J Child Adolesc Psychopharmacol [JOURNAL]
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200 papers
Sedative Antipsychotic Use by Children and Adolescents in The Netherlands: Dosages, Duration, and Prescribers.
Gangapersad RN, Zhou G, Garcia-Gomez P … +5 more , Bos JHJ, Hak E, Koch BCP, Schuiling-Veninga CCM, Dierckx B
J Child Adolesc Psychopharmacol · 2026 May · PMID 42101110 · Publisher ↗
BACKGROUND: Increasing dispensing of sedative antipsychotics in children and adolescents has been reported in several countries, including the Netherlands, raising concerns about appropriate prescribing and safety. While...
BACKGROUND: Increasing dispensing of sedative antipsychotics in children and adolescents has been reported in several countries, including the Netherlands, raising concerns about appropriate prescribing and safety. While previous studies have described antipsychotic use in Dutch youth, detailed information on dispensing patterns, dosages, treatment duration, and prescribers of sedative antipsychotics remains limited. This study therefore examined the dispensing patterns of quetiapine, olanzapine, and pipamperone and compared them with aripiprazole and risperidone, using data from the IADB.nl database. METHODS: Data from the IADB.nl pharmacy dispensing database (120 Dutch community pharmacies) were analyzed to assess sedative antipsychotic dispensing patterns in children and adolescents, aged between 0 and 19 from 2017 to 2022. Dispensing rates, dosages, durations, sex differences, and prescriber types were analyzed using descriptive statistics, Kaplan-Meier survival analysis, Wilcoxon signed-rank tests, and Kolmogorov-Smirnov tests. RESULTS: Dispensing rates increased for quetiapine (0.33 to 0.63/1000) and olanzapine (0.16 to 0.23/1000) from 2017 to 2022, while pipamperone decreased (0.54 to 0.33/1000). Most quetiapine prescriptions (91.5%) were low-dose (<100 mg). Girls received significantly lower doses (43.37 mg) compared with boys (53.25 mg). Median use duration was shortest for quetiapine (3 months) and longest for pipamperone (10 months). General practitioners (GPs) initiated 26% of sedative antipsychotic prescriptions, with quetiapine being the most frequently prescribed, especially by GPs. Specialist-initiated prescriptions generally had longer durations than those initiated by GPs. CONCLUSION: Rising quetiapine and olanzapine prescriptions, especially low-dose quetiapine despite known adverse effects, raise safety and efficacy concerns. Increased olanzapine use may reflect broader indications; decreased pipamperone suggests shifting preferences. Sex differences in dosage and treatment duration underscore potential clinical or pharmacological differences. These findings call for safer use through individualized prescribing based on clinical indication, patient characteristics, and clear treatment goals, supported by specialist oversight and structured monitoring, alongside stricter guideline adherence and further research on the long-term impacts of sedative antipsychotics in youth.
Cardiac Biomarkers as Potential Indicators of Neuroimaging Brain Changes in Children and Young Adults with Psychiatric Disorders: A Systematic Review.
Sangster-Carrasco L, Azamet I, Bakir CN … +5 more , Delaney K, Gerberi D, Romanowicz M, Athreya AP, Croarkin PE
J Child Adolesc Psychopharmacol · 2026 Aug · PMID 42084301 · Publisher ↗
BACKGROUND: Cardiac biomarkers are recognized as potential indicators for brain function, emotion regulation, and psychiatric risk. While research in adults has suggested associations between cardiac variables of autonom...
BACKGROUND: Cardiac biomarkers are recognized as potential indicators for brain function, emotion regulation, and psychiatric risk. While research in adults has suggested associations between cardiac variables of autonomic function and neural changes, little is known about these relationships in children and young adults with psychiatric conditions. This systematic review aimed to examine the evidence linking cardiac biomarkers with structural, functional, and connectivity-based brain changes in this population. METHODS: A systematic review was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Multiple databases were searched for studies examining associations between any cardiac biomarker and neuroimaging findings in individuals under 21 years old with psychiatric diagnoses. After screening and full-text review, 11 eligible studies were included. RESULTS: The included studies investigating a range of psychiatric conditions and cardiac biomarkers were associated with brain changes across three domains: structure, connectivity, and neural responses. Associations were most consistent between higher vagal tone and structural and functional integrity of emotion-regulating regions such as the prefrontal cortex, amygdala, and insula. However, findings were heterogeneous and potentially moderated by symptom severity or environmental stressors. CONCLUSIONS: This review supports the potential of cardiac biomarkers, particularly high-frequency heart rate variability and root mean square of the successive differences, as proxies of brain changes in youth with psychiatric disorders. While promising, current evidence is too limited and variable for clinical applications. Future research should prioritize large-scale, longitudinal studies using harmonized protocols and wearable technologies to validate these indices as translational tools in child and adolescent psychiatry.
Age-Related Patterns and Longitudinal Trends in Psychotropic Medication Use Among Commercially Insured Children with Autism Spectrum Disorder in the United States: A Claims Database Study.
Chan CM, Stitt KM, Peasah SK … +3 more , Rosenberg EM, Pierri JN, Good CB
J Child Adolesc Psychopharmacol · 2026 Jun · PMID 42084294 · Publisher ↗
OBJECTIVES: This study aimed to describe changes in psychotropic medication use over time in commercially insured children with autism spectrum disorder (ASD) across age groups and characterize the comorbidity burden in...
OBJECTIVES: This study aimed to describe changes in psychotropic medication use over time in commercially insured children with autism spectrum disorder (ASD) across age groups and characterize the comorbidity burden in patients with more complex treatment regimens. METHODS: Using deidentified administrative claims from the Workpartners Research Reference Database, we conducted a retrospective cohort study of employee dependents aged 0-17 years with ASD followed for 3 years. Psychotropic medication use was analyzed across three age groups (0-4, 5-9, and 10-17 years). In a subgroup with high treatment complexity, defined as polypharmacy (≥3 drug classes) and/or antipsychotic use, the prevalence of various co-occurring conditions associated with ASD was also described. RESULTS: Among 2747 children with ASD, psychotropic medication use and polypharmacy were more common in older age groups. At Year 1, 32.8% of children aged 10-17 used ≥2 drug classes concurrently, compared with 0.9% and 15.3% in the 0-4 and 5-9 age groups, respectively. From Year 1 to Year 3, medication use increased in younger children but declined in the 10-17 age group. High treatment complexity was observed in 20.5% of children ( = 562) over the entire 3-year study period, most frequently in the 10-17 age group. A higher prevalence of comorbidities, including attention-deficit hyperactivity disorder, mental health conditions, conduct disorders, and irritability and agitation, was observed in those with high treatment complexity compared with those without. CONCLUSIONS: Pharmacologic treatment patterns varied by age in children with ASD, and higher treatment complexity was associated with more frequent diagnoses of co-occurring psychiatric and behavioral conditions. Further understanding of longitudinal treatment trajectories should be explored in future research, such as by contextualizing treatment changes with symptom assessment and evaluating the social impact of treatment complexity.
Does Short-Term Memory Moderate the Relation Between Attention-Deficit/Hyperactivity Disorder Symptom Dimensions and Anger Regulation in Children with Attention-Deficit/Hyperactivity Disorder?
Tamm L, Quiroz M, Peugh JL … +2 more , Epstein JN, Becker SP
J Child Adolesc Psychopharmacol · 2026 Apr · PMID 42026757 · Publisher ↗
BACKGROUND: Emotion regulation (ER) difficulties affect many children with attention-deficit/hyperactivity disorder (ADHD). ADHD is also associated with working memory (WM) and related short-term memory (STM) impairments...
BACKGROUND: Emotion regulation (ER) difficulties affect many children with attention-deficit/hyperactivity disorder (ADHD). ADHD is also associated with working memory (WM) and related short-term memory (STM) impairments, including functionally and anatomically distinct phonological (PH) and visuospatial (VS) subsystem deficits. Neurocognitive deficits in PH and VS may moderate the link between ADHD symptoms and anger dysregulation, which the current study tested in children diagnosed with ADHD. METHOD: Participants were 168 children aged 8-12 years with ADHD. Caregivers and teachers completed ADHD inattentive (IN) and hyperactivity-impulsivity (HI) symptom ratings. Children reported on their responses to anger including suppression, dysregulation, and coping and completed PH and VS WM tasks from which STM variables were derived. Multivariate linear models evaluated whether PH and VS factors and their interactions with IN and HI were associated with anger regulation, controlling for sex and medication status. RESULTS: Main effects were observed for caregiver-rated HI on anger dysregulation and coping; for VS on anger suppression, dysregulation, and coping; and PH on anger dysregulation. Significant caregiver-rated HI × VS interactions for anger dysregulation and coping emerged, as well as a significant caregiver-rated IN × PH interaction for anger dysregulation. Higher HI symptoms were associated with more anger dysregulation and lower anger coping only at high (stronger) levels of VS performance. Higher IN symptoms were associated with lower anger dysregulation only at very low (poorer) levels of PH performance. No significant findings emerged for teacher-rated ADHD symptoms. DISCUSSION: The findings add to the literature suggesting that ADHD symptoms, particularly HI, play a role in anger regulation, and that the association may be partially modulated by STM. Future studies of ER in ADHD should consider specific anger management strategies, in addition to disaggregating VS and PH, given that both interacted with the association of caregiver-rated ADHD and anger regulation. Implications for intervention are discussed.
Application of Gut Microbiota in the Treatment and Efficacy Evaluation of Tic Disorders: A Systematic Review.
Cao B, Zhou X, Cao X … +3 more , Shi J, Liu C, Yuan B
J Child Adolesc Psychopharmacol · 2026 Jun · PMID 42026738 · Publisher ↗
OBJECTIVE: To systematically review existing evidence on the role of gut microbiota in the pathogenesis of tic disorders (TD) and to assess the therapeutic potential of microbiome-targeted interventions such as probiotic...
OBJECTIVE: To systematically review existing evidence on the role of gut microbiota in the pathogenesis of tic disorders (TD) and to assess the therapeutic potential of microbiome-targeted interventions such as probiotics and fecal microbiota transplantation in the management of TD. METHODS: A comprehensive search was conducted in PubMed, Web of Science, EMBASE, and The Cochrane Library (up to May 26, 2025). The review followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 guidelines and was registered in PROSPERO (CRD420251067880). RESULTS: Eleven studies were included, with four focusing on gut microbiome-based therapies and seven studies with gut microbiota and its metabolites as outcome indicators. At the genus level, children with TD exhibited specific alterations in gut microbiota: increased abundance of Bacteroides, Faecalibacterium, and Ruminococcus, alongside decreased levels of Bifidobacterium and Prevotella. This functional dysbiosis may trigger neuroinflammation via disrupted short-chain fatty acid metabolism and impaired intestinal barrier function, ultimately disturbing the glutamate and γ-aminobutyric acid neurotransmitter balance and leading to dysfunction in the cortico-striato-thalamo-cortical circuit. Meanwhile, probiotics as an intervention have been consistently reported to alleviate tic symptoms, although clinical evidence remains limited. CONCLUSION: Gut microbiota may contribute to TD pathogenesis via immune modulation and neurotransmitter metabolism. While microbiota-based strategies show promise, heterogeneity and methodological limitations in current studies necessitate further high-quality research to validate mechanisms and support clinical application.
Methylphenidate and Psychotic Symptoms in Children and Adolescents: A Disproportionality Analysis on the WHO Safety Database (VigiBase).
Chrétien B, Blouet C, Alexandre J … +4 more , Jardri R, Nishida K, Desaunay P, Guénolé F
J Child Adolesc Psychopharmacol · 2026 Apr · PMID 42015492 · Publisher ↗
BACKGROUND: Methylphenidate (MPH) is widely used to treat attention-deficit/hyperactivity disorder (ADHD) in children and adolescents. However, concerns persist about its potential to induce psychotic symptoms, including...
BACKGROUND: Methylphenidate (MPH) is widely used to treat attention-deficit/hyperactivity disorder (ADHD) in children and adolescents. However, concerns persist about its potential to induce psychotic symptoms, including hallucinations. OBJECTIVE: This study aimed to evaluate the association between MPH exposure and psychotic symptoms in children and adolescents using VigiBase®, the World Health Organization global pharmacovigilance database. METHODS: We conducted a retrospective, observational study using disproportionality analysis on reports from children and adolescents (5-17 years) exposed to MPH and other ADHD drugs (amitriptyline, atomoxetine, clomipramine, clonidine, desipramine, guanfacine, and nortriptyline). Multivariate logistic regression was used to calculate adjusted reporting odds ratios (aRORs) of psychotic symptoms in MPH-exposed children and adolescents. RESULTS: Among 1,992 cases of psychotic symptoms, 1,232 were MPH-associated, with 51.7% classified as serious; significant disproportionalities were observed for the overall age range (aROR = 1.27; 95% confidence intervals [CI]: 1.15-1.40) and the 5-11 (children) age group (aROR = 1.35; 95%CI: 1.19-1.53). Of 1,250 hallucination cases, 809 were MPH-associated, with 59.2% serious; significant disproportionalities were found for the entire age range (aROR = 1.35; 95% CI: 1.19-1.52) and the children age group (aROR = 1.43; 95% CI: 1.23-1.67). The most common type of hallucination was visual (43.2%). MPH discontinuation or dose reduction led to a significantly higher rate of symptom abatement (88.6% of cases) compared to those without these measures (12.0%) ( < .001). CONCLUSIONS: These results suggest that MPH exposure in children is associated with an increased probability of serious psychotic symptoms, including hallucinations, which typically resolve with discontinuation or dose reduction. Further research is needed to better understand the MPH-induced psychotic symptoms.
Pilot Trial of Adjunctive Curcumin for Treatment-Resistant Bipolar Depression in Youth: Focus on Inflammation and Oxidative Stress.
Osei-Bonsu GA, Dimick MK, Kennedy KG … +5 more , Barton JS, Sultan AA, Young LT, Andreazza AC, Goldstein BI
J Child Adolesc Psychopharmacol · 2026 Apr · PMID 42015491 · Publisher ↗
INTRODUCTION: While youth with bipolar disorder (BD) spend the majority of the time experiencing symptoms of depression, there are fewer evidence-based options for the pharmacological treatment of bipolar depression vers...
INTRODUCTION: While youth with bipolar disorder (BD) spend the majority of the time experiencing symptoms of depression, there are fewer evidence-based options for the pharmacological treatment of bipolar depression versus mania. Given evidence of increased inflammation and oxidative stress in BD, engaging these treatment targets may address underlying pathophysiological mechanisms. We conducted a pilot trial of curcumin, a widely available, safe nutraceutical with anti-inflammatory and antioxidative properties, for the treatment of bipolar depression in youth. METHODS: Six participants with bipolar depression were enrolled and received 8 weeks of open-label curcumin. The starting dose was 500 mg daily, then increased to 500 mg twice daily at week 2, then increased to 1000 mg twice daily at weeks 3-8. Symptoms were evaluated with the Children's Depression Rating Scale-Revised (CDRS-R), Kiddie Schedule for Affective Disorders and Schizophrenia Depression Rating Scale (DRS), and Clinical Global Impression Scale. Treatment response was defined as greater than or equal to 50% reduction in CDRS-R score. Blood biomarkers of inflammation (interferon-gamma, interleukin-10 [IL-10], IL-8, tumor necrosis factor alpha) and oxidative stress (8-iso-prostaglandin F2alpha [8-ISO], lipid peroxidation [LPO]) were evaluated at baseline, 4 weeks, and 8 weeks. Analyses examined changes in depressive symptoms in relation to changes in biomarkers over time. RESULTS: There were significant reductions in clinical global impression of depression severity [χ(4) = 10.97, = 0.03, = 0.46] and overall illness severity [χ(4) = 10.25, = 0.04, = 0.43] from baseline to 8 weeks. The most common side effects were related to the central nervous system and gastrointestinal system. From baseline to 4 weeks, greater reduction in CDRS-R scores was associated with greater reduction in 8-ISO ( = 0.89, = 0.02), and a greater reduction in DRS scores was associated with a greater reduction in LPO ( = 0.82, = 0.05). CONCLUSIONS: This trial provides preliminary evidence that the antidepressant effects of curcumin may be associated with its antioxidative properties. However, larger controlled trials are needed to evaluate the efficacy of curcumin for bipolar depression, and to examine oxidative stress markers as predictors and/or mediators of antidepressant effects.
Efficacy of Centanafadine for Executive Functioning and Learning Problems in Children and Adolescents with Attention-Deficit/Hyperactivity Disorder.
Wilens TE, Oberdhan D, Jin N … +4 more , Skubiak T, Childress AC, van Stralen J, Ward CL
J Child Adolesc Psychopharmacol · 2026 Jun · PMID 41958186 · Publisher ↗
OBJECTIVE: The objective of these analyses was to evaluate the efficacy of centanafadine for treatment of attention-deficit/hyperactivity disorder (ADHD) associated features of executive functioning and learning problems...
OBJECTIVE: The objective of these analyses was to evaluate the efficacy of centanafadine for treatment of attention-deficit/hyperactivity disorder (ADHD) associated features of executive functioning and learning problems measured over 6 weeks in children and adolescents with ADHD. METHODS: Two phase 3, randomized, double-blind, placebo-controlled trials were conducted in children and adolescents with a primary diagnosis of ADHD at sites in the United States and Canada. Data presented here are from the total population of children aged 6-12 years (NCT05428033) or adolescents aged 13-17 years (NCT05257265) who received high-dose centanafadine or placebo for 6 weeks. Secondary and other efficacy endpoints assessed change from baseline in the Conners 3-Parent Short Executive Functioning and Learning Problems Content Scale T-scores and the Conners 3-Self-report Short Learning Problems Content Scale T-scores, all analyzed using a mixed-effect model for repeated measures. Clinically meaningful within-patient change and findings from a caregiver and/or adolescent self-report exit survey are also presented. RESULTS: Overall, 76.5% (367/480) of children (mean age 9.2 years, 41.7% female) and 80.8% (371/459) of adolescents (mean age 14.7 years, 40.7% female) completed their respective studies. There were clinically significant improvements with centanafadine treatment observed as early as Week 1 in the Conners 3-Parent Short Executive Functioning (T-score least squares mean change from baseline [standard error] to Week 6: children, -6.8 [1.1] vs. -11.3 [1.1], = 0.0026 and adolescents, -8.1 [1.0] vs. -13.0 [1.0], 0.0003) and Learning Problems content scale T-scores when compared to placebo (children, -8.2 [1.0] vs. -2.8 [0.9], < 0.0001 and adolescents, -8.0 [0.9] vs. -3.1 [0.9], < 0.0001). Similar changes from baseline were observed by adolescent self-report (-6.1 [0.9] vs. -2.5 [0.9], 0.0023). Compared to placebo, there was a 50% and 88% greater chance of experiencing clinically meaningful within-patient change in executive functioning for children and adolescents, respectively, and a 79% and 81% chance for experiencing clinically meaningful within-patient change in learning problems, respectively. Exit survey data support findings from clinical outcome measures. CONCLUSIONS: In addition to its impact on the core symptoms of ADHD, centanafadine improved executive functioning, learning problems, and impact on daily tasks in children and adolescents with ADHD.
A Neurodevelopmental Model of Social Threat Sensitivity as a Mechanism Linking Fearful Temperament, Social Anxiety, and Depression in Youth.
Politte-Corn M, Burkhouse KL, Buss KA
J Child Adolesc Psychopharmacol · 2026 Apr · PMID 41958150 · Full text
Sensitivity to social threat is one form of emotion dysregulation implicated in internalizing psychopathologies, yet its developmental origins and mechanistic role remain insufficiently specified. One of the most reliabl...
Sensitivity to social threat is one form of emotion dysregulation implicated in internalizing psychopathologies, yet its developmental origins and mechanistic role remain insufficiently specified. One of the most reliable, early-emerging predictors of internalizing disorders is extreme fearful temperament, which is characterized by heightened sensitivity to novelty and threat, especially if social in nature. Links between early fearful temperament, social reticence with unfamiliar peers in childhood, and the later emergence of social anxiety disorder are well-established, as is the link between social anxiety and subsequent depression. This narrative review integrates research on altered processing of social threat across units of analysis (behavior, electroencephalography/event-related potential, functional magnetic resonance imaging, self-report) in youth with fearful temperament, anxiety, and depression, as well as the role of social threat sensitivity in shaping these prospective associations. We propose a conceptual model in which hypervigilance to social threat beginning in early childhood promotes social avoidance, which, in turn, heightens sensitivity to signals of negative social feedback from peers. These vulnerabilities may be compounded by normative increases in sensitivity to social threat across adolescence, leading to higher rejection sensitivity, a lower sense of connectedness with peers, and increased risk for the onset of internalizing disorders. We conclude with recommendations for future research, including the need to delineate how these neurobehavioral vulnerabilities unfold in real-world social contexts, improve precision in predicting subtypes of internalizing symptoms, and identify risk and protective factors that alter this trajectory.
Access to Care in Pediatric Acute-Onset Neuropsychiatric Syndrome: A Survey of Families' Journeys to and Experiences with Intravenous Immunoglobulin Treatment.
Calaprice D, Moon C, Helvick M … +7 more , Harvey C, Tang A, Aguirre K, Tererri R, Hunt J, Whitty C, Fitzgerald M
J Child Adolesc Psychopharmacol · 2026 May · PMID 41954156 · Publisher ↗
BACKGROUND: Pediatric acute-onset neuropsychiatric syndrome (PANS) is characterized by abrupt-onset neuropsychiatric symptoms, often infection-triggered. Intravenous immunoglobulin (IVIG) is recommended by expert guideli...
BACKGROUND: Pediatric acute-onset neuropsychiatric syndrome (PANS) is characterized by abrupt-onset neuropsychiatric symptoms, often infection-triggered. Intravenous immunoglobulin (IVIG) is recommended by expert guidelines in select cases, yet insurance denials and high out-of-pocket costs have been barriers to access. METHODS: We surveyed 60 caregivers and adult PANS patients who pursued IVIG therapy, collecting data on insurance coverage, treatment protocols, financial strategies, and quality of life (QoL) before and after treatment. RESULTS: Most patients (88%) eventually received IVIG, 10% were still in pursuit, and 2% discontinued trying. Insurance approval without appeal occurred for 24%, often for patients with comorbidities for which IVIG is typically covered. Only 5% of those receiving IVIG for PANS alone were treated within a month of the doctor's order compared with 38% of those receiving IVIG for comorbidities plus PANS; 14% waited ≥9 months. Financial strain was routine: at least one-third of families without "substantial" insurance coverage (≥70% of expenses) reported extreme stress (10 on scale of 1 to 10), 58% borrowed money, and 21% sold major assets. Even families with substantial insurance coverage commonly depleted savings or took on additional work. Before IVIG, patient QoL ratings were poor (means 2.1-2.9 across domains), with over one-third selecting the lowest possible overall QoL rating. During the 6 months following IVIG initiation, mean ratings rose to 6.2-6.8, with over 60% reporting "good" to "exceedingly good" overall outcomes. Caregivers reported parallel gains, with family QoL ratings rising from 2.4-4.0 pretreatment to 5.7-6.6 posttreatment. CONCLUSIONS: Families pursuing IVIG for PANS reported prolonged delays, repeated denials, and financial strain, often resorting to loans, asset sales, and additional work. Despite these burdens, IVIG was correlated with marked improvements in perceived QoL for patients and caregivers.
Home Initiation of Buprenorphine in Adolescents with Opioid Use Disorder: A Preliminary Feasibility Study.
Kaliamurthy S, Straton E, Kumar P
J Child Adolesc Psychopharmacol · 2026 May · PMID 41944073 · Publisher ↗
BACKGROUND AND OBJECTIVES: The prevalence of opioid use disorder (OUD) among adolescents has increased, yet few adolescents receive medication for OUD (MOUD), particularly buprenorphine. However, initiation can be challe...
BACKGROUND AND OBJECTIVES: The prevalence of opioid use disorder (OUD) among adolescents has increased, yet few adolescents receive medication for OUD (MOUD), particularly buprenorphine. However, initiation can be challenging, as the medication, a high-affinity partial agonist at the mu opioid receptor, can precipitate withdrawal if administered inappropriately. Many adolescents lack access to appropriate levels of supervised care, making it increasingly important for physicians to feel equipped to initiate buprenorphine at home. This is a preliminary feasibility case series for a protocol used in a pediatric addiction clinic for home initiation of buprenorphine in patients 18 and younger. The primary objective is to outline the protocol used, and the secondary objective is to examine the rate of successful initiation. METHODS: Patients aged 18 years old and younger, who entered treatment for OUD in a child and adolescent outpatient psychiatry clinic between 2022 and 2024 and who chose home buprenorphine initiation were consecutively included. Data from the intake appointment and planned follow-ups at the 1 and 3 month mark were collected. The data collected included characteristics of adolescents who entered treatment and the proportion who successfully initiated buprenorphine. Successful initiation was defined as those who self-reported initiation of buprenorphine at the first follow-up appointment. RESULTS: Out of 19 patients (mean age = 15.7), we found that 10 (53%) adolescents initiated buprenorphine at the first follow-up appointment, 3 (16%) were successful at subsequent follow-up appointments, and 6 (32%) adolescents dropped out of treatment. We also identified several individual and systemic barriers to successful initiation including insurance status, transportation and housing status, and relapse on fentanyl. CONCLUSIONS: This early descriptive study finds that a standard protocol for buprenorphine initiation in adolescents implemented by a trained health care professional in an outpatient setting is preliminarily feasible.
Efficacy and Safety of Extended-Release Clonidine Hydrochloride for Attention Deficit Hyperactivity Disorder in Chinese Children and Adolescents: A Multicenter, Randomized, Double-Blind, Placebo-Controlled Trial.
Qian Y, Ke X, Gao F … +6 more , Chen W, Wu W, Li Y, Du L, Li H, Du Y
J Child Adolesc Psychopharmacol · 2026 Jun · PMID 41944053 · Publisher ↗
INTRODUCTION: Attention-deficit/hyperactivity disorder (ADHD) is a prevalent neurodevelopmental condition in children and adolescents, yet randomized controlled trial evidence supporting pharmacological treatment in Chin...
INTRODUCTION: Attention-deficit/hyperactivity disorder (ADHD) is a prevalent neurodevelopmental condition in children and adolescents, yet randomized controlled trial evidence supporting pharmacological treatment in Chinese populations remains limited. This study evaluated the efficacy and safety of clonidine hydrochloride extended-release tablets (CLON-XR) as monotherapies for ADHD among Chinese children and adolescents. MATERIALS AND METHODS: In this 6-week, multicenter, randomized, double-blind, placebo-controlled phase 3 trial, 75 patients aged 6-17 years with ADHD were assigned (2:1) to receive once-daily CLON-XR (target dosage 0.2 mg/day) or placebo. The primary endpoint was the change from baseline to week 5 in the Swanson, Nolan, and Pelham Version-IV (SNAP-IV) total score. Secondary endpoints included SNAP-IV subscales, Clinical Global Impression-Severity (CGI-S) and Improvement (CGI-I) scores, and safety assessments. RESULTS: Compared with placebo, CLON-XR significantly improved the primary endpoint (least squares mean change in the SNAP-IV total score: -17.5 vs. -10.3; = 0.0039). Significant improvements were also observed in the SNAP-IV inattention and hyperactivity/impulsivity subscales, CGI-S, and CGI-I (all < 0.05). The incidence of treatment-emergent adverse events (TEAEs) in the CLON-XR group was comparable with that in the placebo group; the TEAEs were mild, and the dropout rate was low (5.3%). No serious adverse events or clinically significant vital sign abnormalities were reported. CONCLUSIONS: CLON-XR was efficacious and well tolerated in Chinese children and adolescents with ADHD, supporting its potential as a nonstimulant treatment option in this population. These findings provide evidence for ADHD management in China and suggest that further investigations in longer-term and real-world settings are needed.
Long-Acting Injectable Antipsychotics and Time to Readmission in Early Psychosis.
Wang C, Lynch S, Noureddine C … +8 more , Burlant N, Ahuja N, Haruguchi K, Hong S, Zisu M, Cohen L, Rice T, Sterchele A
J Child Adolesc Psychopharmacol · 2026 Jun · PMID 41944042 · Full text
BACKGROUND: Long-acting injectable (LAI) antipsychotics have demonstrated benefits in reducing relapse and hospitalization in psychotic disorders, yet their real-world impact in early-phase psychosis remains incompletely...
BACKGROUND: Long-acting injectable (LAI) antipsychotics have demonstrated benefits in reducing relapse and hospitalization in psychotic disorders, yet their real-world impact in early-phase psychosis remains incompletely understood. This study examined baseline characteristics, hospitalization features, and postdischarge outcomes among young patients with early psychosis treated with LAI versus oral (PO) antipsychotics. METHODS: This retrospective chart review included 229 patients under age 25 hospitalized for psychosis at a multicenter health system between 2018 and 2022. Patients receiving LAI ( = 144) were compared with those receiving PO antipsychotics ( = 85) on sociodemographic, clinical, and admission variables. The primary outcome was psychiatric readmission within 1 year of discharge. Secondary outcomes included time to readmission, which was analyzed using Kaplan-Meier survival analysis. Multivariable logistic regression evaluated whether LAI treatment independently predicted readmission after adjusting for length of stay, prior hospitalizations, and undomiciled status. RESULTS: The LAI group was older and exhibited greater clinical and social risk, including more prior hospitalizations, higher rates of undomiciled status, and more suicide attempts. They also had longer inpatient stays and greater medication complexity during hospitalization. One-year readmission rates were similar between groups (30.6% LAI vs. 24.7% PO). Among readmitted patients, the LAI group showed longer time to readmission. In adjusted analyses, LAI treatment was not independently associated with readmission. Undomiciled status was independently associated with readmission, paradoxically in the direction of lower odds. CONCLUSIONS: For young patients with early psychosis, LAIs were preferentially prescribed to higher-risk patients but were not independently associated with reduced 1-year readmission. Comparable outcomes between groups despite greater baseline risk in the LAI cohort suggest that LAIs may partially mitigate elevated risk, though this interpretation requires prospective confirmation. Housing instability emerged as a critical determinant of readmission patterns, underscoring the need for integrated pharmacologic and social interventions in this population.
Knowledge, Skills, Attitudes, and Perceived Barriers Related to Clozapine Use Among Child and Adolescent Psychiatry Professionals: A Cross-Sectional Survey.
Tuncturk M, Mert Kilic D, Yesilkaya C … +5 more , Akcay E, Senses Dinc G, Buyuktaskin D, Ermis C, Cop E
J Child Adolesc Psychopharmacol · 2026 Mar · PMID 41937407 · Publisher ↗
OBJECTIVES/BACKGROUND: Clozapine is the treatment of choice for treatment-resistant schizophrenia (TRS), yet it remains underutilized in child and adolescent psychiatry. This study aimed to assess knowledge, clinical ski...
OBJECTIVES/BACKGROUND: Clozapine is the treatment of choice for treatment-resistant schizophrenia (TRS), yet it remains underutilized in child and adolescent psychiatry. This study aimed to assess knowledge, clinical skills, attitudes, and perceived barriers related to clozapine use among child and adolescent psychiatry professionals in Türkiye. METHODS: A cross-sectional online survey was distributed to child and adolescent psychiatry residents, specialists, and academics across Türkiye via professional email lists and messaging groups. The questionnaire assessed sociodemographic characteristics, clozapine prescribing experience, perceived barriers, self-rated competence, training exposure, and attitudes toward clozapine. Group comparisons were performed using chi-square tests. RESULTS: A total of 517 professionals participated (180 residents, 212 specialists, and 125 academics). Only 30.0% had prescribed clozapine in the past 12 months, and 28.6% had received specific clozapine training. Barriers were common across all groups, with concerns about medication adherence (43.2%-58.0%), blood test compliance (56.8%-65.6%), and side effects being most frequently endorsed. A clear experience-related gradient emerged: residents reported significantly more barriers, lower self-rated competence, and greater reluctance to prescribe than specialists and academics. Clinicians without inpatient access reported more barriers and lower confidence and were less likely to have gained meaningful clozapine experience during residency (35.2% vs. 66.0%, < 0.001) or to have observed clozapine's superiority firsthand (57.7% vs. 79.7%, < 0.001). Despite these barriers, 92.3% of respondents acknowledged clozapine's superior efficacy compared with other antipsychotics. CONCLUSIONS: This nationwide survey, the largest to examine clozapine-related attitudes among child and adolescent psychiatry professionals globally, reveals substantial gaps in training, confidence, and service infrastructure in Türkiye. While efficacy is widely recognized, safety concerns and monitoring-related barriers, particularly among less experienced clinicians and those without inpatient access, limit appropriate prescribing. Findings underscore the unmet need for structured residency training programs, national clinical guidelines, and expanded service infrastructure to ensure equitable access to clozapine for youth with TRS.
Response to the Letter to the Editor by Dr. Adler and Her Colleagues.
Saito E, Nikolov R, Edwards S … +1 more , Taylor R
J Child Adolesc Psychopharmacol · 2026 Mar · PMID 41937406 · Publisher ↗
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Risperidone Treatment in Children and Adolescents: A Naturalistic Observational Study of Metabolic, Cardiac, and Clinical Outcomes.
Sari M, Göl Özcan G, İmrek Y … +4 more , Balta Kesikbaş B, Taşkan M, Öztürk Y, Tufan AE
J Child Adolesc Psychopharmacol · 2026 Mar · PMID 41937405 · Publisher ↗
BACKGROUND: Risperidone is an atypical antipsychotic commonly used in pediatric psychiatry that may be associated with metabolic and endocrine adverse effects. Prospective data on drug-naive children and adolescents are...
BACKGROUND: Risperidone is an atypical antipsychotic commonly used in pediatric psychiatry that may be associated with metabolic and endocrine adverse effects. Prospective data on drug-naive children and adolescents are limited. OBJECTIVE: To prospectively evaluate anthropometric, metabolic, endocrine, cardiovascular, and clinical changes during the first 6 months of risperidone treatment in drug-naive children and adolescents. METHODS: This single-center, prospective observational study included 90 drug-naive patients aged 3-18 years who received risperidone treatment between September 2021 and September 2023. Participants were included if they were aged 3-18 years, planned to start risperidone, accepted treatment, and provided informed consent from parents with verbal or written assent from children. Exclusion criteria included chronic medical or neurological diseases requiring treatment, overweight or obesity, prior child psychiatry referrals, use of psychotropic medications, receipt of chronic medical treatment, and having illiterate parents. Assessments at baseline and visits at three and 6 months included height, weight, body mass index (BMI) percentile, waist circumference, fasting glucose, lipid profile, serum prolactin, blood pressure, pulse, and Clinical Global Impression-Severity (CGI-S) scores. Nonparametric tests were used to compare repeated measures, and correlations between risperidone dose and metabolic/endocrine variables were analyzed. RESULTS: The median age was 10.0 years, and 70% of the participants were male. The participant flow throughout the study is presented in Figures 1 and 2. The mean risperidone dose was 1.62 ± 1.00 mg/day at 3 months and 1.99 ± 1.12 mg/day at 6 months. Significant increases were observed in height, weight, BMI percentile ( = 0.000, = 0.000, = 0.044, respectively), and waist circumference ( = 0.014). Serum prolactin levels increased ( = 0.006), and high-density lipoprotein (HDL) cholesterol levels decreased ( = 0.018), whereas other metabolic and cardiovascular parameters showed no significant change. CGI-S scores improved ( < 0.001). A strong positive correlation between risperidone dose and waist circumference was observed at 3 months (r = 0.715, = 0.000) and 6 months (r = 0.803, = 0.000). Forty-eight participants did not attend the 3-month evaluation, and 17 did not attend the 6-month evaluation, which was addressed with sensitivity analyses. CONCLUSIONS: Within 6 months of initiation, risperidone use in drug-naive pediatric patients was associated with increased weight and abdominal adiposity, early prolactin elevation, HDL reduction, and clinical improvement. Waist circumference showed a strong dose-dependent association and should be routinely monitored along with metabolic and endocrine parameters.
Catatonia Treatment in Down Syndrome Regressive Disorder with Repeated Vineland Assessment: A Case Report.
Harris NM, Marler S, Grochowsky A … +2 more , Graham TB, Smith JR
J Child Adolesc Psychopharmacol · 2026 May · PMID 41930451 · Full text
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d-Amphetamine Transdermal System in Treatment of Children and Adolescents With ADHD: SKAMP Subscale Analysis and Subgroup Analysis from a Pivotal Trial.
Cutler AJ, Komaroff M, Castelli M … +2 more , Meeves S, Khan M
J Child Adolesc Psychopharmacol · 2026 May · PMID 41928428 · Publisher ↗
OBJECTIVES: d-Amphetamine transdermal system (d-ATS) is FDA-approved for treating attention-deficit/hyperactivity disorder (ADHD) in adults and pediatric patients ≥6 years. In a pivotal study, d-ATS met its primary (SKAM...
OBJECTIVES: d-Amphetamine transdermal system (d-ATS) is FDA-approved for treating attention-deficit/hyperactivity disorder (ADHD) in adults and pediatric patients ≥6 years. In a pivotal study, d-ATS met its primary (SKAMP total score) and secondary endpoints. This analysis further evaluated d-ATS efficacy using SKAMP subscale scores and total score by subgroup. METHODS: The pivotal study comprised a 5-week, open-label dose-optimization period (DOP) followed by a 2-week, randomized, cross-over double-blind treatment period (DBP). All eligible patients received d-ATS 5 mg/9 h, with weekly evaluation for dose increase and the optimal dose maintained during the DBP. Preplanned subgroup analyses of mean SKAMP total score in the DBP by optimized dose, sex, age group, ADHD type, and baseline ADHD severity were conducted. Efficacy was assessed by difference (d-ATS vs. placebo) in least-squares (LS) mean SKAMP total and subscale scores (Attention, Deportment, and Quality of Work) from a mixed-model repeated-measures (MMRM) analysis and is reported throughout as LS mean (95% confidence interval [CI]). Model-based effect sizes were calculated . RESULTS: In total, 110 patients were enrolled in the DOP; 106 were randomized in the DBP. The LS mean difference in SKAMP total score of d-ATS versus placebo was -5.9 (-6.8, -5.0), with differences in subscale scores (Attention, Deportment, and Quality of Work) of -1.4 (-1.7, -1.1), -1.9 (-2.2, -1.5), and -1.3 (-1.5, -1.0), respectively. Model-based effect sizes were 0.57, 0.42, 0.43, and 0.47, respectively. Patients receiving d-ATS demonstrated improvements versus placebo in LS mean SKAMP total score at each optimized dose in both male and female patients and children and adolescents and regardless of ADHD subtype or baseline ADHD severity. CONCLUSIONS: Consistent efficacy of d-ATS across subgroups and all SKAMP subscale scores suggests broad utility of d-ATS in all patients, regardless of age, sex, ADHD type, or baseline ADHD severity, and broad applicability of these results to patients with varying clinical presentations of functional impairment by ADHD.
A Retrospective Study of Long-Term Associations of Behavioral Intervention Combined with Medications in Young Children with Attention-Deficit/Hyperactivity Disorder.
Price T, Bommersbach TJ, Saliba M … +6 more , Kelly CK, LeMahieu A, Tarikogullari I, Sharma P, Abulseoud OA, Romanowicz M
J Child Adolesc Psychopharmacol · 2026 Apr · PMID 41902630 · Publisher ↗
OBJECTIVE: This study aimed to examine whether parent-child interaction therapy (PCIT), compared with other therapy modalities, was associated with differences in substance use and psychiatric outcomes in a cohort of chi...
OBJECTIVE: This study aimed to examine whether parent-child interaction therapy (PCIT), compared with other therapy modalities, was associated with differences in substance use and psychiatric outcomes in a cohort of children with attention-deficit/hyperactivity disorder (ADHD). METHODS: This retrospective cohort study was conducted using medical record data from the Rochester Epidemiology Project (REP). The sample included 643 children aged ≤7 years who were diagnosed with ADHD and received either stimulant or nonstimulant medication, along with psychosocial therapy. Participants were categorized into two groups: those who documented exposure to PCIT versus other therapy modalities such as behavioral management, play therapy, cognitive behavioral therapy, parent management training, occupational therapy, speech therapy, parenting class, applied behavior analysis, and social skills training. Conditional logistic regression models were used to examine differences in baseline characteristics and outcomes between the two treatment groups. RESULTS: Individuals in the PCIT group were more likely to have private insurance (66% vs. 57%; = 0.016) and to fall into higher socioeconomic status quartiles ( = 0.024) at baseline. PCIT recipients also had a higher prevalence of emotional and behavioral disturbances at baseline (40% vs. 25%; < 0.001). The median age of the participants at follow-up was 19.6 years, indicating a median follow-up period of approximately 13 years from the initiation of treatment. At follow-up, the PCIT group demonstrated higher rates of problematic alcohol (24% vs. 17%; HR = 1.50, 95% CI: [1.02, 2.20]; = 0.038) and cannabis use (25% vs. 18%; HR = 1.48, 95% CI: [1.03, 2.15]; = 0.037). However, after controlling for covariates in the adjusted model, no statistically significant differences emerged between the groups across any substance use outcome. No significant differences were observed in other psychiatric diagnoses or mental health service utilization. CONCLUSIONS: Findings indicate that individuals who documented exposure to PCIT demonstrated elevated rates of alcohol and cannabis use in young adulthood, but had no other differences in psychiatric outcomes. While this aligns with prior literature reporting increased substance use risk in ADHD populations, our study cannot confirm this association relative to non-ADHD controls because such a comparison was not included.These associations likely reflect underlying differences in clinical severity and clinical comorbidities at baseline, rather than a direct effect of PCIT. Further investigation is warranted to determine the treatment effects based on baseline risk factors.
SSRI-Induced Galactorrhea in Adolescents.
Adıgüzel S, Hamoda HM
J Child Adolesc Psychopharmacol · 2026 May · PMID 41882957 · Publisher ↗
BACKGROUND: Selective serotonin reuptake inhibitors (SSRIs) are generally regarded as safe and widely used in children and adolescents. Although rare, SSRIs can cause neuroendocrine side effects such as hyperprolactinemi...
BACKGROUND: Selective serotonin reuptake inhibitors (SSRIs) are generally regarded as safe and widely used in children and adolescents. Although rare, SSRIs can cause neuroendocrine side effects such as hyperprolactinemia and galactorrhea. Galactorrhea is inappropriate milk secretion outside of pregnancy or breastfeeding and may occur with normal prolactin levels. Although numerous cases have been reported in adults, only a few have been reported in adolescents. METHODS: A PubMed and Embase search was conducted to identify English-language case reports and case series involving patients ≤18 years with SSRI-associated galactorrhea. Seven adolescent female cases were identified, including five case reports and two cases from pharmacovigilance data. RESULTS: SSRIs involved included citalopram, escitalopram, fluoxetine, sertraline, and paroxetine, as well as sequential exposure to other serotonergic antidepressants. Time to onset ranged from days to several weeks after initiation or dose escalation, with longer latency reported in a pharmacovigilance case. Prolactin levels ranged from normal to markedly elevated. In all cases, galactorrhea improved or resolved after dose reduction, discontinuation of the offending agent, or treatment modification, with recurrence observed in some patients following exposure to another serotonergic antidepressant. CONCLUSION: Reports show that SSRI-induced galactorrhea and hyperprolactinemia, though uncommon, can occur in adolescents. Clinicians should be aware that SSRI-related galactorrhea may occur even when prolactin levels are normal or mildly elevated and should actively inquire about this adverse effect. Further research is needed to clarify prevalence, risk factors, and mechanisms involved.
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