J Am Acad Child Adolesc Psychiatry [JOURNAL]
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200 papers
Clinical and Cognitive Mediators Underlying Subsequent Depression in Individuals With Attention-Deficit/Hyperactivity Disorder: A Developmental Approach.
Padaigaitė-Gulbinienė E, Hammerton G, Heron J … +7 more , Eyre O, Michelini G, Wilson-Newman A, Garavini C, Eley TC, Thapar A, Riglin L
J Am Acad Child Adolesc Psychiatry · 2026 Jun · PMID 42302992 · Publisher ↗
OBJECTIVE: Attention-deficit/hyperactivity disorder (ADHD) may lead to depression, but little is known about its underlying mechanisms. We examined whether clinical factors (irritability, anxiety), cognitive-affective pr...
OBJECTIVE: Attention-deficit/hyperactivity disorder (ADHD) may lead to depression, but little is known about its underlying mechanisms. We examined whether clinical factors (irritability, anxiety), cognitive-affective processes (emotion recognition, response inhibition, working memory, sustained attention), and negative thought patterns (external locus of control, negative cognitive style) mediated ADHD-depression associations across development and whether these pathways differ by sex. METHOD: Analyses were performed in the Avon Longitudinal Study of Parents and Children (ALSPAC) and the Twins Early Development Study (TEDS). In both samples, ADHD was assessed using the Strengths and Difficulties Questionnaire (SDQ) hyperactivity/inattention subscale at ages 7, 12/13, and 16/17 years. Depressive symptoms were assessed using the short Mood and Feelings Questionnaire at ages 12, 18/21, and 26/27. Mediators were assessed at ages 8-11, 16-17, and 21-25 years with counterfactual mediation models. RESULTS: Clinical factors were assessed and mediated the ADHD-depression effect in both cohorts across development. In ALSPAC, clinical mediators contributed most in childhood (30%) and young adulthood (25%), whereas in TEDS, they contributed most in adolescence (46%). In ALSPAC, negative thought patterns mostly contributed in adolescence (39%), whereas cognitive-affective factors did not show consistent evidence of mediating effects across development. All mediators combined explained 30%, 48%, and 29% of the total effect of ADHD on depression in childhood, adolescence, and young adulthood, respectively. In sex-stratified models, the relative contribution of mediators varied by sex and developmental stage. In childhood, mediators accounted for a greater proportion of the total effect in male (37%) than in female (25%) individuals, whereas a similar proportion of mediated effects was observed across sexes during adolescence (48% in female and 45% in male individuals). In young adulthood, the indirect effect via all mediators was evident only in female individuals (36%). CONCLUSION: Mechanisms linking ADHD and depression are developmental stage and sex specific. Irritability and anxiety in childhood and young adulthood (particularly for female individuals), and external locus of control and negative cognitive style in adolescence, might represent promising intervention targets for preventing depression in youth with ADHD. STUDY PREREGISTRATION INFORMATION: Study Preregistration: Clinical and Cognitive Mediators Underlying Subsequent Depression in Individuals With Attention-Deficit/Hyperactivity Disorder: A Developmental Approach; https://www.jaacap.org/article/S0890-8567(25)00171-6/fulltext.
Problematic Smartphone Use and Mental Health Trajectories During Brazil's First-Year School-Hour Restrictions.
Martins MDS, Martinez VML, Viola TW
J Am Acad Child Adolesc Psychiatry · 2026 Jun · PMID 42302991 · Publisher ↗
Smartphones can facilitate communication and access to information. However, excessive use has been associated with poorer mental health among children and adolescents. Recent longitudinal evidence suggests that earlier...
Smartphones can facilitate communication and access to information. However, excessive use has been associated with poorer mental health among children and adolescents. Recent longitudinal evidence suggests that earlier smartphone acquisition and high frequency of use are linked to increased internalizing and externalizing symptoms in early adolescence. In response, multiple education systems have implemented restrictions on in-school smartphone use..
Editorial: Scaling Up Trauma-Focused Treatment for Youth: From Recognition to Real-World Impact.
Hein IM
J Am Acad Child Adolesc Psychiatry · 2026 Jun · PMID 42302990 · Publisher ↗
Over the past decades, posttraumatic stress disorder (PTSD) has become firmly established as a prevalent and consequential condition in children and adolescents, with recognition evolving alongside advances in developmen...
Over the past decades, posttraumatic stress disorder (PTSD) has become firmly established as a prevalent and consequential condition in children and adolescents, with recognition evolving alongside advances in developmentally informed assessment and treatment. As exposure to potentially traumatic events is widespread, and as trauma-related problems operate as a transdiagnostic driver of psychopathology, the need for effective and scalable trauma-focused care has become a health imperative. In this context, the large-scale observational study featured in this issue provides compelling real-world evidence that Trauma-Focused Cognitive Behavioral Therapy (TF-CBT) can be delivered with both fidelity and flexibility across diverse routine care settings, achieving outcomes comparable to those reported in clinical trials. At the same time, the persistence of residual symptoms in a substantial minority of youth underscores the need for continued refinement of interventions, stepped-care approaches, and systematic trauma screening. Together, these findings shift the field beyond questions of efficacy toward the crucial challenge of organizing and sustaining trauma-focused mental health services at the scale required to meaningfully improve developmental trajectories for trauma-exposed youth.
Treatment Effects in Micronutrient Trial for Adolescent Irritability.
Parikh A
J Am Acad Child Adolesc Psychiatry · 2026 May · PMID 42214464 · Publisher ↗
I read with great interest the randomized clinical trial by Rucklidge and colleagues, "Efficacy and Safety of Micronutrient Treatment for Irritability in Teenagers: 8-Week Double-Blinded Randomized Placebo-Controlled Tri...
I read with great interest the randomized clinical trial by Rucklidge and colleagues, "Efficacy and Safety of Micronutrient Treatment for Irritability in Teenagers: 8-Week Double-Blinded Randomized Placebo-Controlled Trial (BEAM)." This article examines broad-spectrum micronutrient supplementation for adolescents with moderate to severe irritability. Severe irritability is one of the most common reasons for which youth are referred to psychiatric care. Yet clinicians often face limited treatment options that are limited and can carry significant side effects, creating strong interest in safer and more scalable interventions. The authors' findings raise an important question about how clinicians should interpret the overall results compared with the subgroup findings.
Treatment Effects in Micronutrient Trial for Adolescent Irritability-Authors' Reply.
Rucklidge JJ, Sherwin A, Mulder RT … +2 more , Manna L, Boden J
J Am Acad Child Adolesc Psychiatry · 2026 May · PMID 42214463 · Publisher ↗
We thank Dr. Parikh for their thoughtful commentary on the BEAM trial and welcome the opportunity to clarify our interpretation of the findings.
We thank Dr. Parikh for their thoughtful commentary on the BEAM trial and welcome the opportunity to clarify our interpretation of the findings.
Addressing Nihilism and the Glorification of Violence in Adolescents in Clinical Settings.
Rousseau C, Miconi D, Desmarais C
J Am Acad Child Adolesc Psychiatry · 2026 May · PMID 42214462 · Publisher ↗
Nihilistic violence has recently become a source of concern for security agencies, schools, and youth mental health clinicians. Preliminary empirical data, albeit limited, suggests that nihilistic violence is more freque...
Nihilistic violence has recently become a source of concern for security agencies, schools, and youth mental health clinicians. Preliminary empirical data, albeit limited, suggests that nihilistic violence is more frequent in vulnerable adolescents (10-17 years of age) referred for high risk of violence toward others than in their adult counterparts (18 years and over). Beyond the growing fascination with mass murderers and school shooters glorified on social media, the recent rise of multiple organized online groups that actively target and recruit vulnerable adolescents to promote, glorify, and act out extreme violence is deeply concerning and remains relatively unknown among youth practitioners. This Translation piece builds on the experience of a specialized clinical team who receives requests regarding nihilistic violence in adolescents to help youth mental health clinicians to recognize and address this new phenomenon. The objectives are as follows: (1) to describe key clinical manifestations of nihilistic violence; (2) to propose specific guidelines for assessment and intervention; and (3) to address countertransference and effective measures to safeguard clinicians from the emotional impact of such violence.
Underrepresentation of the Cannabis Youth Treatment Trials in the AACAP Clinical Practice Guideline on Adolescent Substance Use Disorders.
Busch G
J Am Acad Child Adolesc Psychiatry · 2026 May · PMID 42202944 · Publisher ↗
We commend the American Academy of Child and Adolescent Psychiatry (AACAP) Committee on Quality Issues for producing a rigorous and clinically useful guideline on adolescent substance use disorders. However, we wish to c...
We commend the American Academy of Child and Adolescent Psychiatry (AACAP) Committee on Quality Issues for producing a rigorous and clinically useful guideline on adolescent substance use disorders. However, we wish to call attention to a meaningful gap in the guideline's treatment of cannabis use disorder (CUD): the near-absence of substantive engagement with the Cannabis Youth Treatment (CYT) trials, which represent the largest randomized study of behavioral treatment for adolescent CUD conducted to date..
Underrepresentation of the Cannabis Youth Treatment Trials in the AACAP Clinical Practice Guideline on Adolescent Substance Use Disorders-Authors' Reply.
Rockhill CM, Steele DW, Becker TD … +2 more , Diamond JM, Walter HJ
J Am Acad Child Adolesc Psychiatry · 2026 May · PMID 42202943 · Publisher ↗
We appreciate the letter to the editor by Dr. Busch regarding the "Clinical Practice Guideline: Assessment and Treatment of Adolescents and Young Adults With Substance Use Disorders and Problematic Substance Use (Excludi...
We appreciate the letter to the editor by Dr. Busch regarding the "Clinical Practice Guideline: Assessment and Treatment of Adolescents and Young Adults With Substance Use Disorders and Problematic Substance Use (Excluding Tobacco)" and the authors' advocacy for expanded discussion of the Cannabis Youth Treatment (CYT) trials. We agree that CYT is a valuable contribution to the adolescent cannabis use disorder literature and that clinical guidance for adolescent cannabis use disorder remains a high priority.
Optimizing Pharmacological Treatment in Children and Adolescents With Major Depressive Disorder: An Individual Participant Data Analysis.
Xiang Y, Cuijpers P, Li W … +16 more , Bao Q, Weisz JR, Shi J, Du X, Yang H, Barth J, Coghill D, Leucht S, Hazell P, Cohen D, Ravindran AV, Michael KD, Teng T, Zhou X, Lu L, Xie P
J Am Acad Child Adolesc Psychiatry · 2026 May · PMID 42167647 · Publisher ↗
OBJECTIVE: The influence of individual characteristics on antidepressant efficacy and tolerability in pediatric major depressive disorder (MDD) remains unclear. This study aimed to characterize subgroup-specific treatmen...
OBJECTIVE: The influence of individual characteristics on antidepressant efficacy and tolerability in pediatric major depressive disorder (MDD) remains unclear. This study aimed to characterize subgroup-specific treatment efficacy and to establish a preliminary scientific foundation for precision psychiatry in pediatric MDD management. METHOD: An individual participant data (IPD) analysis of double-blind randomized trials (RCTs) was conducted to compare antidepressants with placebo for the acute treatment of MDD in children and adolescents. Subgroup analyses identified treatment outcome differences by participant characteristics, with mixed-effects models used to examine effect modifiers. Primary outcomes were efficacy (depressive symptom change, mean difference [MD]) and tolerability (adverse event-related withdrawals, odds ratio [OR]). Secondary outcomes included deterioration and suicide-related outcomes. The protocol is registered with PROSPERO (CRD42016051657). RESULTS: IPD from 10 RCTs (2,584 participants) on 5 antidepressants (fluoxetine [n = 475], imipramine [n = 95], paroxetine [n = 413], desvenlafaxine [n = 358], duloxetine [n = 341]), and placebo [n = 902] were analyzed. Fluoxetine demonstrated superior efficacy in children, female participants, White participants, healthy weight participants, and those with severe symptoms (MDs = -3.90 to -2.60). Paroxetine was effective in adolescents and participants with a healthy weight (MDs = -2.59 and -2.92), but it was less well tolerated among White participants, participants with mild/moderate symptoms, and those with a family history of psychiatric disorders (ORs = 1.13 to 1.95). Fluoxetine also showed less deterioration in female participants (OR = 0.55, 95% CI = 0.37 to 0.83). No significant differences in suicide-related outcomes were observed across subgroups based on individual characteristics. Most trials had "some concerns" for risk of bias. CONCLUSION: These findings advance a preliminary understanding of the precision medicine framework for pediatric MDD, indicating that individual characteristics (age, sex, ethnicity, body mass index [BMI], symptom severity, family history) may influence treatment outcomes. Exploratory subgroup analyses suggest fluoxetine's efficacy may be more pronounced in certain populations: children, female participants, White individuals, healthy weight participants, and those with severe symptoms. These findings require validation in diverse cohorts. Universal suicide-related outcome assessment across all subgroups (regardless of individual characteristics) remains essential. The study advocates for regulatory reforms to promote subgroup analysis reporting in clinical trials, consistent with emerging precision psychiatry initiatives. STUDY REGISTRATION INFORMATION: Comparative efficacy and tolerability of new-generation antidepressants for major depressive disorder in children and adolescents: protocol of an individual patient data meta-analysis; https://www.crd.york.ac.uk/PROSPERO/view/CRD42016051657.
Study Preregistration: Do Parenting Programs Change Interrelations Among Child Attention-Deficit/Hyperactivity Disorder, Oppositional-Defiant Disorder, Conduct Disorder Characteristics? Individual Participant Data Network Analysis.
Psyllou C, Deserno MK, Leijten P … +6 more , van der Oord S, van den Hoofdakker BJ, Dekkers TJ, PAINT-IPDMA Collaborators, Luman M, Groenman AP
J Am Acad Child Adolesc Psychiatry · 2026 May · PMID 42167646 · Publisher ↗
There is high co-occurrence between attention-deficit/hyperactivity disorder (ADHD) and disruptive behavior problems in children, including oppositional defiant disorder (ODD) and conduct disorder (CD). Recommended non-p...
There is high co-occurrence between attention-deficit/hyperactivity disorder (ADHD) and disruptive behavior problems in children, including oppositional defiant disorder (ODD) and conduct disorder (CD). Recommended non-pharmacological interventions for managing ADHD, ODD, and CD characteristics in children largely overlap, with behavioral parent training programs showing empirical evidence of effectiveness. By improving parent-child interaction patterns, these programs may also interrupt cycles linking characteristics of ADHD with ODD and CD in children. For example, after intervention, children may be less likely to argue and fight with their parents when restrained from leaving their seat. However, much parenting program research relies on composite scores, which capture overall intervention effects but offer limited insight into how changes in specific characteristics contribute to overall improvement. In the present study, we will pool data from around 44 randomized controlled trials (RCTs) of parenting programs for children with ADHD and/or disruptive behavior problems, yielding a large sample suitable for applying network analysis to better understand how parenting programs change the interplay among child ADHD, ODD, and CD characteristics.
Pimavanserin for Irritability in Children and Adolescents With Autism Spectrum Disorder: Phase 2 Randomized Trial.
Bugarski-Kirola D, Hofbauer RK, Sameljak S … +8 more , Marco EJ, Sumiła A, Darwish M, Ortiz S, Liu IY, Nunez R, Zhang PH, Arango C
J Am Acad Child Adolesc Psychiatry · 2026 May · PMID 42162607 · Publisher ↗
OBJECTIVE: This study evaluated the efficacy and safety of pimavanserin in children and adolescents with irritability associated with autism spectrum disorder (ASD). METHOD: In this phase 2, randomized, double-masked, pl...
OBJECTIVE: This study evaluated the efficacy and safety of pimavanserin in children and adolescents with irritability associated with autism spectrum disorder (ASD). METHOD: In this phase 2, randomized, double-masked, placebo-controlled study (NCT05523895), patients were randomized 1:1:1 to low-dose pimavanserin (5-12 years, 10 mg/d; 13-17 years, 20 mg/d), high-dose pimavanserin (5-12 years, 20 mg/d; 13-17 years, 34 mg/d), or placebo for 6 weeks, followed by a 30-day follow-up period. The primary endpoint was the change from baseline at week 6 in the caregiver-rated Aberrant Behavior Checklist-Irritability (ABC-I) subscale score. Key secondary endpoints included week 6 change from baseline in Clinical Global Impression (CGI)-Severity irritability score, CGI-Improvement irritability score, Repetitive Behavior Scale-Revised, Vineland Adaptive Behavior Scales-socialization subscale score, and the Caregiver Strain Questionnaire. Treatment-emergent adverse events were assessed. RESULTS: A total of 216 (93.1%) randomized patients completed double-masked treatment (low-dose pimavanserin, n = 76; high-dose pimavanserin, n = 78; placebo, n = 78). The least squares mean (LSM [95% CI]) improvement in the ABC-I subscale score was not significantly different from placebo for either pimavanserin group (placebo, -9.6 [-11.7, -7.5]; low-dose pimavanserin, -11.2 [-13.3, -9.0]; high-dose pimavanserin, -11.2 [-13.3, -9.1]). No statistically significant differences occurred between the placebo and pimavanserin groups for any secondary endpoint. Treatment-emergent adverse events (TEAEs) were similar across groups (placebo, n = 39 [50.0%]; low-dose pimavanserin, n = 36 [46.8%]; high-dose pimavanserin, n = 43 [53.1%]). No serious TEAEs or deaths occurred. CONCLUSION: Pimavanserin was well tolerated, but selected doses were not demonstrated to be efficacious compared with placebo for the short-term treatment of irritability in children or adolescents with ASD. CLINICAL TRIAL REGISTRATION INFORMATION: A study to evaluate the efficacy and safety of Pimavanserin for the treatment of irritability associated with Autism Spectrum Disorder; https://clinicaltrials.gov/study/NCT05523895 DIVERSITY & INCLUSION STATEMENT: We worked to ensure that the study questionnaires were prepared in an inclusive way.
Developmental Pathways From Genetic Predispositions to Psychopathology in Adolescence.
Larose MP, Schuurmans IK, Barker ED … +4 more , Mondragon LG, Waldman ID, Tiemeier H, Cecil CAM
J Am Acad Child Adolesc Psychiatry · 2026 May · PMID 42162606 · Publisher ↗
OBJECTIVE: Psychopathologies are interrelated and often co-occur, suggesting shared genetic and environmental influences. We examined the mediated associations between children's genetic predispositions for higher-order...
OBJECTIVE: Psychopathologies are interrelated and often co-occur, suggesting shared genetic and environmental influences. We examined the mediated associations between children's genetic predispositions for higher-order psychopathology-represented by polygenic scores (PGS)-and the development of psychopathology symptoms from childhood to adolescence via baseline levels of psychopathology symptoms in childhood. METHOD: We performed the same set of analyses in 2 longitudinal birth cohorts (Generation R Study, N = 4,657; Avon Longitudinal Study of Parents and Children [ALSPAC], N = 4,368) and assessed the consistency of our results. PGS for externalizing, internalizing, and neurodevelopmental psychopathology were calculated using the LDpred2-automatic technique. Using growth curve modeling, we modeled the developmental slopes of child psychopathology symptoms into adolescence (ages 6-14 years, assessed by mothers using the Child Behavior Checklist [Generation R Study] and the Development and Well-Being Assessment [DAWBA; ALSPAC]). We next performed 3 sets of mediation analyses (one per PGS) predicting the development of psychopathological symptoms via baseline levels (at age 6 years) of psychopathology during childhood. RESULTS: The PGS for neurodevelopmental problems was linked to most baseline levels and developmental slopes of psychopathological symptoms through direct or mediated effects (ie, via higher levels of symptomatology at baseline). CONCLUSION: The PGS for neurodevelopmental problems could serve as a broad index of susceptibility to psychopathological symptoms in the general youth population. STUDY REGISTRATION INFORMATION: Direct and Indirect Developmental Pathways From Genetic Predispositions to Mental Health Symptomatology in Adolescence; https://osf.io/hwv9a/.
A Doubly Robust Machine Learning Procedure to Estimate Disparities by Race/Ethnicity and Sex in the Relationship Between Adverse Childhood Experiences and Suicidality.
Harris A, Emery K, Sheftall AH
J Am Acad Child Adolesc Psychiatry · 2026 May · PMID 42155625 · Publisher ↗
OBJECTIVE: Suicide is a leading cause of death among youth, and adverse childhood experiences (ACEs) are established risk factors for suicidality. This study is the first to investigate disparities in the cumulative impa...
OBJECTIVE: Suicide is a leading cause of death among youth, and adverse childhood experiences (ACEs) are established risk factors for suicidality. This study is the first to investigate disparities in the cumulative impact of ACEs in individuals with suicidal ideation only (SI+) and suicide attempt (SA+) in a current, diverse, and nationally representative sample using a causal inference analysis framework. METHOD: Using the 2023 National Youth Risk Behavior Survey (YRBS) (N = 20,103), adolescent demographics, suicidal thoughts and behaviors (STBs), ACEs, and confounders (eg, bullied at school) were examined. First, bivariate differences were analyzed by race/ethnicity and sex for ACE prevalence. Next, the dose-response relationship of ACEs on suicidality was estimated with a doubly robust estimation process and tested for moderation by race/ethnicity and sex. RESULTS: There were significant disparities by race/ethnicity in the types of ACEs that participants endorsed. Female adolescents saw higher prevalences across most ACEs compared to their male counterparts. For SI+ and SA+ outcomes, a dose-response effect of ACEs on suicidality was observed, with higher effects for SI+ compared to SA+. For both outcomes, disparities in this effect across race/ethnicity and sex were not observed. CONCLUSION: These results suggest that the number of ACEs has a similar incremental impact on the risk of youth suicidality across races/ethnicities and sex despite differences in the types of ACEs experienced (ie, emotional abuse vs physical abuse). It is critical that suicide intervention and prevention strategies better support youth experiencing ACEs; in addition, they should consider differences in prevalences of ACE types by demographics for effective risk mitigation. 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. We actively worked to promote inclusion of historically underrepresented racial and/or ethnic groups in science in our author group.
Influence of Age and Gender on Short-Term Efficacy, Acceptability, and Safety of Antipsychotic Drug Treatment of Adolescents With Schizophrenia: An Individual Patient Data Meta-Analysis.
Storosum BWC, Cohen SE, Tilkema N … +5 more , Mattila TK, van den Brink W, de Haan L, Denys DAJP, Zantvoord JB
J Am Acad Child Adolesc Psychiatry · 2026 May · PMID 42155624 · Publisher ↗
OBJECTIVE: To investigate whether age or gender moderates short-term antipsychotic efficacy, acceptability, or safety in adolescents with early-onset schizophrenia (EOS). METHOD: We analyzed data from 4 placebo-controlle...
OBJECTIVE: To investigate whether age or gender moderates short-term antipsychotic efficacy, acceptability, or safety in adolescents with early-onset schizophrenia (EOS). METHOD: We analyzed data from 4 placebo-controlled, randomized registration trials of antipsychotics in EOS (2003-2015). An individual patient data meta-analysis evaluated how age and gender affected efficacy (Positive and Negative Syndrome Scale [PANSS] total change, response), acceptability (all-cause discontinuations), and safety (adverse event incidence). Covariates included age at onset, body mass index, baseline negative symptoms, and study year. The study was registered in the PROSPERO database (ID: CRD42024572863). RESULTS: We included 949 adolescents (61% male, 39% female; mean age = 15.4 years). Neither age (β = 0.251, 95% CI= -1.561-2.064) nor gender (β = 3.057, 95% CI = -0.206-8.175) significantly altered overall antipsychotic efficacy on mean PANSS improvement or response rate. All-cause discontinuation was likewise not affected. Younger adolescents on active medication showed a higher incidence of adverse events than those on placebo, whereas older adolescents exhibited similarly low rates across arms (correlation coefficient = -0.272, p < .001). Gender did not significantly influence adverse-event incidence (aggregate β = 0,037, p = .832). The overall correlation coefficient -0.131 (p = .342) between age and 5 major side effect classes (weight gain, extrapyramidal side effects, QTc prolongation, prolactin increase, sedation) suggested no meaningful age impact, with odds ratios ranging from 0.858 (p = .691) for weight gain to 1.244 (p = .225) for sedation. CONCLUSION: Younger adolescents demonstrated greater vulnerability to antipsychotic-related adverse events despite exhibiting efficacy and acceptability comparable to those in older adolescents. These findings suggest that age-based dosing and monitoring may be warranted when treating adolescents with EOS. STUDY REGISTRATION INFORMATION: Influence of age and gender on short-term efficacy and safety of antipsychotic drugs in the treatment of adolescents with schizophrenia: an Individual Patients Data Meta-Analysis; https://www.crd.york.ac.uk/PROSPERO/view/CRD42024572863 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. 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 inclusion of historically underrepresented racial and/or ethnic groups in science in our author group.
The Developmental Afterlife of Trauma: Adaptation, Identity, and the Search for Integration.
Richards MC, Schreiber J
J Am Acad Child Adolesc Psychiatry · 2026 May · PMID 42140555 · Publisher ↗
Some stories follow us long after they unfold, shaping how we see ourselves, relate to others, and navigate the world. Trauma - whether acute or chronic, singular or relational - does not simply reside in the past: it or...
Some stories follow us long after they unfold, shaping how we see ourselves, relate to others, and navigate the world. Trauma - whether acute or chronic, singular or relational - does not simply reside in the past: it organizes development in enduring ways. It shapes how children come to understand themselves, relate to others, and construct meaning from their experiences. This month's Media Forum brings together two works that, albeit distinct in form and tone, converge on a central clinical truth: that adaptation to early trauma is both a source of vulnerability and a pathway toward resilience.
Understanding Protective Factors That Impact Adolescent Suicidal Behaviors Across Race/Ethnicity and Sex.
Solidum E, Harris A, Emery K … +1 more , Sheftall AH
J Am Acad Child Adolesc Psychiatry · 2026 May · PMID 42140554 · Publisher ↗
OBJECTIVE: Rising suicide rates disproportionately affect youth across racial, ethnic, and sex groups, highlighting the need to identify protective factors associated with specific suicidal behaviors in diverse populatio...
OBJECTIVE: Rising suicide rates disproportionately affect youth across racial, ethnic, and sex groups, highlighting the need to identify protective factors associated with specific suicidal behaviors in diverse populations. This study aims to estimate and compare the effects of protective factors among youth with suicidal ideation only (SI+) and those with suicide attempts (SA+) across race/ethnicity and sex. METHOD: We analyzed data from the New Mexico Youth Risk and Resiliency Survey (N = 50,887) from years 2005 - 2021. Using a causal inference framework, we estimated doubly-robust adjusted risk ratios (aRRs) of protective factors on SI and SA through inverse probability of treatment weighting (IPTW), weighted logistic regression, and G-Computation. RESULTS: Protective factors significantly reduced suicidality with stronger effects for SA (aRRs = 0.59 (95% CI [0.54 - 0.64]) - 0.93 (95% CI [0.85 - 1.01])) compared to SI (aRRs = 0.74 (95% CI [0.69 - 0.79]) - 0.94 (95% CI [0.86 - 1.01])). Overall, three factors effectively distinguished between outcomes. There were racial/ethnicity and sex differences, however, differences were more pronounced across race/ethnicity than sex, and for SA compared to SI. CONCLUSION: Protective factors significantly reduced both SI and SA among adolescents, with stronger effects and more pronounced differences for SA. These findings show that protective factors are not one-size-fits-all, highlighting the importance of culturally and demographically tailored prevention strategies. While most previous work has focused on risk factors for suicidality in adolescents, focusing on protective factors is critical for effective prevention.
Editorial: Fetal Exposure to Maternal Infection by SARS-CoV-2 and Effects on Child Neurodevelopment.
Swanson JM
J Am Acad Child Adolesc Psychiatry · 2026 May · PMID 42119916 · Publisher ↗
The systematic review and meta-analysis by Rizzo et al. should be of interest to child psychiatrists and pediatricians based on its historical and contemporary relevance (Table 1). Historically, it addresses the 2019 COV...
The systematic review and meta-analysis by Rizzo et al. should be of interest to child psychiatrists and pediatricians based on its historical and contemporary relevance (Table 1). Historically, it addresses the 2019 COVID-19 pandemic-so far the most devastating health-related event of the 21 century-which may haunt us for decades because of post-acute sequelae of SARS-CoV-2 (PASC) or Long-COVID, which is now affecting millions of individuals. Contemporarily, it addresses an unresolved issue regarding neurodevelopment in children with a history of fetal exposure to SARS-CoV-2 during pregnancy (presumably uninfected, because vertical transmission is rare), as well as a contentious public debate regarding outcomes of children with fetal and childhood exposure to COVID-19 vaccinations. For this review, the authors applied both a narrow approach (by restricting the review to studies of neurodevelopment in children) and a broad approach (by including studies with "neurodevelopmental outcomes of the child at any age" and "any available measure of child development"). They did the following: (1) identified studies that met the exposure criteria (ie, maternal infection or vaccination) for the review ("70 studies" with 88 neurodevelopmental outcomes); (2) described basic characteristics and findings of all studies in an informative table ("which summarizes methodologies, key findings, and covariates adjustments"); (3) presented structured narrative syntheses for the studies classified into 7 outcome subdomains (with "… consistency [defined] as >70% of studies within a domain reporting effects in the same direction"): and (4) conducted meta-analyses for multiple studies with dichotomous outcomes (based on "…the number of individuals screening positive versus negative for specific auditory or developmental concerns"). As outlined in Table 1, the narrative syntheses suggested reassurances that fetal exposure did not disrupt neurodevelopment (because adverse effects of were not consistent across studies for any outcome domain), but the authors did not accept the null hypothesis (even though it was consistent with their own research). Instead, they conducted meta-analyses that suggested that there may be cause for concern (given that adverse effects were statistically significant for an initial neonatal auditory test and for some ratings of neurodevelopment).
Heat Exposure and Hospital Admissions for Mental Health Disorders in a Changing Climate.
He WQ, Dey C, Li C … +7 more , Hu N, Perkes I, Kan H, Lingam R, Sara G, Jay O, Nassar N
J Am Acad Child Adolesc Psychiatry · 2026 May · PMID 42107835 · Publisher ↗
OBJECTIVE: To examine associations between ambient temperature and hospital admissions for mental health disorders among children (aged <=12), adolescents (aged 13-17) and young adults (aged 18-24), and to project future...
OBJECTIVE: To examine associations between ambient temperature and hospital admissions for mental health disorders among children (aged <=12), adolescents (aged 13-17) and young adults (aged 18-24), and to project future heat-attributable admissions under various climate change scenarios. METHOD: We conducted a case-crossover time-series study using hospital admissions for mental health disorders in New South Wales, Australia (2001-2022). Daily average temperature was the exposure. Conditional logistic regression with lag-distributed non-linear models was used to examine the association in cold and warm seasons. Relative risk (RR) was determined by comparing risk of high temperature (99 percentile) with the minimum morbidity temperature (MMT). Attributable fractions (AF) of heat (temperatures above MMT) were estimated, and future heat-attributable admissions were projected under three greenhouse gas emission scenarios (1980-2099). RESULTS: Among 719,375 admissions, high temperature was associated with increased admissions: RR 3.03 (95%CI 2.56-3.60) in cold seasons and 1.92 (95%CI 1.58-2.34) in warm seasons. Elevated risks were observed for substance use, depressive, anxiety, obsessive-compulsive, reaction and adjustment, and attention-deficit, disruptive, impulse-control disorders in both seasons (RR range 2.02-5.49), and for schizophrenia, eating disorders, and deliberate self-harm in cold seasons (2.22-5.23), but no effect was observed for manic episode and bipolar disorders in either season. Risks were higher among female patients and young adults in cold seasons, and among male patients and children (0-11 years) in warm seasons, and with increasing effects in recent years. Heat accounted for 8.36% of admissions in cold seasons and 2.94% in warm seasons. By 2090-2099, heat-attributable admissions are projected to rise by 6.0%, 7.7%, and 20.8% under low, medium, and high emission scenarios. CONCLUSION: High temperatures were associated with increased hospital admissions for mental health disorders among children and young adults. Climate change is projected to amplify this burden, highlighting the urgent need to prioritise mental health outcomes in climate adaptation and public health strategies.
Is There Any Level of Stress Exposure That Is Beneficial?
Smith IC, Prytherch S, Shanahan L … +1 more , Copeland WE
J Am Acad Child Adolesc Psychiatry · 2026 May · PMID 42107834 · Publisher ↗
OBJECTIVE: Exposure to a modicum of stress-neither too much nor too little-may confer an adaptive advantage in the face of subsequent stress. This study tests whether there is a "sweet spot" of stress exposure in childho...
OBJECTIVE: Exposure to a modicum of stress-neither too much nor too little-may confer an adaptive advantage in the face of subsequent stress. This study tests whether there is a "sweet spot" of stress exposure in childhood. METHOD: The analysis uses data from the prospective, longitudinal, representative Great Smoky Mountains Study. Childhood emotional symptoms and exposure to 32 different stressful events were assessed with a structured diagnostic interview in individuals aged 9 to 16 years (6,674 total observations). Three definitions of "moderate stress" were derived based upon the type of the prior event, the number of prior stressful events, and the severity of the stressful events. A series of planned post hoc comparisons tested whether prior exposure to moderate stress was advantageous when dealing with recent stressful life events. RESULTS: The majority of participants reported no/low stress (67.8.5%-77.5%). Moderate stress or exposure to one stressful event was reported at between 14.8% and 26.0% of all childhood observations. In all models, both recent stress and past stress were independently associated with current emotional symptoms. Planned post hoc comparisons, however, suggested no evidence of an advantage of prior exposure to moderate stress in participants' response to recent stressful events. Findings were most consistent with a risk saturation effect. CONCLUSION: In this cohort study, there was no evidence of an adaptive level of prior stress exposure consistent with concepts of steeling or stress inoculation. Rather, both past and current stressful events affect current functioning up to some point beyond which there is little additional vulnerability. 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 actively worked to promote sex and gender balance in our author group.
Translating Evidence Into Practice: Using the Open-Access Evidence-Based Intervention Database for Attention-Deficit/Hyperactivity Disorder (EBI-ADHD) Platform to Support Shared Decision-Making.
Gosling CJ, Garcia-Argibay M, Solmi M … +2 more , Delorme R, Cortese S
J Am Acad Child Adolesc Psychiatry · 2026 May · PMID 42092538 · Publisher ↗
We are pleased to introduce the Evidence-Based Intervention database for Attention-Deficit/Hyperactivity Disorder (EBI-ADHD; https://ebiadhd-database.org/), a new and open-access online resource for the clinical and rese...
We are pleased to introduce the Evidence-Based Intervention database for Attention-Deficit/Hyperactivity Disorder (EBI-ADHD; https://ebiadhd-database.org/), a new and open-access online resource for the clinical and research community in child and adolescent psychiatry. EBI-ADHD provides a comprehensive, user-friendly synthesis of the evidence on ADHD interventions.
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