Background

Sleep deprivation is a prevalent problem among adolescents which is closely related to various adverse outcomes. The lack of efficacy of current sleep education programs among adolescents argues for the need to refine the content and format of the intervention. This study aimed to evaluate the effectiveness of a group-based sleep intervention using motivational interviewing plus text reminders in changing adolescent sleep habits.

Methods

This study is a randomized controlled trial comparing motivational group-based sleep intervention with nonactive control group. The primary outcomes were the sleep–wake patterns measured by both sleep diary and actigraphy at postintervention, 3 and 6 months after the intervention. The trial was registered with the Clinical Trial Registry (NCT03614572).

Results

A total of 203 adolescents with school day sleep duration of <7 hr (mean age: 15.9 ± 1.0 years; males: 39.9%) were included in the final analysis. Sleep diary and actigraphy data both showed that adolescents in the intervention group had earlier weekday bedtime at postintervention (sleep diary: estimated mean difference: 33.55 min, p = .002; actigraphy: 33.02 min, p = .009) and later wake-up time at 3-month follow-up compared to the control group (sleep diary: −28.85 min, p = .003; actigraphy: −30.03 min, p = .01), and the changes in diary measured weekday bedtime were sustained up to 6-month follow-up. In addition, adolescents in the intervention group had longer sleep diary reported weekday sleep duration at 3- (35.26 min, p = .003) and 6-month follow-up (28.32 min, p = .03) than the controls. Adolescents in the intervention group also reported improved daytime alertness postintervention, which was maintained at the 6-month follow-up.

Conclusions

The motivational group-based sleep intervention is effective in advancing bedtime with improved sleep duration and daytime alertness in sleep-deprived adolescents.

Background

Nonsuicidal self-injury (NSSI), or ‘the deliberate, self-inflicted destruction of body tissue…without suicidal intent and for purposes not culturally sanctioned’, is a robust predictor of future suicide-related behavior and therefore a modifiable target for suicide prevention. The prevalence of NSSI is rising in adolescents, particularly among females; however, it is unknown whether sex differences also exist in the clinical and psychosocial factors associated with NSSI. Understanding how the correlates of NSSI differ by sex is important for developing tailored treatments. This study systematically reviews sex differences in the clinical and psychosocial correlates of NSSI among adolescents.

Methods

MEDLINE and PsycINFO were searched using the keywords ‘adolescents’, ‘self-injury’, and ‘sex factors’ and synonyms for English-language articles published between January 1, 2000 and May 10, 2022. We included studies that presented original data on NSSI, included adolescents ages 10–19, reported sex differences, and explicitly defined self-injury as that done without suicidal intent. Fifty-seven studies containing 54 unique samples were included. Data were summarized by sex and recorded by: (a) characteristics of NSSI, (b) clinical and psychosocial correlates of NSSI, and (c) associations with suicide.

Results

We used data on NSSI from 54 unique samples of adolescents worldwide. Males more commonly used violent methods of NSSI, such as burning, and were more likely to be physically aggressive and experience substance abuse. Females more commonly self-injured by cutting, and their NSSI was more likely to be repetitive and associated with emotional distress. In both sexes, NSSI was associated with adverse childhood experiences (ACEs) such as sexual abuse/violence and bullying. NSSI was predictive of suicide in females but not males.

Conclusions

Data from 22 countries and 352,516 participants suggest important sex differences in the clinical and psychosocial factors associated with NSSI among adolescents that future assessment and treatment strategies ought to consider.

Background

Attention deficit hyperactivity disorder (ADHD) is a common neurodevelopmental outcome among children with a history of early institutional care. Prior research on institutionalized children suggested that accelerated physical growth in childhood is a risk factor for ADHD outcomes.

Methods

The current study examined physical and neurophysiological growth trajectories among institutionalized children randomized to foster care treatment (n = 59) or care as usual (n = 54), and never institutionalized children (n = 64) enrolled in the Bucharest Early Intervention Project (NCT00747396, clinicaltrials.gov). Participants completed physical and electroencephalography (EEG) assessments at six time points from infancy through adolescence, as well as structured diagnostic interviews at the 54-month and 12-year time points. A series of multilevel growth models and cross-lagged path models were estimated to examine associations among physical and neurophysiological maturation, treatment group, age of foster care placement, and ADHD diagnostic outcomes.

Results

Twenty-seven percent of the institutionalized children met research criteria for ADHD at one or both time points. Slowed, prolonged growth of height and head circumference were associated with both ADHD and delayed foster care placement. Placement in foster care versus care as usual, but not ADHD, was associated with maturation of the peak alpha frequency. Among children randomized to foster care, average theta-beta ratio was lower among those with ADHD. There was no evidence that rapid physical maturation led to atypical cortical activity.

Conclusions

Delayed, prolonged physical growth and atypical neurophysiology from infancy through adolescence is associated with ADHD among institutionalized children, over and above the protective effects of foster care.

Background

Standardised Diagnostic Assessment tools, such as the Development and Well-Being Assessment (DAWBA), may aid detection and diagnosis of emotional disorders but there is limited real-world evidence of their clinical or cost effectiveness.

Methods

We conducted a multicentre, two-arm parallel group randomised controlled trial in eight large National Health Service Trusts in England providing multidisciplinary specialist Child and Adolescent Mental Health Services (CAMHS). Participants (5–17 year-olds with emotional difficulties referred to CAMHS) were randomly assigned (1:1), following referral receipt, to either receive the DAWBA and assessment-as-usual (intervention group) or assessment-as-usual (control group). Data were self-reported by participants (parents and/or young person, depending on age) at baseline, 6- and 12-month post-randomisation and collected from clinical records up to 18 months post-randomisation. The primary outcome was a clinician-made diagnosis decision about the presence of an emotional disorder within 12 months of randomisation. Trial registration: ISRCTN15748675.

Results

In total, 1,225 children and young people (58% female sex) were randomised (615 intervention; 610 control). Adherence to the intervention (full/partial completion) was 80% (494/615). At 12 months, 68 (11%) participants in the intervention group received an emotional disorder diagnosis versus 72 (12%) in the control group (adjusted risk ratio (RR) 0.94 [95% CI 0.70, 1.28]). The intervention was not cost effective. There was no evidence of any differences between groups for service-related or participant-reported secondary outcomes, for example, CAMHS acceptance of the index referral (intervention 277 (45%) versus control 262 (43%); RR: 1.06 [95% CI: 0.94, 1.19]) was similar between groups.

Conclusions

As delivered in this pragmatic trial, we found no evidence for the effectiveness or cost effectiveness of using a Standardised Diagnostic Assessment tool in aiding the detection of emotional disorders or clinical outcomes in clinically referred children and young people. Despite regular efforts to encourage clinicians to view the DAWBA report and consider its findings as part of assessment and diagnosis, we did not collect data on usage and therefore cannot confirm the extent to which clinicians did this. As a pragmatic trial that aimed to test the effectiveness of incorporating the DAWBA into usual practice and clinical care, our study found that, in the format as delivered in this trial, there was no impact on diagnosis or clinical outcomes.

Background

Attention Deficit Hyperactivity Disorder (ADHD) is a prevalent neurodevelopmental disorder in childhood, characterized by symptoms of inattention, hyperactivity, and impulsivity. Impaired inhibitory control is observed in the majority of individuals with ADHD. Understanding the relationship between inhibitory control and the developmental trajectory of ADHD is essential for informing clinical prognosis and guiding early interventions.

Methods

We utilized Latent Growth Curve Modeling (LGCM) to map the developmental course of ADHD symptoms using data from the Adolescent Brain Cognitive Development study. Concurrently, we examined the longitudinal correlation between inhibitory control and ADHD symptoms at corresponding time points. Additionally, a Bivariate Latent Change Score Model (BLCSM) was employed to investigate the relationship between changes in inhibitory control and ADHD symptoms. We also integrated Polygenic Risk Scores (PRS) into the LGCM as predictors to explore the impact of genetic factors associated with inhibitory control and ADHD on the trajectory of ADHD symptoms.

Results

The LGCM analysis demonstrated that baseline inhibitory control influenced both the initial state and the rate of change of ADHD symptoms. Inhibitory control exhibited both concurrent and prospective associations with ADHD symptoms. Notably, the BLCSM revealed that changes in inhibitory control could predict future changes in ADHD symptoms, and vice versa. Dynamic changes in inhibitory control were found to affect future changes in ADHD symptoms. Additionally, the PRS for inhibitory control and ADHD were significantly linked to the initial state and rate of change of ADHD symptoms.

Conclusions

Our findings underscore a sustained correlation between inhibitory control and ADHD symptoms, highlighting the critical association between inhibitory control and the developmental trajectory of ADHD in children. Furthermore, the predictive value of inhibitory control for ADHD suggests a new avenue for early intervention, potentially improving the prognosis for ADHD patients.

Psychosis in children and adolescents has been studied on a spectrum from (common) psychotic experiences to (rare) early-onset schizophrenia spectrum disorders. This research review looks at the state-of-the-art for research across the psychosis spectrum, from evidence on psychotic experiences in community and clinical samples of children and adolescents to findings from psychosis risk syndrome research, to evidence on early-onset psychotic disorders. The review also looks at new opportunities to capture psychosis risk in childhood and adolescence, including opportunities for early intervention, identifies important unanswered questions, and points to future directions for prevention research.

Background

More research is needed to understand psychopathology among parents of children with mental disorders in the years before and after the child is diagnosed. Here, we estimated the risk of mental disorders and psychotropic medication use in parents of children with versus without mental disorders and the temporal associations between child and parental psychopathology.

Methods

We conducted a population-based matched cohort study using Danish register data. The study population included child–parent pairs of all children diagnosed with a mental disorder of interest (attention-deficit/hyperactivity disorder, autism spectrum disorder, intellectual disability, anxiety disorder, mood disorder, eating disorder, substance use disorder, and schizophrenia spectrum disorder) by 18 years of age during the period 1999–2014 and a matched reference population. Each child with a diagnosis was matched to 10 children of the same sex and birth year who had not been diagnosed with the mental disorder of interest. For all parents, we estimated the yearly incidence proportion of parental mental disorders and prescriptions for psychotropic medications 4 years before and after the child's diagnosis.

Results

We observed a substantially increased risk of mental disorders and psychotropic medication use among parents of children with a mental disorder, compared to the reference population. On average, parents of children with a diagnosis had twice the odds of mood disorders, anxiety disorders, and prescriptions for anti-depressants and anti-psychotics. The incidence of mood and anxiety disorders peaked in the 1–2 years before and after the child's diagnosis. The incidence of parental prescriptions for psychotropic medications (particularly anti-psychotics) peaked in the year the child was diagnosed and in the 3 years before the child's diagnosis for anti-depressants and sleep medications.

Conclusions

This study demonstrates clear temporal associations between child and parental psychopathology, with parental psychopathology peaking in the years immediately before and after the child's diagnosis.

Background

Suicide attempts and deaths among children are increasing in the United States, yet suicide in this preadolescent population remains understudied. A clearer understanding of which youth experience early onset of suicidal behavior is crucial for predicting risk and identifying youth best suited to early intervention. This paper examines how intersectional marginalized identities may predict the onset of suicidal behaviors among preadolescent youth.

Methods

The Adolescent Brain and Cognitive Development (ABCD) Study is a prospective cohort study with annual assessments of youth ages 9 and 10 and their caregivers. Lifetime suicide attempts and preparatory suicidal behaviors were assessed annually. Survival models examined overall trends and demographic differences in the onset of suicidal behaviors.

Results

The final sample included 11,223 participants (mean age = 9.9 years old, SD = 7.5 months). 5,280 (47%) reported a minoritized racial/ethnic identity, and 1,410 (12.6%) were categorized as sexual or gender minorities. 208 suicide attempts and 143 instances of preparatory suicidal behaviors were reported across the study period. An interaction effect was found such that youth who hold multiple minoritized identities (i.e., sexual and gender minority youth from minoritized racial/ethnic backgrounds) were at elevated risk for onset of both suicide attempts (HR = 2.97, 95% CI = 1.59–5.56, p = .001) and preparatory suicidal behaviors (b = 3.09, 95% CI = 1.38–6.93, p = .006).

Conclusions

Intersectional marginalized identities were associated with earlier onset of suicide attempts and preparatory suicidal behaviors. Findings suggest that early interventions for minoritized youth may be important to reduce the rapidly increasing suicide rate among preadolescent youth.

Background

Numerous studies have investigated the associations between the home literacy environment (HLE) and children's word reading skills. However, these associations may partly reflect shared genetic factors since parents provide both the reading environment and their child's genetic predisposition to reading. Hence, the relationship between the HLE and children's reading is genetically confounded. To address this, parents' reading abilities have been suggested as a covariate, serving as a proxy for genetic transmission. The few studies that have incorporated this covariate control have made no distinction between the HLE reported by each parent or controlled for different skills in parents and children. We predicted children's reading development over time by the reading abilities of both parents as covariates and both parents' self-reported HLE as predictors.

Methods

We analyzed data from 242 unrelated children, 193 mothers, and 144 fathers. Children's word reading was assessed in Grades 1 and 3, and parents' word reading was assessed on a single occasion. Predictors of children's reading development included literacy resources and shared reading activities.

Results

Children's reading in Grade 3 was predicted by mothers' engagement in reading activities and by literacy resources at home, even after controlling for the genetic proxy of parental reading abilities. The longitudinal rate of change from Grades 1 to 3 was not associated with the HLE or parental reading.

Conclusions

Our finding that parental reading skills predicted children's word reading beyond children's initial word reading underscores the importance of considering genetic confounding in research on the home environment. Beyond parental reading abilities, children's skills were predicted by literacy resources in the home and by how often mothers engage in reading activities with their children. This suggests true environmental effects.