Clinical Child Psychology and Psychiatry

Who are homeless youths? This is the question I asked after observing a young man and his dog in the lobby of a bank on a cold January evening in Montreal. In attempting to answer this question I found that a universally accepted definition for “homeless youth” does not exist. Nonetheless, research exist that define who they are, the issues associated with homelessness and the health risks they face on the street. This led me wo ask what I could have done to help the young man. My experience help me realize that the street in unfortunately not only diverse, but also potentially inclusive of everyone, but like the rest of society it is not necessarily equitable.

Given the tone of this article the abstract I believe is in plain language and summarizes the article.

Ethnic disparities in cancer prevalence and health outcomes have been widely documented in adults. However, less is known about the impact of ethnic differences in young cancer patients who present with complex needs along their developmental trajectories. The present review aimed to examine psychological outcomes amongst ethnically minoritised adolescents and young adults (AYAs) with cancer.

A systematic search was conducted on four databases using terms related to AYAs, cancer, ethnic minority and psychological outcomes. Quantitative studies of any design were included and screened against the eligibility criteria. Studies were rated for methodological quality and synthesised narratively.

Twelve studies conducted in the United States were identified with mostly moderate to low quality and the evidence was mixed. Six studies found ethnic disparities in psychological outcomes: the majority demonstrated that ethnically minoritised AYAs experienced significantly more distress compared to White peers with cancer. Hispanic youths were highlighted as a vulnerable group that fared worse in their mental health compared to other minoritised youths. Longitudinal data showed that minoritised AYAs experienced more marked improvement in their psychological health over time compared to Caucasians.

There is emerging evidence regarding inter-ethnic differences in psychological outcomes amongst AYAs with cancer. However, the findings are inconsistent, reflecting methodological weaknesses and the complexities of intersectionality impacting on mental health. Further cross-cultural research is necessary to substantiate these findings and elucidate mechanisms behind these inequalities to promote more equitable healthcare.

People’s risks of getting cancer, how they manage and their likelihood to survive can vary across different ethnic backgrounds. However, we do not know whether these differences we see in adults also exist in younger cancer patients. To understand more about this younger group who may have additional needs as they grow up to become adults, we wanted to find out from existing research whether the mental health of young cancer patients from minoritised backgrounds differ compared to White young patients. We conducted an in-depth search on four databases and compared the results from the relevant research studies.

After comparing 12 studies, our results were:

• Half of the studies showed that minoritised young people struggle more with their mental health compared to White young people.

• Hispanic youths in particular had worse mental health amongst all groups.

• The studies measured different things and their results were mixed, so it is hard to compare or draw any firm conclusions about whether young cancer patients’ mental health differed between ethnic groups.

  We need to do more research to confirm these results and to understand more about why some ethnic groups with cancer might have poorer mental health.

Lesbian, gay, bisexual, transgender, and queer or questioning (LGBTQ+) individuals experience health inequalities. Young people living with a health condition are also more likely to experience adverse mental health outcomes. Developing positive identity can help to mitigate the impact of this. Young black LGBTQ+ people have additional barriers to developing positive identity. Current research rarely considers the intersection of these identities for young people despite the discrimination they may face, and the impact this may have on their health. A narrative approach allows these voices to be heard in research. Eight participants were interviewed using a narrative approach. Interviews were analysed using content and thematic narrative analysis. Global summaries of each interview were developed and ‘plot lines’ emerged from these. A central plot related to identity development, with two plots embedded in these exploring experiences of illness and of healthcare. Participants had positive experiences of healthcare despite encountering stigma. Access to positive role models and being able link in with various communities allowed participants to integrate and accept their identities. A key discussion point in this study is the ways in which healthcare staff could become role models for young LGBTQ+ people and help them to integrate and accept their identities.

Young LGBTQ+ people can experience discrimination which can impact on their health, including preexisting health conditions. Having a positive identity can help young people to be more resilient in the face of these difficulties. Current research has rarely given young black and mixed-race LGBTQ+ people with a physical health condition an opportunity to share their stories and explore their identity. Eight young people were interviewed using a narrative approach, which allowed them an opportunity to tell their whole life story. Shared plot lines emerged from the young people's life stories about identity development, experience of illness, and experiences of healthcare. The young people had all had positive experiences of healthcare staff as well as some negative experiences of discrimination. It was important to the young people to have positive role models who supported their identity and access to supportive communities. This study suggests that healthcare staff could be suited to become positive role models for the young people they care for.

Globally, there is an increasing trend of forcibly displaced people, of which over 40% are children. Unaccompanied asylum-seeking children (UASC) are at risk of experiencing psychological distress and developing mental health difficulties. However, in the UK, the approach from statutory mental health services is inconsistent across different geographical areas.

This report outlines recommendations for statutory mental health services in the UK in relation to working with UASC.

A rapid evaluation method was adopted including interviewing fifteen key informants as well as reviewing existing clinical guidelines. Key informants included clinicians, service managers, social workers and commissioners from Local Authorities, National Health Services, and third sector partners. Recommendations were synthesised using narrative synthesis.

Existing service provision and barriers to the implementation of interventions were summarised and compared against existing guidelines. The report presents recommendations on assessments, screening tools, and psychological interventions for developing a pathway for UASC within statutory services.

Globally, there is an increasing trend of asylum seekers and refugees, and 40% of which are children. Unaccompanied asylum-seeking children (UASC) are at risk of experiencing psychological distress and developing mental health difficulties. Yet, service provision for this population is inconsistent across different regions in the UK and may not be sufficient to meet their psychosocial needs. We hope to provide recommendations for services in England on how to better support UASC through reviewing the existing literature, clinical guidelines, and interviewing different service providers in the country in order to identify gaps in services. We interviewed key informants, including clinicians, service managers, social workers and commissioners from Local Authorities, National Health Services, and third sector partners. We present findings on how to improve the current assessment, screening and psychological interventions for UASC.

This study explored the mental health needs and strengths of young people (aged 11–18 years) living on the remote island of Saint Helena (SH). 24 young people and their carers completed standardised inventories assessing mental health and resilience, of whom 15 of the young people and their carers participated in semi-structured interviews enquiring into mental health awareness, contributing factors to young people’s mental health and resilience, as well as experience with local mental health services. Descriptive data were reported based on the quantitative measures and thematic analysis was applied to the interview transcripts. A number of young people were found to meet criteria for mental health problems while they showed high levels of resilience. The themes derived from young people’s interviews were broadly centred around mental health boosters, including personal successes, social interactions, engagement in pleasurable activities and use of anxiety management strategies; and around limitations of living in SH in terms of limited resources and difficulty in maintaining trust in the community. From the carers, the themes revolved around awareness of mental health needs and strengths in young people, perceived barriers to access support mainly due to apprehensions around stigma and anonymity. Recommendations for improvement of mental health provision are made.

Limited research has been carried out on the mental health of young people who live in remote geographical places. This study explored mental health and resilience in a group of young people living on Saint Helena Island. A total of 24 young people and their carers completed questionnaires assessing mental health and resilience and within the group 15 young people and their carers completed interviews with a researcher. We used the scores on the questionnaires to describe the characteristics of the young people and we analysed the interviews for themes denoting common patterns in attitudes, perceptions and behaviours. Young people and their carers reported mental health problems and needs but, positively, high levels of resilience too in young people. The themes derived from young people’s interviews were broadly centred around mental health boosters, including personal successes, social interactions, engaging in pleasurable activities and using anxiety management strategies; and around limitations of living in Saint Helena Island in terms of limited resources and difficulty in maintaining trust in the community. From the side of the carers, the generated themes revolved around awareness of mental health needs and strengths in young people through their observed behaviours, perceived barriers to accessing mental health support mainly due to concerns around stigma and maintaining anonymity, and recommendations for improvement of mental health service provision involving further training and psychoeducation. Implications for future research are discussed such as why the number of people who consented to participate was small and how the findings from the current study could be used to inform and improve child and adolescent mental health service provision on Saint Helena Island.

This retrospective chart review aimed to identify the intersection between young people with Autism Spectrum Disorder (ASD)’s needs and CAMHS inpatient service needs. A retrospective chart review was conducted on all referrals to a CAMHS inpatient unit over three years (n = 352). Referrals which specified a formal diagnosis or suspected diagnosis of ASD were identified (n = 111), and basic demographic data were collected. Young people with either a formal or suspected diagnosis of ASD referred to the unit presented with a wide range of co-occurring conditions. Of these young people, 30 were admitted to the unit and only 6 of them were engaged with an ASD specialist service. Young people with diagnosed or suspected ASD were more likely to be admitted if they presented with suicidality. Males with diagnosed or suspected ASD were more likely to have a diagnosis of OCD while females with diagnosed or suspected ASD were more likely to present with eating and feeding disorders and personality development difficulties. Findings highlight the lack of a clear care pathway for young people with co-occurring autism or suspected autism and complex mental health problems.

Many children and adolescents who are referred to Child and Adolescent Mental Health Services (CAMHS) inpatient units may also have autism spectrum disorder (ASD). It is important that we understand their needs and how best services can support them. Methods: In this study, we reviewed the files of all young people referred to a CAMHS inpatient service over a 3 year period (n = 352), and identified those where the young person had a diagnosis of ASD, or where the referring clinician suspected the young person may have had autism (n = 111). We collected details about their demographics, the mental health difficulties with which they presented, and the services that were supporting them. Results: We found that young people with either a formal or suspected diagnosis of ASD referred to the unit presented with a wide range of co-occurring conditions. Of these young people, 30 were admitted to the unit and only 6 of them were engaged with an ASD specialist service. Young people with diagnosed or suspected ASD were more likely to be admitted if they presented with suicidality. Males with diagnosed or suspected ASD were more likely to have a diagnosis of OCD while females with diagnosed or suspected ASD were more likely to present with eating and feeding disorders and personality development difficulties. Conclusion: Presentations of confirmed and suspected ASD represented a significant number of referrals for inpatient care. This means that it is important for mental health services to work alongside disability services to ensure that the needs of these young people are met.

Previous research has demonstrated the positive associations with parental support with better mental health outcomes in gender-diverse young people. However, less is known about what happens within a family structure if an unsupportive parent or family member leaves the family unit and sees the child only on the condition that they present in a way that conforms to their birth gender. This paper will focus on the first interviews with nine families within the wider sample of 39 families in the LOGIC-Q (Longitudinal Outcomes of Gender Identity in Children – qualitative) study who reported they had experienced rejection by a parent or family member after the young person had disclosed their gender non-conformity. These families’ narratives are examined through two themes: How rejection impacts visitation, and Moving past the loss of rejection. The families all spoke about how they had adapted to the loss of their family members. They described how any negative impact would have been worse had they stayed living together, or were in contact with, the rejecting family member. Here, it becomes important then to understand the context of why a gender-diverse young person may choose to no longer see a parent or family member.

Young people who feel that their gender identity does not align with the gender they were assigned at birth can be described as gender non-conforming. Previous research has shown us that gender-non-conforming young people have better mental health when their parents are supportive. However, not all parents and family members accept when a young person discloses that they are gender non-conforming, and will refuse contact with the young person as a result. We know less about how this impacts the young person and the remaining family members as a whole. Out of the 39 families who took part in the LOGIC-Q (Longitudinal Outcomes of Gender Identity in Children – qualitative) study, nine families had experienced a parent or other family member refuse contact unless the child started behaving in a way they felt conformed more in-line with the child’s birth gender. We read through their interviews several times and two common experiences became clear: 1. A parent or family member’s rejection of the young person impacted if and when they saw them, and 2. The young person and remaining family members experienced loss and had to find ways to cope this this. When talking about how they adapted to the loss of their family members, the families all spoke about how they realised there would have been greater negative impacts on the young person if the family had remained living together. Understanding the individual experiences of the young person and remaining family members is therefore important to ensure the young person’s continued wellbeing.

This commentary explores the ‘cost of poverty’ for child development, with particular reference to the current UK context. Specifically, it comments on the adverse impacts of poverty on child mental health, education, and maltreatment.

The Cost of Poverty for Child Development: Recent reports highlight the growing issue of child poverty in the UK, with over 4 million children affected, and 1 million in Northern England alone. The Joseph Rowntree Foundation reveals that 600,000 more people, half of them children, have fallen into absolute poverty. Poverty has significant impacts on children’s well-being and increasing the risk of neglect and abuse. Data shows that many children referred to authorities for neglect and abuse are under five, and in areas like Blackpool, 1 in 52 children is in care. Poverty also severely affects children’s mental health. A report from the Children’s Commissioner links poverty to higher levels of stress, anxiety, and depression in children. NHS data shows that children in households with reduced income are more likely to experience mental health issues, with 1 in 4 affected children showing probable mental disorders. Educationally, children in poverty face serious challenges. They leave school significantly behind their peers, and only 4 in 10 disadvantaged children meet basic academic standards. This disadvantage extends into poor health and job prospects. Addressing these issues requires poverty-aware practices among professionals working with children. Mental health and social care services should integrate support for financial difficulties, including poverty screenings and financial counselling. Research is needed to evaluate the effectiveness of combined financial and psychological interventions to break the cycle of poverty. By focusing on poverty-informed practices, professionals can help improve outcomes for children in education, mental health, and overall well-being, emphasising that tackling child poverty is a necessary investment for society's future.

Social class is an often neglected component of a clinical psychologist’s multicultural competence, and there have been calls for more research and commentary on how personal social class identities impact upon clinical practice. This article presents the conversations of four working class mental health practitioners reflecting on the process of training and working in NHS children’s mental health in the UK. Throughout the paper we will include both academic research about various parts of the pathway, and also share some of our lived experience, captured from our conversations. We make recommendations for improving the experiences of psychologists from working class backgrounds, and making the most of their unique strengths and experiences.

The experiences of psychologists from working class backgrounds working in children’s mental health services: Social class is often overlooked when thinking about a clinical psychologist’s ability to understand and work with people from different backgrounds. However, researchers have called for more discussion on how personal social class identities affect clinical practice. This article shares conversations between three working-class clinical psychologists as they reflect on their experiences training and working in NHS children’s mental health services in the UK. Alongside academic research on different stages of this journey, we also share our personal experiences. We offer recommendations to improve the experiences of psychologists from working-class backgrounds and highlight how their unique strengths can benefit the profession.

In 2020 we launched a programme of activity (‘The Rainbow Project’) across our inner city hospital to make services more accessible and relevant to the needs of LGBTQ + young people and families living with a chronic health condition (detailed in Huckridge et al., 2021). In this article, we celebrate the five year anniversary of the project, and share how it has evolved, with a particular focus on the creation of a quarterly group for young people to meet together to support one another and share experiences. We share some of the dilemmas we have encountered and how we have responded to these, and provide inspiration and ideas for other services who may wish to do the same. Additionally, we talk about setting up a ‘Rainbow Advocate’ role for young people, who collaborate with us on further developing and delivering the project. Two of our Rainbow Advocates share their experiences of working on the project and their wisdom for practitioners to take forth into their work.

In 2020 we launched The Rainbow Project across our inner city hospital to make services more accessible and relevant to the needs of LGBTQ+ young people and families living with a chronic health condition. In this article, we celebrate five years of the project, and share how it has evolved, with a particular focus on the creation of a quarterly group for young people to meet together to support one another and share experiences. We share some of the problems we have encountered and how we have responded to these, and provide inspiration and ideas for other services who may wish to do the same. Additionally, we talk about setting up a ‘Rainbow Advocate’ role for young people, who support us with further developing the project. The article ends with two of our Rainbow Advocates sharing their experiences of working on the project.

Suicide among adolescents is a serious global health concern. Previous research has highlighted that interpersonal factors are vital determinants of suicidality. However, little is known about the cumulative effects of interpersonal risks and the protective factors that buffer individuals from developing suicidal tendencies. The present study examined whether linear or nonlinear models best account for the relationship between cumulative interpersonal risk and suicidal ideation and attempts among early adolescents and the protective value of self-esteem in these associations.

A sample of 605 seventh-grade students from in Hunan, China was tracked over a 6 month interval. Measures of interpersonal risk, suicidal ideation, suicide attempts, and self-esteem were obtained from adolescents’ self-reports.

The findings indicated both concurrent and longitudinal linear associations between cumulative interpersonal risk and adolescent suicidal ideation. Cumulative interpersonal risk was only associated with concurrent adolescent suicide attempts, showing a nonlinear relationship. Self-esteem moderates the association between cumulative interpersonal risk and subsequent suicidal ideation. The results also showed that identifying interpersonal risk early and simultaneously reducing multiple interpersonal risks would benefit high-suicide-risk youths.

Adolescents who face more than three interpersonal risks are particularly at risk for suicide attempts. Self-esteem is insufficient to counteract the cumulative impact of interpersonal risk completely. Study analyzing whether personal worth plays a moderating role in the suicidal ideation and attempts of early Chinese adolescents. While suicide among adolescents is a serious global health concern, little is known about the cumulative effects of interpersonal risks and the protective factors that buffer individuals from developing suicidal tendencies. As such, we followed 605 seventh graders over six months to investigate the combined influence of various interpersonal stressors such as low teacher support, limited classmates’ support, ineffective communication with parents, and experiences of social ostracism on suicidality. In addition, we explored whether a good sense of personal worth (self-esteem) made a difference. Our findings showed that, as interpersonal risks accumulate, the likelihood of an adolescent experiencing suicidal thoughts increases. Although self-esteem offers some protection, it does not fully counteract the detrimental effects of combined interpersonal problems. In particular, when an adolescent faces three or more interpersonal stressors, the risk of suicide attempts increases. Based on our findings, we believe that interventions aimed at reducing these interpersonal risks and bolstering adolescent self-esteem could be pivotal for suicide prevention.

While suicide among adolescents is a serious global health concern, little is known about the cumulative effects of interpersonal risks and the protective factors that buffer individuals from developing suicidal tendencies. As such, we followed 605 seventh graders over six months to investigate the combined influence of various interpersonal stressors such as low teacher support, limited classmates support, ineffective communication with parents, and experiences of social ostracism on suicidality. In addition, we explored whether a good sense of personal worth (self-esteem) made a difference. Our findings showed that, as interpersonal risks accumulate, the likelihood of an adolescent experiencing suicidal thoughts increases. Although self-esteem offers some protection, it does not fully counteract the detrimental effects of combined interpersonal problems. In particular, when an adolescent faces three or more interpersonal stressors, the risk of suicide attempts increases. Based on our findings, we believe that interventions aimed at reducing these interpersonal risks and bolstering adolescent self-esteem could be pivotal for suicide prevention.

Despite rising rates of suicidal thoughts and behaviors in children, little is known about best practices for conducting suicide risk assessments in this population. The acquisition of the concept of death occurs during childhood, and thoughts and preoccupation with death can be developmentally normative. This review highlights a critical gap in knowledge about how children with suicide ideation understand death—a foundational issue in assessing suicide risk. First, we provide an overview of studies that examined the concept of death and related constructs (e.g., preoccupation with death) among children who experienced suicidal ideation or attempted suicide, many of which date back to the 1970s and ’80s. We describe indirect methods of assessing death cognitions, such as the Death Implicit Association Test, representations of death/suicidal themes in play, and the role of exposure to these themes through screens (e.g., social media, videogames). Given the potential impact of sociocultural changes since the 1970s–1980s on how children understand death, gaining a contemporary perspective on how children think about death and its relationship to suicide risk is warranted. Guided by a developmental approach, we provide recommendations for future areas of research to advance this field and inform the design of developmentally appropriate risk assessments and interventions for children.

The concept of death among children who experience suicide ideation or attempt suicide: The development of the concept of death takes place in childhood and entails the understanding of five dimensions: inevitability, universality, irreversibility or finality of death, cessation, and causality. Historically, some researchers and clinicians have argued that without understanding the concept of death, children could not think about or attempt suicide. This idea has been discarded, yet evidence to contradict this statement is lacking. We conducted a review of studies examining the concept of death and related constructs among children who experience suicide ideation or attempt suicide. Most studies on this topic were conducted in the 1970s and 1980s and suggested that children who think about or attempt suicide may have a distorted concept of death, often making more references to the afterlife and resurrection than children without these behaviors. They tend to describe death as more pleasant and less permanent, report a greater preoccupation with death, and endorse more violent ways of dying. Societal changes since these studies were conducted may have influenced how children now conceptualize death. Gaining an updated perspective on how children think about death and its relationship to suicide risk can help clinicians assess the severity of suicidal thoughts and behaviors and make recommendations for care. Guided by a developmental approach, we provide a critical review of prior studies, discuss alternative ways to assess death constructs (e.g., implicit identification with death, representations of death and suicidal themes in play), consider exposure to death-related themes through screens (e.g., social media, videogames), and propose new research directions to advance the field. We believe these contributions will aid in designing developmentally appropriate risk assessments and interventions for children.

Adolescent presentations to the emergency department (ED) for suicide-related thoughts and behaviors (SRTBs) increased during the COVID-19 pandemic. Gender expansive youth were particularly impacted by the loss of gender-specific services, however, data examining ED pandemic presentations of gender expansive youth for SRTBs are scarce.

Data were collected at a tertiary care center in Canada. Adolescents aged 12 to 17 presenting with SRTBs were recruited during two periods: March 2018 - March 2020 (pre-pandemic) and March 2021 - May 2023 (during pandemic). Patient demographics, mental health symptoms, and pre-ED visit healthcare utilization were examined.

We identified 202 adolescents (70 pre-pandemic; 132 during pandemic), with a mean age of 14.3 years. Compared with pre-pandemic, during pandemic adolescents were more likely to identify as gender expansive [pre: 5.7% versus during: 24.2%; p = .01] and were of European descent [pre: 28.6% versus during: 59.1%; p < .01]. During the pandemic, gender expansive adolescents, on average, exhibited higher suicidal ideation, measured by Suicide Ideation Questionnaire Junior scores, compared with cisgender adolescents [gender expansive: mean = 64.3 (standard deviation = 12.1) versus cisgender participants: mean = 58.0 (standard deviation = 14.5); p = .03]. There were no differences in demographics, healthcare utilization, depression or anxiety symptom severity between gender expansive and cisgender adolescents.

Adolescents presenting to the ED with SRTBs during the pandemic were more likely to identify as gender expansive than those presenting pre-pandemic. Gender expansive adolescents exhibited increased suicidal ideation compared to cisgender adolescents during the pandemic.

During the COVID-19 pandemic, emergency departments experienced an increase in suicide-related visits by adolescents. Gender expansive youth, i.e., youth whose gender identity does not align with their assigned sex at birth, were particularly impacted due to the loss of gender-specific services. In this study, we investigated possible factors to better understand the differences in suicide-related emergency department visits before and during the pandemic between cisgender and gender expansive adolescents. Our study comprised of 70 adolescents before the pandemic and 132 during the pandemic. We saw an increase in gender expansive youth and adolescents of European descent that visited the emergency department due to suicide-related concerns during the pandemic. We also found higher suicidal ideation among gender expansive adolescents compared to cisgender youth during the pandemic. However, gender expansive and cisgender adolescents did not differ in demographic characteristics, healthcare utilization, depression or anxiety symptoms. The pandemic appears to have changed the profile of adolescents seeking emergency department care for suicide-related concerns, emphasizing the importance of addressing gender diversity and shifts in outpatient mental health care utilization during societally stressful times.

Cognitive behavioral therapy (CBT) is an evidenced-based treatment for sleep concerns but may be insufficient on its own to resolve adolescent sleep problems – combining this treatment with motivational interviewing may result in more robust improvements to sleep in adolescents and young adults (AYA). This study aimed to conduct the first meta-analysis of integrated CBT and motivational interviewing (MI) for AYA sleep concerns. Following PRISMA guidelines, PsycINFO, PubMed, and Google Scholar were searched through January 2024. Cohen’s d was computed for effect sizes. Eligible articles included AYA utilized an integration of CBT and MI, reported quantitative outcomes related to sleep, and were published in peer-reviewed journals and available in English. Four studies were eligible for the meta-analysis (N = 435). Results showed a small-medium effect size for reduced daytime sleepiness (d = 0.39, p = .001) and increased total sleep time (d = 0.25, p = .008) following integrated CBT and MI. Risk of bias was assessed using CMA. The findings suggest integrated CBT and MI is beneficial for AYA daytime sleepiness and sleep duration, more effective than CBT alone and other control groups. These findings contribute to the understanding of effective interventions for AYA sleep concerns, offer practical insights for practitioners, and highlight the need for further investigation into the integration of CBT and MI.

This article looks at existing studies that have combined cognitive behavioral therapy and motivational interviewing to improve sleep in adolescents and young adults. We use meta-analytic techniques to look at the combined efficacy of these studies. We found that the combination of these therapy techniques results in more total sleep time and less daytime sleepiness for adolescents and young adults when compared to other techniques.

The purpose of this study was to perform a systematic review to describe the empirical support on TF-CBT and therapeutic alliance. Three electronic databases (PsychInfo, Web of Science, and SCOPUS) were searched through October 2023. Quantitative studies containing TF-CBT and measures of alliance were included. A total of 3,036 studies were screened, resulting in 15 quantitative studies being included in the review and charted. The Standard Quality Assessment Criteria for Evaluating Primary Research Papers from a Variety of Fields tool was used to check quality. Results suggest the importance of building early alliance, highlight differences in alliance perspectives between raters, and emphasize the strong influence caregivers have on children’s perceptions of treatment. The review is limited by moderate-to-weak methodological rigor among studies and a relatively small number of studies available for review indicating the need for future methodologically rigorous research on this topic. This work did not receive funding, and authors have no conflicts of interest to declare.

Treating childhood trauma with trauma-focused cognitive behavioral therapy (TF-CBT) can significantly improve mental health for both children and parents, reducing trauma symptoms and increasing satisfaction. This review looked at how the relationship between therapists and children, known as therapeutic alliance, affects TF-CBT outcomes. It found that early positive connections between therapists and children are crucial. However, there were differences in how therapists, children, and caregivers rated these relationships. Caregivers’ support also plays a significant role in how children perceive treatment and respond to it. The review noted that while these findings are important, many studies had methodological limitations and few were available for review.

Anxiety rates amongst autistic youth range from 11% to 84%. While Cognitive Behavioural Therapy (CBT) is an effective treatment of anxiety in neurotypical youth, there are concerns autistic youth lack the cognitive resources necessary to effectively engage with CBT. It is also unclear whether standard or adapted CBT is more effective. This review aims to compare the effects of standard and adapted CBT in the treatment of anxiety in autistic youth.

Articles were searched across three online databases. 24 articles were selected for final review. All articles were published between 2008 and 2024. Total sample size was 1,140 and participant age ranged from 4–18 years. Various designs, settings, and CBT formats were incorporated.

When treating anxiety in autistic youth, standard CBT is effective although CBT adapted to accommodate the autism-related needs of the youth appears more effective, with gains maintained up to 26 months post-treatment. Statistical analysis was not significant.

Standard and adapted CBT are effective treatments of anxiety in autistic youth. To optimise outcomes, it may be important to consider the common cognitive styles associated with autism and adapt the therapeutic intervention accordingly. However, there is not yet statistical evidence for this hypothesis.

A review of studies investigating the use of Cognitive Behavioural Therapy to treat anxiety in young people with Autism Spectrum Disorder: Why was this review done? Up to 84% of autistic youth have anxiety. Cognitive Behavioural Therapy (CBT) is often used to treat anxiety in youth without autism. However, there are concerns autistic youth lack the thinking processes necessary to effectively engage with CBT. It is also unclear whether standard or adapted CBT is more effective. This review therefore aims to compare the effects of standard and adapted CBT in the treatment of anxiety in autistic youth. What did the researchers do? Three online databases were used to find relevant studies for review. 24 studies were included in the final review. All studies were published between 2008 and 2024 and involved 1,140 participants overall. Participant age ranged from 4-18 years. Different study designs, settings, and CBT formats were included. What did the researchers find? CBT can help reduce anxiety in autistic young people. Greatest treatment effects may be found when the CBT has been adapted to suit the specific autism-related needs of the youth, and these effects can last up to 26 months post-treatment. Statistical analysis between standard and adapted CBT however did not show any significant differences. What do the findings mean? CBT helps to reduce anxiety in autistic youth. To achieve the greatest treatment effects, it may be important to adapt the CBT to suit the thinking processes of the autistic young people. However, there is not yet statistical evidence for this hypothesis.

Internalizing and externalizing psychiatric disorders among children are common and debilitating, affecting family interactions, learning and peer relations. The aim of the present quasi-randomised pilot-study was to investigate preliminary effects of a mentalization-based time-limited treatment (MBT-C) for children with mixed psychiatric disorders. The trial comprised 17 children, aged 4–11 with mixed disorders, and their parents, admitted to an outpatient psychotherapy clinic. Quasi-randomization allocated patients to 12 sessions MBT-C with parallel parent support, or wait-list control. Compared to wait-list controls, significant improvements were observed in child pathology (d = 1.23, p = .006), therapist-rated global functioning (d = 1.73, p = .002), parent-perceived overall distress and impairment (d = 1.42, p = .017), and child-perceived emotional distress (d = 1.32, p = .024). No significant effects were observed for parent-perceived symptoms (d = 0.41, p = .28). Within-group changes and long-term effects were calculated for all participants including the wait-list after being crossed-over to treatment. Results were either maintained or further improved at 6- and 12-months follow-ups. This trial provides preliminary support for MBT-C in children with mixed disorders.

Psychiatric disorders, both internalizing and externalizing, are common and have a significant impact on children’s lives. They affect their family dynamics, learning abilities, and relationships with peers. The purpose of this pilot study was to investigate the effects of a time-limited treatment called mentalization-based therapy for children (MBT-C) who have a variety of psychiatric disorders. The study included 17 children, aged 4–11, who had common mental health problems, along with their parents. These participants received treatment at an outpatient psychotherapy clinic. Patients were assigned to either 12 sessions of MBT-C with additional support for their parents or placed on a wait-list control. The results showed that compared to the wait-list controls, the group receiving MBT-C experienced significant improvements in various areas. These included the child’s overall pathology as rated by a psychiatrist, the child’s global functioning as evaluated by the therapist, the overall distress and impairment experienced by the parents, and the child’s own perception of emotional distress. However, there were no significant effects observed in terms of the parents’ perception of symptoms. The positive results from this trial were maintained or even further improved during the 6- and 12-month follow-up assessments. This study provides preliminary evidence supporting the use of MBT-C as an effective treatment for children with common mental health problems.

Adolescence is a critical life period that marks the transition into adulthood. This novel study aims to evaluate the benefits of 4- day intervention, Sudarshan Kriya Yoga (SKY), a breathing technique, on the emotional, mental, and cognitive health of teenagers. Open label trial tests were administered at pre-intervention, immediately after SKY, and after 40 days of SKY practice. Cognitive abilities of 275 adolescents were tested using the Six letter cancellation test. Mental well-being was assessed using the World Health Organization-five Index (WHO-5), and Emotional well-being using the Strength and Difficulty Questionnaire (SDQ) questionnaire. The Results were analyzed using a paired-sample t test. The results showed an improvement in cognitive abilities for 71% of the study population as measured by the six-letter cancellation test, better mental health scores for 86%, and better SDQ scores for 95% of the population after SKY practice.

The present study evaluates the impact of mind body interventions such as yogic breathing on the mental and social wellbeing of teenagers. In doing so, it proposes healthy, noninvasive, low cost interventions to help teenagers deal with the challenges of adolescence and grow into well-adjusted, healthy citizens of the future.

Today, for divorcing parents, the social norms of “good” parenting appear to impose obligations to “fight” for shared custody of their children. However, this may intensify conflicts experienced by their children in the form of cognitive dissonance. Authors conducted a rapid review to explore children’s experiences of divorce (ages three to 12 years old) in the context of narrative therapy, in order to uncover the mechanism of cognitive dissonance. Four databases of Scopus, PsychINFO, Family and Societies Studies Worldwide, and PubMed were searched for literature in the last 10 years. Results included 11 study articles, one policy brief, and one book chapter, representing the experiences of 1169 children from seven developed countries/regions. Our findings suggest four themes associated with cognitive dissonance, whereby the first three represent the formation of harmful perceptions of cognitive dissonance resulting from divorce. The fourth represents the children’s coping strategies to reduce their cognitive dissonance. We advocate that family mediators consider narrative therapy targeting cognitive dissonance as a means of repairing disruptions to family coherence. In this regard, we recommend that future research explore the consequences of children’s confrontation of their cognitive dissonance in narratives found to be prevalent in children’s experiences of divorce.

Children who experience parental rejection during divorce: Would targeting children’s conflicting beliefs in stories of their relationships help them to better adjust?: Divorce can be emotionally traumatic on children, especially in the early years between three and 12 years old. However, not all children that experience divorce are traumatized. Rather, children that experience parental rejection or avoidance as part of divorce, can be helped through telling their stories, to make sense and transform their experiences. We were guided by a question of whether children going through parental divorce, and whom hold two contradicting ideas (like love and hate towards one or more parents), might be helped when they talk about their conflicting perceptions with a therapist. In this paper, we explored children’s storied literature in the last 10 years to better describe children who talked about their conflicting ideas in their relationships during divorce, and what were the consequences for them. We found that loyalty conflicts were prevalent in their relationships with parental figures, but that these were not only emotionally harmful to their adjustment, but could also help them repair their relationships. In the latter case, family therapists drew on children’s contradicting beliefs to help children work through them. This strategy shifted children’s moral obligation from their parents to themselves, and helped them find alternative ways to cope. We recommend family therapists draw out conflicting perceptions in children’s storied experiences of divorce, to help them reconsider their moral obligations and forge better working alliances in their relationships.

This study’s primary aim is to evaluate the relationship between obesity and sluggish cognitive tempo (SCT).

The study group consisted of obese (n = 37) and morbidly obese (n = 42) patients. The healthy control group included 38 children and adolescents. SCT was evaluated using the Barkley Child Attention Scale (BCAS). Clinical interviews were supplemented with standardized questionnaires to assess symptoms of depression, anxiety, and ADHD.

BCAS scores were significantly higher in both the morbidly obese and obese groups than in the control group (p < .001). BCAS cutoff point showed that the prevalence of SCT was significantly higher in both the obese and morbidly obese groups compared to the control group (p < .001). Moreover, a logistic regression analysis identified screen time (OR = 1.330), maternal education (OR = 0.164), and BCAS scores (OR = 1.122) as independent risk factors for obesity.

The current study found a significant relationship between SCT and obesity in children and adolescents. Given that obesity is a public health issue, our findings underscore the importance of evaluating SCT in morbidly obese and obese children. This understanding can lead to more comprehensive and effective treatment strategies for these children.

Obesity poses a significant public health issue among children and adolescents. Research has linked various psychiatric disorders (e.g., ADHD) to obesity, yet the connection between sluggish cognitive tempo and obesity remains underexplored. This study indicates that the sluggish cognitive tempo, higher screen time, and lower maternal education (high school or less) contribute to the risk of obesity.

Motivation plays an important role in the field of medicine, as it significantly influences behavior change, such as becoming more physically active. This study aimed to investigate the role of motivation in engagement in a physical activity and its impact on quality of life for adolescents suffering from obesity. We assessed the time dedicated to physical activities, the type of motivation, and the relationship between those factors and their quality of life. Seventy-two adolescents aged 12–18 years (51% girls) participated in the study. Fifteen percent of the sample (11/72) were overweight, 56% (n = 40) were affected by obesity and 29% (n = 21) by severe obesity. We found that adolescents were mostly driven to engage in physical activity by self-determined motivation, but those affected by severe obesity were more motivated by external factors. Moreover, there was a disparity in physical activity engagement between genders, with boys being more active than girls. Finally, our data demonstrated that physical exercise contributed to improving quality of life of our population. This study demonstrates that self-determined motivation plays a significant role in promoting physical activity among adolescents with overweight or obesity, with notable differences between genders. Encouraging intrinsic motivation can improve physical functioning and quality of life.

Motivation is a key factor in encouraging healthy behaviors, like being physically active. This study looked at how motivation influences physical activity and quality of life in adolescents with overweight or obesity. Researchers wanted to understand how much time these adolescents spend being active, what motivates them, and how this affects their well-being. The study included 72 adolescents with overweight or obesity aged 12 to 18. The study found that most adolescents were motivated to exercise by internal reasons (like personal goals or enjoyment). However, those with severe obesity were more influenced by external factors (like pressure from others). Boys were generally more physically active than girls. The study highlights the importance of encouraging self-motivation in adolescents with obesity. Helping them find personal reasons to stay active—rather than relying on external pressure—can lead to better physical health and an improved quality of life. Programs that support self-motivation, especially for girls and those with severe obesity, may be particularly beneficial.

Our objective was to explore clinicians’ views on the MyHEARTSMAP screening report; whether this report has impacted their patient care, and if so, how. MyHEARTSMAP is a psychosocial self-screening tool for youth to identify mental health concerns.

We conducted a cross-sectional study as a sub-study of the MyHEARTSMAP In-Patient randomized control trial. Eligible clinicians (nurses and physicians who have cared for patients in one of our partnered specialties and have seen a MyHEARTSMAP report in their patients’ charts) provided their perceptions of the screening report through a survey.

Sixty-five clinicians were enrolled; 60 (92.3%; 95% CI 85.8–98.8%) believe psychosocial screening is beneficial, with many finding it helpful for building rapport with patients/families and providing additional mental health information. Thirty-seven clinicians (56.9%; 95% CI 44.9–69%) had previously read or used the MyHEARTSMAP report, and 31 (83.8%; 95% CI 71.9–95.7%) of these clinicians found the report helpful. Clinicians specifically found the report helpful for communicating with the patient, and guiding patient-centered care.

Clinicians’ perceptions towards the MyHEARTSMAP report were positive amongst those who had previously encountered it. While clinicians believe psychosocial screening is beneficial, exploring options for better accessibility to the screening results is necessary to increase utilization.

Understanding Clinicians’ Views on Mental Health Screening, Hospital Care, and Discharge Planning: In this study, we asked clinicians about their thoughts on the MyHEARTSMAP screening report and how it affects their patient care. MyHEARTSMAP is a tool that helps identify mental health issues in youth who are hospitalized. Once the youth completes the tool, the results are printed and placed in the patients’ physical chart so that their care team can assess it. We found that most clinicians believe overall screening for mental health concerns (not specific to MyHEARTSMAP) is useful for building relationships with patients and families, and it provides them with new information about their patients' mental health. When clinicians used the MyHEARTSMAP report, they found it specifically helpful for communicating with patients/families and helpful for allowing the patient to have a platform to provide their own input into their care plans. Overall, clinicians had positive views about the MyHEARTSMAP screening report, but we need to make it easier for them to access the results of the screenings.

Adolescents with mental illnesses often struggle with adhering to prescribed medication regimens. This study investigates how patient perceptions influence medication adherence among adolescents with psychiatric disorders. It also examines the role of patient characteristics and medication-related factors on adherence and attitudes. The Pediatric Medication Adherence Scale (PMAS)- 9 questions and the Pediatric Attitude toward Medication Scale (PAMS)- 18 questions, two reliable self-report scales designed for the adolescent population, were used to assess negative adherence behaviors and patients’ perceptions of medication. Statistical analysis examined correlations between adherence, attitudes, and patient characteristics. The scales were administered to 288 adolescents with psychiatric disorders, and a significant correlation was found between concern scores and attitudes toward medication (r = 0.886, p < .05). Patients receiving monotherapy demonstrated lower concern scores and more positive attitudes (p < .05). Experiencing side effects was significantly linked to reduced medication adherence and more negative attitudes toward treatment. Patients with eating disorders demonstrated more negative attitudes, while those using antidepressant-antipsychotic combinations demonstrated more negative attitudes than those using stimulants. This study emphasizes the necessity of addressing critical factors that influence medication adherence and attitudes toward psychiatric medication among adolescents with psychiatric disorders. In particular, it highlights the importance of considering concern perception, managing side effects, and evaluating polypharmacy to optimize pharmacotherapy in this population.

Adolescents with mental health conditions often find it challenging to stick to their prescribed medications. This study explores how teenagers' thoughts and feelings about their medications affect their ability to take them as recommended. It also looks at how their personal characteristics and the type of medications they use influence their attitudes and behavior. To better understand this, researchers used two specialized tools designed for teenagers: one to measure how well they follow their medication routine and another to gauge their attitudes toward medications. A total of 288 teenagers with mental health conditions participated in this study. The results showed that teenagers who had more worries about their medications were less likely to follow their treatment and had more negative feelings about taking them. Those taking only one type of medication had fewer worries and more positive attitudes compared to those on multiple medications. Experiencing side effects made it harder for adolescents to stick to their treatment and made them feel less positive about their medications. Additionally, teens with eating disorders or those using a combination of antidepressants and antipsychotics had more negative attitudes compared to those using stimulants. This study highlights the need to address factors like medication concerns, side effects, and the use of multiple medications to improve how adolescents perceive and use their psychiatric treatments. Focusing on these areas can help make their treatment more effective and easier to follow.