J Child Adolesc Psychopharmacol [JOURNAL]
Sun
200 papers
The Effect of Methylphenidate Treatment on Oxidative Stress Levels in Children Diagnosed with Attention-Deficit/Hyperactivity Disorder: An Observational Study.
Altunkılıc EF, Alnak A, Karacetın G … +3 more , Eroglu Iclı H, Kayan Ocakoglu B, Gurel Fıcıcıoglu IE
J Child Adolesc Psychopharmacol · 2026 May · PMID 41873451 · Publisher ↗
BACKGROUND: Oxidative stress (OS) has been implicated in the pathophysiology of attention-deficit/hyperactivity disorder (ADHD), yet findings-particularly regarding treatment-related changes-remain inconsistent. This stu...
BACKGROUND: Oxidative stress (OS) has been implicated in the pathophysiology of attention-deficit/hyperactivity disorder (ADHD), yet findings-particularly regarding treatment-related changes-remain inconsistent. This study evaluated short-term differences in circulating oxidant/antioxidant markers after methylphenidate (MPH) treatment and explored whether baseline biomarkers predict clinically significant symptom improvement. METHODS: In this single-center, prospective observational cohort study, medication-naïve children aged 6-11 years diagnosed with DSM-5-TR ADHD were assessed at enrollment and after 3 months of conventional MPH treatment. Clinical severity was measured using the Conners' Parent Rating Scale-Revised: Short Form (CPRS-R:S) and Conners' Teacher Rating Scale-Revised: Short Form (CTRS-R:S). Serum biomarkers included total oxidant status (TOS), total antioxidant status (TAS), superoxide dismutase (SOD), malondialdehyde (MDA), oxidized LDL (Ox-LDL), and the OS index (OSI = TOS/TAS). Changes were tested with paired analyses; correlations were examined between percent changes in scale scores and biomarkers; and ROC analyses evaluated baseline biomarkers' ability to identify a >50% reduction in CPRS-R:S and CTRS-R:S total scores. RESULTS: Thirty-nine participants completed both assessments (SOD analyses: = 37). Significant reductions were observed in CPRS-R:S and CTRS-R:S total and subscale scores (all < .001). TOS, TAS, SOD, MDA, and Ox-LDL decreased significantly over 3 months, while OSI showed a nonsignificant downward trend ( = 0.066). No significant correlations emerged between percent symptom change and percent biomarker change. In ROC analyses, baseline MDA, Ox-LDL, and TOS significantly discriminated >50% CPRS-R:S improvement (AUC ≈ 0.71-0.74), whereas for >50% CTRS-R:S improvement, several biomarkers demonstrated good discrimination (AUC ≈ 0.82-0.85). CONCLUSIONS: Three months of MPH treatment was associated with robust clinical improvement and parallel reductions in multiple oxidant and antioxidant biomarkers. Baseline OS markers may help identify children most likely to show marked symptom reduction, though findings should be interpreted cautiously, given the sample size.
Developing a Novel Coding System for Retrospective Chart Review of Attention-Deficit/Hyperactivity Disorder, Anxiety, and Medication Adherence in Pediatric Psychiatry.
Andrew LM, Zhang I, Saldana L … +7 more , Santoro B, Lohman N, Ryee MY, Gestricht-Thompson W, Russo K, Willing L, Saleh A
J Child Adolesc Psychopharmacol · 2026 Jun · PMID 41862288 · Publisher ↗
OBJECTIVES: Pediatric mental health prevalence rates have increased in recent years, while gaps remain in the number of available providers. Ongoing evaluation and understanding of treatment progress and engagement are c...
OBJECTIVES: Pediatric mental health prevalence rates have increased in recent years, while gaps remain in the number of available providers. Ongoing evaluation and understanding of treatment progress and engagement are critical to psychiatric care, and these details are often documented in the electronic health record (EHR). Given the utility of retrospective chart review (RCR) as a tool for psychiatrists, we developed a coding system examining common comorbid conditions (anxiety and attention-deficit/hyperactivity disorder [ADHD]) and adherence and evaluated interrater reliability. METHODS: We created a coding system with a comprehensive manual and coding instructions that explore both symptom severity domains (anxiety, ADHD, and global) and adherence to medication. Codes were rated using Likert scales, and two independent raters coded all data. RESULTS: RCR was completed for 142 patients with a total of 1139 visits over 2 years. Weighted linear kappa statistics ranged between 0.77 and 0.95, and weighted quadratic kappa statistics ranged between 0.74 and 0.96, suggesting substantial to almost perfect agreement. Interrater agreement was highest for anxiety severity. CONCLUSIONS: We created a novel coding system for RCR and found substantial to almost perfect interrater reliability for assessing ADHD severity, anxiety severity, global severity, and medication adherence using psychiatry encounter notes documented in an EHR. Our coding system explores conditions that are often heterogeneous and have waxing and waning presentations, using a continuum that captures the complexity of symptoms. Future directions include utilization of coding systems to explore emotion and behavior change over time to optimize treatment.
Polypharmacy and Diabetes in Attention-Deficit/Hyperactivity Disorder: A Comment on Zhu et al.
Pliszka SR
J Child Adolesc Psychopharmacol · 2026 May · PMID 41851026 · Publisher ↗
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Disruptive Mood Dysregulation Disorder and Its Association with Treatment Trajectories and Outcomes in Youth with Attention-Deficit/Hyperactivity Disorder and Internalizing Disorders.
Baweja R, Waschbusch DA, Carlson GA … +1 more , Waxmonsky JG
J Child Adolesc Psychopharmacol · 2026 Mar · PMID 41804951 · Publisher ↗
OBJECTIVES: Disruptive mood dysregulation disorder (DMDD), along with other internalizing disorders, is associated with greater impairment in youth with attention-deficit/hyperactivity disorder (ADHD). However, it remain...
OBJECTIVES: Disruptive mood dysregulation disorder (DMDD), along with other internalizing disorders, is associated with greater impairment in youth with attention-deficit/hyperactivity disorder (ADHD). However, it remains unclear whether DMDD is associated with differences in treatment course and outcomes among youth with ADHD and comorbid internalizing disorders. Using real-world data, this study compared treatment patterns and clinical outcomes among youth with ADHD and internalizing disorders with and without comorbid DMDD. METHODS: A retrospective cohort study analyzed electronic health records from the TriNetX U.S. Collaborative Network, including 340,225 youth aged 6-18 years with ADHD and at least one internalizing disorder (major depressive disorders or anxiety disorder), of whom 25,580 (7.5%) had comorbid DMDD. Outcomes included treatment patterns and clinical outcomes. Propensity score matching and Cox proportional hazards models adjusted for confounding were used to estimate relative risks (RR), adjusted hazard ratios (aHR), and 95% confidence intervals (CI) over 1 year. RESULTS: Youth with ADHD, internalizing disorders, and DMDD exhibited greater psychiatric comorbidity and higher healthcare utilization than those without DMDD. They received more ADHD medications, with a marked shift toward nonstimulants (RR 1.73, 95% CI 1.69-1.77), and other psychotropic medications, including antidepressants, antipsychotics, and mood stabilizers (RR range 1.36-3.02). New central nervous system (CNS) stimulant prescriptions did not differ between youth with and without DMDD. Compared with nonstimulants, CNS stimulants were associated with lower risks of all adverse outcomes-including suicidal ideation/attempts, inpatient hospitalization, emergency visits, and subsequent antipsychotic or mood stabilizer initiation-in youth both with and without DMDD (aHR range 0.33-0.73). CONCLUSIONS: Comorbid DMDD adds clinical complexity among youth with ADHD and internalizing disorders, influencing treatment patterns toward nonstimulants and other psychotropics. Despite this shift, CNS stimulants were associated with the most favorable outcomes across cohorts.
Fentanyl Test Strips in Adolescent Care: Considerations for Safe Implementation.
Tariq M, Yusuf M, Genovese A
J Child Adolesc Psychopharmacol · 2026 May · PMID 41804942 · Publisher ↗
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Antipsychotics in Children and Adolescents with Schizophrenia-Spectrum Disorders: A Systematic Review, Meta-Analysis, and Long-Term Prospective Evidence.
Vazquez P, Lolich M, Dines M … +1 more , Vázquez G
J Child Adolesc Psychopharmacol · 2026 Mar · PMID 41804937 · Publisher ↗
OBJECTIVE: To compare the short-term efficacy and tolerability of second-generation antipsychotics (SGAs) versus placebo for schizophrenia-spectrum disorders in children and adolescents using pairwise meta-analysis of ra...
OBJECTIVE: To compare the short-term efficacy and tolerability of second-generation antipsychotics (SGAs) versus placebo for schizophrenia-spectrum disorders in children and adolescents using pairwise meta-analysis of randomized trials, and to summarize prospective long-term evidence. METHODS: We pooled acute double-blind randomized controlled trials (RCTs) (≤12 weeks; participants ≤19 years; Diagnostic and Statistical Manual of Mental Disorders [DSM]/International Classification of Diseases [ICD] schizophrenia-spectrum) with random-effects models. Efficacy was change in Positive and Negative Syndrome Scale (PANSS) or Brief Psychiatric Rating Scale [BPRS] total score, expressed as standardized mean difference (SMD) versus placebo. Short-term tolerability was defined as adverse event-related outcomes and expressed as risk ratios (RRs) for potentially drug-related treatment-emergent adverse events (TEAEs) versus placebo. Trials without a placebo arm and long-term prospective studies were synthesized narratively. RESULTS: Seventeen acute RCTs were identified; ten were placebo-controlled and entered pooling (agents: olanzapine [OLZ], risperidone [RSP], asenapine [ASP], aripiprazole [APZ], brexpiprazole [BRX], blonanserin [BNS], quetiapine [QTP], lurasidone [LUR], paliperidone [PAL], ziprasidone [ZPD]); seven head-to-head or open-label trials were not pooled. Placebo-referenced efficacy favored several agents: OLZ -1.12 [-1.44 to -0.81], RSP -0.93 [-1.22 to -0.63], BNS -0.50 [-0.89 to -0.11], ASP -0.41 [-0.65 to -0.17], APZ -0.37 [-0.61 to -0.13], BRX -0.34 [-0.61 to -0.07], QTP -0.33 [-0.61 to -0.06], LUR -0.31 [-0.54 to -0.08], PAL -0.25 [-0.57 to -0.07], and ZPD -0.06 [-0.31 to -0.19]. For tolerability, most drugs showed numerically higher TEAE risk versus placebo with wide confidence intervals (typical RR ≈ 2-3); APZ showed a statistically higher risk (RR 2.34 [1.42-3.86]), whereas the point estimate for LUR was below 1 (0.47 [0.18-1.17]). One randomized maintenance study and 12 open-label extensions were reviewed narratively and were not meta-analyzed. CONCLUSIONS: Several SGAs produce short-term symptom reductions versus placebo in children and adolescents with schizophrenia-spectrum disorders, with heterogeneity in TEAE risk across agents. Evidence for long-term maintenance and continuation remains limited, underscoring the need for adequately powered randomized continuation trials to guide sustained treatment in this population.
Rapids Crisis Service for Children and Adolescents 2019-2024: 6-Year Changes in Crisis Service at Lambeth Children and Adolescent Mental Health Services in London, United Kingdom.
Salazar de Pablo G, Aymerich C, Burke L … +13 more , Collier S, Torres-Cortes J, Cronin M, Lin-Li C, Maceiras G, Osis H, Patel E, Ripa J, Roseweir R, Spalding O, Tucker G, Anderson J, Ryckaert C
J Child Adolesc Psychopharmacol · 2026 Apr · PMID 41782285 · Publisher ↗
OBJECTIVE: The demand for children and adolescent mental health crisis services has risen dramatically in recent years, yet evidence on real-world implementation models remains limited. Rapids is a community-based crisis...
OBJECTIVE: The demand for children and adolescent mental health crisis services has risen dramatically in recent years, yet evidence on real-world implementation models remains limited. Rapids is a community-based crisis intervention service developed within Lambeth Children and Adolescent Mental Health Services (CAMHS) at South London and Maudsley NHS Foundation Trust. The primary aim of this study was to examine how clinical presentations, risk profiles, and service outcomes changed over time among children and adolescents accessing Rapids over a 6-year period. We also aimed to describe the characteristics of individuals accessing Rapids. METHODS: This service evaluation used routinely collected clinical data from all children and adolescents up to 18 years who accessed Rapids between January 1, 2019, and December 31, 2024. Sociodemographic, diagnostic, pharmacological, and risk-related variables were evaluated. Diagnoses were coded using International Classification of Diseases, 10th Revision (ICD-10) criteria. Descriptive and inferential analyses were conducted to assess changes in clinical presentations and service outcomes. RESULTS: In total, 325 children and adolescents were included (mean age = 15.5 years, 61.8% females, 64.6% non-White). Anxiety disorders (29.5%), depressive disorders (42.2%), and autism spectrum disorder (33.5%) were the most common diagnoses. Inpatient admissions increased (1.5%-5.8%, = 0.043), and high risk to self also rose notably (19.5%-31.7%, < 0.001). Referrals accepted to adult services decreased significantly over time (38.5%-16.8%, < 0.001). Diagnostically, eating disorders increased (3.7%-10.0%, = 0.032), whereas emotionally unstable personality disorder traits decreased (14.1%-7.4%, = 0.049). CONCLUSIONS: Rapids has evolved into an established model of crisis care within CAMHS, addressing acute needs through timely community-based interventions. We observed meaningful temporal changes in the clinical acuity, diagnostic profile, and service use outcomes of young people presenting to our community-based CAMHS crisis service. Our findings support the feasibility and scalability of intensive community-based crisis care and highlight the need for sustained investment in culturally responsive, multidisciplinary service models.
Prevalence and Correlates of Emotion Dysregulation in Children: Results from the ABCD Study.
Koleilat R, Sabalbal A, Baroud E … +1 more , Shamseddeen W
J Child Adolesc Psychopharmacol · 2026 Mar · PMID 41776831 · Publisher ↗
BACKGROUND: Emotion dysregulation (ED) is the inability to modulate the intensity and quality of emotional responses. It is strongly associated with psychopathology among youth, carries significant morbidity and predicts...
BACKGROUND: Emotion dysregulation (ED) is the inability to modulate the intensity and quality of emotional responses. It is strongly associated with psychopathology among youth, carries significant morbidity and predicts long-term impairments. Data on ED are limited among nonclinical populations. This study aims to estimate the prevalence of ED and to identify its demographic and clinical correlates in children. METHODS: Data from the Adolescent Brain Cognitive Development study, = 11,878 children (ages 9-10), were analyzed. ED was measured using cutoff scores of ≥180 and <210 on the sum of the Attention, Aggression, and Anxious/Depressed subscales of the Child Behavior Checklist. Demographic and socioeconomic variables, sleep-related variables and physical activity levels, screen time use, and psychopathology were examined as correlates. RESULTS: 9.9% of participants screened positive for ED (moderate 8.4%, severe 1.5%) with a male predominance (60.9% and 64.8% of those who screened positive for moderate and severe ED, respectively). Moderate ED was associated with parental education (adjusted odds ratio [aOR] = 0.716 for graduate university degree vs. bachelor's degree, = 0.004). Financial hardships such as inability to afford food (aOR = 1.389, = 0.012) and medical/dental services (aOR = 1.271, = 0.035) were correlated with moderate ED, while severe ED was associated with lower perceived neighborhood safety (aOR = 1.583, = 0.024). Psychiatric disorders (current and past), including mood, anxiety, post-traumatic stress, and behavioral disorders, suicidal/homicidal thoughts/behaviors, self-harm, and sleep disturbance, were linked to both moderate and severe ED, while psychosis was linked to severe ED (aOR = 2.873, < 0.001). CONCLUSION: Psychiatric disorders, socioeconomic factors, and sleep disturbances are important correlates of ED. Findings highlight the importance of early screening for ED and call for the implementation of emotion regulation skills during childhood as a strategic, evidence-based preventive intervention focus.
Bidirectional Associations Between Screen Time and Irritability in Preadolescence: A Temporal Network Analysis.
Zhang L, Bellaert N, Zhuo H … +2 more , Liew Z, Tseng WL
J Child Adolesc Psychopharmacol · 2026 Aug · PMID 41700679 · Publisher ↗
INTRODUCTION: Irritability, a form of emotion dysregulation, is a transdiagnostic symptom cutting across internalizing and externalizing problems. Clinical practitioners and parents have expressed concerns about the pote...
INTRODUCTION: Irritability, a form of emotion dysregulation, is a transdiagnostic symptom cutting across internalizing and externalizing problems. Clinical practitioners and parents have expressed concerns about the potential negative impact of screen use on irritability in youth. Despite the significant concerns, no studies have examined the association between screen usage and irritability and its directionality. Using a novel temporal network approach, this study investigated bidirectional associations between irritability and screen time across different activities in preadolescents. MATERIALS AND METHODS: We used data from the Adolescent Brain and Cognitive Development (ABCD) study. Data from baseline, 1-year, and 2-year follow-ups were included ( = 8979, baseline mean age = 9.5 years, 49.1% females). All data used in the study were collected from 2016 to 2019. At each timepoint, time spent on different screen activities was self-reported by youth using the ABCD Youth Screen Time Survey, and irritability was measured using parent-rated Child Behavior Checklist. RESULTS: The cross-sectional Gaussian Graphical Model showed that irritability was negatively associated with time spent on video streaming at Year 2. The temporal network, estimated by Graphical Vector Autoregressive Model, revealed bidirectional associations between irritability online chatting. Specifically, online chatting predicted decreases in irritability over time, whereas irritability predicted increased time spent on online chatting. Additionally, watching TV and using social media were both associated with subsequent increases in irritability. Results controlled for co-occurring attention-deficit/hyperactivity disorder, anxiety, and depressive symptoms. CONCLUSIONS: These findings suggest a bidirectional association between irritability and online chatting. TV watching and social media unidirectionally predicted increased irritability. These associations highlighted the importance of monitoring screen use patterns as both potential behavioral symptoms and modifiable risk factors in interventions targeting emotion dysregulation. More research is needed to better understand how various screen activities and contents and adolescents' motives to use them are linked to irritability.
Eye Movement Desensitization Reprocessing and Transcranial Magnetic Stimulation in an Adolescent with Comorbid Major Depression Disorder and Posttraumatic Stress Disorder: A Case Report.
Karadag M, Calisgan B, Yilmaz Saygili G … +1 more , Erk I
J Child Adolesc Psychopharmacol · 2026 Apr · PMID 41700662 · Publisher ↗
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Fluoxetine for Behavioral Problems in an 8-Year-Old with Mucopolysaccharidosis IIIA.
Abrantes M, Clemente T
J Child Adolesc Psychopharmacol · 2026 Apr · PMID 41657230 · Publisher ↗
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Prevalence of Pediatric Acute-Onset Neuropsychiatric Syndrome and Associated Obsessive-Compulsive Symptoms in Youth with Avoidant/Restrictive Food Intake Disorder.
Breithaupt L, Ji C, Zhao Z … +13 more , Petterway F, Gydus J, Stern C, Kahn DL, Kambanis PE, Burton-Murray H, Becker KR, Misra M, Eddy KT, Micali N, Williams K, Lawson EA, Thomas JJ
J Child Adolesc Psychopharmacol · 2026 Mar · PMID 41636319 · Publisher ↗
OBJECTIVES: Individuals with both avoidant/restrictive food intake disorder (ARFID) and pediatric acute-onset neuropsychiatric syndrome (PANS) report restrictive eating. Inflammatory and immunological alterations may dri...
OBJECTIVES: Individuals with both avoidant/restrictive food intake disorder (ARFID) and pediatric acute-onset neuropsychiatric syndrome (PANS) report restrictive eating. Inflammatory and immunological alterations may drive the onset of restrictive eating and comorbid obsessive-compulsive (OC) symptoms in PANS, while the etiology of restrictive eating in ARFID is unknown. Nevertheless, few studies have explored PANS and related OC symptoms among individuals with ARFID. We aimed to identify the frequency and nature of PANS and OC symptoms among those with full or subthreshold ARFID. We also explored associations between OC severity, ARFID profiles, and infection history. METHODS: The study included 37 adolescents and young adults with subthreshold or full ARFID. We quantified the frequency of PANS/pediatric autoimmune neuropsychiatric disorders associated with streptococcal infection symptoms and diagnoses, as well as OC symptoms and severity, in our ARFID sample. We analyzed associations between ARFID profiles and OC severity, along with the relationship between infection history and OC severity. RESULTS: Two individuals (5%) met PANS criteria, and 17 (46%) reported lifetime mild-severe OC severity. The fear of aversive consequences profile was associated with a significant increase in log-transformed OC severity (β = 1.2, = 0.04, adjusted = 0.10) after adjusting for sensory sensitivity, lack of interest, and body mass index z-score. We did not find any associations between OC severity and infection history. DISCUSSION: In the first study to examine PANS and related symptoms among individuals with ARFID, we demonstrated salient overlap between PANS, OC symptoms, and ARFID. Further research is needed to examine the relationship between ARFID and PANS.
Relationships Between Cognitive Disengagement Syndrome, Impulsivity, and Emotion Regulation Among Adolescents.
Yitik Tonkaz G, Özyurt G, Çakir A … +5 more , Öğütlü H, Önal BS, Çobanoğlu Osmanli C, Şahin B, Tufan AE
J Child Adolesc Psychopharmacol · 2026 Jun · PMID 41636111 · Publisher ↗
OBJECTIVE: Cognitive disengagement syndrome (CDS) is associated with internalizing symptoms, emotion regulation (ER) difficulties, daytime sleepiness, and impulsivity; however, their interrelations in adolescents with su...
OBJECTIVE: Cognitive disengagement syndrome (CDS) is associated with internalizing symptoms, emotion regulation (ER) difficulties, daytime sleepiness, and impulsivity; however, their interrelations in adolescents with subthreshold attention-deficit/hyperactivity disorder (ADHD) remain underexamined. This study aimed to evaluate the relationships between CDS, ADHD symptoms, ER problems, daytime sleepiness, trait impulsivity, and internalizing symptoms and to determine the mediating roles of ER problems and daytime sleepiness. METHODS: This cross-sectional, clinic-based study included 144 treatment-naïve adolescents (12-18 years) referred for inattention and/or hyperactivity/impulsivity complaints. Parent-reported measures (; ) and adolescent self-reports (, , , ) were administered. Pearson correlations with Bonferroni-Holm correction and structural equation modeling were performed. The CPRS ADHD index and CABI-SCT served as predictors, DERS-16 and PDSS as mediators, RCADS-CV-Total as the outcome, and trait impulsivity, sex, and socioeconomic status were included as confounders. RESULTS: CDS showed moderate-to-high correlations with ADHD indices and significant associations with all internalizing domains except separation anxiety. CDS and daytime sleepiness were moderately correlated, and both were significantly associated with ER difficulties. Trait impulsivity correlated with CDS, ER problems, and internalizing symptoms. CDS was associated with internalizing symptoms through an indirect pathway involving ER difficulties, whereas daytime sleepiness did not a significant mediating effect. Trait impulsivity significantly predicted CDS, ADHD symptoms, ER difficulties, and daytime sleepiness, supporting its role as a shared vulnerability factor. CONCLUSION: CDS symptoms appear more closely related to ER difficulties and internalizing symptoms than subthreshold ADHD symptoms in clinically referred adolescents. ER problems may represent a key mechanism linking CDS to internalizing psychopathology. Routine assessment of CDS symptoms, ER skills, and sleep-related problems may facilitate early identification of at-risk youth. Interventions targeting ER skills and sleep-related processes may represent potential targets for future interventional research, and that longitudinal studies using multimethod assessments are needed to clarify causal pathways.
Treatment of Non-Delirious Acute Agitation in the Pediatric Hospital Setting.
Adler LD, Law C, Scharko AM
J Child Adolesc Psychopharmacol · 2026 Mar · PMID 41622494 · Publisher ↗
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Sex-Specific Effects of Relative Fat Mass on Attention-Deficit/Hyperactivity Disorder: Insights from the 1999-2004 National Health and Nutrition Examination Survey.
Bi S, Li H, Xu X … +1 more , Li L
J Child Adolesc Psychopharmacol · 2026 Apr · PMID 41609190 · Publisher ↗
BACKGROUND: Attention-deficit/hyperactivity disorder (ADHD) is a common neurodevelopmental disorder in childhood. Conventional adiposity indicators have been linked to ADHD. Relative fat mass (RFM), a novel adiposity mea...
BACKGROUND: Attention-deficit/hyperactivity disorder (ADHD) is a common neurodevelopmental disorder in childhood. Conventional adiposity indicators have been linked to ADHD. Relative fat mass (RFM), a novel adiposity measure, has demonstrated advantages in predicting metabolic and cardiovascular disease risk, conditions that share overlapping pathophysiological mechanisms with ADHD. This study aimed to investigate the association between RFM and ADHD, with a particular focus on sex-specific differences. METHODS: Data were obtained from the 1999-2004 National Health and Nutrition Examination Survey, including 5089 children aged 6-14 years. RFM was calculated using height and waist circumference, and ADHD was defined based on physician diagnosis reported in the questionnaire. Multivariable logistic regression models were applied to assess the association between RFM and ADHD. Smooth curve fitting was conducted to validate the results, and subgroup analyses were performed separately for boys and girls. RESULTS: A significant sex-specific association between RFM and ADHD was observed. Among boys, higher RFM levels were inversely associated with ADHD (Model 3: odds ratio [OR] = 0.967, 95% confidence interval [CI]: 0.946-0.989), whereas among girls, higher RFM levels were positively associated with ADHD (Model 3: OR = 1.043, 95% CI: 1.007-1.081). Smooth curve fitting confirmed these opposite linear trends in both sexes. Subgroup analyses further demonstrated that this sex-specific pattern was consistent across strata defined by age, health insurance status, maternal smoking during pregnancy, and birth weight. CONCLUSIONS: There is a significant sex-specific association between RFM and ADHD, showing an inverse relationship in boys and a positive association in girls. These findings suggest that the influence of adiposity distribution on ADHD differs by sex, highlighting the importance of considering sex differences when evaluating risk factors for ADHD.
Psychotropic Classes Concomitant with Stimulants and the Association with the Risk of Diabetes in Medicaid-Insured Youth.
Zhu Y, Zito JM, Gardner JF … +3 more , Young HA, Quinlan S, Elmi A
J Child Adolesc Psychopharmacol · 2026 Jan · PMID 41469033 · Publisher ↗
IMPORTANCE: Psychotropic classes concomitant with stimulants (PCCWS) in children and adolescents have shown an inconsistent impact on the risk of diabetes mellitus. PCCWS with 2-5 classes is common but the risk of diabet...
IMPORTANCE: Psychotropic classes concomitant with stimulants (PCCWS) in children and adolescents have shown an inconsistent impact on the risk of diabetes mellitus. PCCWS with 2-5 classes is common but the risk of diabetes subsequent to stimulant initiation is unknown. OBJECTIVE: To assess the risk of diabetes in youth with PCCWS regimens with 2-5 additional psychotropic classes. DESIGN: A retrospective cohort study was conducted using Medicaid claims data from 2007-2014. Youth aged 2-17 years with 1-7.5 years of continuous enrollment who were new stimulant users with clinician-reported psychiatric diagnosis were followed. SETTING: Outpatient clinic and inpatient records for statewide Medicaid-insured youth in a mid-Atlantic state. PARTICIPANTS: The study cohort comprised 30,112 youth with an average follow-up of 6.4 years. EXPOSURES: Among stimulant users, five groups were defined according to concomitant use. MAIN OUTCOMES AND MEASURES: The major outcome is diabetes risk and was assessed using discrete-time failure models, after adjustment for disease risk score which was categorized using more than 120 baseline and time-dependent covariates. RESULTS: Among 30,112 new stimulant users, 43 were new diabetes patients and 30,069 were nondiabetes patients. The absolute risk of diabetes in youth had an eight-fold increase from 3 to 5 class PCCWS regimens that included antipsychotics, antidepressants, or anticonvulsant-mood stabilizers (0.5; 1.13; 4.20 per 10,000 person-months, respectively). Compared with stimulant monotherapy, PCCWS with any of these 3 classes were significantly more likely to develop diabetes (adjusted relative risk [ARR], 2.58, (95% CI 1.05-6.82); 5.81, (2.29-14.75); 18.91, (6.07-58.90) for 3, 4 and 5 class PCCWS, respectively). Similarly, there was a significantly greater risk of diabetes for those with 120-779 days of cumulative duration than for shorter exposures, and in 4 and 5 class combined PCCWS including antipsychotics, antidepressants, or anticonvulsant-mood stabilizers [ARR, 3.78, (1.16-12.40)]. CONCLUSIONS: In a large Medicaid-insured, long-enrolled youth cohort, the use of PCCWS, particularly concomitant use with antipsychotic, antidepressant, and/or antipsychotic-mood stabilizers, and with long duration of these combinations were associated with an increased risk of diabetes. RELEVANCE: The findings support a call for corroboration in a large national cohort of continuously enrolled Medicaid-insured pediatric youth with long follow-up.
The Role of Maladaptive Behaviors and Adjustment Disorders in Linking Separation Anxiety to Depression in Primary School Students.
Zhang J, Pan C, Du G
J Child Adolesc Psychopharmacol · 2026 Apr · PMID 41449955 · Publisher ↗
OBJECTIVE: Children who experience prolonged separation anxiety may develop "avoidance" patterns of emotional regulation that manifest in stressful behavioral responses. This study tests whether maladaptive habits and ad...
OBJECTIVE: Children who experience prolonged separation anxiety may develop "avoidance" patterns of emotional regulation that manifest in stressful behavioral responses. This study tests whether maladaptive habits and adjustment disorders mediate the link between separation anxiety and depression in primary school students. METHODS: In November 2022, we conducted a cross-sectional survey of 4474 students from elementary schools in Qionghai and Dongfang cities, Hainan Province, China, using stratified cluster sampling. Parents completed the Mental Health Rate Scale for Pupils. Data were analyzed with SPSS 22.0 (descriptive statistics, analysis of variance, correlations), AMOS 26.0 (structural equation modeling [SEM]), and Mplus 8.3 (latent class analysis). RESULTS: SEM revealed that 12.2% of participants met criteria for depression. Students with separation anxiety had 4.5-5.0 times higher odds of depression compared to those without separation anxiety (95% confidence interval [CI]: 3.8-6.2). Mediation analysis indicated that maladaptive habits and adjustment difficulties partially mediated this association, with stronger indirect effects observed in older grades (Grades 5 and 6: β = 0.32, 95% CI: 0.24-0.41 vs. Grades 3 and 4: β = 0.21, 95% CI: 0.15-0.28). CONCLUSIONS: These findings suggest that early identification of maladaptive coping patterns in children with separation anxiety could improve mental health outcomes. We recommend integrating "secure separation" education strategies into teacher training programs and school counseling services, including structured transition activities and separation rituals, to support children's emotional adjustment during school transitions.
Emotional Abuse as an Upstream Factor Influencing Non-Suicidal Self-Injury in Depressed Adolescents: A Network Analysis.
Yueying L, Zheng L, Na L … +6 more , Mengyan L, Xuezhu Y, Zhe Z, Jianqiang W, Youdong L, Lanlan K
J Child Adolesc Psychopharmacol · 2026 Apr · PMID 41449701 · Publisher ↗
OBJECTIVE: To construct a network model depicting non-suicidal self-injury (NSSI) and its influencing factors in adolescents diagnosed with depression, identify the core symptoms within this network, explore the potentia...
OBJECTIVE: To construct a network model depicting non-suicidal self-injury (NSSI) and its influencing factors in adolescents diagnosed with depression, identify the core symptoms within this network, explore the potential causal pathways, and generate hypotheses for future research. METHODS: A sample of 705 adolescent patients with depressive disorders was recruited and assessed using three standardized questionnaires, namely the Childhood Trauma Questionnaire, the Aggression Questionnaire, and the Adolescent Self-Injury Questionnaire. Undirected network analysis, coupled with directed Bayesian network analysis, was employed to elucidate the interrelationships among symptoms. RESULTS: In the network of NSSI-related influencing factors in adolescents with depression, emotional abuse, hostility, sexual abuse, and emotional neglect are important influencing factors. Hostility and anger serve as bridges that connect NSSI to other influencing factors. In the Bayesian network, emotional abuse is shown to precede other symptoms, such as hostility and anger; conversely, NSSI and physical aggression were positioned at the periphery of the network, indicating a greater reliance on other symptoms for their occurrence. Emotional abuse demonstrated the strongest associations with the greatest number of other problems in the network, indicating that emotional abuse plays a crucial role. CONCLUSION: Emotional abuse plays an important role in the network model of NSSI of adolescent depression patients and its influencing factors.
Medical Cannabis Use in Autism: Insights from an Israeli HMO on Patient Characteristics and Alignment with National Guidelines.
Sadeh H, Razi T, Arbel R … +2 more , Netzer D, Meiri G
J Child Adolesc Psychopharmacol · 2026 Jan · PMID 41334706 · Publisher ↗
OBJECTIVE: Evidence for medical cannabis use and effectiveness in autism has begun to accumulate but remains limited, even as clinical interest has rapidly increased. In Israel, medical cannabis may be prescribed for aut...
OBJECTIVE: Evidence for medical cannabis use and effectiveness in autism has begun to accumulate but remains limited, even as clinical interest has rapidly increased. In Israel, medical cannabis may be prescribed for autism with severe behavioral disturbances under strict Ministry of Health criteria requiring prior trials of two Food and Drug Administration (FDA)-approved antipsychotics. Using a large real-world dataset, this study aimed to characterize autistic individuals prescribed medical cannabis and evaluate adherence to national guidelines. METHODS: A retrospective cohort study was conducted using electronic medical records from Clalit Health Services, Israel's largest Health Maintenance Organization. All individuals with a documented autism diagnosis between 1990 and 2025 were identified ( = 36,610) and classified as cannabis-prescribed ( = 462) or not-prescribed ( = 36,148). Demographic and clinical characteristics were compared, including prior use of FDA-approved antipsychotics. RESULTS: Only 1.2% of individuals with autism were prescribed medical cannabis. Of these, 4.3% of prescriptions were issued for children under 5 years of age. The cannabis-prescribed group was diagnosed earlier (median 3 vs. 5 years, < 0.001) and had higher rates of ADHD (42% vs. 30%), intellectual disability (12% vs. 5%), and epilepsy (14% vs. 6%) (all < 0.001). While 69% had used at least one FDA-approved antipsychotic medication prior to cannabis initiation, only 28% had documented trials of both, as required by national guidelines. Marked sociodemographic disparities were also observed: the cannabis-prescribed group had a higher socioeconomic status (median SES 7 vs. 6, < 0.001) and lower representation of Arab individuals (2.7% vs. 11%, < 0.001). CONCLUSIONS: Medical cannabis use among autistic individuals was rare and mainly observed among those with more complex clinical profiles and higher socioeconomic backgrounds. Most prescriptions did not fully comply with guidelines requiring prior antipsychotic trials. These findings underscore the need for enhanced regulatory oversight, equitable access, and longitudinal research to evaluate real-world outcomes and guide evidence-based clinical practice.
Rising Prevalence of Pediatric Catatonia Presenting to Inpatient Care: A Retrospective Analysis.
Smith JR, Baldwin I, York T … +2 more , Zaim N, Luccarelli J
J Child Adolesc Psychopharmacol · 2026 Mar · PMID 41334704 · Full text
PURPOSE: There has been recent concern for the rising rates of catatonia diagnosis in pediatric populations. We set out to determine if the rates of catatonia diagnosis have risen at an academic pediatric medical center....
PURPOSE: There has been recent concern for the rising rates of catatonia diagnosis in pediatric populations. We set out to determine if the rates of catatonia diagnosis have risen at an academic pediatric medical center. METHODS: The clinical records of 131 patients were obtained from encounters during 2018-2023 in which a diagnosis of catatonia was made in the pediatric emergency department or inpatient medical hospital. Ordinary least squares regression and linear regression analyses were used to determine if the prevalence of catatonia diagnoses, underlying diagnostic category, and Bush-Francis Catatonia Rating Scale scores changed over time. RESULTS: A 10-fold increase was observed in catatonia diagnoses between 2018 and 2023. A statistically significant relationship between the year of pediatric catatonia diagnoses was discovered ( = 0.01), with an value of 0.83 suggesting that approximately 83% of the variance can be attributed to the passage of time. Both medical and psychiatric causes of catatonia showed an upward trend over the course of the study period. The average Bush-Francis Catatonia Rating Scale scores showed a slight upward trend but were not statistically significant. CONCLUSION: In this sample of pediatric patients hospitalized at a large academic medical center, the rate of catatonia diagnoses related to both medical and psychiatric causes rose between 2018 and 2023. These data are consistent with previous evidence highlighting an increase in catatonia diagnoses during this period. The COVID-19 pandemic and increasing awareness of catatonia in children may have contributed to this trend. These data support the importance of investigation into this trend and improving education on catatonia for clinicians and the public.
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