IntroductionPsychotic symptoms in children and adolescents may represent either normative developmental phenomena or severe psychiatric and medical conditions, requiring careful differential diagnosis.MethodsThis retrospective study aimed to evaluate the medical workup of children and adolescents admitted for a first presentation of psychotic symptoms at a tertiary pediatric center over a 10-year period. The sample included 68 patients (mean age 13.7 ± 3.7 years) who underwent clinician-directed evaluations including physical exams, laboratory tests, toxicology screens, neuroimaging, and lumbar puncture when indicated.ResultsSixteen patients (23.5%) were diagnosed with substance-/medication-induced or medically-associated psychosis. In this cohort, younger age, very early onset psychosis (<13 years), and catatonia at first presentation were more frequently observed among patients with secondary etiologies, whereas documented prior subthreshold symptoms were more frequently documented among those diagnosed with primary psychiatric disorders. Most investigations did not identify a secondary cause, reflecting clinician-directed evaluation in routine practice; however, selected cases (e.g., autoimmune encephalitis, multiple sclerosis) illustrate the clinical importance of careful assessment when specific suspicion is present.ConclusionThese findings suggest that targeted medical evaluation may be useful in pediatric psychosis, particularly when clinical features raise suspicion for secondary etiologies, and may help inform clinical decision-making in tertiary pediatric settings.

Abstract Tourette Syndrome and other tic disorders (TD) are common, highly heritable neurodevelopmental conditions with complex genetic architectures. We conducted a genome-wide association study of 13,247 TD cases and 536,217 European ancestry controls and identified six independent genome-wide significant loci, including a pleiotropic signal at 3p21 shared with attention-deficit/hyperactivity disorder, among other traits. Gene prioritization highlighted 20 genes, including PCDH9, HCN1, NCKIPSD, WDR6, DALRD3 , and CELSR3 . Integrative analyses provide genetic support for the role of cortico-striato-thalamo-cortical circuits in TD pathophysiology and further localize TD genetic risk to specific cell types, including dopamine D1- and D2-receptor-positive medium spiny neurons, cortical pyramidal neurons, and oligodendrocyte-lineage cells. We further demonstrate extensive genetic correlations with neurodevelopmental and psychiatric traits, but not with neurological disorders. These findings advance our understanding of the genetic basis of TD, pinpointing specific genes and cell types that drive pathophysiology and providing a foundation for future mechanistic studies.

The treatment of tic disorders in children and adolescents poses significant challenges, especially when comorbid conditions such as obsessive-compulsive disorder (OCD) and attention-deficit/hyperactivity disorder (ADHD) are present. Pharmacological treatments are often guided by clinical judgment, prescriber preferences, and medication availability. This study describes pharmacological treatment use in a large cohort of children and adolescents with chronic tic disorders (CTDs). We analyzed baseline data from the European Multicenter Tics in Children Study (EMTICS) to examine associations between medication use, tic severity, and psychiatric comorbidities, using parent-reported questionnaires and clinical interviews to assess tics, obsessive-compulsive disorder (OCD), attention-deficit/hyperactivity disorder (ADHD), oppositional defiant disorder (ODD), and children’s self-rated premonitory urges. Among 709 children aged 3–16 years with CTDs, 230 (32

While suicide rates have stabilized or declined in many regions, there is a concerning global rise in non-fatal suicidal behaviors (STBs) among youth, placing immense strain on mental healthcare systems. This has resulted in a surge in youth psychiatric emergency department visits and a systemic crisis of extended wait times and low treatment engagement. Given that the period following a suicidal crisis carries the highest risk for repeat attempts, there is an urgent need for innovative, scalable service delivery models that can provide rapid, effective, and sustained care. This study proposes a novel, stratified stepped-care (SSC) model that integrates non-specialist mental health professionals (MHPPs) to deliver low-intensity, evidence-based counseling for youth with STBs. This study protocol details the design and methodology of a randomized controlled trial (RCT) that will evaluate the efficacy and implementation outcomes of the proposed SSC model. We will compare the SSC intervention to care as usual (CAU) for youth (ages 6–18) with STBs. The SSC model utilizes a standardized triage system and a tiered intervention approach: low-intensity Interpersonal Counseling adapted for suicide crisis intervention (IPC-A-SCI) delivered by MHPPs for mild to moderate STBs, and brief IPT-A-SCI by licensed professionals for severe cases. Primary outcome will be the reduction of STBs, measured by the Columbia-Suicide Severity Rating Scale (C-SSRS), while secondary outcomes include changes in depression, anxiety, trauma symptoms, and functioning. We will also estimate key implementation outcomes, including waiting time, accessibility, acceptability, and cost-effectiveness. We anticipate that this RCT will demonstrate not only the effectiveness of the SSC model in reducing STBs and related symptoms but also its feasibility and accessibility within a public mental health setting. The anticipated outcomes of decreased wait times and increased treatment engagement will provide a crucial blueprint for health policymakers and clinicians. Successful implementation of this SSC model could offer a scalable solution for closing the treatment gap and reducing high-risk periods following suicidal crises, potentially transforming how accessible and effective mental health services are delivered to youth. ClinicalTrials.gov registration number, NCT07321171 01–06-2026. (retrospectively registered).

Adolescent hidden dropout and suicidal behaviors pose major public health concerns, with family dynamics playing a critical role in youth adjustment. This study examined associations between parental supervision, gender, hidden dropout, and suicidal behaviors among 769 adolescents. We tested direct and indirect pathways linking supervision to school engagement, unjustified absenteeism, self-harm, and suicidal ideation through low subjective well being, anxiety, and behavioral problems. Higher parental supervision was associated with greater school engagement and lower suicidal ideation, with stronger associations among boys. Among girls, higher supervision was paradoxically associated with increased unjustified absenteeism. Hidden dropout partially mediated the association between supervision and suicidality. Findings highlight the complex, gender-dependent role of parental supervision and underscore the need for gender-sensitive prevention and intervention approaches.

Post-concussion symptoms (PCS) and posttraumatic stress symptoms (PTSS) are common after mild traumatic brain injuries (mTBI) in children. Psychological factors, especially pre-injury trait anxiety, are associated with the development of PCS and PTSS. However, the underlying mechanisms are understudied. The current study aimed to explore whether alexithymia (difficulty in identifying and describing emotions) moderates the associations between children's pre-injury trait anxiety and PCS, as well as PTSS in bothchildren and parents following mTBI. Participants were 53 children aged 8-16 with mTBI and their parents, recruited from the Emergency Department. Immediate mTBI symptoms were assessed by the Emergency Department physician within 24 hours post-injury. One-week post-injury, acute PTSS (children and parents), children's pre-injury trait anxiety, and alexithymia were measured using self-reported questionnaires. PCS were measured by symptom reports (including a baseline; reported by parents) and neuropsychological tests assessing cognitive functioning, including performance validity tests. PCS and cognitive functioning were assessed one-week and four-month post-injury. We found that alexithymia significantly moderated the associations between children's pre-injury trait anxiety and both PCS and PTSS in children and parents at one-week post-injury. Higher levels of alexithymia strengthened these associations. Alexithymia was found significantly associated with PCS at four-month post-injury. However, alexithymia did not moderate the association between pre-injury trait anxiety and PCS at four-month post-injury or cognitive functioning at one-week or four months. In conclusion, pre-injury trait anxiety and alexithymia are crucial in mTBI outcomes, being associated with PCS and PTSS development. Therefore, addressing emotional factors is important in TBI recovery.

Chronic Tic disorders (CTD) including Tourette Syndrome (TS), are associated with psychopathological comorbidities. Attention deficit/hyperactivity disorder (ADHD), autism spectrum disorder (ASD) and other comorbidities have been linked to delays in early developmental milestones. Few studies have investigated the relationship between early developmental milestones, tic severity, and related comorbidities. 383 participants aged 3–16 years (76.8

The expanded Simple View of Reading model suggests language processing and word reading as contributors to reading comprehension and points at the participation of executive functions as supporting these abilities. Switching and inhibition are both executive functions (EF) contributing to reading, especially in languages with two writing systems-shallow and deep, such as Hebrew. Here, we aimed to determine the specific role of switching/inhibition both cognitively and neurobiologically in the Simple View of Reading model among 49 eight- to 12-year-old Hebrew-speaking children. Children underwent reading and cognitive behavioural testing as well as a five-min resting-state fMRI scan. Functional connectivity of the fronto-parietal network related to switching/inhibition was determined and included in a moderation model. Results suggest that both switching/inhibition abilities and functional connectivity within the fronto-parietal network moderate the relations between word reading and reading comprehension. This strengthens the contribution of switching/inhibition to facilitating reading comprehension and supports the need to include it as part of the expanded SVR model.

Objective: This cross-sectional study examined assumptions about the role of parenting qualities in predicting child problems. Background: Children with ADHD often experience distress, partially linked to less adaptive parenting practices. Our working assumptions are that: parental mindfulness, insecure parent attachment styles, and parental child rejection have a significant impact upon the severity of child problems and therefore should be addressed in parental training. Methods: A total of 122 Israeli parents (55 fathers (Mage = 43.8; SD = 4.01) and 67 mothers (Mage = 41.6; SD = 4.59)) of 75 children with attention deficit hyperactivity disorder (ADHD) (Mage = 8.4; SD = 1.56) completed self-report measures: the Experience of Close Relationships scale (ECR), the Mindfulness Attention Awareness Scale (MAAS), the Parental Acceptance–Rejection Questionnaire (PARQ), and Achenbach Child Behavior Checklist (CBCL). Data were analyzed using descriptive statistics, Pearson correlations, and structural equation modeling (SEM). Results: The key finding was that a latent ‘parental rejection/non-warmth’ factor mediated the relationship between (a) parents’ anxious attachment and child behavior problems, and (b) parental mindfulness and child problems. Parental rejection emerged as the strongest predictor of child difficulties. Conclusions: Parental training for parents of children with ADHD should prioritize reducing rejection while also addressing mindfulness and anxious attachment style to promote child well-being. Clinical Trial Registration: Group training for parents whose children suffer from ADHD and comorbidity using a behavioral-dynamic approach (SPBT). Registered at Veeva Vault.

Environmental factors such as Home Literacy Environment (HLE), screen time, and parental executive functions (EF) may influence the development of the child's EF. The purpose of this study was to determine the effect of these factors on behavioral and neurobiological measures of EF in 4-year-old children. Electroencephalogram (EEG) data were collected while children performed the Attention Network Task (ANT), showing a smaller difference between incongruent and congruent conditions is related to better EF abilities. Data were analyzed using an Event-Related Potential (ERP) technique focusing on the N200 and P300 components (reflecting executive control and orienting attention, respectively). N200 and P300 differences (delta) between amplitudes and latencies for the incongruent and congruent conditions were computed and correlated with child EF skills, HLE, screen exposure, and parental EF. Screen exposure was associated with lower EF in children and their parents. Additionally, smaller differences between N200 amplitudes and latencies for the incongruent vs. congruent conditions were associated with higher HLE scores. In contrast, greater differences between P300 amplitudes and latencies were related to longer screen time. HLE was positively associated with EF's neurobiological (EEG) and behavioral measures, and screen time was negatively associated with these measures. This study also highlights the important relationship between parental EF (i.e., family predisposition) and EF's neurobiological and behavioral measures in their children.

As suicide is a leading cause of adolescent death, innovative evaluation of imminent suicide risk factors is needed. This study followed high-risk adolescents who presented with recent suicidal thoughts and behaviors (STB) for six months. They were digitally monitored and periodically observed during in-clinic visits. We aimed to classify their STB levels and identify severe cases based on two types of digital monitoring: (1) weekly self-reported questionnaires by patients and (2) continuously collected cellphone usage data. We present a novel approach for utilizing the immense amounts of unlabeled cellular logs in a supervised classification problem. Satisfying prediction results from both data types showed the feasibility of using digital monitoring for STB prediction. Such a capability may enrich periodic clinical assessments with frequent digital follow-ups and raise awareness whenever necessary.

The global prevalence of suicidal behaviors in children is rising, with attention-deficit hyperactivity disorder (ADHD) proposed as a contributing factor. This study examines the association between ADHD facets (hyperactivity and inattention) and suicidal behavior and attempts in children. Additionally, it seeks to compare self-reported ADHD symptoms and suicide-related incidents with parental reports. A cohort of 71 children referred from emergency departments due to suicidal thoughts and behaviors completed self- and parental report questionnaires. The results revealed that elevated hyperactivity scores, surpassing the ADHD diagnosis threshold, were significantly associated with increased rates of suicidal behavior. Hyperactivity demonstrated a stronger association with lifetime suicide attempts compared to inattention. Moreover, children’s self-reported ADHD symptoms exhibited a stronger correlation with suicide attempts than parental reports. This study highlights the critical role of hyperactivity in understanding suicidal behaviors among children with ADHD. It underscores the importance of considering hyperactivity-related symptoms in assessment and treatment approaches for suicidal behavior in this population.

BACKGROUND:In recent years, suicidal thoughts and behaviors have become increasingly common among children and adolescents, leading to an elevation in the number of visits to emergency departments in pediatric hospitals. In Israel, the rising demand for mental health treatment due to suicidal distress is also salient, creating prolonged wait periods and low case acceptance rates. Addressing the urgent need for streamlined interventions, the present study outlines the design and results of a non-inferiority effectiveness trial of an ultra-brief suicide crisis intervention based on Interpersonal Psychotherapy for Adolescents (IPT-A-SCI). METHODS:309 children and adolescents presenting to the Depression and Suicide Clinic at Schneider Children's Medical Center of Israel with depressive and anxiety symptoms and/or suicidal ideation/behavior were assigned to either IPT-A-SCI, Treatment as Usual (TAU), or waitlist condition. Assessments were conducted pre- and post-intervention/after five sessions/five weeks (as secondary assessments) in accordance with group assignment. RESULTS:At secondary assessment, post IPT-A-SCI, suicide ideation, and behavior as well as depression and anxiety symptoms significantly decreased, with no group differences observed between IPT-A-SCI, TAU, and control groups. CONCLUSION:IPT-A-SCI is feasible and as effective as the standard treatment in reducing suicidal, depressive, and anxiety symptoms among children and adolescents.

Implicit identification with death (i.e., subconsciously self-associating oneself with death), measured by the Death-Suicide Implicit Association Test (D/S-IAT), is associated with Suicide Ideation (SI). Our understanding of the mechanisms underlying this association is limited. The current study examined (1) the mediating role of depression between D/S-IAT and recent SI and (2) the association between SI, D/S-IAT, and clinician evaluation of SI among a clinical sample of adolescents. 148 adolescents aged 10-18 years (69.4% female) from two outpatient clinics were assessed at intake. Participants completed D/S-IAT and self-report measures for recent SI and depression during intake. Findings indicate that depression is a mediator between D/S-IAT and recent SI, controlling for gender, site differences, and past suicidal thoughts and behaviors. D/S-IAT and clinician evaluation were correlated with recent SI but not beyond depression. Our findings highlight the importance of examining the underlying psychological mechanisms regarding the association between D/S-IAT and suicide.

The article by Lock et al.1 in this month's issue of the Journal highlights 3 features that are of interest to child and adolescent psychiatrists. First, it provides further evidence for an effective therapy for an extremely debilitating condition, with additional means for improving prognosis. Second, it underscores how families can be helpful in supporting therapy for their children, thus avoiding unnecessary scapegoating of parents. Finally, it is a fine example of a clinical trial performed in accordance with all the principles of modern methodology.

ObjectivesAdolescent suicidal behavior is highly prevalent in pediatric psychiatric emergency departments, and there is a growing occurrence of such behavior among preadolescent children. This study aims to examine the psychosocial factors associated with nonfatal suicidal behaviors in children (<12 years old) and adolescents (aged 12-18), to gain insight into unique and shared characteristics of suicidal behavior across these two age groups. MethodThis study investigates the psychosocial characteristics associated with suicidal ideation and behaviors in an emergency department sample of 183 children and adolescents aged 7-18 years in Israel. Participants completed a diagnostic interview, and self-report and parent-report questionnaires of psychosocial measures. Cross-sectional correlational and regression analyses were used to determine significant correlates of suicidal outcomes within the two age groups. ResultsAmong adolescents, females exhibited a higher prevalence of suicidal thoughts and behaviors, while in children, both boys and girls showed similar rates. Depression correlated with suicidal ideation for both adolescents and children. In children, anxiety and conduct symptoms were associated with suicidal behavior, whereas in adolescents, suicidal behavior was associated with depression and anxiety. ConclusionsThe present findings contribute to the growing understanding of factors associated with suicidal thoughts and behaviors among children in comparison to adolescents. These findings underscore the importance of targeting specific risk factors when developing assessment and intervention strategies tailored to the two age groups.

Introduction: Exposure to a range of stressful life events (SLE) is implicated in youth psychopathology. Previous studies point to a discrepancy between parents'/children's reports regarding stressful life events. No study systematically assessed the correlation between such discrepancies and psychopathology in depressed youth. This study was designed to assess parent-youth discrepancies regarding stressful life events and its association with severity of psychopathology at baseline and response to selective serotonin reuptake inhibitor (SSRI) treatment in depressed youth.Methods: Reports regarding stressful life events were assessed in children/adolescents suffering from depressive/anxiety disorders using the life events checklist (LEC), a self-report questionnaire measuring the impact of negative life events (NLE) and positive life events (PLE), as reported by the children and their parents. The severity of depression/anxiety disorders and response to antidepressant treatment were evaluated and correlated with both measures of LEC.Results: Participants were 96 parent-child dyads (39 boys, 57 girls) aged 6-18 years (mean = 13.90 years, SD = 2.41). Parents reported more NLE and higher severity of NLE events than their children (number of NLE: 7.51 +/- 4.17 vs. 6.04 +/- 5.32; Cumulative severity of NLE: 24.95 +/- 14.83 vs. 17.24 +/- 12.94). Discrepancy in PLE, but not NLE, was associated with more severe psychopathology and reduced response to treatment.Discussion: Discrepancy in informant reports regarding life events in depressed/anxious youth, especially regarding PLE, is associated with more severe psychopathology and reduced response to pharmacotherapy. It is essential to use multiple reporters in assessing stressful life events in children.

Neural fingerprinting is a method to identify individuals from a group of people. Here, we established a new connectome-based identification model and used diffusion maps to show that biological parent–child couples share functional connectivity patterns while listening to stories. These shared fingerprints enabled the identification of children and their biological parents from a group of parents and children. Functional patterns were evident in both cognitive and sensory brain networks. Defining “typical” shared biological parent–child brain patterns may enable predicting or even preventing impaired parent–child connections that develop due to genetic or environmental causes. Finally, we argue that the proposed framework opens new opportunities to link similarities in connectivity patterns to behavioral, psychological, and medical phenomena among other populations. To our knowledge, this is the first study to reveal the neural fingerprint that represents distinct biological parent–child couples.

The most robust and well-replicated neurochemical finding in this disease is the increase seen in whole-blood serotonin in autistic individuals. The factors influencing WHBS levels in normals include platelet structure and activity, 5-HT synthesis, and monoamine oxidase activity. Differing hypotheses about the hyperserotonemia seen in autism therefore have been related to these three different areas. One method for examining the production rate of 5-HT involves the measurement of the primary 5-HT metabolite 5-hydroxyindoleacetic acid. The dietary precursor of 5-HT is tryptophan, and plasma-free TRP levels are thought to have a major effect on central TRP metabolism and 5-HT synthesis. 5-hydroxytryptophan, the immediate metabolic precursor of 5-HT, crosses the blood-brain barrier and increases central 5-HT availability after oral administration. Interest in 5-HT and autism has also spurred therapeutic endeavors, and a number of treatment studies have been performed. A final provocative line of evidence supporting the indoleamine hypothesis of autism is the finding of 5-HT receptor antibodies in some autistic children.

Psychopharmacological treatment is an important component of the multimodal intervention approach to treating mental health conditions in children and adolescents. Currently, there are many unmet needs but also opportunities, alongside possible risks to consider, regarding the pharmacological treatment of mental health conditions in children and adolescents. In this Position Paper, we highlight and address these unmet needs and opportunities, including the perspectives of clinicians and researchers from the European College of Neuropsychopharmacology-Child and Adolescent Network, alongside those of experts by lived experience from national and international associations, via a survey involving 644 participants from 13 countries, and of regulators, through representation from the European Medicines Agency. We present and discuss the evidence base for medications currently used for mental disorders in children and adolescents, medications in the pipeline, opportunities in the development of novel medications, crucial priorities for the conduct of future clinical studies, challenges and opportunities in terms of the regulatory and legislative framework, and innovations in the way research is conducted, reported, and promoted.