A Pilot Study on the Predictive Validity of Prognostic Tools in a Risk Group of Assessed Young Offenders Abstract: Background: This pilot study examined associations between established risk assessment instruments (PCL-YV/R, SAVRY, HCR-20 V3) and later criminal outcomes in a sample of 20 justice-referred adolescents, comparing those who reoffended in adulthood with those who did not. In addition to instrument scores, we assessed psychiatric diagnoses and social/criminological factors. Methods: We conducted a matched case-control and longitudinal analysis using data from forensic psychiatric/psychological evaluations in adolescence and, for the recidivist group, follow-up assessments in adulthood. We tested group differences at both the scale and domain levels. Results: Total instrument scores showed no significant group differences, though higher SAVRY total scores were linked with a greater frequency of subsequent violent convictions. In addition, a higher risk management factor score on the HCR-20 V3 was associated with later delinquency, indicating an increased need for support and intervention. This finding can be interpreted both as reflecting individual risk constellations and as potentially indicating insufficient structural conditions. Psychiatric diagnoses as well as social and criminological risk factors were highly prevalent in both groups. Conduct disorders occurred more frequently in the recidivism group, which also committed more violent offenses - a finding that underscores the importance of targeted tertiary preventive measures. Over time, risk assessments remained stable or increased slightly. Larger studies are needed to further examine the associations between risk assessment scores and later delinquency in high-risk groups of juvenile offenders.
Zusammenfassung: Hintergrund: Psychische Störungen bei jungen Kindern im Alter von 0 bis 5;11 Jahren sind heterogen und gehen mit einer hohen Beeinträchtigung einher. Das Ziel der Revision dieser interdisziplinären Leitlinie ist es, den aktuellen Stand zur Diagnostik und Therapie der wichtigsten Störungen zusammenzufassen und praxisorientierte Empfehlungen zu formulieren. Im zweiten Teil werden weitere Störungen besprochen, speziell Ess- und Fütter-, Regulations-, sensorische Verarbeitungs-, Ausscheidungs-, depressive und Angststörungen. Methoden: Die Leitliniengruppe setzte sich aus 18 Fachgesellschaften zusammen. Diese S2k-Leitlinie wurde auf der Basis aktueller Literaturrecherchen in mehreren online Abstimmungen und Konsensuskonferenzen nach den Regeln und unter der Moderation der Arbeitsgemeinschaft der Wissenschaftlichen Medizinischen Fachgesellschaften (AWMF) verabschiedet. Ergebnisse: Eine Vielzahl von psychischen Störungen können nach der DC: 0 – 5 und/oder einem Klassifikationssystem wie der ICD-10 diagnostiziert werden. Eine Beratung soll in jeden Fall erfolgen. Nach Indikation wird eine jeweils störungsspezifische Psychotherapie unter Einbeziehung der Eltern und Bezugsperson empfohlen. Ess- und Fütterstörungen, Regulations- und sensorische Verarbeitungsstörungen betreffen vor allem Säuglinge und Kleinkinder. Ausscheidungsstörungen, depressive und Angststörungen treten vor allem bei Klein- und Vorschulkindern auf. Für diese Störungen liegen jeweils wirksame Therapiemöglichkeiten vor. Schlussfolgerungen: Im Konsensusverfahren konnten alle Empfehlungen mit hoher Zustimmung verabschiedet werden. Die Empfehlungen zur Diagnostik, Beratung und Therapie können in verschiedenen klinischen Kontexten und unterschiedlichen Berufsgruppen wirksam eingesetzt werden.
Trauma-Associated Disorders, ADHD, Externalizing and Obsessive-Compulsive Disorders - Mental Health Disorders in Infants, Toddlers, and Preschool Children: Clinical Guideline for Assessment, Counseling and Treatment (Part 3) Abstract: Objective: A wide variety of mental health disorders can affect young children aged 0 to 5;11 years. The aim of revising these interdisciplinary guidelines is to present the current state of knowledge regarding the assessment and therapy of the most important disorders. We formulate consensus-based, practical recommendations. The third part focuses on disorders that primarily affect children over the age of 3 years, specifically trauma-associated disorders, ADHD, externalizing and obsessive-compulsive disorders, and other disorders. Methods: The Guideline Commission consisted of 18 professional associations. The guideline was based on current literature searches and several online consensus conferences, following standard procedures. Results: The prevalence and variety of disorders according to DC: 0 - 5 and/or ICD-10 increase with age among preschool children. Trauma-associated disorders can be highly incapacitating. ADHD and externalizing disorders can become chronic if untreated. Obsessive-compulsive disorders have been overlooked among young children. Counseling should be offered in every case. If indicated, specific psychotherapeutic approaches for each disorder are recommended, involving parents and other caregivers. Except for ADHD, medication is usually not indicated. All disorders can be treated effectively. Conclusions: The recommendations of this guideline were adopted with a high consensus. The recommendations regarding assessment, counseling, and treatment can be implemented effectively in different clinical contexts and by various professional groups.
Mental Health Disorders in Infants, Toddlers, and Preschool Children: Basic Aspects of Their Assessment and Treatment as well as Relationships, Crying, and Sleep Disorders. A Clinical Guideline for Assessment, Counseling, and Treatment (Part 1) Abstract: Objective: Mental health disorders are just as common among young children aged 0 to 5;11 years as in older children and adolescents. These disorders are heterogeneous and can be incapacitating. They vary depending on the developmental stage of the child but can be diagnosed and treated effectively. The aim of revising these interdisciplinary guidelines is to present the current state of knowledge on the assessment and therapy of the most important disorders. We formulate consensus-based, practical recommendations. The first part focuses on the basic principles of assessment, counseling, and treatment. In addition, it covers relationships, crying, and sleep disorders. Methods: The Guideline Commission consisted of 18 professional associations. The guideline was based on current literature searches and several online consensus conferences, following standard procedures. Results: A total of 16 different groups of mental health disorders could be identified among young children. Relationship disorders and the relational context play an important role in this age group. In addition to standard assessment procedures, specific diagnostic approaches can be helpful if indicated. The diagnoses should be based on the DC: 0 - 5 and/or other classification systems such as the ICD-10. Counseling should be offered in every case. If indicated, specific psychotherapeutic approaches for each disorder are recommended, including the involvement of parents and other caregivers. Medication is usually not indicated. Specifically, excessive crying and sleep disorders, which predominantly affect infants and toddlers, can be treated effectively. Conclusions: The recommendations of this guideline were adopted with a high consensus. The recommendations regarding assessment, counseling, and treatment can be implemented in different clinical contexts and by various professional groups. More research is required for some disorders.
Digital media have become a central part of children's and adolescents' daily lives, with increasing usage time and decreasing age of first exposure in recent years. While digital technologies offer opportunities for social participation, access to information, education, and therapeutic support, they are also associated with several risks to mental health. These include problematic use patterns, cyberbullying, exposure to harmful content and hazardous contacts as well as commercial exploitation through manipulative design practices ("dark patterns"). This evidence review summarizes current research on the opportunities and risks of digital media use from a developmental perspective across three age groups (0 - 5, 6 - 13, and 14 - 18 years). Evidence suggests associations between intensive media use and risks for sleep, attention, language development, psychosocial well-being, and academic performance. In adolescence, problematic internet use is also associated with behavioral addictions and mental health problems. Overall, the findings highlight the need for a balanced approach to digital media use, including age-appropriate protection, media literacy, and regulatory measures to safeguard the mental health of young people. This overview forms the basis for the position statement of the German Scientific Society and Associations for Child and Adolescent Psychiatry, Psychosomatics, and Psychotherapy on digital media use and mental health of children and adolescents.
This article examines the role of school support assistance in Germany from both a pedagogical and a child and adolescent psychiatric and psychotherapeutic perspective. It analyzes its conditions, potentials, and limitations based on legal and structural-systemic considerations. The findings indicate that school support services too often serve as a central prerequisite for attendance in mainstream schools, as they are frequently deployed when schools are unable to provide the structural conditions for inclusive education. As a result, the responsibility for ensuring educational participation is shifted from the institutional level of the school system to individually approved services within the child and youth welfare system. Coordination and delineation problems emerge at the interface of these two systems. These problems are further intensified by heterogeneous qualification levels and role conflicts and increase the risk of unintended exclusionary effects. Particularly for students experiencing psychological distress, school support assistance often assumes tasks that would require a continuous and professionally grounded integration of child and adolescent psychiatric and psychotherapeutic expertise in school-based support processes. This situation points to the need for a quantitatively and qualitatively stronger presence of relevant professional expertise in everyday school practice as well as for systematically coordinated cooperation with the therapeutic systems involved in treatment. From the perspective of child and adolescent psychiatry and psychotherapy, binding cooperation structures between schools, child and youth welfare services, and child and adolescent psychiatry and psychotherapy as well as clearly defined qualification standards and an increased emphasis on structurally oriented support models must therefore be developed and consistently implemented to secure inclusive education in a sustainable and participation-oriented manner.
Neurodiversity refers to the natural diversity of human beings and thus emphasizes the natural range of differences between people. As simple, convincing, and popular as this assumption is, the interpretations, conclusions, and implications of this statement are just as varied. This article focuses on the scientific basis of the concept, on the one hand, and on autism and divergence, on the other. It outlines the implications regarding biological determinism, identity, and the effects on diagnosis and therapy, and examines and critically reflects on the demands arising from the concept. The author concludes that the claim of "neurological difference" posited in the context of neurodiversity - which asserts a fundamental, innate distinctiveness and, at the same time, a specific mode of functioning, as well as the determination of a persons identity by these factors - has not been sufficiently substantiated by empirical research. Clinical evidence regarding the etiology, heterogeneity, course, and changeability of the diagnoses encompassed by this concept is not compatible with the assumed determinism regarding a persons identity. Neurodiversity is an important approach to reducing stigmatization and promoting acceptance of difference, but diversity should not be limited by new stereotypes, and in-group-out-group processes are not helpful regarding acceptance, openness, and tolerance. Diagnoses instrumentalized in the sense of identity formation, stabilization, and justification for otherness do not imply an appreciative attitude toward those whose deficits, limited behavioral and developmental possibilities, suffering, and impairments are described by the diagnoses.
Objective: This study aimed to assess how relevant mental health professionals consider intercultural competence to be for their work, to evaluate the existing self-rated knowledge in this area, to conduct a needs analysis for additional training opportunities, and to identify influencing variables. Method: We sent a link to an online survey via the mailing list of the German Society for Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy. We supplemented a standardized tool for assessing intercultural competence with aspects relevant to Child and Adolescent Psychiatry and Psychotherapy. Results: Of the N = 142 participants, over 95 % considered cultural aspects to be relevant in their work. Only 20 % had ever attended intercultural training, and over 90 % would like to receive further training. Variables such as age, sex, and experience abroad correlated with some of the item responses. Conclusions: The findings clearly show a need and desire for training in this field. We suggest including intercultural competence in curricula and training offers for all mental health professionals to improve the quality of mental healthcare in Child and Adolescent Psychiatry and Psychotherapy.
Neurodiversity and Autism - A Critical Examination of a Popular Concept Abstract: Neurodiversity refers to the natural diversity of human beings and thus emphasizes the natural range of differences between people. As simple, convincing, and popular as this assumption is, the interpretations, conclusions, and implications of this statement are just as varied. This article focuses on the scientific basis of the concept, on the one hand, and on autism and divergence, on the other. It outlines the implications regarding biological determinism, identity, and the effects on diagnosis and therapy, and examines and critically reflects on the demands arising from the concept. The author concludes that the claim of "neurological difference" posited in the context of neurodiversity - which asserts a fundamental, innate distinctiveness and, at the same time, a specific mode of functioning, as well as the determination of a person´s identity by these factors - has not been sufficiently substantiated by empirical research. Clinical evidence regarding the etiology, heterogeneity, course, and changeability of the diagnoses encompassed by this concept is not compatible with the assumed determinism regarding a person´s identity. Neurodiversity is an important approach to reducing stigmatization and promoting acceptance of difference, but diversity should not be limited by new stereotypes, and in-group-out-group processes are not helpful regarding acceptance, openness, and tolerance. Diagnoses instrumentalized in the sense of identity formation, stabilization, and justification for otherness do not imply an appreciative attitude toward those whose deficits, limited behavioral and developmental possibilities, suffering, and impairments are described by the diagnoses.
Objective: Depression is among the most common disorders in adolescence and is closely linked to sleep behavior and quality of life. Long-term studies examining the course of depressive symptoms after inpatient treatment are scarce. The present study investigated changes in depressive symptoms among adolescents following inpatient treatment, focusing on associations with sleep-wake rhythm and subjective quality of life. Method: The sample comprised n = 38 adolescents (Mage = 18.63, SDage = 1.71; 85.4 % female) who had previously been hospitalized for a depressive disorder. The follow-up study spanned 5 years, during which sociodemographic data as well as the values from the Beck Depression Inventory-II (BDI-II), the Morningness-Eveningness Questionnaire (MEQ), and the KIDSCREEN were collected annually online. Results: Significant reductions in depressive symptoms and increases in life satisfaction were observed between follow-up II and the catamnesis assessment. BDI-II and MEQ scores were significantly correlated, whereas changes in depressive symptoms were not associated with alterations in sleep behavior. The MEQ indicated a significant shift in chronotype from eveningness to morningness over time. Conclusion: Symptom improvement was evident at the catamnesis timepoint. Due to the small sample size, no generalizable conclusions can be drawn. Further follow-up studies are needed to examine symptom trajectories after inpatient treatment.
ADHS-ZEBRA:Algorithm for the Retrospective Diagnostic Assessment of ICD-10, ICD-11, and DSM-5 ADHD Symptoms in Primary School Reports Abstract: According to the German S3 guideline, diagnosing attention deficit/hyperactivity disorder (ADHD) requires evidence of symptom onset during childhood. This poses a particular challenge when assessing adolescents and young adults. Primary school reports can provide valuable information about earlier patterns of work and social behavior, thereby allowing a retrospective assessment of ADHD-related symptoms - specifically inattention, impulsivity, and hyperactivity. In our 2025 study (Waltereit et al., 2025), we systematically and quantitatively analyzed primary school reports from a sample in the German federal state of Saxony using the diagnostic criteria for ADHD according to ICD-10, ICD-11, and DSM-5. The results demonstrated high diagnostic discrimination between reports of children with ADHD and those of healthy controls. Based on these findings, we developed the ADHD-ZEBRA (Analysis of Primary School Reports for Symptoms of ADHD) through an iterative design process. This article presents and discusses the procedure that operationalizes the empirical findings for the practical application in clinical settings. The aim is to make this frequently used, but to date nonstandardized source of information more usable and to strengthen the diagnostic validity of ADHD in adolescence and young adulthood.
School Support Assistance as an Instrument for Inclusive Schooling in Germany: A Pedagogical and Child and Adolescent Psychiatric Perspective Abstract: This article examines the role of school support assistance in Germany from both a pedagogical and a child and adolescent psychiatric and psychotherapeutic perspective. It analyzes its conditions, potentials, and limitations based on legal and structural-systemic considerations. The findings indicate that school support services too often serve as a central prerequisite for attendance in mainstream schools, as they are frequently deployed when schools are unable to provide the structural conditions for inclusive education. As a result, the responsibility for ensuring educational participation is shifted from the institutional level of the school system to individually approved services within the child and youth welfare system. Coordination and delineation problems emerge at the interface of these two systems. These problems are further intensified by heterogeneous qualification levels and role conflicts and increase the risk of unintended exclusionary effects. Particularly for students experiencing psychological distress, school support assistance often assumes tasks that would require a continuous and professionally grounded integration of child and adolescent psychiatric and psychotherapeutic expertise in school-based support processes. This situation points to the need for a quantitatively and qualitatively stronger presence of relevant professional expertise in everyday school practice as well as for systematically coordinated cooperation with the therapeutic systems involved in treatment. From the perspective of child and adolescent psychiatry and psychotherapy, binding cooperation structures between schools, child and youth welfare services, and child and adolescent psychiatry and psychotherapy as well as clearly defined qualification standards and an increased emphasis on structurally oriented support models must therefore be developed and consistently implemented to secure inclusive education in a sustainable and participation-oriented manner.
