This perspective article introduces Gender Affirming Psychiatry (GAP), a conceptual framework that integrates queer phenomenology, the gender minority stress model, and gender-affirming care to guide psychiatric assessment, formulation, and treatment of transgender and gender diverse (TGD) youth. This approach acknowledges the cultural and institutional structures that negatively impact the mental health of gender diverse youth, while leveraging resilience, community connection, and support structures that are known to improve mental health outcomes. In this time of greater awareness and increased scrutiny, GAP is a practical, person-centered approach that is clinically sound and ethically grounded.
This article reviews current evidence documenting the significant relationship between participation in bullying among children and adolescents and later substance use. In this context, it examines the role of child and adolescent psychiatrists in detecting and treating bullying-related symptoms and risk behaviors, such as substance use. Furthermore, it proposes strategic directions for future research and clinical practice.
Youth appear to be disproportionately impacted by addictive behaviors (ie, gaming/gambling disorders and problematic use of pornography, social media, and artificial intelligence chatbots) and may benefit from greater clinical attention in screening and treatment. This review synthesizes current evidence on the diagnosis, screening, and treatment of behavioral addictions, with specific recommendations for future research and clinical practice. The review suggests the need to understand addictive behaviors from a continuum-based lens rather than diagnostic thresholds alone, offer flexible treatment models that are responsive to different levels of need, and build a stronger evidence base for existing and emerging (eg, neuromodulation) interventions.
Adolescent opioid use has evolved amid a fentanyl-dominated drug supply, leading to sharp increases in overdose mortality, often among youth without a prior opioid use history, and those using counterfeit pills containing fentanyl. This article reviews epidemiology, clinical presentation, and assessment of adolescents with suspected opioid use and opioid use disorder (OUD), emphasizing diagnostic challenges, withdrawal recognition, and level-of-care determination. Evidence-based pharmacologic management is outlined alongside psychosocial and family-based interventions. Key barriers to care, stigma, and regulatory challenges are examined. The article concludes with a strong case for universal overdose education and naloxone distribution as components of adolescent OUD care.
Abstract Introduction Cognitive ability has been linked to posttraumatic stress disorder (PTSD) vulnerability and may influence trauma-focused treatment response, yet its role in youth Trauma-Focused Cognitive Behavioral Therapy (TF-CBT) outcomes remains unclear. Clarifying this issue is relevant for equitable access to evidence-based care. We examined whether formally assessed IQ was associated with PTSD symptom change from pre- to post-treatment based on youth and caregiver reports and with treatment dropout in children and adolescents undergoing TF-CBT after abuse or neglect. Method Data came from N = 320 youth aged 5–21 years from a randomized clinical effectiveness trial. Intelligence quotient (IQ) was assessed with standardized tests, PTSD symptoms with the Child and Adolescent Trauma Screen (CATS-2), and dropout was defined as not completing therapy as intended. Symptom change was calculated as post- (T1) minus pre-treatment (T0) and evaluated separately for youth and caregiver reports. Regression models included age, gender, baseline PTSD severity, and treatment satisfaction assessed after treatment as an additional model variable. Results Mean IQ was M = 97.41 ( SD = 13.19, range = 51–138). PTSD severity was high at baseline ( M = 34.21, SD = 8.09) and decreased substantially (ΔCATS-2 T1 ₋ T0 youth report: M = −17.54, SD = 12.34; Cohen’s d paired = 1.42). IQ showed small but significant negative correlations with symptom change in youth reports ( r = −.14, p = .040) and caregiver reports ( r = −.17, p = .018), indicating greater symptom reductions at higher IQ. In regressions, IQ was not a significant predictor in the youth-report model (β = −.10, p = .077), while a small effect remained in the caregiver-report model (β = −.15, p = .011). Baseline PTSD severity and post-treatment satisfaction showed more consistent associations with symptom reduction. Dropout was 29.1%. IQ neither differed between completers and dropouts nor was associated with dropout in logistic regression (OR = 0.99, p = .536), whereas higher post-treatment satisfaction was associated with lower dropout risk. Discussion TF-CBT was associated with substantial symptom reductions across the observed IQ range, suggesting its suitability for routine care without excluding youth solely on the basis of cognitive ability. Baseline severity and treatment satisfaction at post-treatment showed stronger associations with symptom change and dropout than IQ. Trial registration The BESTFORCAN study was registered in the German Clinical Trial Registry (DRKS00020516) on 12 February 2020.
Abstract Background Bullying poses a major risk for poor mental health. While findings from the general population highlight harmful effects of bullying, data from clinical samples with diverse diagnoses and evidence-based diagnostic methods is rare. This study aimed at exploring the association between psychopathology and active bullying involvement in child and adolescent psychotherapy outpatients. Methods The preregistered study ( https://aspredicted.org/VYW_9TT ) included data from N = 719 outpatients aged 6–20 years from a German child and adolescent psychotherapy centre. Current experiences as a victim, bully-victim, or bully and distressing bullying-specific intrusions were assessed with a screening instrument. Gold-standard diagnostic assessment of psychopathology provided categorial ICD-10 diagnoses. The Strength and Difficulties Questionnaire depicted a dimensional proxy measure of psychopathology. Analyses included examining the frequencies of the bullying roles (victim, bully-victim, bully) and the occurrence of distressing bullying-specific intrusions, Pearson’s chi-square tests for gender-specific differences, binary logistic regression analyses testing the bullying roles as predictors of ICD-10 diagnoses, and multiple one-way ANOVAs examining group differences on the Strength and Difficulties Questionnaire scores between the bullying roles. Results 29% of all outpatients reported to be actively involved in bullying (22% victims, 5% bully-victims, 2% bullies), with 32% frequently experiencing distressing bullying-specific intrusions. While victims were more likely to have mood disorders (ICD-10 F3 disorders), bully-victims were less likely to have internalising and more likely to have externalising disorders and behavioural and emotional disorders with onset usually occurring in childhood and adolescence (ICD-10 F9 disorders). Bullies were more likely to have multiple disorders but less likely to have internalising disorders. Independent from specific diagnoses, victims, bully-victims, and bullies overall reported greater emotional and behavioural difficulties than outpatients without bullying experiences. Conclusions Among outpatients in child and adolescent psychotherapy, bullying is linked to specific related psychological burden and role-specific psychopathology. Bullying and related psychological burden should be addressed and routinely assessed in mental health care settings. The link between bullying and psychopathology as well as specific intervention methods may be explored further in future research.
Abstract Background This German multicenter study aimed to analyze the efficacy of telephone-assisted self-help (TASH) and changes during subsequent adaptive treatment in children with mild-to-moderate ADHD. Methods Participants were children (6;0–11;11 years) with mild-to-moderate ADHD. Study Step 1 comprised a randomized waitlist-controlled trial on the efficacy of three-month, parent-directed TASH. Depending on their response to TASH, in Step 2, children were assigned to booster TASH (full response), behavior therapy (partial response), or pharmacotherapy plus behavior therapy or counseling (non-response) for six months. The primary outcome was the change in blinded-clinician-rated ADHD symptoms; for subsequent changes (Step 2), we considered semi-blinded ratings. The primary analyses were by intention-to-treat. Results Of the 163 included children (77.9% boys), 80 were randomized to TASH and 83 to the waitlist control group. Following TASH, 12 children (8.8%) were classified as full responders, 40 (29.2%) as partial responders, and 85 (62.0%) as non-responders. An analysis of covariance did not yield an effect of TASH on the primary outcome (mean between-group difference = 0.00 ± 0.07, 95% CI [− 0.14, 0.13]; p = 0.95; d = –0.01, 95% CI [− 0.37, 0.34]). During Step 2, full responders demonstrated a stable symptom level (piecewise mixed-effects model for repeated measures; d = − 0.07, 95% CI [− 0.61, 0.47], p = 0.80), partial responders a small increase in ADHD symptoms ( d = 0.29, 95% CI [0.00, 0.59], p = 0.05), and non-responders a large decrease ( d = − 1.00, 95% CI [− 1.27, − 0.73], p < 0.001). Conclusions TASH is not effective in reducing blinded-clinician-rated ADHD symptoms in children with mild-to-moderate ADHD. Based on the changes within the response groups during Step 2, hypotheses are generated for adaptive treatment after TASH. Trial registration German Clinical Trials Register (DRKS): DRKS0000897; URL: https://drks.de/search/de/trial/DRKS00008973/details ; registered on December 18th 2015.
Young violent offenders frequently face significant developmental adversities, including learning difficulties, mental disorders, and substance use during childhood and adolescence. Many also grow up in circumstances requiring child welfare interventions. However, limited information is available regarding the services provided to them. To describe the timing, duration and components of school support services, child welfare services, as well as mental health services and substance abuse services used by young violent offenders. Data were derived from the forensic psychiatric examination statements of 42 Finnish violent offenders aged 15–22 years and analyzed using qualitative and quantitative content analyses. Almost all young people (95
To systematically compare the efficacy of pharmacological, adjunctive, and non-pharmacological interventions across multiple behavioral domains in children and adolescents with autism spectrum disorder (ASD), including irritability, hyperactivity, social withdrawal, stereotypic behavior, and inappropriate speech. Following the 2020 PRISMA guidelines, five databases were searched from inception to March 2026 for randomized controlled trials (RCTs). A frequentist network meta-analysis was conducted to estimate the comparative efficacy and ranking probabilities of different interventions across behavioral domains (PROSPERO: CRD420261368925). Sixty-seven RCTs (N = 4,203) were included. For irritability, structured exercise ranked highest (SUCRA = 88.0
The predictive value of symptom severity on post-discharge criminal offending in forensic psychiatric settings remains unknown, potentially leading to prolonged institutionalization of stabilized patients under the rationale of public safety. Furthermore, outcomes of adolescent forensic psychiatric inpatient care are understudied. To explore if clinical symptom severity predicts subsequent criminal offending, to investigate the role of severe disorders in future offending, and to quantify offence rates among former adolescent forensic inpatients compared to the general population. This national register-based study followed 289 youths (under 18 years) consecutively admitted to a forensic psychiatric inpatient unit in Finland between 2003 and 2019 for up to 18 years. Offence rates were analyzed using Cox proportional hazards regression, comparing patients against 1,149 matched general population controls. Predictors included the Brief Psychiatric Rating Scale (BPRS; score range 18–126 points) and Structured Assessment of Violence Risk in Youth (SAVRY), both assigned during a two-month evaluation. Former patients had a significantly higher hazard of offending than controls (HR 6.67, 95
