Attachment is often treated as one psychological theory among many. Yet Bowlby originally conceptualised attachment as a biologically grounded regulatory system for managing safety and threat. We argue that recovering this broader understanding may provide a unifying framework across disciplines and strengthen recognition of stable, responsive caregiving relationships as foundational to human development.
BackgroundMany children referred to child psychiatry show insecure attachment, indicating difficulties in the parent-child relationship. Attachment-based interventions aim to strengthen this relationship by enhancing parental sensitivity and under-standing of the child's needs. As the quality of the parent-child relationship has a profound influence on a child's overall well-being and psychopathology, it is important to explore whether increased focus on parents' relational capacity can positively affect children's psychiatric symptoms.ObjectiveTo investigate parents' experiences of participating in an attachment-based parenting intervention, Circle of Security Parenting (COS-P), within a child and adolescent mental health services setting.MethodQualitative semi-structured interviews were conducted with six parents participating in COS-P, alongside a focus group interview with four clinical therapists, to gain insights into their experiences with the program in a child psychiatric context. Data were analyzed using NVivo 12 and a reflexive thematic analysis approach.ResultsThe analysis resulted in three main themes: (i) challenges prior to COS-P, (ii) expectations of the intervention, and (iii) perceived changes following the intervention.ConclusionSeveral parents reported positive changes in their interactions with their children after participating in COS-P. They described an improved understanding of their children's behavior and needs, as well as increased use of appropriate strategies to meet those needs. Additionally, most parents reported gaining insight into how difficulties in regulating their own emotions, rooted in their own childhood experiences, had been unintentionally transmitted to their children. Transdiagnostic parent training programs such as COS-P have the potential to empower parents to support their children before, during, and/or after psychiatric assessment, regardless of diagnosis.
Background:Brain-Derived Neurotrophic Factor (BDNF) is the most abundant neurotrophin in the central nervous system with essential roles in neurodevelopment and maintenance of healthy brain function. Accordingly, BDNF has been suggested to play a role in the pathophysiology of Attention Deficit Hyperactivity Disorder (ADHD). Objectives:To investigate whether medication-naïve children with ADHD exhibit altered plasma BDNF levels compared with healthy controls, and to examine whether methylphenidate treatment is associated with changes in plasma BDNF and clinical outcomes. Methods:In this study we measured plasma BDNF levels before and after 12 weeks of standard treatment with methylpheni-date (MPH) in 21 medication-naïve children (aged 7-12 years) with ADHD and 25 matched control children. Blood samples were drawn after an overnight fast and analyses were controlled for body mass index, pubertal status, and physical activity. Associations between plasma BDNF levels and clinical symptoms were also evaluated. Results:Baseline plasma BDNF levels were significantly higher in the patient group than in the control group and remained significantly higher in the patient group after 12 weeks of MPH treatment. Moreover, higher baseline BDNF levels predicted greater positive effects of MPH treatment as measured by parent-rated inattentive and hyperactivity symptom scores. The findings are discussed in relation to the compensation theory of BDNF for neuropathology.
Background Excessive screen time in adolescents has become a growing concern, with parents seeking effective strategies to manage its impact.Objectives To investigate parents perceived causal networks linking children's screen use, child mental health problems, and parent-related factors, as a first step toward informing parent-focused interventions.Methods This study used the PErceived CAusal Networks (PECAN) method to explore how parents perceive causal relationships between screen-related problems and associated mental health challenges. A total of 128 parents participated (mean age 48.1 years) reporting about children aged 12-19 years (mean age 14.1 years). Each parent selected problems relevant to their child, and rated perceived causal relations among 20 predefined problem areas. These problem areas covered child behaviors and emotions, as well as contextual factors and parental behaviors and emotions.Results Most importantly, passive scrolling emerged as the problem most frequently perceived by parents as influencing other difficulties. Further, parents of boys highlighted gaming and lack of real-life friendships as perceived to be causing other problems, while parents of girls perceived physical inactivity and sadness as central. Parents rarely perceive their own behaviors or emotions as causing child problems, with the exception of problems with setting screen time boundaries.Conclusions These findings are relevant for the development of supportive interventions aimed at parents, suggesting passive scrolling may be an important target for future parent-focused interventions. Further, interventions might be adapted to address gender-specific concerns, providing parents with practical tools to mitigate the negative effects of excessive screen time.
Nasal congestion is a known but likely underreported side effect of antipsychotic treatment and is not captured by most side-effect interviews or rating scales. Although usually benign, it can in some cases lead to substantial discomfort. We report a case of a young patient with quetiapine-induced nasal congestion in whom surgical intervention was avoided by switching medication.
Background:Recently there has been a rapid adoption of initiatives driven by a desire to be inclusive of diversity. Though this is certainly positive, many strategies are implemented based on the untested hypothesis that their adoption is genuinely wanted and beneficial to those whom these approaches are designed to benefit. One area where this phenomenon is occurring is in the context of neurodivergence, where events are increasingly employing silent clapping, otherwise known as "jazz hands" or "flapplause," in place of traditional applause, with the aim of creating more inclusive environments. Methods:We conducted an international survey to examine whether "silent clapping" is indeed of substance to the neurodivergent community by surveying neurodivergent (n=389) and neurotypical (n=237) individuals. We compared the perspectives of neurodivergent and neurotypical respondents on silent clapping and also examined whether endorsement of silent clapping varied among specific subgroups of the neurodivergent population. Results:Generally, both neurotypical and neurodivergent individuals perceived silent clapping similarly. However, there were mixed responses regarding the endorsement of silent clapping, and no clear consensus emerged. Autistic individuals tended to endorse silent clapping more than other neurodivergent individuals, although variability in endorsement remained. Qualitative responses reflected both support for silent clapping but also concerns about its use. Conclusions:While silent clapping is largely endorsed, we find no overwhelming support or clear consensus. Findings suggest that silent clapping may be beneficial and wanted by particular subsets of the neurodivergent community, particularly for autistic individuals, but that it can also introduce other concerns. We caution against the indiscriminate implementation of such initiatives in favor of more considered and targeted strategies. Implementation of any initiative aimed at increasing inclusion should be guided by consultation with the relevant community.
Introduction:Although both nonsuicidal self-injury (NSSI) and cyberbullying (CB) are very common among adolescents, there are only a few studies examining the relationship between the two phenomena. The aim of our study was to explore the relationship between CB and NSSI, and to examine the potential mediating effects of anxiety and depression. Methods:119 Hungarian adolescents (70% female, 13-18-year-olds) were involved in the study. A self-report questionnaire about CB, the Inventory of Statements About Self-injury, and the Mini International Neuropsychiatric Interview - Kid were administered. Regression and network analysis were conducted to analyze the interrelationships among CB, NSSI, and anxiety/depression. Results:The prevalence of NSSI was significantly higher among those who were involved in CB, compared to those who were not, χ2(1) = 5.62, p = 0.02. CB and NSSI were mediated by anxiety, and anxiety disorder was directly related to NSSI. Conversely, depression was not directly related to CB, only to anxiety. Victimization was positively related to anxiety, which, in turn, was positively associated with NSSI. Conclusion:Our results draw attention to the importance of focusing on comorbid anxiety disorders and to both those who are involved in CB and those who witness CB in NSSI prevention strategies.
Background:Serotonin selective reuptake inhibitor (SSRI) - induced activation and manic/hypomanic switch in children should be defined and delimited from each other. If not, this could contribute to inappropriate treatment decisions. This systematic review aimed, therefore, to explore how SSRI - induced activation and manic/hypomanic switch in children are defined, delimited from each other, assessed, and diagnosed. Methods:The PRISMA guidelines were followed. A systematic literature search was conducted in Pubmed, Cochrane, Scopus, and PsychINFO (from 8th to 15th March 2023). Eligible studies were in English, covering a population aged six to 18 years, where the outcome was activation or manic/hypomanic switch in relation to SSRI treatment. Two blinded assessors independently screened all abstracts, and thirty articles were included. Definitions, described symptoms, assessments, and inter-rater reliability were recorded. Results:Twelve articles were categorized as activation and 18 as mania/hypomania. Eight articles presented a clear definition of activation and four of mania/hypomania. Two articles presented inter-rater/test-retest reliability. One specific instrument was used for assessment of activation. No instrument was used for assessment of mania/hypomania. Symptom overlap was found, but more symptoms of 'aggression and hostility', 'anxiety and panic', and 'suicide and self-harm' were reported in activation while more 'cognitive and thought process alterations' and 'changes in mood and emotions' were reported in mania/hypomania. Discussion/conclusion:Vague definitions, and inadequate assessments and diagnostic procedures were found. There were some differences in symptoms between activation and manic/hypomanic switch. Other:The study protocol was published on Prospero 2023, CRD42023422133.
Background:Level of social functioning is an important outcome in psychiatric research and in clinical practice. The Personal and Social Performance Scale is a comprehensive and well-validated measure of social functioning in adults with psychiatric illness. Objective:Evaluations of the psychometric qualities of the scale are scarce when applied to adolescents. This small-scale study examines the inter-rater reliability of the Personal and Social Performance Scale in adolescents. Methods:A semi-structured interview was conducted with eight Danish participants between age 13 and 17 years, with or without a diagnosed psychiatric illness. Agreement on ratings of the Personal and Social Performance Scale between six independent assessors was evaluated with Intraclass Correlation Coefficient (ICC). Results:We found that agreement on the Personal and Social Performance Scale total scores was good (ICC=0.85). Agreement on subareas of the Personal and Social Performance Scale ranged from moderate to excellent (ICC=0.59 to ICC=0.92). Conclusions:These findings contribute with preliminary evidence of the reliability of the Personal and Social Performance Scale when applied in adolescents. We suggest that future studies should explore the psychometric quality in larger samples with more variation in level of social functioning.
Background:Children of parents with mental illness are known to be at risk of developing mental illnesses due to hereditary and socio-economic factors. The family-focused practice in the treatment of adult patients with severe mental illness benefits patients and their children, and can help prevent mental health problems in children of parents with mental illness. Therefore, professionals caring for adult patients must contribute to the early identification of families at risk and initiate the necessary care. Objective:This study aimed to determine the current practices of psychologists and psychiatrists in the Czech Republic-the extent to which they include parental issues and their patients' children in their treatment, how informed they are about the available support, their attitudes toward a family-focused practice, potential barriers to family-focused practice, and recommendations for improvements in care for children of parents with mental illness. Methods:A structured online questionnaire completed by 193 professionals (51.8% psychiatrists, 48.2% psychologists) working with adults with severe mental illness in various healthcare settings. Results:A large majority (95.9%) of respondents regularly asked about the parenting status of their patients and 75.1% had a positive attitude toward involving children more in treatment. Although most respondents were comfortable discussing parenting (91.2%), they only discussed parenting topics if the patients themselves brought them up. Minors were rarely invited to treatment (26.4%), usually on a one-off basis. Major barriers cited include a lack of set procedures for working with families, lack of coherence of services, lack of time, shortage of professionals to refer to, and perceived lack of training and experience. Conclusion:Although most professionals know that their patients have children and believe that children of parents with mental illness are at risk of developing problems, they are hindered by a variety of organizational and systemic barriers in implementing the family-focused approach more frequently in practice. Subject to wider expert discourse, the findings may contribute to informed policy formulation.
This systematic review summarizes studies of the association between traditional leisure activity engagement in adolescence and subsequent psychiatric morbidity up to early adulthood. The literature search for the review was conducted in May 2022 and in November 2023 utilizing three electronic databases. In total, eleven studies published between 2010 and 2023 fulfilled the inclusion criteria. The results showed that active participation to leisure time activities in adolescence associated with a lower likelihood of being diagnosed with a psychiatric disorder by young adulthood. The most well-established link and strongest supporting data were found for depression, anxiety, and psychotic disorders but for other psychiatric disorders, the evidence was indicative. The findings of reviewed studies highlight the importance of socially engaging recreational activities for adolescents' long-term mental health. Additional research is required to explore the associations between different leisure activities, including solo hobbies, and different specified mental disorders.
Background:Growing emphasis is placed on supporting children and adolescents with attention deficit hyperactivity disorder (ADHD) in participating in their own healthcare; however, more knowledge is needed to guide practice. Objective:To review the scientific literature on user participation and opportunities for shared decision-making involving younger people referred for ADHD in mental healthcare services, to provide recommendations for clinical practice and future research. Method:A systematic scoping review was performed. Eligibility was determined in two steps by two and three independent researchers, respectively. Data were extracted and analyzed using qualitative content analysis. The findings were synthesized across the various contexts and participation groups represented in the included studies. In all, the analysis involved three phases: preparation, organization, and reporting. Results:Of the thirty full-text papers identified, five met the inclusion criteria. Four categories and seven subcategories related to user participation and opportunities for shared decision-making involving children and adolescents with ADHD were identified. The four categories were: (1) sidelined from the start, (2) lack of information, (3) trapped in medication, and (4) growing into active decision-makers; these indicate that children with ADHD feel excluded from the diagnostic process, may have limited treatment choices, and may not be heard. This review also discovers a bias in the existing literature on user participation, with a tendency to emphasize caregivers' or clinicians' perspectives over those of the young people. Conclusions:Young people with ADHD experience they have limited opportunities to participate in their mental healthcare services. User participation and shared decision-making by young people with ADHD should be promoted in clinical practice. Accordingly, future research should explore ways to implement user participation among young people themselves when assessing and treating ADHD, not only among clinicians and caregivers.
Background:Screen use, including gaming and social media, has increased over the past decade, potentially having adverse effects on child development and mental health. To prevent the potential problems arising from excessive screen use (ESU) and problem gaming (PG) scholars have developed a Family centered program for PG and ESU (FAME) involving both children and at least one parent in the program. The aim of this study was to explore the experiences of children's and parents' participation in the pilot-FAME program. Method:Out of ten families who participated in the pilot-FAME, eight children (age 12-15; two girls), along with ten parents, out of which three fathers, participated in individual semi-structured interviews involving questions about a) families' perceptions of the program and b) suggestions for improvement of the program. The data were analyzed with Reflexive Thematic Analysis. Results:Four distinct themes were constructed: Theme 1, "Positivity regarding program", Theme 2, "Criticism regarding the program", Theme 3, "Program delivery", and Theme 4, "Content development". Specifically, while the program was well-received for its group format and the peer support it facilitated, making adaptions such as incorporating more discussion and learning opportunities, along with extending the duration, would have potential to improve its delivery and feasibility. Conclusion:The pilot-FAME program shows promise in addressing the challenges associated with PG and ESU among children and their parents. With further refinements, the program could become an effective tool for supporting healthy family dynamics and screen use.
Background:Socialization and communication are complex processes. It is important to identify the factors related to their development. Objectives:This study aimed to determine how attention to social information affects the development of socialization and communication in children with typical development. Methods:We recruited 24 typically developing preschool children. Using the all-in-one eye-tracking system, Gazefinder, we measured the percentage fixation time allocated to social information depicted in movies with human faces, people, and geometry in preference paradigm movies showing these stimuli simultaneously, as well as others at Waves 1 (4.01±0.84 years), 2 (5.22±0.66 years), and 3 (6.57±0.63 years). We also used the Second Edition of the Vineland Adaptive Behavior Scales to measure socialization and communication in Waves 1-3. We then used a 3-wave cross-lagged effects model in a structural equation modeling framework to determine the impact of attention to social information on the development of socialization and communication. Results:Only the preference paradigm, movies simultaneously presenting people and geometric shapes, fulfilled the model fit criteria. The percentage of fixation times on the people region in Wave 1 affected the socialization score in Wave 2. Conclusions:Although the limitation of "the sample size is small" should be considered, the degree of interest in people has a strong positive influence on the development of socialization during early childhood. Attention to social information other than the preference paradigm may have been influenced by a relatively large number of factors and/or by the lesser degree of effects of the factors that strongly influenced the preference paradigm and did not fit the model criteria proposed in this study.
Developmental regression (DR) is a clinically relevant phenomenon that is most recognized in neurodevelopmental disorders such as in autism spectrum disorder, but it is also described in association with psychological trauma and post-traumatic stress disorder (PTSD) in children. It is not uncommon for children with PTSD to present symptoms of DR, which manifests as a loss of recently acquired developmental skills such as toilet training or language skills. International diagnostic classifications are not consistent regarding DR nosology. There exists, however, some theoretical ground to group DR with the cluster of dissociative symptoms in PTSD. There is no agreement on how to define, classify and manage DR in PTSD due to a research gap, which require further studies.
Background:Based on Achenbach's school-age questionnaires, research groups have investigated supplementary scales for stress problems, obsessive-compulsive problems, sluggish cognitive tempo, positive qualities, dysregulation, autism spectrum disorders, and mania in 6-18-year-olds partly only in some of the three perspectives the Achenbach System of Empirically Based Assessment (ASEBA) provides. Objective:We aimed to evaluate these dimensions for the German-language forms and, if possible, to extend their use to further rating perspectives. Methods:The internal consistencies of the supplementary scales were examined for three types of informants (parents, adolescents, and teachers) and different samples (community sample, clinical sample, and disorder-specific subsamples). Age-and gender-specific effects are displayed as well as cross-informant correlations. Additionally, different aspects of validity were analyzed: (a) convergent/divergent validity via correlations with traditional ASEBA scales (problem scales as well as the scales oriented to the Diagnostic and Statistical Manual of Mental Disorders 5th edition); (b) discriminative validity via differences between clinical vs. community-based sample as well as disorder-specific subgroup vs. clinical sample. Results:Most of the supplementary scales showed at least acceptable internal consistency. For some scales, we found significant but rather small and informant-dependent gender and age differences. Convergent validity of the supplementary scales differed across informants. Mean differences between the supplementary scales in the clinical and the community sample as well as the diagnosis-specific subsamples were mostly significant, with predominantly large effect sizes. Conclusions:Overall, the validity and reliability of the supplementary scales differed depending on informants and subgroups. While further research is necessary before the supplementary scales are implemented in clinical practice, initial recommendations for their use are derived. Trial registration:This project was carried out as a reanalysis of the datasets upon which the German norms for the school-age versions are based (1). Therefore, the trial was not registered.
Background:Attention Deficit Hyperactivity Disorder (ADHD) is a commonly occurring neurodevelopmental disorder associated with impairments in numerous aspects of functioning and quality of life. There is a growing recognition that brief and effective psychosocial interventions are needed for youth with ADHD. Objective:The aim of this study was to assess the feasibility and preliminary effectiveness of a dialectical behavioral therapy-based skills training group for adolescents with ADHD in a routine clinical care setting. Methods:Ten adolescents with ADHD/ADD (Attention Deficite Disorder) commenced a 10-week training group including psychoeduction, mindfulness and other self-regulatory skills training. Primary outcomes were pre- to post-treatment changes in guardian-rated ADHD-symptoms and participant-rated quality of life. Secondary outcomes were pre- to post-treatment changes in participant-rated executive functioning, depression, anxiety, and treatment satisfaction, as well as parent/guardian-rated executive functioning. All symptom/functioning scales were administered at pre-treatment, post-treatment, and a 12-week follow-up. Results:Eight of the ten participants completed treatment, with > 80% attendance for treatment completers and high ratings for treatment satisfaction. Based on the intention-to-treat analyses, there were improvements from pre-treatment to follow-up in primary and secondary outcomes except quality of life. Based on the completer's analyses, there were improvements from pre-treatment to follow-up for guardian rated ADHD symptoms and executive functioning, depression, anxiety, and quality of life. Uncontrolled effect sizes for pre-treatment to 12-week follow-up for treatment completers were medium for inattention, executive functioning, and quality of life, and large for depression and anxiety. Conclusions:The present study suggests that the DBT-based skills group training was feasible and, for treatment completers, yielded significant improvements across a range of symptom domains and quality of life assessed at the 12-week follow-up. However, this is only an exploratory finding and could be attributed to natural improvement or regression toward the mean. Therefore, further studies are warranted.
Background:The Beck Depression Inventory (BDI) is a widely acknowledged self-report screening tool for evaluating the presence and intensity of depressive symptoms. The BDI-IA, although an older version, is highly correlated with the updated BDI-II, remains clinically valuable, and is widely used due to its free availability. Aim:This study aimed to examine the psychometric properties of the BDI-IA and compare its diagnostic accuracy with the abbreviated BDI-SF, BDI-PC, and BDI-6 versions against gold-standard research diagnoses in a representative Finnish adolescent clinical population. Methods:The participants were referred outpatient adolescents aged 13-20 years (N = 752, 73% female). We investigated structural validity with item factor analysis and evaluated the criterion validity of mean scores and factor scores with various diagnostic measures. Sample-optimal cut-offs (criterion unweighted Cohen's kappa) were estimated with a bootstrap procedure. Results:The sample-optimal cut-off for the full BDI was 19, slightly higher than that suggested by the previous literature. The abbreviations of the BDI-IA were demonstrated to be as good as the full scale in detecting depressive symptoms in all three diagnostic categorizations. Conclusion:The use of brief and user-friendly questionnaires such as the BDI-PC or BDI-6 is recommended to ensure optimal depression screening and minimize the administrative burden, especially in primary care settings where clinical decision-making and referrals often need to occur within a limited time frame.
Introduction:Previous research has demonstrated a strong relationship between personality and psychopathology. However, the relationship between the traits listed in the Alternative Model for Personality Disorders (AMPD) and Disruptive Behavior Disorders (DBD) in adolescents has not been examined in detail. This study aimed to examine the relationship between the Personality Inventory for DSM-5 (PID-5) domains and DBD symptoms in an adolescent inpatient sample. Methods:A total of 127 adolescents (71% female) aged 12-17 years (M = 15.24, SD = 1.33) were recruited from an inpatient psychiatric hospital. These participants exhibited a wide range of psychiatric disorders unresponsive to prior interventions. They completed the PID-5-Short Form, the Child Behavior Checklist (CBCL), and the Diagnostic Interview Schedule for Children - Computerized Version (DISC-IV). Results:The antagonism, disinhibition, and psychoticism domains showed significant correlations with DBD scores. Hierarchical regression models predicting total DISC-IV and CBCL scores indicated that the addition of the PID-5 Antagonism and Disinhibition scales did not provide incremental predictive validity over total DBD symptoms. Conclusion:DBD symptoms are related to psychoticism, antagonism, and disinhibition. However, total Antagonism and Disinhibition scores did not contribute additional predictive power for overall psychopathology beyond DBD scores. These findings highlight questions about the discriminant validity of the PID-5 and suggest further research into the construct validity of these domains.
