J Am Acad Child Adolesc Psychiatry [JOURNAL]
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200 papers
Different Changes in Brain Functional Networks Following 12-Week Psychostimulant Treatment in Attention-Deficit/Hyperactivity Disorder Youth With and Without Familial Risk for Bipolar I Disorder.
Qin K, Pan N, Lei D … +7 more , Zhu Z, Tallman MJ, Patino LR, Gong Q, Sweeney JA, DelBello MP, McNamara RK
J Am Acad Child Adolesc Psychiatry · 2026 Jul · PMID 40712681 · Full text
OBJECTIVE: Although psychostimulants are the first-line treatment for attention-deficit/hyperactivity disorder (ADHD) and can normalize associated brain network abnormalities, their neural effects in ADHD youth with a fa...
OBJECTIVE: Although psychostimulants are the first-line treatment for attention-deficit/hyperactivity disorder (ADHD) and can normalize associated brain network abnormalities, their neural effects in ADHD youth with a family history of bipolar I disorder (BD) have not yet been systematically investigated. METHOD: This study investigated the effects of 12-week mixed amphetamine salts-extended release (MAS-XR) treatment on brain functional networks and symptom changes in ADHD youth with ("high-risk" [HR]) and without ("low-risk" [LR]) a first-degree relative with BD. LR received 12-week open-label MAS-XR and HR were randomized to MAS-XR or placebo (PLA). Healthy controls (HC) were included for comparative purposes. Resting-state functional magnetic resonance imaging scans were acquired at baseline and week 12. Global and nodal network topological metrics were evaluated based on functional connectivity matrices using graph theoretical analysis. RESULTS: A total of 135 youth were included (HC, n = 45; LR-MAS, n = 46; HR-MAS, n = 28; HR-PLA, n = 16). For comparisons between HR-MAS and LR-MAS groups, significant group-by-time interactions were identified in global efficiency, characteristic path length, left superior parietal gyrus degree, and right amygdala efficiency. Relative to the HC group, all baseline abnormalities were normalized at week-12 in the LR-MAS group, whereas a decrease in right amygdala efficiency uniquely emerged in the HR-MAS group. Significant correlations were identified between changes in network topology and ADHD symptoms. Connectome-based predictive modeling analysis revealed that baseline network dysconnectivity predicted ADHD treatment outcomes in the HR-MAS group only. CONCLUSION: These findings provide novel evidence that ADHD youth with and without BD familial risk exhibit different changes in brain network topology and associated symptoms following 12 weeks of psychostimulant treatment. PLAIN LANGUAGE SUMMARY: Although psychostimulants can alter brain network connectivity in youth with attention-deficit/hyperactivity disorder (ADHD), their effects in ADHD youth with a family history of bipolar disorder (BD) have not been investigated. This double-blind randomized controlled study compared the effects of psychostimulants on brain networks in a total of 135 youth. Results indicate that ADHD youth with and without BD family history exhibit different brain network changes. These findings suggest that ADHD in conjunction with BD family history may have a neurobiological profile that is distinct from ADHD alone without such a family history. CLINICAL TRIAL REGISTRATION INFORMATION: Neuroimaging Study of Risk Factors for Adolescent Bipolar Disorder (NERF); https://clinicaltrials.gov/study/NCT02478788.
Noninvasive Brain Stimulation in Attention-Deficit/Hyperactivity Disorder: A Systematic Review and Meta-Analysis of Treatment Efficacy and Targeting Strategies.
Chen Q, Pan N, Long Y … +6 more , Qin K, Sangchooli A, Cao Y, Singh MK, Chen Y, Gong Q
J Am Acad Child Adolesc Psychiatry · 2026 Mar · PMID 40701403 · Publisher ↗
OBJECTIVE: Noninvasive brain stimulation (NIBS) has emerged as a promising novel treatment for attention-deficit/hyperactivity disorder (ADHD). However, the precise effects of NIBS in ADHD as well as optimal stimulation...
OBJECTIVE: Noninvasive brain stimulation (NIBS) has emerged as a promising novel treatment for attention-deficit/hyperactivity disorder (ADHD). However, the precise effects of NIBS in ADHD as well as optimal stimulation protocols remain elusive. This systematic review and meta-analysis aimed to provide a rigorous evaluation and robust quantified evidence on the therapeutic efficacy of NIBS in ADHD. METHOD: A systematic search of PubMed, Web of Science, and Embase identified 59 studies (repetitive transcranial magnetic stimulation [rTMS]: 11; transcranial direct current stimulation [tDCS]: 35; other NIBS: 13). Of these, 33 randomized controlled trial studies (7 for rTMS, 26 for tDCS; 1,049 participants with ADHD) were included in meta-analyses of therapeutic efficacy. Subgroup analyses were performed to investigate the impact of stimulation targets on therapeutic outcomes, and meta-regression analyses were included to evaluate the dose-response relationship. RESULTS: NIBS has favorable tolerability, but evidence for its therapeutic efficacy in ADHD remains inconclusive. Meta-analyses indicated that rTMS was effective in alleviating inattention symptoms (Hedges' g = -1.44, p = .002), reducing hyperactivity/impulsivity symptoms (Hedges' g = -0.95, p = .005), and improving attention-related functions (Hedges' g = 0.53, p = .023), and tDCS showed therapeutic benefits in reducing hyperactivity/impulsivity symptoms (Hedges' g = -0.28, p = .024) and improving inhibitory control (Hedges' g = 0.39, p = .028). tDCS positioned over the left dorsolateral prefrontal cortex and right orbitofrontal cortex demonstrated significant effects in improving inhibitory control. No significant dose-response relationship was found for either tDCS or rTMS in ADHD. CONCLUSION: This meta-analysis supports the therapeutic potential of NIBS in ADHD, revealing domain-specific benefits across different stimulation devices and sites. Although more data are needed, NIBS shows promise as an intervention for ADHD. PLAIN LANGUAGE SUMMARY: This systematic review and meta-analysis investigated the role of noninvasive brain stimulation in the treatment of attention-deficit/hyperactivity disorder (ADHD). Drawing on data from 33 randomized controlled trial studies with 1,049 participants, the authors found that repetitive transcranial magnetic stimulation (rTMS) was associated with improved attention and reduced hyperactivity/impulsivity, while transcranial direct current stimulation (tDCS) helped enhance inhibitory control and reduce hyperactivity/impulsivity. The effectiveness was linked to which brain region was stimulated. These results suggest that noninvasive brain stimulation may be a valuable treatment option for individuals with ADHD, particularly for those who do not respond well to standard medications. STUDY REGISTRATION INFORMATION: Efficacy of Noninvasive Brain Stimulation and the Impact of Targeting in Attention Deficit/Hyperactivity Disorder: An Updated Systematic Review and Meta-Analysis; https://osf.io/bmhax DIVERSITY & INCLUSION STATEMENT: We worked to ensure sex and gender balance in the recruitment of human participants. We worked to ensure race, ethnic, and/or other types of diversity in the recruitment of human participants. We worked to ensure that the study questionnaires were prepared in an inclusive way. Diverse cell lines and/or genomic datasets were not available. We actively worked to promote inclusion of historically underrepresented racial and/or ethnic groups in science in our author group. We actively worked to promote sex and gender balance in our author group. While citing references scientifically relevant for this work, we also actively worked to promote inclusion of historically underrepresented racial and/or ethnic groups in science in our reference list. While citing references scientifically relevant for this work, we also actively worked to promote sex and gender balance in our reference list. The author list of this paper includes contributors from the location and/or community where the research was conducted who participated in the data collection, design, analysis, and/or interpretation of the work.
Systematic Review and Meta-Analysis: Neurocognitive Alterations in Offspring of Individuals With Schizophrenia or Bipolar Disorder Compared to Offspring of Unaffected Parents.
Pedruzo B, Aymerich C, Martínez-Asensi C … +11 more , Yorca-Ruiz A, Herrero RM, Díaz-Pons A, Ortiz-García de la Foz V, Radua J, Alonso-Alconada D, Salazar de Pablo G, González-Torres MÁ, Fusar-Poli P, Catalán A, Ayesa-Arriola R
J Am Acad Child Adolesc Psychiatry · 2026 Jun · PMID 40684854 · Publisher ↗
OBJECTIVE: The aim of this study is to conduct a meta-analytic examination of neurocognitive functioning in offspring of parents with schizophrenia (FHR-SZ) and offspring of parents with bipolar disorder (FHR-BD), examin...
OBJECTIVE: The aim of this study is to conduct a meta-analytic examination of neurocognitive functioning in offspring of parents with schizophrenia (FHR-SZ) and offspring of parents with bipolar disorder (FHR-BD), examining both their differences from healthy control offspring (HC) and from each other. METHOD: A systematic search was conducted from inception to November 7, 2024. Studies included FHR-SZ and/or FHR-BD, a group of HC, and measures of neurocognitive performance. Exclusion criteria included studies without a control group or non-English-language publications. Data were extracted by 4 researchers and assessed using a modified version of the Newcastle-Ottawa Scale. Random-effects meta-analyses were conducted, with heterogeneity assessed using the Q statistic and I index. Meta-regressions examined the effects of age, sex, and study quality. RESULTS: The sample comprised 3,475 FHR-SZ (mean age = 8.34 years, SD = 1.36; 54% female), 3,020 FHR-BD (mean age = 8.62 years, SD = 1.26; 46% female), and 5,272 HC (mean age = 8.48 years, SD = 1.23; 51% female). FHR-SZ showed significant impairments compared to HC across most cognitive domains, with the largest deficits in visual learning (g = -2.47), motor functioning (g = -1.85), and general intelligence (g = -1.30). In contrast, FHR-BD showed milder deficits, notably in visual learning (g = -0.87), verbal learning (g = -0.83), and processing speed (g = -0.53). FHR-SZ performed significantly worse than FHR-BD in attention, general intelligence, motor functioning, verbal memory and working memory. CONCLUSION: Offspring of parents with SZ or BD show generalized neurocognitive dysfunction, with greater impairments in FHR-SZ. Neurocognitive functioning is a critical target for early interventions. PLAIN LANGUAGE SUMMARY: In this meta-analysis, the authors reviewed 68 studies on children of parents with schizophrenia or bipolar disorder. Compared to children of healthy parents, children of parents with schizophrenia and bipolar disorder both showed worse cognitive functioning, especially in memory, learning, and intelligence. Cognitive deficits were more severe in children of parents with schizophrenia. CLINICAL GUIDANCE: • Routine cognitive screening may be warranted in clinical settings for youth with familial risk for severe mental illness, even in the absence of symptoms. STUDY REGISTRATION INFORMATION: Differences in Cognitive Performance Between Individuals at Familial High Risk for Schizophrenia or Bipolar Disorder and Healthy Controls: A Protocol for a Systematic Review and Meta-Analysis; https://www.crd.york.ac.uk/PROSPERO/view/CRD42024498909. DIVERSITY & INCLUSION STATEMENT: We worked to ensure sex and gender balance in the recruitment of human participants. We worked to ensure race, ethnic, and/or other types of diversity in the recruitment of human participants. We worked to ensure that the study questionnaires were prepared in an inclusive way. One or more of the authors of this paper self-identifies as a member of one or more historically underrepresented sexual and/or gender groups in science. The author list of this paper includes contributors from the location and/or community where the research was conducted who participated in the data collection, design, analysis, and/or interpretation of the work. While citing references scientifically relevant for this work, we also actively worked to promote inclusion of historically underrepresented racial and/or ethnic groups in science in our reference list. We actively worked to promote inclusion of historically underrepresented racial and/or ethnic groups in science in our author group. While citing references scientifically relevant for this work, we also actively worked to promote sex and gender balance in our reference list. We actively worked to promote sex and gender balance in our author group.
Predicting the First Onset of Suicidal Thoughts and Behaviors in Adolescents Using Multimodal Risk Factors: A 4-Year Longitudinal Study.
Nguyen J, Dwyer DB, Toenders YJ … +22 more , Tagliaferri SD, van Velzen LS, Clark SR, Scott I, Hartmann S, Wigman JTW, Lin A, Thompson AD, Wannan CMJ, Gao CX, Wood SJ, Amminger GP, Yung AR, Koutsouleris N, Hartmann JA, Yuen HP, Davey CG, Ronald A, McGorry PD, Middeldorp C, Nelson B, Schmaal L
J Am Acad Child Adolesc Psychiatry · 2025 Jul · PMID 40681146 · Publisher ↗
OBJECTIVE: Suicide is one of the leading causes of death among youth worldwide, yet existing studies that aimed to predict the first onset of suicidal thoughts and behaviors (STB) included a limited number of data modali...
OBJECTIVE: Suicide is one of the leading causes of death among youth worldwide, yet existing studies that aimed to predict the first onset of suicidal thoughts and behaviors (STB) included a limited number of data modalities and/or focused on adult populations. This study aimed to prospectively predict first-onset STB across 4-year follow-ups in adolescents using an existing STB history classification model that was previously applied to baseline data and a new machine learning model with 195 biopsychosocial features. METHOD: Participants were 7,503 unrelated adolescents (54.5% female, ages 9-11 years at baseline) from the multisite, longitudinal Adolescent Brain Cognitive Development (ABCD) Study. An existing baseline STB history classification model was applied to predict longitudinal first-onset STB in adolescents compared with healthy controls and clinical controls (individuals with a mental health disorder but no STB). A new elastic net logistic regression model with 195 features was trained on data from 14 sites (n = 5,220), and the resulting top 15 features were validated at 7 independent sites (n = 2,283). RESULTS: The previously developed model to classify STB lifetime history also prospectively predicted first-onset STB in adolescents with an area under the curve (AUC) [95% CI] of 0.73 [0.70, 0.75], p < .001, compared with healthy controls and AUC [95% CI] of 0.63 [0.60, 0.66], p < .001, compared with clinical controls. The newly trained model with top 15 features performed similarly with AUC [95% CI] of 0.73 [0.71, 0.76], p < .001, and AUC [95% CI] of 0.64 [0.60, 0.66], p < .001, for the same comparison groups. The most consistent predictors across models included female sex, sleep disturbances, and maladaptive home and school environments. CONCLUSION: The models predicted first-onset STB in adolescents with moderate accuracy. This study also confirmed the roles of well-established psychological risk factors for STB and identified several novel neurocognitive and brain imaging risk factors. Future studies should validate these models in large-scale diverse samples before clinical translation. DIVERSITY & INCLUSION STATEMENT: We worked to ensure sex and gender balance in the recruitment of human participants. We worked to ensure race, ethnic, and/or other types of diversity in the recruitment of human participants. We worked to ensure that the study questionnaires were prepared in an inclusive way. Diverse cell lines and/or genomic datasets were not available. One or more of the authors of this paper self-identifies as a member of one or more historically underrepresented racial and/or ethnic groups in science. One or more of the authors of this paper self-identifies as a member of one or more historically underrepresented sexual and/or gender groups in science. We actively worked to promote sex and gender balance in our author group. One or more of the authors of this paper received support from a program designed to increase minority representation in science. We actively worked to promote inclusion of historically underrepresented racial and/or ethnic groups in science in our author group. While citing references scientifically relevant for this work, we also actively worked to promote sex and gender balance in our reference list. While citing references scientifically relevant for this work, we also actively worked to promote inclusion of historically underrepresented racial and/or ethnic groups in science in our reference list. The author list of this paper includes contributors from the location and/or community where the research was conducted who participated in the data collection, design, analysis, and/or interpretation of the work.
Attention-Deficit/Hyperactivity Disorder Subtypes Defined by Cognition Have a Distinct Neural and Clinical Profile and Differ in Response to Atomoxetine.
Leikauf JE, Griffiths KR, Clarke SD … +2 more , Kohn MR, Williams L
J Am Acad Child Adolesc Psychiatry · 2026 May · PMID 40681145 · Full text
OBJECTIVE: Attention-deficit/hyperactivity disorder (ADHD) is clinically and etiologically heterogeneous across multiple levels of organization. This study sought to parse the heterogeneity of ADHD by identifying cogniti...
OBJECTIVE: Attention-deficit/hyperactivity disorder (ADHD) is clinically and etiologically heterogeneous across multiple levels of organization. This study sought to parse the heterogeneity of ADHD by identifying cognitive subtypes based on common features of ADHD, including inhibitory control, sustained attention, and working memory. To validate the subtypes, constructs at other meaningful levels of organization were used: quantitative electroencephalogram (qEEG), clinical symptoms, and response to treatment with atomoxetine and methylphenidate. METHOD: Hierarchical cluster analysis of cognitive measures defined clusters in 1 clinical sample (n = 112). Replication was tested in a second, held-out clinical sample (n = 336). Cluster subtypes were assessed for neural validation using resting-state qEEG and heart rate and for clinical applicability using ADHD and anxiety symptom ratings. Further, clusters were assessed for differential treatment response after 6 weeks of atomoxetine or methylphenidate. RESULTS: Two clusters defined by specific cognitive profiles were identified and replicated. The inhibitory control subtype was distinguished by more activity in qEEG delta (β = -.47, p = 4.89 × 10), theta (β = -.39, p = 7.84 × 10), and beta (β = -.36, p = 4.21 × 10) bands and higher resting heart rate. Clinically, this subtype also had more severe anxiety (mean [SD] = 7.6 [6.0]) than the sustained attention subtype (mean [SD] = 4.7 [4.3], p = .02) and had a markedly better response to atomoxetine (β = 8.4, p = .008, Cohen's d = 0.71). CONCLUSION: Cognitive performance appears to be effective for identifying ADHD subtypes that have a distinct neural basis and that may particularly benefit from nonstimulant medications such as atomoxetine. PLAIN LANGUAGE SUMMARY: Current attention-deficit/hyperactivity disorder (ADHD) subtypes, based on parent-reported symptoms, are not very useful for clinical predictions or research breakthroughs. This study identified new ADHD subtypes using computerized attention-based tasks and compared these new subtypes' responses to 2 ADHD medications: methylphenidate (stimulant) and atomoxetine (nonstimulant). A subtype with a more impulsive, error-prone style had higher resting heart rates and electroencephalogram (EEG) differences and responded well to both medications. A subtype with more lapses in sustained attention responded well only to methylphenidate. These results are a step toward targeting treatments based on attention testing. These novel subtypes could also help understand underlying biological mechanisms. DIVERSITY & INCLUSION STATEMENT: We worked to ensure sex and gender balance in the recruitment of human participants. We worked to ensure race, ethnic, and/or other types of diversity in the recruitment of human participants. We worked to ensure that the study questionnaires were prepared in an inclusive way. One or more of the authors of this paper self-identifies as a member of one or more historically underrepresented sexual and/or gender groups in science. We actively worked to promote sex and gender balance in our author group. The author list of this paper includes contributors from the location and/or community where the research was conducted who participated in the data collection, design, analysis, and/or interpretation of the work. While citing references scientifically relevant for this work, we also actively worked to promote sex and gender balance in our reference list. While citing references scientifically relevant for this work, we also actively worked to promote inclusion of historically underrepresented racial and/or ethnic groups in science in our reference list. CLINICAL TRIAL REGISTRATION INFORMATION: International Study to Predict Optimised Treatment in Attention Deficit/Hyperactivity Disorder; https://www. CLINICALTRIALS: gov/study/NCT00863499.
Clinical Assessment and Implications of Parasocial Relationships in Adolescents.
Diaz AD, Leong AW, Bilge-Johnson S … +3 more , Shapiro M, Noureddine C, Kaliebe K
J Am Acad Child Adolesc Psychiatry · 2026 Mar · PMID 40681144 · Publisher ↗
Parasocial relationships (PSRs) are 1-sided socioemotional connections made by individuals with media figures such as influencers, celebrities, and fictional characters. Sociologists Horton and Wohl introduced the term i...
Parasocial relationships (PSRs) are 1-sided socioemotional connections made by individuals with media figures such as influencers, celebrities, and fictional characters. Sociologists Horton and Wohl introduced the term in a seminal paper in 1956, responding to the rise of new mass media such as radio, television, and film. Adolescents are particularly vulnerable to PSRs as they begin to separate from their primary caregivers and seek independence. Adolescence is a period marked by a growing need for peer connection and belonging. To meet developmental needs, adolescents may turn toward PSRs for validation and guidance as these offer a low-risk context for exploring new identity roles and different perspectives. Particularly during the COVID-19 pandemic, many adolescents turned to social media to alleviate isolation, strengthening the formation of PSRs and creating a digital trend. Following the COVID-19 pandemic, PSRs persist, providing a sense of emotional security of connecting without social rejection. However, excessive reliance on PSRs may pose risks.
A 4-Year Combined General Psychiatry and Child and Adolescent Psychiatry Residency: A Bridge Too Far?
Hunt JI, Fritz GK, Williamson ED … +1 more , Walkup JT
J Am Acad Child Adolesc Psychiatry · 2026 Jan · PMID 40669812 · Publisher ↗
The AACAP Task Force on the Crisis in Recruitment, beginning in 2018, has been dedicated to addressing key factors associated with barriers to recruitment for child and adolescent psychiatry (CAP) fellowship programs. Th...
The AACAP Task Force on the Crisis in Recruitment, beginning in 2018, has been dedicated to addressing key factors associated with barriers to recruitment for child and adolescent psychiatry (CAP) fellowship programs. The AACAP Advancing Innovation in Residency Education (AIRE) Proposal for a 4-year combined general psychiatry and CAP residency was developed consistent with a historical effort to address workforce challenges that has included the AACAP 10-year workforce initiative in the early 2000s, with creation of funded summer research opportunities for medical students and residents and special interest groups with the funding support of the Klingenstein Third Generation Foundation (KTGF). This commentary examines the evolution and current status of the AACAP AIRE proposal in the wake of its nonapproval by the American Board of Psychiatry and Neurology. It further calls on key stakeholders to engage in collaborative, forward-thinking efforts to develop innovative and sustainable solutions to the critical challenges facing the CAP workforce.
Editorial: Firearm Access Restriction in Children With Escalating Mental Health Symptoms: Opportunity for Common Ground.
Uspal NG, McCartney LE, Kodish I
J Am Acad Child Adolesc Psychiatry · 2026 Feb · PMID 40669811 · Publisher ↗
Childhood firearms access is a public health crisis in the United States. Firearm injury is now the country's leading cause of childhood death, with death rates by firearm in 0- to 18-year-olds increasing by 51% between...
Childhood firearms access is a public health crisis in the United States. Firearm injury is now the country's leading cause of childhood death, with death rates by firearm in 0- to 18-year-olds increasing by 51% between 2016 and 2022. In 2022, homicide and suicide accounted for 65% and 26% of these deaths, respectively..
Correction.
J Am Acad Child Adolesc Psychiatry · 2025 Nov · PMID 40669810 · Publisher ↗
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Revision to Stage 1 Registered Report, "Specificity of Parenting Program Component Effects: Relational, Behavioral, and Cognitive Approaches to Children's Conduct Problems".
J Am Acad Child Adolesc Psychiatry · 2025 Nov · PMID 40645326 · Publisher ↗
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Editorial: Preteens and Suicide Risk: It Doesn't Hurt to Ask.
Horowitz LM, Bridge JA, Pao M
J Am Acad Child Adolesc Psychiatry · 2026 Jan · PMID 40639498 · Publisher ↗
Suicide is an increasingly urgent public health issue among preteens, defined as youth aged 8 to 12 years. Within the last decade, rates of suicide deaths in preteens rose 8% annually, and suicidal thoughts and behaviors...
Suicide is an increasingly urgent public health issue among preteens, defined as youth aged 8 to 12 years. Within the last decade, rates of suicide deaths in preteens rose 8% annually, and suicidal thoughts and behaviors (STBs) have significantly increased in this population. Given these sobering statistics, screening and early detection of suicide risk is critical for connecting more preteens to mental health care. Prior research shows that over 70% of 8- to 9-year-olds who screened positive in an emergency department presented with physical complaints and that STBs were found only through screening, further highlighting the importance of asking about suicide risk in this population. A third to a half of preteens who present for a behavioral health concern screen positive for suicide risk..
Systematic Review: The Psychosocial Impacts of Autism-Related Genetic Testing.
Wills BC, Matthews MM, Johnston J … +3 more , Bolo I, Ottman R, Appelbaum PS
J Am Acad Child Adolesc Psychiatry · 2026 Apr · PMID 40619096 · Full text
OBJECTIVE: To perform a systematic literature review of the psychosocial impacts on parents and autistic people of receiving autism-related genetic test results. METHOD: Systematic searches of MEDLINE, PsycINFO, CINAHL,...
OBJECTIVE: To perform a systematic literature review of the psychosocial impacts on parents and autistic people of receiving autism-related genetic test results. METHOD: Systematic searches of MEDLINE, PsycINFO, CINAHL, Web of Science Core Collection, Sociological Index, and Scopus were conducted for articles appearing through October 27, 2024. The authors screened 3,606 articles. The quality of the included articles was assessed with the Quality Appraisal for Diverse Studies (QuADS) appraisal tool. RESULTS: Inclusion criteria were met by 22 articles. Across research and clinical settings, articles assessed impacts of receiving actual (18 articles) or hypothetical (4 articles) genetic test results. Twenty articles assessed impacts on parents and prospective parents, whereas 2 articles assessed impacts on autistic adults. Psychological impacts of receiving results varied and included relief, peace of mind, reduced guilt, disappointment, fear, frustration, stress, blame, and guilt. Comparison of the frequencies of these responses was limited by heterogeneous assessment methods, variable reporting formats, and inconsistent outcome measures across studies. Receiving results sometimes confirmed diagnoses, led to altered care plans, influenced family planning, or impacted the decision to end or continue a pregnancy. Most articles reported low-to-mild or highly variable satisfaction with the testing experience. Studies of autistic adults reported strong concerns about testing without consent and discriminatory uses of genetics. CONCLUSION: Impacts on parents and prospective parents appeared to be relatively modest, albeit with mixed valences-a finding broadly similar to studies addressing return of results for other complex genetic conditions. Although the findings of the 2 studies of autistic adults differ substantially, they suggest that autistic people and current and prospective parents of autistic children may have significantly different experiences and perspectives. Clinicians should recognize these differences and help parents understand and weigh them in decision making. PLAIN LANGUAGE SUMMARY: This review analyzed the impact on patients and their families receiving genetic test results about autism using data from 22 studies. Psychological impacts of receiving results varied and included relief, peace of mind, reduced guilt, disappointment, fear, frustration, stress, blame, and guilt. Methods and results varied widely, making it hard to compare studies. The study also indicated the need for more research with and for autistic people, including children when possible. STUDY REGISTRATION INFORMATION: Systematic Review of the Psychosocial and Behavioral Impacts of Returning Genetic Results for Autism Spectrum Disorder; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=258842.
Centanafadine for Attention-Deficit/Hyperactivity Disorder in Adolescents: A Randomized Clinical Trial.
Ward CL, Childress AC, Jin N … +3 more , Turkoglu O, Skubiak T, Wilens TE
J Am Acad Child Adolesc Psychiatry · 2026 Jun · PMID 40619095 · Publisher ↗
OBJECTIVE: This randomized, double-blind, placebo-controlled trial evaluated the efficacy, safety, and tolerability of centanafadine-a norepinephrine, dopamine, serotonin reuptake inhibitor-in the treatment of attention-...
OBJECTIVE: This randomized, double-blind, placebo-controlled trial evaluated the efficacy, safety, and tolerability of centanafadine-a norepinephrine, dopamine, serotonin reuptake inhibitor-in the treatment of attention-deficit/hyperactivity disorder (ADHD) in adolescents. METHOD: Adolescents (aged 13-17 years, inclusive) with a primary diagnosis of ADHD were randomized to once-daily centanafadine 164.4 mg, 328.8 mg, or placebo for 6 weeks. Dosing was not titrated. The primary endpoint was change from baseline in the ADHD Rating Scale, version 5 (ADHD-RS-5) symptoms total raw score at week 6. This trial is registered with ClinicalTrials.gov (NCT05257265). RESULTS: Of 459 participants (centanafadine 164.4 mg, n = 155; 328.8 mg, n = 155; placebo, n = 149), 451 received ≥1 dose of study drug and 371 (80.8%) completed the trial. At week 6, improvements in ADHD-RS-5 symptoms total raw score were significantly greater with centanafadine 328.8 mg than with placebo (-18.50 [0.93] vs -14.15 [0.93]; p = .0006); centanafadine 164.4 mg did not meet the primary endpoint. Centanafadine 328.8 mg showed separation from placebo at week 1, the first postbaseline timepoint, with the effect maintained throughout the study. Treatment-emergent adverse events (TEAEs) occurred in 48 of 153 (31.4%, 164.4 mg), 76 of 151 (50.3%, 328.8 mg), and 35 of 147 (23.8%, placebo) participants. The most common (≥5% any group) TEAEs were decreased appetite, nausea, headache, and rash. Most TEAEs were of mild or moderate severity; 3 events were severe: liver function test increase (n = 1, 164.4 mg); aggression (n = 1, 164.4 mg); and somnolence (n = 1, placebo). CONCLUSION: Centanafadine 328.8 mg was efficacious for ADHD treatment in adolescents. Both doses were generally safe and well tolerated. PLAIN LANGUAGE SUMMARY: Centanafadine is a drug under investigation for the treatment of attention-deficit/hyperactivity disorder (ADHD). This clinical trial tested how well centanafadine worked in treating symptoms of ADHD in adolescents (ages 13 to 17 years) when compared to placebo. A total of 459 adolescents participated in this clinical trial. Adolescents treated with higher-dose centanafadine (328.8 mg) had greater improvement in ADHD symptoms at 6 weeks compared to those treated with placebo or centafadine at lower dose (164.4 mg). Centanafadine was generally safe and generally well tolerated in adolescents. CLINICAL TRIAL REGISTRATION INFORMATION: A Trial of Centanafadine Efficacy and Safety in Adolescents With Attention-Deficit/Hyperactivity Disorder; https://clinicaltrials.gov/study/NCT05257265 DIVERSITY & INCLUSION STATEMENT: We worked to ensure sex and gender balance in the recruitment of human participants. We worked to ensure race, ethnic, and/or other types of diversity in the recruitment of human participants. We worked to ensure that the study questionnaires were prepared in an inclusive way. One or more of the authors of this paper self-identifies as a member of one or more historically underrepresented racial and/or ethnic groups in science. One or more of the authors of this paper self-identifies as a member of one or more historically underrepresented sexual and/or gender groups in science. One or more of the authors of this paper self-identifies as living with a disability. We actively worked to promote sex and gender balance in our author group. The author list of this paper includes contributors from the location and/or community where the research was conducted who participated in the data collection, design, analysis, and/or interpretation of the work.
Structural Brain Correlates of Childhood Inhibited Temperament: An ENIGMA-Anxiety Mega-Analysis.
Bas-Hoogendam JM, Bernstein RA, Benson BE … +57 more , Frank SEC, Buss KA, Gunther KE, Pérez-Edgar K, Salum GA, Jackowski A, Bressan RA, Zugman A, Degnan KA, Filippi CA, Fox NA, Henderson HA, Tang A, Zeytinoglu S, Harrewijn A, Hillegers MHJ, Muetzel RL, White T, van IJzendoorn MH, Schwartz CE, Felicione JM, DeYoung KA, Shackman AJ, Smith JF, Tillman RM, van den Berg YHM, Cillessen AHN, Roelofs K, Tyborowska A, Hill SY, Battaglia M, Tettamanti M, Dougherty LR, Jin J, Klein DN, Leung HC, Avery SN, Blackford JU, Clauss JA, Bjork JM, Hettema JM, Moore AA, Roberson-Nay R, Sawyers C, Hayden EP, Liu P, Vandermeer MRJ, Goldsmith HH, Planalp EM, Nichols TE, Thompson PM, Westenberg PM, van der Wee NJA, Groenewold NA, Stein DJ, Winkler AM, Pine DS
J Am Acad Child Adolesc Psychiatry · 2026 Apr · PMID 40619094 · Full text
OBJECTIVE: Childhood inhibited temperament (cIT) is associated with an increased risk for developing internalizing psychopathology. Neurobiological characteristics identified by structural magnetic resonance imaging (MRI...
OBJECTIVE: Childhood inhibited temperament (cIT) is associated with an increased risk for developing internalizing psychopathology. Neurobiological characteristics identified by structural magnetic resonance imaging (MRI) may elucidate the neural substrates for cIT, but studies are scarce and often focus on particular regions of interest. Moreover, current findings lack replication. This preregistered analysis from the ENIGMA-Anxiety Working Group examined structural brain characteristics associated with cIT using a comprehensive whole-brain approach. METHOD: Temperament assessments (behavioral observations, parent/teacher reports or self-reports on cIT before age 13 years) and MRI data (age at scan, 6-25 years) from international research sites (Europe, North America, South America) were pooled for mega-analysis. Following image processing and quality control, associations between cIT and brain structure were examined in 3,803 participants. Subcortical volumes, cortical thickness, and surface area (main analyses) and detailed subcortical characteristics (eg, subnuclei, subfields, partial volume effects; exploratory analyses) were considered. RESULTS: In the full sample, cIT showed no relation with brain structure, either as a main effect or in interactions with sex or age. Subgroup analyses (based on cIT assessment type) revealed cIT by sex interactions on mean cortical thickness (p = .037) and thickness of the right superior parietal region (p = .029) in youth with parent/teacher reports on cIT levels. Exploratory analyses revealed findings in the hippocampus, putamen, and caudate, but most did not survive statistical correction for multiple testing. CONCLUSION: This mega-analysis found no consistent associations between cIT and regional brain structure, although the role of parietal regions warrants further investigation. Future studies should consider brain function in cIT, preferably using longitudinal designs. PLAIN LANGUAGE SUMMARY: Inhibited temperament during childhood is a risk factor for the development of anxiety and depression later in life. A preregistered study from the international ENIGMA-Anxiety Working Group investigated whether characteristics of brain structure are associated with the level of childhood inhibited temperament, using brain scans and data on temperamental traits from participants aged 6 to 25 years, which have been previously acquired at research sites worldwide (total sample > 3,800 subjects). Analyses revealed no consistent correlations between brain structure and inhibited temperament. STUDY REGISTRATION INFORMATION: Structural Brain Correlates of Childhood Inhibited Temperament: An ENIGMA-Anxiety Mega-analysis. https://www.jaacap.org/article/S0890-8567(22)00299-4/fulltext.
Editorial: Findings From a 16-Year Study on Juvenile Detainees.
Tastenhoye CA, McBride AB
J Am Acad Child Adolesc Psychiatry · 2026 Mar · PMID 40617319 · Publisher ↗
The Northwestern Juvenile Project is a longitudinal study of 1,829 youths enrolled from 1995 to 1998 at the Cook County Juvenile Temporary Detention Center. Youth involved in the study were assessed through structured di...
The Northwestern Juvenile Project is a longitudinal study of 1,829 youths enrolled from 1995 to 1998 at the Cook County Juvenile Temporary Detention Center. Youth involved in the study were assessed through structured diagnostic interviews and reassessed up to 13 times over a period of 16 years. Incredibly, of the original sample of 1,829 youths, 1,394 (76%) participants had a 16-year interview. To date, this remains the largest study of its kind and has provided invaluable information about outcomes of justice-involved youth. Previously published results from the project have elucidated the depth of trauma in this population, with 93% of the youth sampled reporting exposure to life-threatening trauma and the challenges they face in obtaining mental health care after release from detention..
Editorial: Uniformity Before Prediction: The Unfinished Science of Attention-Deficit/Hyperactivity Disorder Forecasting.
Caye A
J Am Acad Child Adolesc Psychiatry · 2026 Feb · PMID 40617318 · Publisher ↗
A central ambition of medicine-particularly in the realm of chronic and developmental disorders-is not only to diagnose with precision, but also to anticipate the course of illness with foresight and nuance. In psychiatr...
A central ambition of medicine-particularly in the realm of chronic and developmental disorders-is not only to diagnose with precision, but also to anticipate the course of illness with foresight and nuance. In psychiatry, this has historically been an elusive pursuit. Whereas other specialties have long relied on prognostic models to shape prevention and personalize care, mental health research has only more recently begun to systematically identify predictors of clinical trajectories and long-term outcomes. This need is particularly relevant in attention-deficit/hyperactivity disorder (ADHD), a condition with a highly variable course and often underestimated long-term impact. Once dismissed as a self-limited feature of childhood, ADHD is now firmly established as a condition that for many persists into adulthood-reshaping education, employment, relationships, and mental health.3,4 Yet the fundamental clinical question endures: which children with ADHD are most at risk for poor adult outcomes? Also, can we identify early indicators that genuinely alter the course of care?
A Nationwide Analysis of Acute Pediatric Healthcare Encounters Attributed to Substance Use Before, During, and Following the COVID-19 Pandemic.
Kelly SW, Smith DL, Davis Z … +2 more , Mermelstein R, Karnik NS
J Am Acad Child Adolesc Psychiatry · 2026 May · PMID 40602679 · Publisher ↗
OBJECTIVE: To examine changes in acute health care encounters, and to identify risk factors associated with substance use among the pediatric population before, during, and after the COVID-19 pandemic. METHOD: We conduct...
OBJECTIVE: To examine changes in acute health care encounters, and to identify risk factors associated with substance use among the pediatric population before, during, and after the COVID-19 pandemic. METHOD: We conducted an interrupted time series analysis to assess changes in acute health care encounters related to substance use from 2017 to 2023 among a national sample of youth 6 to 17 years of age. Based on sociodemographic variables, logistic regression analyses were used to predict substance use encounters. We examined their interactions with the COVID-19 era to highlight differences in these acute encounters before, during, and after the pandemic. RESULTS: Records for more than 20 million acute health care encounters were examined among the pediatric population from 2017 through 2023. Of these records, 219,267 had substance use diagnoses. During the COVID-19 era, the proportion of encounters associated with substance use increased, and then post pandemic declined to pre-pandemic levels. The most common substances attributed to acute health care encounters were marijuana (n = 141,273) and alcohol (n = 45,147). Health care encounters attributed to substance use were more common in older youth (13-17 years of age), male youth, and youth who were American Indian or Alaska Native. Additional disparities were associated with certain substances, indicating the need for tailored public health and clinical interventions among these populations. CONCLUSION: Although overall health care encounters dropped during the pandemic, the proportion of visits attributed to substance use increased significantly during that time. Of note, encounters attributed to marijuana use have remained elevated among youth. Unique risk factors may exist for health care encounters based on substance, warranting the need for additional research on these disparities. PLAIN LANGUAGE SUMMARY: Using data from the Epic electronic health records' Cosmos database to identify trends in acute healthcare encounters related to substance use before, during, and following the COVID-19 pandemic, over 20 million pediatric acute healthcare encounters were examined from 2017 through 2023. The authors found that the proportion of healthcare encounters related to substance use surged during the pandemic across all substance types. Post-pandemic, marijuana was the only substance for which healthcare encounters remained elevated. These findings highlight the need for ongoing research on the persistently elevated rate of marijuana-related healthcare. DIVERSITY & INCLUSION STATEMENT: We worked to ensure sex and gender balance in the recruitment of human participants. We worked to ensure race, ethnic, and/or other types of diversity in the recruitment of human participants. We worked to ensure sex balance in the selection of non-human subjects. One or more of the authors of this paper self-identifies as a member of one or more historically underrepresented sexual and/or gender groups in science. One or more of the authors of this paper self-identifies as a member of one or more historically underrepresented racial and/or ethnic groups in science. We actively worked to promote sex and gender balance in our author group. While citing references scientifically relevant for this work, we also actively worked to promote inclusion of historically underrepresented racial and/or ethnic groups in science in our reference list. The author list of this paper includes contributors from the location and/or community where the research was conducted who participated in the data collection, design, analysis, and/or interpretation of the work. While citing references scientifically relevant for this work, we also actively worked to promote sex and gender balance in our reference list. One or more of the authors of this paper received support from a program designed to increase minority representation in science. We actively worked to promote inclusion of historically underrepresented racial and/or ethnic groups in science in our author group. One or more of the authors of this paper self-identifies as living with a disability.
Preadolescent Benefits of Parent-Child Interaction Therapy Emotion Development for Preschool Depression: 4-Year Follow-Up.
Elansary M, Barch DM, Tillman R … +6 more , Dandrea CB, Vogel AC, Donohue MR, Hennefield L, Gilbert K, Luby JL
J Am Acad Child Adolesc Psychiatry · 2026 May · PMID 40582466 · Full text
OBJECTIVE: Childhood depression can arise as early as age 3 years and is a chronic and relapsing disorder, with high rates of comorbidity and functional impairment. Previous research demonstrated a high rate of sustained...
OBJECTIVE: Childhood depression can arise as early as age 3 years and is a chronic and relapsing disorder, with high rates of comorbidity and functional impairment. Previous research demonstrated a high rate of sustained gains in remission from preschool depression 18 weeks after completion of a novel intervention for depression, Parent-Child Interaction Therapy-Emotion Development (PCIT-ED). However, there have been no data regarding longer-term outcomes. We investigated whether response to PCIT-ED was evident 4 years after treatment completion and whether individuals who were remitted had decreases in mental health service use and psychotropic prescriptions compared to nonresponders. METHOD: We followed participants into preadolescence 4 years after participation in a randomized controlled trial of PCIT-ED delivered during the preschool period. Potential predictors of depression remission, obtained from pre-therapy and post-therapy assessments, were investigated using logistic regression models. Characteristics of participants in remission at preadolescence were compared to those not in remission. We also tracked psychiatric care. RESULTS: There was a high rate of remission at preadolescence (57.1%). Post-therapy externalizing symptoms predicted relapse. Participants with remission at preadolescence had significantly lower rates of lifetime use of α-agonist, antidepressant, and atypical antipsychotic medication as well as decreased use of intensive mental health interventions. CONCLUSION: PCIT-ED for preschool depression had effects at long-term follow-up in a majority of young children. Early intervention, when effective, was associated with reduced psychotropic and intensive mental health service use. PCIT-ED, as a brief early intervention, may be a cost-effective way to minimize relapse and to decrease subsequent mental health interventions. PLAIN LANGUAGE SUMMARY: This longitudinal study followed children (N = 105) who participated in a randomized controlled trial for a novel parent-child therapy for preschool depression, Parent-Child Interaction Therapy-Emotion Development (PCIT-ED). Four years later, in preadolescence, over half (57.1%) of the children were in remission. Those in remission had lower lifetime use of alpha agonist, antidepressant, and atypical antipsychotic medication, as well as decreased utilization of intensive mental health interventions. These findings suggest that early intervention for childhood depression can have lasting benefits and may reduce the need for future mental health care. CLINICAL TRIAL REGISTRATION INFORMATION: A Randomized Controlled Trial of PCIT-ED for Preschool Depression; https://clinicaltrials.gov/study/NCT02076425.
Neighborhood Deprivation and Adolescent Mental Health: The Protective Role of School Staffing Patterns.
Vargas TG, Costello M, Tiemeier H … +4 more , Lam P, Bollmann-Dodd T, Kaur J, Schuster RM
J Am Acad Child Adolesc Psychiatry · 2026 Jul · PMID 40578756 · Full text
OBJECTIVE: Schools are key for advancing adolescent well-being, yet the role of school-level factors in supporting student mental health in the context of neighborhood deprivation is unknown. METHOD: Students (N = 30,469...
OBJECTIVE: Schools are key for advancing adolescent well-being, yet the role of school-level factors in supporting student mental health in the context of neighborhood deprivation is unknown. METHOD: Students (N = 30,469, age: mean = 15.11 years, SD = 1.75 years) in 62 middle and high schools in Massachusetts completed the Substance Use and Risk Factors (SURF) Survey to assess psychiatric symptoms. Neighborhood deprivation was assessed through the census-extracted Area Deprivation Index (ADI). School-level moderators included school staffing patterns (teacher and mental health staff-to-student ratios, teaching staff increases) and characteristics that may support belonging and inclusion (school written commitment to inclusivity, proportion of teachers of shared race/ethnic minority status). Linear mixed models clustered by school examined links between neighborhood deprivation and psychiatric symptoms and tested school moderators, covarying for student age and sex as well as neighborhood density of substance retailers and crime. RESULTS: Higher neighborhood deprivation related to higher psychiatric symptom endorsement (β values = 0.04-0.08, p values <.04). Higher mental health staff ratios weakened the associations of neighborhood deprivation with anxiety and depressive symptoms (β [SE] = -0.03 [0.01], p = .04), suicidal thoughts and behaviors (β [SE] = -0.03[0.01], p = .04), and substance use (β [SE] = -0.04 [0.02], p = .04). Interactions were not observed for other school staffing patterns or characteristics supporting belonging and inclusion. CONCLUSION: School mental health staffing patterns may represent a modifiable protective factor with the potential to address mental health needs in disadvantaged communities and neighborhood contexts. PLAIN LANGUAGE SUMMARY: Schools play a key role in adolescent well-being, yet little is known about school-level factors in supporting student mental health in the context of neighborhood deprivation. In this study, the authors collected information from 30,000 adolescents in Massachusetts and found that those living in more disadvantaged neighborhoods reported more mental health issues. However, schools with more mental health staff helped protect students from these effects. Boosting school-based mental health support could improve well-being in underserved communities. STUDY REGISTRATION INFORMATION: School-Level Protective Factors for Mental Health Distress and Substance Use in Youth Exposed to Systemic Neighborhood Deprivation; https://osf.io/qkp25. DIVERSITY & INCLUSION STATEMENT: We worked to ensure race, ethnic, and/or other types of diversity in the recruitment of human participants. We worked to ensure sex and gender balance in the recruitment of human participants. One or more of the authors of this paper self-identifies as a member of one or more historically underrepresented racial and/or ethnic groups in science. One or more of the authors of this paper self-identifies as living with a disability. One or more of the authors of this paper received support from a program designed to increase minority representation in science. While citing references scientifically relevant for this work, we also actively worked to promote sex and gender balance in our reference list. The author list of this paper includes contributors from the location and/or community where the research was conducted who participated in the data collection, design, analysis, and/or interpretation of the work.
Systematic Review: Convergence and Divergence Between Autism Spectrum Disorder and Obsessive-Compulsive Disorder: Genetic, Neuroimaging, and Cognitive Findings.
Pereira JA, Veenstra-VanderWeele J, Jutla A
J Am Acad Child Adolesc Psychiatry · 2026 Feb · PMID 40578755 · Full text
OBJECTIVE: Autism spectrum disorder (ASD) and obsessive-compulsive disorder (OCD), albeit distinct diagnoses, overlap in presentation and frequently co-occur. However, the relationship between them remains poorly underst...
OBJECTIVE: Autism spectrum disorder (ASD) and obsessive-compulsive disorder (OCD), albeit distinct diagnoses, overlap in presentation and frequently co-occur. However, the relationship between them remains poorly understood. We reviewed comparative studies of ASD and OCD to identify patterns of convergence and divergence across these diagnoses at cognitive, neurobiological, and genetic levels. METHOD: We searched MEDLINE, Web of Science, and PsycInfo databases. The systematic review was registered on PROSPERO (ID: CRD42023395895). Studies that compared individuals with ASD and OCD regarding cognition, neurobiology, or genetics were included. Articles were screened in 2 phases: (1) for relevancy, and (2) based on exclusion and inclusion criteria. We conducted a qualitative synthesis of the results. RESULTS: The search yielded 2,009 articles. After excluding irrelevant articles (n = 1,623), including studies examining compulsivity without an OCD scale (n = 71), nonempirical reports (n = 97), nonhuman studies (n = 42), studies that were out of scope (n = 6), duplicates (n = 7), and studies with fewer than 20 participants in any comparator group (n = 111), 50 articles remained and were included in the qualitative synthesis. CONCLUSION: At a genetic level, ASD and OCD share heritability, but studies of polygenic risk are limited. At a neuroimaging level, both diagnoses are associated with reduced cortical thickness in the temporal lobe, but ASD is specifically associated with increased frontal cortical thickness. At a cognitive level, inflexibility may be characteristic of both conditions, but performance in facial emotion processing and sustained attention may differ. The literature is limited by heterogeneity and reduced focus on quantitative traits. Future studies are needed to clarify these relationships. PLAIN LANGUAGE SUMMARY: Autism spectrum disorder (ASD) and obsessive-compulsive disorder (OCD) are different diagnoses, but both involve repetitive behavior, and children with ASD are much more likely than neurotypical children to be diagnosed with OCD. But the connection between ASD and OCD is not well understood. This systematic review examined the relationships of ASD and OCD at three levels: genetic, neurobiological, and cognitive. Similarities and differences were identified at all levels, though existing studies have some limitations. Future work is needed to better understand the relationships between these diagnoses. STUDY REGISTRATION INFORMATION: Comparison of Genetic, Neurobiological, and Cognitive Underpinnings of Autism Spectrum Disorder and Obsessive-Compulsive Disorder: A Systematic Review; https://www.crd.york.ac.uk/PROSPERO/view/CRD42023395895.
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