontal brain regions. The current study examined whether reappraisal changes neural reactivity to aversive sensory stimulation in autistic compared to typically developing (TD) children. METHODS:Forty-seven ASD and 45 age/IQ-matched TD youth aged 8-15 years participated in fMRI while experiencing aversive tactile stimulation on their arm and alternately focused either on how the stimulus made them feel ('React'), or how they would describe the stimuli objectively ('Reappraise'). Aversiveness ratings were provided after each stimulus. Parents reported on participants' SOR severity. RESULTS:Autistic youth showed reduced activation in sensory cortical regions during Reappraisal compared to React. Reappraisal also resulted in increased dorsomedial prefrontal cortex activation, with a trend toward more increases in the TD group but no significant group differences. Despite these reappraisal-related neural changes across both groups, only TD youth showed a reduction in aversiveness ratings for Reappraisal compared to React. Among ASD youth, higher SOR was associated with fewer decreases in sensory cortices but greater increases in frontal regions during Reappraisal compared to React. Older ASD youth also showed increased activity in the ventral prefrontal cortex during Reappraisal. CONCLUSIONS:Results suggest that cognitive reappraisal modulates neural responses during sensory processing and, more specifically, may reduce hyperactivity in sensory cortical regions previously shown to be associated with SOR. However, individual differences such as age and SOR severity may affect the extent to which top-down cognitive processes are uniquely engaged during reappraisal.
BACKGROUND:Attention-deficit/hyperactivity disorder (ADHD) symptoms and emotional problems frequently co-occur. Longitudinal data provide opportunities to understand how and why they co-develop. METHODS:Data were drawn from the Twins Early Development Study, which included 27,890 participants. Emotional problems and ADHD symptoms were parent-reported using the Strengths and Difficulties Questionnaire and Conners' Parent Rating scales. We modeled the co-development of ADHD symptoms and emotional problems from ages 4 to 21 using joint trajectory analysis. The predictors included polygenic scores (PGSs) for multiple psychiatric symptoms, maternal depression, family chaos, and socioeconomic status (SES). The outcomes included SES, lifetime psychiatric diagnoses, undergraduate diploma attainment, and entry into parenthood at age 26. RESULTS:A four-class joint trajectory model was selected as best fitting and included: 'Low ADHD, Low emotional problems', 'High-decreasing ADHD, Low emotional problems', 'Mid-decreasing ADHD, Increasing emotional problems', and 'Increasing ADHD, Increasing emotional problems'. The consistently low-symptom group reported lower ADHD and had lower externalizing PGSs, lower maternal depression, higher SES, and less home chaos at baseline, and higher educational attainment and fewer lifetime depression/anxiety diagnoses at 26 than groups with higher symptom levels. Those with high ADHD symptoms in childhood or increasing ADHD symptoms from childhood to adulthood had the lowest educational attainment and SES in adulthood. CONCLUSIONS:Groups characterized by increasing ADHD symptoms also tended to show increases in emotional problems, whereas increases in emotional problems did not necessarily coincide with increases in ADHD symptoms. The trajectories had distinct early-life predictors and adult outcomes, highlighting potential intervention targets.
BACKGROUND:There is increasing recognition of the challenge of representativeness in data, including economic, social, and ethnic diversity, in biological mental health research. This is a particular challenge in adolescence, where brain and body development are impacted by the environment. The first step in addressing this is understanding the scale of the challenge. As such, this scoping review aims to explore existing literature to identify and understand the needs, barriers, and facilitators in collecting biological data in adolescent mental health research. METHODS:A systematic search identified papers recruiting participants aged 11-18, collecting biological data, and focussing on mental health/related psychopathology. Screening was performed in duplicate, and data charting was iterative. RESULTS:The initial search identified 13,752 papers. After removal of duplicates and screening exclusions, 962 papers were included; 892 were explored for recruitment, retention, and engagement. Sample sizes <99 were most common (54.4%), and health settings (45%) were the most frequent recruitment source. As labels for 'barriers', 'facilitators', and 'needs' were rarely used, information on recruitment, retention, and engagement (e.g. strategies for stakeholder engagement) were explored as a proxy. Only 8.6% of papers reported engagement strategies; fewer evaluated their efficacy. Less than half (45.6%) reported retention data, with reasons for lost data mostly relating to the nature of the data collection. CONCLUSIONS:Papers do not adequately report the methods used to ensure sufficient collection of representative data. Limited reporting challenges whether or not facilitators are being implemented. Advancing the field requires detailed guidelines. We present recommendations that serve as a first step towards this development.
BACKGROUND:Attention-deficit/hyperactivity disorder (ADHD) and developmental dyslexia (DD) are two prevalent neurodevelopmental disorders (NDDs) that frequently co-occur, resulting in comorbidity (COM), which is associated with significant cognitive and behavioral difficulties. These disorders are characterized by considerable clinical and neurobiological heterogeneity. The functional connectivity (FC) patterns within each disorder may consist of both individual-shared and individual-specific components. Disentangling these patterns may provide more in-depth insights into the neural mechanisms underlying these conditions. METHODS:In this study, the common orthogonal basis extraction (COBE) method was applied to the resting state electroencephalography (EEG) FC data from children with ADHD, DD, COM, and age-matched typical development (TD) controls, aiming to separate individual-shared and individual-specific FC patterns. RESULTS:Individual-specific FC could significantly predict clinical symptoms in ADHD, DD, and COM, with distinct predictive connectivity patterns across different groups. The predictive features in ADHD were primarily located in the left central and parietal regions. In DD, they involved the left temporal lobe, left parietal lobe, and right central region. In COM, they involved the left frontal lobe and the right parietal lobe. At the group level, compared with TD, individual-shared FC showed significantly enhanced posterior FC in all clinical groups. The differences in shared FC among the three clinical groups further allowed for the classification of ADHD, DD, and COM with an accuracy of 73.55%. CONCLUSIONS:By disentangling the shared and individualized components of EEG FC, this study provides novel insights into the neural organization of ADHD, DD, and their COM. The results suggest that individual-specific FC is more strongly associated with clinical symptoms, whereas shared FC captures group-level connectivity alterations and differences among clinical groups. This framework may present a promising approach for investigating biological heterogeneity in NDDs.
BACKGROUND:The global prevalence of problematic use of the internet (PUI) has increased over time, particularly among youth. To enhance the efficacy of treatments and identify personalized intervention targets, it is important to classify subtypes based on differences in underlying mechanisms rather than solely on symptom severity. This study aimed to identify reliable subtypes of PUI among youth by examining three neurofunctional domains commonly implicated in addictive behaviors-reward processing, negative emotionality, and executive function - and to assess how the identified subtypes differed regarding clinical characteristics and resting-state functional connectivity. METHODS:Data were drawn from the Healthy Brain Network (HBN) study, comprising 484 children and adolescents (ages 6-21; 37.4% female), including 242 individuals with PUI and 242 matched controls. Latent profile analysis, along with sensitivity analyses, was conducted on phenotypic data reflecting the three addiction-related domains. The resulting subtypes were then evaluated for clinical characteristics and resting-state brain functional connectivity to consider their clinical and biological relevance. RESULTS:Three stable PUI subtypes were identified: a 'High approach with low executive function' subtype characterized by steeper delay discounting and poorer executive function, frequently co-occurring with learning disorders (n = 20); a 'Negative emotionality' subtype with elevated negative affect, frequently co-occurring with affective disorders (n = 37); an 'Emotional stress' subtype that only exhibited higher negative affect compared to matched controls and showed no marked dysfunction across other domains (n = 185). Furthermore, each subtype demonstrated distinct patterns of resting-state functional connectivity. CONCLUSIONS:The findings provide empirical evidence that youth with PUI are heterogeneous across three core neurofunctional domains, offering insights for the development of more tailored, subtype-specific interventions.
