Objective Maternal infections during pregnancy have been implicated in offspring neurodevelopmental disorders, but evidence regarding influenza infection, and antiviral treatments remains limited. This study examined the associations between maternal influenza infection and prenatal oseltamivir exposure with attention-deficit/hyperactivity disorder (ADHD) in offspring. Method We conducted a nationwide population-based birth cohort study in Taiwan including 2,231,264 mother-child dyads born between 2004 and 2015. Maternal influenza infection during pregnancy was identified from medical records and categorized by trimester. ADHD in offspring was ascertained using International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) and Tenth Revision, Clinical Modification (ICD-10-CM) codes. We employed Cox proportional hazards models and sibling-comparison analyses to estimate adjusted hazard ratios (aHRs) and 95% confidence intervals (CIs), adjusting for maternal characteristics, comorbidities, and child-specific factors. Results During the follow-up period, of the mothers, 116,080 (5.2%) were diagnosed with influenza during pregnancy. In addition, 102,717 children in the unexposed group (4.86%) and 6,620 children in the exposed group (5.36%) were diagnosed with ADHD. In the partially adjusted model, any trimester of maternal influenza exposure showed a small but statistically significant association with offspring ADHD (aHR 1.04, 95% CI 1.02–1.06). However, in the sibling-comparison analysis, which accounts for shared familial and genetic factors, this association was no longer significant (aHR 1.02, 95% CI 0.96–1.08). Prenatal exposure to oseltamivir among influenza-infected mothers was not significantly associated with an increased risk of ADHD in offspring in the sibling-comparison model (aHR 0.46, 95% CI 0.08–2.67). Conclusion Our initial analyses suggested a very small though statistically significant association between maternal influenza infection during pregnancy and offspring ADHD , but sibling-comparison analysis revealed no significant risk, pointing to familial confounding. Additionally, prenatal oseltamivir exposure may not increase ADHD risk, supporting the safety of antiviral management during pregnancy.
OBJECTIVE:Youth suicide is a major public health problem, yet quantitative evidence on risk factors specific to those aged 25 and younger remains limited. Psychological autopsy studies capture short term and nuanced risk factors absent from other registries and records-based research. We synthesized psychological autopsy data to identify exposures most strongly associated with youth suicide. METHOD:We searched PubMed, Embase, PsycINFO, CINAHL, Web of Science, and Global Health from inception to May 15, 2026. We included quantitative psychological autopsy case-control studies of people aged ≤25 years with community controls. We excluded qualitative studies, high-risk samples, and non-fatal outcomes. We assessed study quality using the Newcastle-Ottawa Scale and obtained age-stratified data from authors when needed. Risk factors were pooled as odds ratios (ORs) with 95% confidence intervals (CIs) using random-effects meta-analysis with Hartung-Knapp adjustment. (PROSPERO ID: CRD420251057274) RESULTS: We identified 1,809 records and included 19 eligible study samples (958 cases; 1,102 controls; ∼70% male). Of 26 pooled risk factors, 21 were statistically significant. The strongest were suicidal ideation (OR=16.1, 95% CI 5.0-51.5), previous suicide attempt (14.2, 6.3-31.8), acute stressful life events (13.7, 9.6-19.5), mood disorders (9.9, 5.3-18.2), and substance abuse (8.9, 6.1-12.9). Study quality was moderate-to-high and four factors showed high heterogeneity (I2>75%). Substance and alcohol abuse showed stronger associations in youth than in an adult meta-analysis following the same methodology. CONCLUSION:Our findings suggest a more impulse-driven and proximal risk profile for suicide in youth. These findings support prevention frameworks that prioritize universal and school-based programs teaching emotional regulation and problem-solving skills, alongside policies reducing access to highly lethal means given the impulsive nature of many youth suicides.
OBJECTIVE:The Emotion Dysregulation Inventory (EDI) and its young-child version (EDI-YC) are widely used informant-report measures for assessing emotion dysregulation (ED). However, scores are not directly comparable due to differing age ranges (EDI: 6-17 years; EDI-YC: 2-5 years), limiting longitudinal research. This study used item response theory (IRT) to link EDI and EDI-YC scores, creating a common metric spanning early childhood through adolescence in general and neurodevelopmental populations. METHOD:Archival data from original calibration and validation studies were analyzed. The EDI sample included 1,755 clinical participants (Age 4-20, 21% female) and 1,000 general population youth (Age 6-17, 49% female). The EDI-YC sample included 1,369 clinical participants (Age 2-5, 27% female) and 768 general population youth (Age 2-5, 51% female). A non-equivalent groups with anchor test (NEAT) design was implemented. Both measures assess Reactivity and Dysphoria. Separate unidimensional IRT co-calibrations were conducted for each subscale using a fixed-parameter approach. RESULTS:Co-calibration revealed near-perfect correlations between EDI and EDI-YC metrics in both the general population (Reactivity ρ = .999; Dysphoria ρ = .995) and clinical samples (Reactivity ρ = .999; Dysphoria ρ = .997). CONCLUSION:The successful linking of the EDI and EDI-YC supports the interpretation of raw scores on a common metric. These findings demonstrate the feasibility of IRT-based linking as a practical tool for longitudinal research and clinical monitoring of ED, pending further validation of anchor item invariance across the full age range.
OBJECTIVE:Specific phobias are among the most common, earliest-onset psychiatric disorders in youth. Although One-Session Treatment (OST) is a well-established intervention, 35-40% of children do not reach full remission. This study examined whether supplementing OST with a child-focused, app-supported homework program enhances outcomes. METHOD:A total of 172 children (ages 7-14; M = 10.65, SD = 2.09; 59% girls) meeting criteria for any specific phobia participated in a parallel-group randomized superiority trial and received standard OST before randomization to therapist-provided homework (OST-only) or an app-supported program (OST + app). Assessments occurred before and after a 3-week baseline, post-OST, post-practice, and at 6-month follow-up. Primary outcomes were diagnostic status and clinician-rated severity; secondary outcomes included behavioral avoidance, self-reported fear and avoidance, and functional impairment. Mixed-effects linear models were used. RESULTS:Both groups showed significant improvements on all outcomes, with medium-to-large effect sizes and gains maintained through post-practice and follow-up. Remission rates were 25.2% post-OST, 46.0% post-practice, and 69.6% at follow-up. Children in both conditions practiced frequently. The app-supported homework program did not enhance outcomes or at-home practice. Families in the OST + app condition reported higher treatment satisfaction. Children with blood-injection-injury phobias showed lower remission rates than those with other phobias. CONCLUSION:Findings underscore the effectiveness of OST across diverse clinical settings. The app-supported homework program did not enhance outcomes, while families reported higher treatment satisfaction, suggesting potential value warranting investigation. Future research should clarify whether specific child or symptom profiles may benefit from app-based support and strengthen OST implementation.
Stress and, often, adversity are inevitable aspects of human life and development. No one can claim that they grew up without exposure to undesired levels of distress. The "old wisdom" has consistently suggested that "what does not break you, makes you stronger"; but this hypothesis is rarely tested, especially in the context of developmental exposure to stress. Arguably, most of our research on childhood adversity has been focused on its negative impact, with cumulative literature showing the deleterious consequences of childhood adversity well into adulthood.1 Cheng et al.2 use data from a prospective longitudinal study of childhood stress and adversity to test the idea of a "sweet spot," examining the impact of the type, severity, and number of stressful experiences. Contrary to the old wisdom, the authors were unable to identify a stress and adversity "sweet spot." All levels of stress, past or present, were associated with more emotional symptoms. Individuals with moderate level of stress and trauma exposure, regardless of recency, showed higher symptoms of psychopathology compared to those with less exposure.
