BACKGROUND:Behavioral parent training (BPT) programs are effective for reducing disruptive behavior of many children with emotional and behavioral disorders (EBD) and improving skills and competencies of their parents. However, these interventions are not sufficiently effective for parents who themselves have depression. This study assessed the feasibility of the Addressing Depression and Positive Parenting Techniques (ADAPT) Program-a novel BPT that includes aspects of cognitive behavioral therapy and dialectical behavior therapy. We identified whether recruitment was possible, attendance was acceptable, participants were satisfied, and facilitators adhered to the protocol. Additionally, we measured trends in changes in parent and child outcomes with intervention. METHODS:Participants were 28 parents and their children with EBD, referred to two hospital-based clinics. Parents were eligible if they (1) had a child aged 6-10 experiencing emotional and behavioral difficulties and (2) were experiencing elevated depressive symptoms. ADAPT took place virtually over 10 weeks. Participants completed measures before, weekly and after treatment. Clinicians recorded attendance and completed weekly treatment fidelity checklists. RESULTS:We found that recruitment was possible, the intervention showed high parental satisfaction, and facilitators reported high program fidelity. Further, secondary outcome measures showed evidence of sensitivity to change in the intended direction. CONCLUSION:Given that a priori progression criteria were met and we found preliminary indication of efficacy, we conclude that an RCT of ADAPT to determine efficacy is warranted.

The suitability of the white matter centrum semiovale (CS) as a pseudo-reference region for simplified reference tissue model 2 (SRTM2) with [¹⁸F]SynVesT-1 PET has not been evaluated in youth cohorts. We aimed to assess noninvasive quantification methods and determine the minimum scan time needed in a sample of youth with mental health challenges. Thirty-five youth participants (16–25 years old) from the Toronto Adolescent Youth cohort underwent 120-minute scans with arterial sampling. Binding potential (BPND) was estimated using one-tissue compartment model (1TCM) as a reference method. The SRTM2 was then applied, with k2′ parameter either set to population average (k2 from 1TCM) or estimated individually by initial coupled fitting in a two-step procedure. Standardized uptake value ratio − 1 (SUVR − 1, 60–90 min) was compared with 1TCM-derived BPND. Linear regression and percent bias analyses were performed. Time stability was assessed using several truncated scans (40–100 min). CS volume (1.7 ± 0.2 mL), VT (4.0 ± 0.6 mL/cm3) and k2 (0.031 ± 0.004 min− 1) were consistent with previously reported values. The population-based k2′ (0.031) and SUVR − 1 closely matched 1TCM results (R2 > 0.9, < 5

Youth (i.e., child and adolescent) mental health difficulties are a prevalent concern, with anxiety, depression, and disruptive behavior disorders being the most common presentations. Even though psychotherapy is often recommended to help youth and families manage mental health difficulties, recent meta-analyses suggest that youth psychotherapy is only moderately effective, highlighting a need for further improvement and innovation. Emotion dysregulation is a transdiagnostic risk factor across childhood emotional and behavioral disorders, yet despite the important connection between emotion regulation and psychopathology, little research has been conducted on emotion regulation as a potential mechanism of change during psychotherapy. This study will test the biobehavioral regulation of negative emotion as a transdiagnostic mechanism of change in youth psychotherapy using the Modular Approach to Therapy for Children with Anxiety, Depression, Trauma, or Conduct Problems (MATCH). MATCH is a well-researched therapy program for youth that is suitable for testing transdiagnostic mechanisms of treatment response. This protocol describes a two-site randomized controlled trial that aims to recruit 202 youth between the ages of 8 to 15 years with anxiety, depression, and/or disruptive behavior. Participants are randomized to the MATCH intervention condition or a waitlist control condition. Youth and their parent(s) in both conditions complete in-lab assessments and online questionnaires at the start of the study, every 3 months (i.e., quarterly), and at post-test (i.e., following the intervention/waitlist period). Physiological measures of emotion regulation such as heart rate variability and skin conductance are acquired during lab-based tasks. Youth symptoms and emotion regulation are monitored weekly for both conditions. The primary outcome is change in youth symptoms of psychopathology at post-treatment, and whether this change is mediated by change in behavioral and physiological emotion regulation. Secondary outcomes include parental functioning, parenting, family functioning, impairment, and additional measures of youth psychopathology. Findings from the study are expected to enhance the understanding of processes that drive therapeutic change, ultimately leading to better therapy personalization and effectiveness. ClinicalTrials.gov NCT05637320. Prospectively registered on November 15, 2022. https://clinicaltrials.gov/study/NCT05637320.

BACKGROUND:Criticism from parents is a risk factor for poor youth mental health, including self-harm and limited response to psychosocial interventions. We identified trajectories of change in parent criticism across treatment for youth self-harm (suicide attempts and non-suicidal self-injury) and compared these trajectories on treatment outcomes. METHODS:This is a preregistered secondary analysis of data from the Self-harm Intervention: Family Therapy trial. Participants (N = 831, 11-17 years; 89% girls, 11% boys; 84% White) were clinically referred for self-harm and randomly assigned to family therapy or usual care. A growth mixture model identified trajectories of parent self-reported criticism across baseline, 3, and 6 months. Trajectories were compared on youth self-harm, suicidal ideation, depression, and hopelessness, and parent mental distress (baseline, and change from baseline to 12 and 12-18 months). RESULTS:Four trajectories of parent criticism were identified: High and remaining elevated despite a small decrease (51.6%); sharply decreasing (7.6%); low/stable (37.2%); and increasing (3.6%). Youth with parents in the high with small decrease class had more severe baseline suicidal behavior. Treatment type was not related to criticism trajectory. Parent mental distress increased in the increasing criticism class. Youth with parents in the increasing class showed less improvement in suicidal ideation at 12-month follow-up compared to the high with small decrease and sharply decreasing classes. CONCLUSIONS:Current treatments for youth self-harm may not reduce parent criticism to subclinical levels. Increasing parent criticism may forecast poorer response to a range of treatments for youth self-harm and be indicative of increases in parent mental distress.

BACKGROUND:According to the network theory of mental disorders, psychopathology emerges from symptoms that causally influence one another and create interconnections and feedback loops that maintain atypical mental states. Analysis of symptom networks during and following psychotherapy may provide clues to some of the mechanisms through which change occurs. Youth with depression are an important population in which to better understand psychotherapy mechanisms because current evidence-based interventions for this population show only modest effects. METHODS:Participants were adolescents with major depressive disorder (N = 465; ages 11-17; 75% female) in a randomized controlled trial comparing cognitive behavioral therapy, short-term psychoanalytical psychotherapy, and brief psychosocial intervention (IMPACT, ISRCTN83033550). Eleven self-reported depression symptoms were used to compute two longitudinal networks: (1) treatment phase, using baseline, 6 and 12 weeks data; and (2) follow-up phase, using 36, 52, and 86 weeks data. RESULTS:During the treatment phase, all depression symptoms were interconnected. Symptoms of insomnia and fatigue showed the highest outstrength centrality (ability to predict other symptoms over time). In contrast, few symptoms were interconnected during the post-treatment phase except worthlessness, which had the highest outstrength centrality. Allowing network parameters to differ across the three treatment types improved model fit during the treatment phase and revealed that symptoms with the highest outstrength centrality varied by treatment type. CONCLUSIONS:Individual symptoms may make key contributions to subsequent depressive psychopathology in adolescents. Longitudinal network analysis reveals that insomnia and fatigue predict other symptoms, allowing for consideration of specific mechanisms associated with depression treatment. The findings further suggest that negative cognitions about the self may emerge as a central putative cognitive vulnerability in those with a history of depression. Our exploratory findings also suggest that the three therapies (cognitive behavioral therapy, short-term psychoanalytical psychotherapy, and brief psychosocial intervention) may have achieved equifinality in part through different mechanisms.

Speech is a noninvasive digital phenotype that can offer valuable insights into mental health conditions, but it is often treated as a single modality. In contrast, we propose the treatment of patient speech data as a trimodal multimedia data source for depression detection. This study explores the potential of large language model-based architectures for speech-based depression prediction in a multimodal regime that integrates speech-derived text, acoustic landmarks, and vocal biomarkers. Adolescent depression presents a significant challenge and is often comorbid with multiple disorders, such as suicidal ideation and sleep disturbances. This presents an additional opportunity to integrate multi-task learning (MTL) into our study by simultaneously predicting depression, suicidal ideation, and sleep disturbances using the multimodal formulation. We also propose a longitudinal analysis strategy that models temporal changes across multiple clinical interactions, allowing for a comprehensive understanding of the conditions' progression. Our proposed approach, featuring trimodal, longitudinal MTL is evaluated on the Depression Early Warning dataset. It achieves a balanced accuracy of 70.8%, which is higher than each of the unimodal, single-task, and non-longitudinal methods.

INTRODUCTION:Mental illness typically onsets during the developmental stages from adolescence to emerging adulthood (ages 15-24 years), referred to as 'youth'. A subset of youth with mental illness may be identified as having 'complex' mental health needs, defined based on requiring prolonged, extensive and resource-intensive services across multiple sectors, functional impairment, and comorbid challenges or multimorbidity . Effective early intervention for youth with complex mental illness is crucial to prevent the sequelae of long-term mental health problems. Several resource-intensive outpatient models have been developed to meet the needs of youth with complex mental illness; however, to the best of our knowledge, no scoping review has synthesised the available evidence on these interventions. A comprehensive synthesis of existing intensive outpatient interventions is needed to identify, target and inform future research and clinical efforts to better serve youth with complex mental illness. As such, the proposed scoping review will address the following research questions: (1) What intensive outpatient interventions have been evaluated for youth with complex mental illness? (2) To which populations are these interventions targeted? and (3) What outcomes have been examined within the context of these models? METHODS AND ANALYSIS:This review will follow the Arksey and O'Malley framework for scoping reviews, and we will report the results following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) recommendations. We will conduct a comprehensive literature search across seven academic databases to identify relevant peer-reviewed material in English from 1990 to the present. Inclusion criteria will address evaluations of outpatient models of care with intensive components targeted to youth ages 15-24 with features of complex mental illness. Studies will be screened independently for eligibility by two reviewers in Covidence using clear inclusion criteria. We will then collate, summarise and present the findings to provide a comprehensive overview of the existing evidence. ETHICS AND DISSEMINATION:Ethical approval will not be required, as no data will be collected for the proposed project. Results will be disseminated in peer-reviewed articles, presented at conferences and shared with stakeholders to inform the development, implementation and evaluation of comprehensive transdiagnostic services targeting youth with complex mental illness.

Mental health disorders are often comorbid, highlighting the need for predictive models that can address multiple outcomes simultaneously. Multi-task learning (MTL) provides a principled approach to jointly model related conditions, enabling shared representations that improve robustness and reduce reliance on large disorder-specific datasets. In this work, we present a tri-modal speech-based framework that integrates text transcriptions, acoustic landmarks, and vocal biomarkers within a large language model (LLM)-driven architecture. Beyond static assessments, we introduce a longitudinal modeling strategy that captures temporal dynamics across repeated clinical interactions, offering deeper insights into symptom progression and relapse risk. Our MTL design simultaneously predicts depression relapse, suicidal ideation, and sleep disturbances, reflecting the comorbid nature of adolescent mental health. Evaluated on the Depression Early Warning (DEW) dataset, the proposed longitudinal trimodal MTL model achieves a balanced accuracy of 70.8%, outperforming unimodal, single-task, and non-longitudinal baselines. These results demonstrate the promise of combining MTL with longitudinal monitoring for scalable, noninvasive prediction of adolescent mental health outcomes.

BackgroundWearable-generated data yield objective information on physical activity and sleep variables, which, are in turn, related to the phenomenology of depression. There is a dearth of wearable-generated data regarding physical activity and sleep variables among youth with clinical depression.MethodsLongitudinal (up to 24 months) quarterly collections of wearable-generated variables among adolescents diagnosed with current/past major depression. Latent class analysis was employed to classify participants on the basis of wearable-generated: Activity, Sleep Duration, and Sleep efficiency. The Patient Health Questionnaire adapted for adolescents (PHQ-9-A), and the Ruminative Response Scale (RRS) at study intake were employed to predict class membership.ResultsSeventy-two adolescents (72.5% girls) were recruited over 31 months. Activity, Sleep Duration, and Sleep efficiency were reciprocally correlated, and wearable-generated data were reducible into a finite number (3 to 4) of classes of individuals. A PHQ-A score in the clinical range (14 and above) at study intake predicted a class of low physical activity (Acceleration) and a class of shorter Sleep Duration.LimitationsLimited power related to the sample size and the interim nature of this study.ConclusionsThis study of wearable-generated variables among adolescents diagnosed with clinical depression shows that a large amount of longitudinal data is amenable to reduction into a finite number of classes of individuals. Interfacing wearable-generated data with clinical measures can yield insights on the relationships between objective psychobiological measures and symptoms of adolescent depression, and may improve clinical management of depression.

Introduction Our group developed an Integrated Care Pathway to facilitate the delivery of evidence-based care for adolescents experiencing depression called CARIBOU-2 (Care for Adolescents who Receive Information ‘Bout OUtcomes, 2 nd iteration). The core pathway components are assessment, psychoeducation, psychotherapy options, medication options, caregiver support, measurement-based care team reviews and graduation. We aim to test the clinical and implementation effectiveness of the CARIBOU-2 pathway relative to treatment-as-usual (TAU) in community mental health settings. Methods and analysis We will use a Type 1 Hybrid Effectiveness-Implementation, Non-randomized Cluster Controlled Trial Design. Primary participants will be adolescents (planned n = 300, aged 13–18 years) with depressive symptoms, presenting to one of six community mental health agencies. All sites will begin in the TAU condition and transition to the CARIBOU-2 intervention after enrolling 25 adolescents. The primary clinical outcome is the rate of change of depressive symptoms from baseline to the 24-week endpoint using the Childhood Depression Rating Scale—Revised (CDRS-R). Generalized mixed effects modelling will be conducted to compare this outcome between intervention types. Our primary hypothesis is that there will be a greater rate of reduction in depressive symptoms in the group receiving the CARIBOU-2 intervention relative to TAU over 24 weeks as per the CDRS-R. Implementation outcomes will also be examined, including clinician fidelity to the pathway and its components, and cost-effectiveness. Ethics and dissemination Research ethics board approvals have been obtained. Should our results support our hypotheses, systematic implementation of the CARIBOU-2 intervention in other community mental health agencies would be indicated.

BACKGROUND: Psychosis spectrum symptoms (PSSs) occur in a sizable percentage of youth and are associated with poorer cognitive performance, poorer functioning, and suicidality (i.e., suicidal thoughts and behaviors). PSSs may occur more frequently in youths already experiencing another mental illness, but the antecedents are not well known. The Toronto Adolescent and Youth (TAY) Cohort Study aims to characterize developmental trajectories in youths with mental illness and understand associations with PSSs, functioning, and suicidality. METHODS: The TAY Cohort Study is a longitudinal cohort study that aims to assess 1500 youths (age 11-24 years) presenting to tertiary care. In this article, we describe the extensive diagnostic and clinical characterization of psychopathology, substance use, functioning, suicidality, and health service utilization in these youths, with follow-up every 6 months over 5 years, including early baseline data. RESULTS: A total of 417 participants were enrolled between May 4, 2021, and February 2, 2023. Participants met diagnostic criteria for an average of 3.5 psychiatric diagnoses, most frequently anxiety and depressive disorders. Forty-nine percent of participants met a pre-established threshold for PSSs and exhibited higher rates of functional impairment, internalizing and externalizing symptoms, and suicidality than participants without PSSs. CONCLUSIONS: Initial findings from the TAY Cohort Study demonstrate the feasibility of extensive clinical phenotyping in youths who are seeking help for mental health problems. PSS prevalence is much higher than in communitybased studies. Our early data support the critical need to better understand longitudinal trajectories of clinical youth cohorts in relation to psychosis risk, functioning, and suicidality.

Abstract Background Adolescents with depression often experience relationship problems with their caregivers, which predict poorer treatment outcomes. Personalising interventions by targeting factors associated with poor treatment outcomes may enhance the effectiveness of interventions. We report the development and initial evaluation of an intervention designed to target caregiver‐adolescent relationship problems in the context of adolescent depression. Methods Following a literature search to identify established caregiver interventions, we developed a new group intervention for caregivers through an iterative process including six rounds of the group with n = 53 caregivers of adolescents age 13–18 in the context of an integrated care pathway for adolescent depression. Caregivers rated their family functioning at the beginning and end of the program and provided anonymous satisfaction ratings. Enrolment and attendance data were examined. Youth with lived experience of depression and their caregivers provided input that was incorporated in the final version of the intervention. Results The final intervention consists of 8 weekly, 1.5 h group sessions, delivered face‐to‐face, addressing: psychoeducation, the cognitive‐behavioural model and caregiving, positive caregiving, listening and validation, expressing emotions effectively, and problem solving. Reach (56%), attendance (M = 63%, SD = 31%), and satisfaction (M = 92%; SD = 7%) supported the feasibility of the program. Caregivers reported significant improvements in family functioning, t(21) = 2.68, p = .014, dz = 0.56 [95% CI 0.11–1.0]. Discussion A group intervention is acceptable to caregivers of adolescents with depression and may be associated with improved family functioning. Further research is needed, including a randomised controlled trial to test effects of the intervention on various dimensions of the caregiver‐youth relationship and on youth depression outcomes.

Several psychological therapy approaches have demonstrated effectiveness for improving adolescent depression, but many still do not benefit sufficiently. This chapter provides an overview of emerging methods being used to guide the selection of psychological therapy approaches for depression most likely to benefit an individual adolescent. We address testing moderators, attempting to match individuals to therapy based on their baseline characteristics, the use of machine learning approaches, Sequential Multiple Assignment Randomized Trial designs, and measurement-based care. We also introduce an alternative approach based on the general psychopathology factor and provide a demonstration in a large pragmatic trial sample. We note the importance of evaluating and implementing psychological therapies for adolescents in low- and middle-income countries. Lastly, we discuss the role of individual preferences and provide an overview of current issues and prospects in the field of personalized psychological therapy for adolescent depression.

Introduction: This secondary analysis of data collected in a randomized controlled trial (RCT) for the treatment of depression in adolescents aimed to test prediction models relating antidepressant (AD) initiation to clinical variables.Methods: The primary study was an RCT where adolescents (ages 11-17) with depression were assigned one of three outpatient psychotherapies over 86 weeks. The current study tested five registered prediction models using data on adolescents not taking ADs at baseline (N = 337). Outcomes of interest included: AD initiation, change in depression severity, and self-injurious thoughts and behaviors (SITBs).Results: Findings from registered analytic strategies were not consistent with our a priori hypotheses; rather we unexpectedly observed a relationship between initiation of AD and increased risk of suicide attempts and suicidal ideation during the same time interval (p > 0.01). Sensitivity analyses found that: (1) higher depressive symptom severity and self-harm each predicted future AD initiation (p < 0.05), and (2) new-onset SITB was associated with AD initiation (p < 0.01).Conclusions: Taken together, our results suggest that depression symptoms severity and SITBs may prompt AD initiation. Researchers may wish to further explore causal pathways relevant to the association ADs between SITBs. Clinicians need to be cognizant of high-quality guideline recommendations when prescribing ADs to adolescents.

Best practice clinical assessment of externalizing problems often necessitates collection of information from parents, youth themselves, and teachers. The present study tested the predictive validity of a psychometrically-driven scoring procedure to integrate multi-informant, dimensional ratings of externalizing problems. Participants were 2264 clinic-referred youth ages 6–18. Parents, teachers, and youth completed questionnaire ratings of externalizing problems (hyperactivity-inattention, conduct problems, and oppositionality-defiance) prior to an initial clinical appointment. The predictive validity of simple (highest informant rating; and all informant ratings separately) and more complex (latent S-1 bifactor model with specific informant factors; and moderated nonlinear factor analysis accounting for child age and sex) methods of informant integration was tested in predicting impairment, comorbidity, and number of clinical encounters. A simple model, in which all informant ratings were included, showed the best predictive validity across outcomes, performing as well or better than the use of the highest informant ratings or more complex latent variable models. The addition of child age and sex as moderators in the factor model did not improve predictive validity. Each informant (parent, teacher, and youth) contributes important information to the prediction of clinically-relevant outcomes. There is insufficient evidence at present to suggest that complex latent variable models should be favored over simpler models that preserve each informant’s ratings.

Adolescence is a period of elevated risk for suicide, and mental health professionals expressed concerns that suicidal behaviours and suicide rates may increase among this age group during the COVID-19 pandemic. Adolescent suicide rates, attempts, and ideation during the pandemic varied depending on the country, data collection methodology, and population (e.g., general population vs. emergency department). Many pre pandemic risk factors for suicidal behaviour or ideation were identified as risk factors during the pandemic; however, there was also some evidence that certain groups were disproportionately at risk, such as girls, and adolescents identifying as Black, Asian, American Indian/Alaska Native, or Asian/Pacific Islander. Given the trend of increased adolescent suicide in many countries over the past two decades, there is an ongoing need to direct resources toward prevention programs, screening, and evidence-based interventions for suicide risk.

Parenting can protect against the development of, or increase risk for, child psychopathology; however, it is unclear if parenting is related to psychopathology symptoms in a specific domain, or to broad liability for psychopathology. Parenting differs between and within families, and both overall family-level parenting and the child-specific parenting a child receives may be important in estimating transdiagnostic associations with psychopathology. Data come from a cross-sectional epidemiological sample (N = 10,605 children ages 4-17, 6434 households). Parents rated child internalizing and externalizing symptoms and their parenting toward each child. General and specific (internalizing, externalizing) psychopathology factors, derived with bifactor modeling, were regressed on parenting using multilevel modeling. Less warmth and more aversive/inconsistent parenting in the family, and toward an individual child relative to family average, were associated with higher general psychopathology and specific externalizing problems. Unexpectedly, more warmth in the family, and toward an individual child relative to family average, was associated with higher specific internalizing problems in 4-11 (not 12-17) year-olds. Less warmth and more aversive/inconsistent parenting are broad correlates of child psychopathology. Aversive/inconsistent parenting, is also related to specific externalizing problems. Parents may behave more warmly when their younger children have specific internalizing problems, net of overall psychopathology.

BackgroundIntensive longitudinal data collection, including ecological momentary assessment (EMA), has the potential to reduce recall biases, collect more ecologically valid data, and increase our understanding of dynamic associations between variables. EMA is typically administered using an application that is downloaded on participants’ devices, which presents cost and privacy concerns that may limit its use. Research Electronic Data Capture (REDCap), a web-based survey application freely available to nonprofit organizations, may allow researchers to overcome these barriers; however, at present, little guidance is available to researchers regarding the setup of EMA in REDCap, especially for those who are new to using REDCap or lack advanced programming expertise. ObjectiveWe provide an example of a simplified EMA setup in REDCap. This study aims to demonstrate the feasibility of this approach. We provide information on survey completion and user behavior in a sample of parents and children recruited across Canada. MethodsWe recruited 66 parents and their children (aged 9-13 years old) from an existing longitudinal cohort study to participate in a study on risk and protective factors for children’s mental health. Parents received survey prompts (morning and evening) by email or SMS text message for 14 days, twice daily. Each survey prompt contained 2 sections, one for parents and one for children to complete. ResultsThe completion rates were good (mean 82%, SD 8%) and significantly higher on weekdays than weekends and in dyads with girls than dyads with boys. Children were available to respond to their own survey questions most of the time (in 1134/1498, 75.7% of surveys submitted). The number of assessments submitted was significantly higher, and response times were significantly faster among participants who selected SMS text message survey notifications compared to email survey notifications. The average response time was 47.0 minutes after the initial survey notification, and the use of reminder messages increased survey completion. ConclusionsOur results support the feasibility of using REDCap for EMA studies with parents and children. REDCap also has features that can accommodate EMA studies by recruiting participants across multiple time zones and providing different survey delivery methods. Offering the option of SMS text message survey notifications and reminders may be an important way to increase completion rates and the timeliness of responses. REDCap is a potentially useful tool for researchers wishing to implement EMA in settings in which cost or privacy are current barriers. Researchers should weigh these benefits with the potential limitations of REDCap and this design, including staff time to set up, monitor, and clean the data outputs of the project.

Purpose of review There are a wide range of psychosocial treatment options, delivered in different modalities, for children with disruptive behaviour. However, clinicians face many challenges in ensuring the empirically supported treatments (ESTs) they select will be effective for their patient. This has prompted studies to generate knowledge on how to improve treatment outcomes for children with disruptive behaviour. This review identifies the major challenges in treatment selection as well as emerging research seeking to improve outcomes. Recent findings This review emphasizes the salience of the research-practice gap associated with establishing ESTs using narrow definitions of clinical problems. Recent research is reviewed considering the complex determinants of disruptive behaviours, including parent and family factors that influence outcomes. The review subsequently outlines recent advances in research and clinical practice guidelines aiming to surmount these challenges. Key advances discussed include examining the most impactful components of ESTs, personalizing interventions by targeting core dysfunction underlying behaviour, and addressing parent factors including mental health and cultural relevance to improve outcomes. Summary Thorough assessment of patients’ needs, combined with knowledge of treatment response predictors, are recommended to determine the most suitable treatment plan. Recent advances have focused on developing and designing interventions that meet needs in a way that is flexible and tailored.