Early regulatory problems (RPs), including excessive crying, sleeping difficulties, and feeding issues in infancy, are associated with later mental health difficulties. However, existing studies used broad mental health outcomes and inconsistent outcome measures. They have also overlooked adolescence, which is a crucial and sensitive developmental period. Using harmonized RP classifications, measured from 6 to 36 months of age, and item-level harmonized mental health dimensions, we examined emotional, social, hyperactivity / inattention, and conduct problems at ages 10, 14, and 18 years in two population-based cohorts (ALSPAC, N = 3870; Generation R, N = 1798). Longitudinal mixed models showed RP-related differences across all mental health dimensions. Specifically, children with multiple (two or more at one timepoint) or multiple-persistent (two or more RPs present at three or more timepoints in the first 36 months) RPs had consistently higher emotional, social, attention, and conduct problems, compared with participants without RPs. These differences remained stable across adolescence, with no evidence of RP-by-assessment wave interactions and were comparable for both sexes. Our cross-cohort findings support early RPs as early indicators of later mental health vulnerability. They additionally show that these associations can be identified reliably using harmonized exposure and outcome constructs across cohorts. Screening for these behaviors in routine pediatric care offers a practical method to identify at-risk children and guide early preventive interventions.
Mental health inequities among young people are often examined through single social dimensions, potentially obscuring heterogeneity across intersecting social positions. This study examined how anxiety and mood disorder diagnoses varied according to intersections of sex, socioeconomic status (SES), and nationality in Catalonia. Population-based cohort included 2,086,641 individuals aged 10–24 years (2008–2022) using anonymized primary care records. Sex-stratified regression models examined associations between SES–nationality intersections and incident anxiety and mood disorder diagnoses. Among young people with Spanish nationality, the likelihood of receiving anxiety and mood disorder diagnoses increased as SES decreased, with the highest risks among lower SES groups (e.g., anxiety among girls: HR = 1.31, 95
To examine associations of maternal early-pregnancy weight change, total gestational weight gain (GWG), and mid-to-late pregnancy GWG rate (GWGR) with infant neurodevelopment from 0–3 years. Utilizing data from the prospective Beijing Birth Cohort Study, this study investigated 5,951 singleton mother–infant pairs. Infant neurodevelopment was assessed via Ages and Stages Questionnaires, Third Edition (ASQ-3) at 2, 6, 8, 12, 18, 24, and 36 months. Latent trajectory modeling identified domain-specific ASQ-3 trajectories. Multivariable logistic regression evaluated associations of early-pregnancy weight loss, total GWG, and GWGR with risk of developmental delay based on ASQ-3 screening thresholds and ASQ-3 low-score trajectories. Early-pregnancy weight loss was associated with increased risks of infant developmental delay based on ASQ-3 screening thresholds in problem-solving (aOR=1.565, 95 domains (aOR=1.222, 95 likelihood of following ASQ-3 low-score trajectories in problem-solving domain(aOR=1.209, 95 early-pregnancy weight loss, failure to achieve catch-up GWG correlated with less favorable ASQ-3 screening outcomes and low-score trajectories across multiple domains. Conversely, catch-up GWG after weight loss was only linked to personal-social and problem-solving developmental delays respectively. Additionally, excessive GWGR after weight loss also showed less favorable ASQ-3 screening outcomes and trajectories. Among women with early-pregnancy weight loss, failure to achieve catch-up GWG or having excessive GWGR was significantly associated with higher risk of infant developmental delay based on ASQ-3 screening thresholds and adverse ASQ-3 low-score trajectories. However, adverse neurodevelopmental associations remained present despite subsequent GWG within recommended ranges.
The co-existence of autism and attention deficit/hyperactivity disorder in tic disorders is a key factor influencing clinical decision-making. Given the shared clinical features and a potentially overlapping aetiology, the need to identify specific tic characteristics associated with these conditions remains. The current study subsequently sought to identify tic phenomenology uniquely predicted by autism and attention deficit/hyperactivity disorder traits in children and adolescents. Data from 473 5-16-year-olds from the 2004 British Child and Adolescent Mental Health Survey with motor and/or vocal tics were used. Regression analyses were conducted to determine the effect of autism and attention deficit/hyperactivity disorder traits on: (i) the presence of motor and/or vocal tics, (ii) tic onset age, (iii) nocturnal tic expression, (iv) self-regulatory control over tic expression, (v) tic frequency during restful/low arousal state, and (vi) rebound tic activity post-suppression, before and after adjustment for confounders. Autism is associated with earlier onset of tics by approximately 2.43 years. Attention deficit/hyperactivity disorder traits are associated with a 2.64x odds of experiencing worsening tics following periods of suppression. Neither autism or attention deficit/hyperactivity disorder traits were specifically associated with motor and/or vocal tics, self-regulatory control over tic expression, nocturnal tic expression, or tic frequency during restful/low arousal states. Comorbid neurodevelopmental traits not only co-occur with tic disorders but actively shape their clinical expression and trajectory. Clinically, earlier support for autistic children with tics may facilitate a timely intervention. Intervention plans for individuals with attention deficit/hyperactivity disorder traits should consider heightened vulnerability to tic rebound post-suppression.
Several children living with Tourette syndrome (TS) also present with recurrent episodes of sudden and intense anger, which are known as explosive outbursts. Nevertheless, individual characteristics influencing the onset of such outbursts remain poorly understood. In adults, impulsivity has been found to be a risk factor for explosive outbursts, but there are no such data among children. Additionally, behavioral inflexibility, which is conceptualized as a pattern of rigid, inflexible behavior in situations where it would be beneficial to adapt one’s behavior to external demands, constitutes a trigger for anger outbursts in other neurodevelopmental conditions. However, its role in TS has not been studied yet. Therefore, the aim of this study was to assess whether impulsivity and behavioral inflexibility were associated with explosive outbursts. Three hundred and seventeen (317) parents of children (aged 6–14, 74.8
In several European countries, national clinical guidelines for the management of ADHD are lacking. In others, guidelines are outdated or do not address more detailed aspects of care, such as medication titration procedures or specific recommendations for school adjustments. Perceptions of the appropriateness of treatment, which influence the delivery of care for ADHD, are shaped by sociocultural aspects. Consequently, practices in the management of ADHD are expected to substantially vary across Europe. To better understand current practices in both pharmacological and non-pharmacological management of ADHD, as well as clinicians’ perceptions of treatment appropriateness, we conducted an online survey among European qualified child and adolescent (neuro)psychiatrists and general psychiatrists or trainees involved in the care of children and adolescents with ADHD. The survey was developed and implemented by the European Society for Child and Adolescent Psychiatry (ESCAP) Research Academy, with input from the European ADHD Guidelines Group (EAGG). It was completed by 1,441 clinicians of varying seniority from 23 European countries. The findings provide updated insights into ADHD management across Europe and highlight three key unmet needs. First, several clinically relevant areas lack sufficient evidence, including how to personalise treatment and identify practical predictors of treatment response. Second, some existing evidence has not yet been adequately translated into clinical guidelines or routine practice, particularly regarding comparative treatment effects and dose–response relationships relevant to medication titration. Third, some respondents reported needs that are already addressed in existing international guidelines, suggesting that language barriers may limit access to guidance and underscoring the importance of developing country-specific recommendations in local languages. Overall, this survey - to our knowledge the largest of its kind conducted in Europe - provides valuable information to inform future clinical guidelines, research priorities, and health policy. It also informs future training programmes aimed at reducing bias in the perception and delivery of ADHD treatment.
Although parent–child relationships and adolescent depressive symptoms have been shown to have reciprocal associations, most studies have either focused on only one parent (typically the mother) or have combined mother–child and father-child relationships into a single overall parenting score. This study aimed to examine the different reciprocal associations of father-child and mother–child relationships with adolescent depressive symptoms, and whether insomnia mediated these associations. A total of 939 Chinese adolescents completed three surveys (baseline Mage = 13.00 ± 0.38, 63.70
Personality functioning (PF) is a transdiagnostic construct central to contemporary models of personality pathology and a key mechanism linking childhood maltreatment (CM) to adult mental health difficulties. Yet the relative contributions of CM subtype, developmental timing, and cumulative exposure characteristics to adult PF impairment remain unclear. Gender-stratified conditional random forest regression was applied to data from a nationally representative German sample (N = 2,467; 51.8
Intensive community care services (ICCS) are community-based alternatives to inpatient care for young people with severe mental health disorders. This systematic review investigated the experiences and satisfaction associated with ICCS. Nine electronic databases were searched from inception to August 2025 for studies on children and adolescents under 18 years receiving mental health care from ICCS. Primary outcomes were experiences and satisfaction from the young people, parents, or clinicians. Quantitative satisfaction data were qualitised before integrating with qualitative data. The synthesis used a meta-aggregative approach to produce statements to inform practice. Nine studies from eight articles were included: two qualitative, three mixed-methods, and four quantitative studies. No studies examining clinician experiences were identified. Positive experiences were generated when ICCS: (a) provide structured emotional and practical support to caregivers; (b) facilitate strong therapeutic relationships across the young person-family-clinician system through frequent, flexible, and community-based contact; (c) offer multidisciplinary expertise and specialist interventions; (d) support sustained improvements beyond treatment by embedding therapeutic work in real-world contexts; (e) actively manage extra-therapeutic factors and family involvement to avoid undermining young people’s autonomy or sense of agency. Parents were particularly satisfied with ICCS due to accessibility, responsiveness, intensity of contact, and reduced hospitalisation. ICCS models successfully generate positive experiences in service users. Satisfaction was generally higher than routine care and particularly pronounced amongst parents. Future studies should explore staff perspectives and specific elements of satisfaction. These findings have implications for service design, workforce training, and balancing family involvement with young people’s autonomy.
Implementation variability is hypothesized to be a key treatment effect modifier of universal, school-based mental health interventions, but the evidence base remains meagre. We used Complier Average Causal Effect (CACE) estimation to determine if dosage variability modified treatment effects of relaxation techniques and mindfulness-based exercises in the INSPIRE cluster randomised trial. Analyses were split by phase of education (mindfulness primary: k = 65 primary schools, N = 3,630 pupils; mindfulness secondary: k = 29 secondary schools, N = 3,708 pupils; relaxation primary: k = 66 primary schools, N = 3,800 pupils; relaxation secondary: k = 26 secondary schools, N = 3,252 pupils) and considered compliance effects at the 50th (moderate) and 75th (high) percentiles in the distribution of intervention dosage (total minutes delivered). Despite null intent to treat findings, we observed compliance effects for both interventions. In primary schools, moderate (320 min) and high (376 min) compliance to relaxation techniques significantly reduced depressive symptoms (d=-1.52 and d=-1.48, respectively). In secondary schools, moderate (207 min) and high (285 min) compliance to mindfulness-based exercises also significantly reduced depressive symptoms (d=-1.15 and d=-1.40, respectively). Contrastingly, in primary schools, moderate (325 min) and high (393 min) compliance to mindfulness-based exercises significantly increased depressive symptoms (d = 0.32 and d = 0.48, respectively). In secondary schools, moderate (180 min) and high (275 min) compliance to relaxation techniques also significantly increased depressive symptoms (d = 0.67 and d = 0.83, respectively). The effects of universal, school-based mental health interventions promoting relaxation and mindfulness are contingent on the delivery of a minimally effective dose. However, these interventions may not be appropriate in all educational contexts and could result in iatrogenic effects. Trial registration: Trial registration number: ISRCTN16386254. Trial registration date:04/09/2018.
Suicide among adolescents is becoming increasingly concerning, with nonsuicidal self-injury (NSSI) as an important proximal predictor of suicidal ideation. However, it remains unclear whether suicide crisis syndrome (SCS), a new construct serving as an imminent warning sign of suicide, can explain the underlying mechanism between NSSI and suicidal ideation and enhance the prediction of prospective suicidal ideation. This study included 1018 Chinese adolescents (50.1
Adolescents frequently seek emotional support from parents and peers when experiencing psychological distress. The quality of these relationships may therefore influence their help-seeking behavior and access to professional care, but it is yet unknown whether the quality of the relationship to parents and peers prospectively predict adolescent mental health service use. Guided by the Behavioral Model of Health Service Use, the present study examined whether perceived relationship quality—specifically closeness and conflict with mother, father, and best friend—prospectively predicted use of specialty mental health services. Data were drawn from a Norwegian birth cohort assessed from ages 12 to 18 across four waves (n = 822), using clinical interviews and questionnaires. Results from an autoregressive cross-lagged panel model including a propensity score of potential confounders (prior service use, gender, parental occupation, cohabitation status, parental depression and anxiety, perceived need for help, symptoms of adolescents’ emotional problems and disruptive behaviors, impairment, and stressful life events) showed that higher conflict with father predicted lower subsequent service use across age. Other relationship factors (i.e., closeness with father, as well as closeness and conflict with mother and best friend) were unrelated to service use. These findings suggest that father–adolescent conflict may be associated with lower use of specialty mental health services among adolescents and warrant further investigation of the role of fathers in adolescents’ help-seeking.
Cognitive functioning in clinical settings is typically summarized by the Full-Scale Intelligence Quotient (FSIQ), although increasing evidence suggests that variability across cognitive domains may provide additional clinically relevant information. Cognitive heterogeneity has been associated with functional impairment and psychopathological vulnerability in youth, but most studies rely on single discrepancy metrics rather than multidimensional approaches capable of identifying distinct cognitive configurations. The present study investigated cognitive heterogeneity in an inpatient adolescent psychiatric population using a data-driven approach and examined its associations with adaptive functioning, psychopathological severity, and suicidality. This retrospective observational study included 194 Adolescents aged 12–18 years hospitalized in a tertiary child and adolescent psychiatric inpatient unit. Cognitive functioning was assessed with the Wechsler Intelligence Scales (WISC-IV or WAIS-IV), yielding Verbal Comprehension (VCI), Perceptual Reasoning (PRI), Working Memory (WMI), and Processing Speed (PSI) indices. A unidimensional Discrepancy Index was calculated as the within-subject standard deviation across the four indices and tested for associations with clinical variables. In parallel, Gaussian Mixture Model clustering was applied to identify latent cognitive profiles based on index scores. Clinical and functional outcomes were compared across clusters. The Discrepancy Index showed minimal clinical associations and was significantly related only to non-suicidal self-injury. In contrast, clustering analysis identified four cognitive profiles: high-discrepant, high-harmonic, low-discrepant, and low-harmonic. Cluster membership was significantly associated with adaptive functioning, illness severity, and suicidality. Adolescents with higher cognitive performance demonstrated better adaptive functioning, whereas those with lower cognitive efficiency showed greater illness severity and poorer adaptive skills. Suicidality scores differed across clusters, with the low-harmonic profile showing lower suicidality compared with the high-discrepant group. A multidimensional, profile-based approach captured clinically meaningful cognitive heterogeneity not identified by a single discrepancy index. These findings highlight the relevance of cognitive configuration, beyond global intellectual level, as a potential marker of neurodevelopmental vulnerability and support the use of multidimensional cognitive profiling in the clinical characterization of adolescents with psychiatric disorders. Trial registration: Not applicable.
The role of genetic factors shaping liability for psychosis remains unclear. Youth with first-episode, early-onset psychosis and youth at increased familial risk for psychosis show higher rates of co-occurring psychiatric diagnoses and cognitive difficulties than the general population. This study assessed polygenic scores (PGS) for psychiatric diagnoses, cognition and educational attainment in 414 youth: N = 69 cases with non-affective, early-onset psychosis (schizophrenia, schizophreniform and schizoaffective disorders), N = 62 cases with affective, early-onset psychoses (bipolar or depressive disorders with psychotic symptoms), N = 52 offspring of patients with schizophrenia, N = 94 offspring of patients with bipolar disorder, and N = 117 healthy controls. After quality control, PGS were calculated using the PRS-CS tool. Differences in PGS were examined by fitting binary logistic models. Sensitivity analyses ruled out effects of potential confounders. PGS for schizophrenia and bipolar disorder were higher in youth with non-affective, early-onset psychoses and offspring of patients with schizophrenia, and higher PGS scores for attention deficit hyperactivity disorder (ADHD) were found in youth with non-affective, early-onset psychoses and offspring of patients with bipolar disorder, relative to controls. PGS for cognition and educational attainment were lower in youth with non-affective, early-onset psychoses, compared with youth with affective, early-onset psychoses, offspring of bipolar disorder patients, and controls (all PFDR<0.05). Conclusion: These findings indicate shared and distinct genetic liability profiles influenced by patient and parental diagnoses. In addition to liability for schizophrenia and bipolar disorder, polygenic profiles for ADHD, cognition, and educational attainment may determine the genetic architecture of psychosis.
Nonadherence to pharmacological treatment for attention-deficit/hyperactivity disorder (ADHD) is common among children and adolescents. Despite well-documented clinical and contextual barriers, to the best of our knowledge no dedicated tool exists to quantify parental challenges in supporting adherence. This study aimed to develop and evaluate the My Experience with ADHD Pharmacotherapy – Parent Report (ME WAPH-P) questionnaire. The ME WAPH-P was developed based on existing instruments, clinical experience, expert input, and literature on nonadherence. The initial 30-item questionnaire assessed adherence-related challenges across six subscales. Parents of children aged 4–18 years who had received ADHD medication were recruited via social media and a commercial survey platform. The final sample included 351 parents. Psychometric evaluation included internal consistency, item discrimination, subscale intercorrelations, and exploratory factor analysis (oblique rotation). After removing one item, the 29-item scale demonstrated excellent internal consistency (Cronbach’s α = 0.90). Subscale reliability demonstrated moderate-to-high intercorrelations. Parallel analysis supported a three-factor structure explaining 44.7
Attention-deficit hyperactivity disorder (ADHD) is associated with a higher risk of premature mortality compared to the general population, although reported risks vary. The aim of this paper was to review studies that have examined associations between premature mortality and ADHD and consider factors that could explain variation in risk estimates. A literature search was carried out using online databases (PMC, OVID, and Scopus library) to identify relevant articles. We then considered: sample ascertainment, sample size, method of diagnosing ADHD and age at diagnosis, sex, age range for mortality data, hazard ratio/ mortality rate ratio (95
Neurodevelopmental disorders such as Autism and ADHD pose significant challenges for families. Parents face additional parenting challenges and stressors, and are more likely to experience mental health problems compared to the general population. This is associated with a more unfavourable course in the children. Still, it is unknown whether addressing parental mental health is of additional benefit for the children. Families with a child referred to a developmental clinic for neurodevelopmental problems, and a parent who was experiencing subclinical or clinical mental health symptoms, were recruited. One hundred and twenty-seven families (caregivers: female n = 119, male n = 23; children: female n = 37, male n = 90) were randomised into (1) standard Stepping Stones Triple P, a parenting program for children with neurodevelopmental issues (n = 63), or (2) Enhanced Stepping Stones Triple P (n = 64) which includes additional modules addressing parental mental health. Participants completed pre and post intervention surveys including the Adult Self Report (ASR) and the Child Behaviour Checklist (CBCL). Significantly greater improvements were seen in the Enhanced Stepping Stones Triple P ASR ADHD scores compared to the Stepping Stones Triple P group, however this was not significant after correcting for multiple testing. No additional benefits of the Enhanced Stepping Stones Triple P group were seen for the children’s scores. In both groups, the CBCL oppositional defiance and ASR anxiety scores showed nominally significant improvements. None of these remained significant after correcting for multiple testing. The results highlight that families with concurrent parent and child mental health symptoms face unique challenges and increased burdens, and further research is needed in how to tailor programs that best suit their needs and to improve program engagement.
