J Am Acad Child Adolesc Psychiatry [JOURNAL]
Sun
200 papers
Systematic Review and Meta-Analysis: Effectiveness of Intensive Community Care Services and Psychosocial Interventions for Adolescents With Severe Mental Health Problems.
Syed S, Pascual-Sanchez A, Adesiyan P … +4 more , Rabot K, Sanson L, Eaton R, Ougrin D
J Am Acad Child Adolesc Psychiatry · 2026 Jan · PMID 41580120 · Publisher ↗
OBJECTIVE: We conducted a systematic review and meta-analysis to assess the effectiveness of intensive community care and services (ICCS) compared with treatment as usual (TAU), including inpatient care, and to synthesiz...
OBJECTIVE: We conducted a systematic review and meta-analysis to assess the effectiveness of intensive community care and services (ICCS) compared with treatment as usual (TAU), including inpatient care, and to synthesize common psychosocial interventions used within ICCS. METHOD: We searched 14 databases from January 1, 1999, to May 30, 2025, for quantitative studies of ICCS for adolescents predominantly (aged 12-18 years) with mental health problems. We used a random-effects meta-analysis of randomized controlled trials (RCTs) comparing ICCS vs TAU (and inpatient care only) on psychosocial functioning, mental health, and cost-effectiveness outcomes. We used a narrative synthesis with an adapted Delphi approach to identify common psychosocial interventions and theoretical mechanisms. The protocol was registered in PROSPERO. RESULTS: We included 48 publications on 38 unique ICCS samples (N = 16,546 adolescents; median age, 14.5 years) involving admission avoidance/home treatment, assertive outreach, and family preservation models. Meta-analysis of 11 unique RCTs (range, 297-1,294 participants per outcome) showed that, compared with TAU, ICCS yielded statistically significant improvements in psychosocial functioning (Hedges g = 0.15, 95% CI = 0.04, 0.26; 9 RCTs), reductions in inpatient admission days (-0.48 -0.82, -0.15; 4 RCTs), total emotional and behavioral problems (-0.15, -0.30, -0.01; 5 RCTs), and externalizing symptoms (-0.18, -0.30, -0.06; 6 RCTs) post treatment. The effect for psychosocial functioning increased and remained significant when comparing ICCS with inpatient care only (0.25, 0.04, 0.46; 5 RCTs). No significant differences were found for internalizing symptoms, family functioning, or total costs. The narrative synthesis showed that psychosocial interventions consistently included enhanced engagement strategies, cognitive- behavioral therapy, family systems approaches, and dialectical behavior therapy skills. CONCLUSION: For adolescents with severe mental health problems, ICCS yielded small but significant improvements in psychosocial functioning, and reductions in inpatient days and emotional and behavioral symptoms, while achieving comparable effects for other outcomes. Findings support the expansion of ICCS as a viable alternative to inpatient care. Future research should prioritize multisite RCTs and developing and evaluating standardized psychosocial intervention guidelines to enhance treatment fidelity and outcomes. STUDY REGISTRATION INFORMATION: Psychosocial interventions for young people with acute and complex mental health problems requiring intensive treatment: a systematic review and meta-analysis; https://www.crd.york.ac.uk/PROSPERO/view/CRD42024574885.
Precision Optimization of Behavioral Activation for Major and Subthreshold Depression: A Meta-Analysis of Exploring Dose-Response Relationships and Moderating Factors.
Huang X, Luo W, Luo J … +5 more , Zhang Y, Chen Y, Luo Y, Sun B, Zhou Y
J Am Acad Child Adolesc Psychiatry · 2026 Jan · PMID 41500406 · Publisher ↗
OBJECTIVE: This meta-analysis evaluated the efficacy of behavioral activation (BA) in adolescents with subthreshold depression (SD) or major depressive disorder (MDD), exploring dose-response relationships and moderating...
OBJECTIVE: This meta-analysis evaluated the efficacy of behavioral activation (BA) in adolescents with subthreshold depression (SD) or major depressive disorder (MDD), exploring dose-response relationships and moderating factors. METHOD: We searched PubMed, EMBASE, Web of Science, EBSCO, Scopus, and the Cochrane Library for randomized controlled trials (RCTs) through December 31, 2024. Risk of bias was assessed using RoB-2, and evidence quality with Grading of Recommendations Assessment, Development, and Evaluation (GRADE). Analyses were performed with R, using standardized mean difference (SMD) for continuous variables and meta-regression for dose-response relationships. Subgroup analyses included symptom severity, intervention setting, delivery format, and parental involvement. The primary outcome was the reduction in depressive symptoms (PROSPERO: CRD42023444273). RESULTS: A total of 14 studies were included (11 RCTs meta-analyzed, comprising 572 participants). BA demonstrated a moderate effect size compared to treatment-as-usual (SMD = -0.42) and a large effect size compared to no-treatment controls (SMD = -0.87). BA was more effective for mild depressive symptoms (SMD = -0.93) than severe symptoms (SMD = -0.43), with significant efficacy in university settings (SMD = -0.94). Intervention without parental involvement exhibited significantly larger effects than those with parental participation (SMD = -0.94 vs -0.38; p < .0001), although this finding was likely confounded by age, symptom severity, and intervention setting. BA moderately improved both behavioral activation levels and functioning (SMD = 0.49). CONCLUSION: Short-term, school-based BA is significantly beneficial for older adolescents with mild depressive symptoms. Findings provide practical guidance for optimizing BA implementation and highlight directions for future research, including the need for larger sample sizes, standardized follow-up assessments, and more representative samples. STUDY REGISTRATION INFORMATION: Precision Optimization of Behavioral Activation for Major and Subthreshold Depression: A Meta-Analysis of Exploring Dose-response Relationships and Moderating Factors; https://www.crd.york.ac.uk/PROSPERO/view/CRD42023444273. 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 sex and gender balance in our author group.
Transcriptional Signatures of Mitochondrial Metabolism Predict Esketamine-Induced rACC Structural Changes in Adolescent Major Depression.
Zhou Y, Li W, Lan X … +16 more , Wang C, Chen X, Luo Z, Zhang F, Liu G, Wu Z, Shen J, Chen Z, Zhu H, Liu X, Xue Y, Lu H, Zhang J, Sun X, Hashimoto K, Ning Y
J Am Acad Child Adolesc Psychiatry · 2025 Dec · PMID 41482174 · Publisher ↗
OBJECTIVE: To investigate neurobiological mechanisms through which esketamine produces rapid antidepressant effects in adolescents with major depressive disorder (MDD), focusing on structural changes in the rostral anter...
OBJECTIVE: To investigate neurobiological mechanisms through which esketamine produces rapid antidepressant effects in adolescents with major depressive disorder (MDD), focusing on structural changes in the rostral anterior cingulate cortex (rACC) and associated molecular pathways. METHOD: A total of 49 adolescents (13-18 years of age) with DSM-5 MDD were randomized to receive intravenous esketamine (0.25 mg/kg) or midazolam (0.02 mg/kg) over 5 days (3 infusions total) and were compared with 25 age-matched healthy controls. Structural magnetic resonance imaging scans were obtained at baseline and 24 hours post treatment to assess bilateral rACC surface area, volume, and thickness using FreeSurfer. Clinical symptoms were evaluated using the Hamilton Depression Rating Scale and Columbia-Suicide Severity Rating Scale. Transcriptomic-neuroimaging coupling analyses were performed using partial least squares regression on Allen Human Brain Atlas data, followed by gene set enrichment and protein-protein interaction analyses. RESULTS: At baseline, adolescents with MDD showed increased right rACC surface area compared with healthy controls (Cohen d = 0.47, 95% CI = 0.08, 1.02, p = .020). Following esketamine treatment, right rACC surface area decreased to levels comparable to those of healthy controls (Cohen d = 0.17, 95% CI = -0.41, 0.75, p = .523), showing a significant group by time interaction (F = 8.06, partial η = 0.15, p = .006). In the esketamine group, greater reductions in right rACC surface area were associated with larger decreases in Hamilton Depression Rating Scale scores (r = -0.44, 95% CI = -0.77, -0.09, p = .040). Partial least-squares regression analysis identified a brain-gene coupling component (r = 0.44, p = .008; p_spin = .018) enriched for pathways related to mitochondrial energy metabolism (oxidative phosphorylation: normalized enrichment score = 5.66, false discovery rate <0.001; tricarboxylic acid cycle: normalized enrichment score = 5.33, false discovery rate <0.001). Protein-protein interaction network analysis highlighted electron transport chain complexes I and V as central modules. CONCLUSION: Esketamine rapidly reduced elevated right rACC surface area in adolescents with MDD, and this structural change correlated with clinical improvement. Moreover, enhanced mitochondrial function-particularly oxidative phosphorylation and electron transport chain activity-may contribute to these structural and clinical effects, providing insight into the mechanisms underlying esketamine's antidepressant action. CLINICAL TRIAL REGISTRATION INFORMATION: A Study to evaluate the efficacy and safety of Esketamine combined with oral antidepressants in the treatment of major depressive disorder with suicidal ideation; https://www.chictr.org.cn/showproj.html?proj=66172 DIVERSITY & INCLUSION STATEMENT: We worked to ensure sex and gender balance in the recruitment of human participants. Diverse cell lines and/or genomic datasets were not available. We actively worked to promote sex and gender balance in our author group.
Meta-Analysis: Parenting Children and Adolescents With Attention-Deficit/Hyperactivity Disorder Compared to Healthy Controls.
Văidean T, Dobrean A, Predescu E … +2 more , Yap MBH, Georgescu RD
J Am Acad Child Adolesc Psychiatry · 2025 Dec · PMID 41478455 · Publisher ↗
OBJECTIVE: This systematic review and meta-analysis aimed to quantify differences in parenting practices between families of children with attention-deficit/hyperactivity disorder (ADHD) and typically developing controls...
OBJECTIVE: This systematic review and meta-analysis aimed to quantify differences in parenting practices between families of children with attention-deficit/hyperactivity disorder (ADHD) and typically developing controls. METHOD: We conducted a systematic review and meta-analysis of studies comparing parenting practices among children and adolescents (≤18 years) with a specialist-confirmed ADHD diagnosis and non-clinical controls. PubMed, PsycINFO, Web of Science, and Scopus were searched from inception through August 12, 2025, without language restrictions. Studies were eligible if they used validated instruments to assess at least one parenting dimension and reported comparative data. A total of 62 studies from 19 countries were included (N = 13,105; ADHD = 6,543; controls = 6,562). We computed pooled standardized mean differences (Hedges g) using random-effects models and evaluated heterogeneity (Q and I), 95% prediction intervals, and risk of bias (Newcastle-Ottawa Scale). Meta-regression and subgroup analyses examined potential moderators. RESULTS: Parents of children with ADHD showed significantly lower levels of positive parenting (g = -0.37, 95% CI = -0.46 to -0.27) and higher levels of negative parenting (g = 0.47, 95% CI = 0.39 to 0.56) than controls. The strongest effects were found for authoritative parenting (g = -0.56), warmth (g = -0.45), abuse (g = 0.60), family conflict (g = 0.52), and hostility (g = 0.51). Heterogeneity was high (I ≥ 90%), and no consistent moderators or small-study effects were identified. CONCLUSION: Parenting differs significantly between families of children with and without ADHD. Interventions should promote structured, warm, and non-coercive parenting. High heterogeneity and cross-sectional designs limit causal inference. STUDY REGISTRATION INFORMATION: Comparison between parenting factors in the upbringing of ADHD vs. non-ADHD children and adolescents: a systematic review and meta-analysis; https://www.crd.york.ac.uk/PROSPERO/view/CRD42024623095.
Editorial: We Need More Research on Youth Suicide.
Dickstein DP
J Am Acad Child Adolesc Psychiatry · 2025 Dec · PMID 41478454 · Publisher ↗
Whereas stigma and bias often lead people to dismiss the importance of youth mental health, the reality is that mental health care providers are striving to address the most common sources of morbidity and mortality worl...
Whereas stigma and bias often lead people to dismiss the importance of youth mental health, the reality is that mental health care providers are striving to address the most common sources of morbidity and mortality worldwide-specifically suicide. The World Health Organization identifies suicide as the third leading cause of death worldwide for people 15 to 29 years old. In the United States from 2016 to 2023, suicide was the second leading cause of death in children as young as 10 to young adults up to age 34. Completed suicide is just the tip of the iceberg-the Centers for Disease Control and Prevention Youth Risk Behavior Survey (YRBS) in 2023 of US high school students showed that during the past year, 20.4% experienced serious suicidal ideation, 18% made a suicide plan, 9.5% made a suicide attempt, and 2% sought medical care for suicide attempt..
A Neurodiverse Perspective on Autism Spectrum Disorder and the Medical Necessity of Applied Behavior Analysis.
Sush DJ, Lustig SL, Morrison LP
J Am Acad Child Adolesc Psychiatry · 2025 Dec · PMID 41456706 · Publisher ↗
Historically, autism spectrum disorder (ASD) has been conceptualized by clinicians, payers, researchers, and policymakers through a biomedical model. As with physical conditions, the biomedical model of disability emphas...
Historically, autism spectrum disorder (ASD) has been conceptualized by clinicians, payers, researchers, and policymakers through a biomedical model. As with physical conditions, the biomedical model of disability emphasizes pathology and characteristics associated with a diagnosis that result in deficits that impede functioning. Accordingly, funding and interventions aimed at supporting autistic individuals have targeted remediation of deficits, arguably to mirror the functioning of neurotypical peers. We describe and advocate for a neurodiversity framework in the context of the medical necessity of Applied Behavior Analysis (ABA) in support of autistic individuals and conclude with recommendations for delivering neurodiversity-affirming ABA.
Editors' Best of 2025.
Novins DK, Althoff RR, Brotman MA … +8 more , DelBello MP, Doyle AE, Fortuna LR, Fristad MA, Middeldorp CM, Njoroge WFM, Rogers CE, Singh MK
J Am Acad Child Adolesc Psychiatry · 2026 Jan · PMID 41455603 · Publisher ↗
There is, in the content of the Journal, an embarrassment of riches, and picking a "best" seems to demand a certain qualification: is the "best" the most interesting, most surprising, most educational, most important, mo...
There is, in the content of the Journal, an embarrassment of riches, and picking a "best" seems to demand a certain qualification: is the "best" the most interesting, most surprising, most educational, most important, most provocative, most enjoyable? How to choose? We are hardly unbiased and can admit to a special affection for the ones that we and the authors worked hardest on, modifying version after version into shape. Acknowledging these biases, here are the 2025 articles that we think most deserve your attention or at least a second read.
Presidential Address: Working Together-Innovating for Impact: A Call to Action to Address the Crisis in Children's Mental Health.
Walkup JT
J Am Acad Child Adolesc Psychiatry · 2026 Jan · PMID 41455602 · Publisher ↗
Abstract loading — click title to view on PubMed.
Examining Associations Between the Timing of Maternal Depressive Symptoms, Parenting Behaviors, and Child Outcomes.
Redic MM, Luby JL, Constantino-Pettit AM … +9 more , Triplett RL, Gerstein ED, Ruscitti M, Loseille D, Alexopoulos D, Smyser TA, Rogers CE, Smyser CD, Barch DM
J Am Acad Child Adolesc Psychiatry · 2025 Dec · PMID 41453734 · Publisher ↗
OBJECTIVE: Perinatal depression is associated with poor psychosocial functioning and impaired parent-child relationship quality and confers risk for offspring psychopathology and altered brain structure. This study inves...
OBJECTIVE: Perinatal depression is associated with poor psychosocial functioning and impaired parent-child relationship quality and confers risk for offspring psychopathology and altered brain structure. This study investigated the relative associations between the timing of perinatal depressive symptoms (prenatal, postnatal, and concurrent) and toddler psychopathology symptoms, toddler brain structure, and parenting behaviors. The study then explored whether parenting behaviors mediated relations between perinatal depressive symptoms and child psychopathology outcomes. METHOD: Using longitudinal data from 220 pregnant women and singleton offspring in the Early Life Adversity and Biological Embedding Study, associations from the first trimester of pregnancy to 3 years postpartum were examined. Linear mixed effect analyses examined associations between the timing of maternal depressive symptoms and toddler brain and behavioral development. The study also investigated whether maternal depressive symptoms were indirectly associated with psychopathology symptoms of children through parenting behaviors. The data included multiple time points of maternal depressive symptoms (prenatal, early postnatal, late postnatal, and concurrent) and children's outcomes (psychopathology symptoms and brain structure at ages 2 and 3 years), which allowed examination of dynamic associations within dyads. RESULTS: Higher levels of early postnatal maternal depressive symptoms, exceeding prenatal and concurrent depressive symptoms, were associated with greater externalizing symptoms in toddlers (β = .15, p = .02, q = .05). Nonsupportive parenting behaviors partially mediated these relations (p = .02) and were directly associated with greater externalizing symptoms in children (β = .14, p = .03). CONCLUSION: Findings suggest temporal differences in the relation of perinatal depressive symptoms to children's psychopathology. Specifically, postnatal maternal depressive symptoms were associated with toddlers' externalizing symptoms. Nonsupportive parenting behaviors partially explained these relations. These results emphasize the importance of early and accessible identification, intervention, and treatment of postnatal depressive symptoms. STUDY REGISTRATION INFORMATION: Investigating the Path From Prenatal Depression Through Parenting Behaviors to Offspring Internalizing Problems and Amygdala and Hippocampal Volume; https://osf.io/s3vma.
Typologies and Phenotypes of Youth Suicide Decedents.
Hale EW, Johnson RL, Cohan T … +2 more , Kelsay K, Stoddard JJ
J Am Acad Child Adolesc Psychiatry · 2025 Dec · PMID 41448487 · Publisher ↗
OBJECTIVE: Youth suicide continues to rise, yet prevention relies largely on adult-derived evidence. We aimed to identify data-driven phenotypes of youth suicide decedents to guide age-appropriate, targeted prevention an...
OBJECTIVE: Youth suicide continues to rise, yet prevention relies largely on adult-derived evidence. We aimed to identify data-driven phenotypes of youth suicide decedents to guide age-appropriate, targeted prevention and to highlight subgroups that current strategies may miss. METHOD: We conducted a cross-sectional latent class analysis of 10,442 youth 10 to 17 years of age who died by suicide recorded in the US National Violent Death Reporting System (2013-2022). A total of 35 demographic, circumstantial, toxicologic, and method variables were modeled in 2- to 10-class solutions; the optimal model was chosen using the Bayesian information criterion (BIC), Akaike information criterion (AIC), entropy, and interpretability. Class distributions by age, calendar year, and race/ethnicity were compared with χ and trend tests. RESULTS: A 5-class solution best fit the data. "Crisis" decedents (25%) experienced acute interpersonal or school crises without prior care. "Disclosing" (12.6%) had documented attempts, treatment, and recent intent disclosure. "Hidden" (21.2%) lacked recorded risk factors and had negative toxicology results. "Identified" (12.2%) was majority female and included more poisoning/asphyxia deaths. "Surveillance" (29%) showed pervasive missing data. Older adolescents clustered in the "Disclosing" class. The "Surveillance" class grew from 22% to 36% between 2013 and 2022 (p < .001). CONCLUSION: Nearly half of youth suicides occurred in groups with no clinical contact or with investigative data gaps, constraining treatment-centered prevention. Universal screening, safe firearm storage, crisis-oriented outreach, and strengthened death scene surveillance are needed to reach and understand these youth. STUDY REGISTRATION INFORMATION: Study Preregistration: Typologies and Phenotypes of Youth Suicide Decedents; https://doi.org/10.1016/j.jaac.2025.03.020.
Stratified Stepped-Care for Reducing Suicide Attempts and Self-Harm in Youth: A Randomized Clinical Trial.
Asarnow JR, Clarke GN, Firemark AJ … +5 more , Bedics J, Miranda J, Zhang L, Duan N, Comulada WS
J Am Acad Child Adolesc Psychiatry · 2025 Dec · PMID 41448486 · Publisher ↗
OBJECTIVE: Identifying effective approaches for reducing suicide attempts and self-harm is critical for preventing suicide deaths and self-harm-related morbidity. This study evaluated whether suicide attempts (SAs), self...
OBJECTIVE: Identifying effective approaches for reducing suicide attempts and self-harm is critical for preventing suicide deaths and self-harm-related morbidity. This study evaluated whether suicide attempts (SAs), self-harm, and related suicide-risk indicators are reduced when a stratified stepped-care for suicide prevention (SC-SP) intervention is added to health system quality improvement. METHOD: Youth selected for past-year suicidal behavior, active suicidal ideation, or previous suicide attempt and/or ≥3 non-suicidal self-injury (NSSI) episodes plus past-year depression (N = 301, ages 12-24 years) were randomized to one of the following: (1) health system Zero Suicide quality improvement (ZSQI) featuring system-level initiatives to improve suicide-risk screening and treatment access; or (2) ZSQI plus SC-SP, which triaged youths to suicide-specific treatments using care-stratification algorithms and a dialectical behavior therapy (DBT)-informed cognitive-behavior therapy (CBT) model, allowing for more intense care with higher and/or increased risk levels. Interviewers blinded to treatment assignment assessed outcomes at 3, 6, and 12-month follow-ups. RESULTS: Intent-to-treat (ITT) analyses included all randomized participants (95% with ≥1 follow-up assessment). Within SC-SP, 95% received ≥1 intervention contact; 90% were assigned a care level; and 96% received care in their original assigned care level. No significant between-group differences were found in 12-month SA rates (primary outcome) (SC-SP 8.09%; ZSQI 9.59%). Compared to ZSQI, at 12 months SC-SP youths showed significantly less total self-harm (relative risk = 0.46, 95% CI = 0.26, 0.79, p = .006, number needed to treat = 10.2) and depression (secondary outcomes), and greater satisfaction with care. No deaths were detected. CONCLUSION: Despite negative results for the primary outcome of SAs, results suggest the promise of SC-SP for reducing youth self-harm and depression and improving patient satisfaction with care. CLINICAL TRIAL REGISTRATION INFORMATION: Randomized Trial of Stepped Care for Suicide Prevention in Teens and Young Adults (Step2Health); https://www. CLINICALTRIALS: gov/study/NCT03092271.
When Groups Are Forgotten.
Schreiber J, Richards MC
J Am Acad Child Adolesc Psychiatry · 2026 May · PMID 41443504 · Publisher ↗
I sit on the Pharmacy and Therapeutics Committee for an insurance company in my area. I am the only child and adolescent psychiatrist and the only pediatrician on the Committee, so really, the only primary representative...
I sit on the Pharmacy and Therapeutics Committee for an insurance company in my area. I am the only child and adolescent psychiatrist and the only pediatrician on the Committee, so really, the only primary representative for children and adolescents. It is amazing how many medications we go through and how few have FDA-approved indications for kids. Some of the medications are for a diagnosis that would not have an impact on kids, but there are ones that should, and yet they are being presented to the Pharmacy and Therapeutics Committee only for adults. It is clear that there are more conditions affecting adults, so it isn't surprising to have more medications coming out for them, but sometimes it feels like kids are forgotten when it comes to the decision of developing the next medication to treat a different condition. During Committee meetings, I will ask why a medication is being considered only for adults, and the response is that they didn't do the trials for children. Although bringing a drug to market inevitably involves significant cost and effort, it still seems that when decisions were made about testing and approval, children were largely overlooked. This is why, as child and adolescent psychiatrists, we are advocates to make sure our patients aren't forgotten. It is also why we need to make sure that other groups who are often overlooked in medicine are not forgotten.
Editorial: Family Immigration to the United States and Children's Mental Health.
Bihani NR, Novins DK
J Am Acad Child Adolesc Psychiatry · 2026 Jun · PMID 41423044 · Publisher ↗
The article by Michel et al. in this month's issue of the Journal gives us the opportunity to consider the relationships between personal and familial immigration history, cultural identification, and experiences of disc...
The article by Michel et al. in this month's issue of the Journal gives us the opportunity to consider the relationships between personal and familial immigration history, cultural identification, and experiences of discrimination with child psychopathology. Prior research has examined these relationships, but many of these studies are focused on adults, use cross- sectional designs, and focus on these factors independently rather than in relationship to one another.
AI Chatbots and Youth Mental Health: Practical Recommendations for Clinicians.
Dvir Y, Moore PS, Kelly MM
J Am Acad Child Adolesc Psychiatry · 2025 Dec · PMID 41423043 · Publisher ↗
Digital technologies have reshaped child and adolescent development. Social media, once considered benign, has since been linked to adverse mental health outcomes. In 2023, the United States Surgeon General warned that s...
Digital technologies have reshaped child and adolescent development. Social media, once considered benign, has since been linked to adverse mental health outcomes. In 2023, the United States Surgeon General warned that social media poses a "profound risk of harm" to youth mental health..
Reimagining Juvenile Legal and Child Welfare Systems Involvement as a Structural Determinant of Health.
Bath E, Lee Whitman K, Liévano-Karim L … +3 more , Rodrigues CF, Howard TC, Langley AK
J Am Acad Child Adolesc Psychiatry · 2025 Dec · PMID 41423042 · Publisher ↗
The health and well-being of children and adolescents are deeply shaped by their social environments. Systems of care, including the child welfare system (CWS) and the juvenile legal system (JLS), play a significant role...
The health and well-being of children and adolescents are deeply shaped by their social environments. Systems of care, including the child welfare system (CWS) and the juvenile legal system (JLS), play a significant role in structuring health outcomes. However, the term "care" is not always synonymous with youths' experience, as these systems can also act as structural drivers of health inequity, contributing to negative health outcomes for youth and families. Systemic racism and disparate surveillance further intensify the development of adversities and reflect structural intersectionality, in that ethno-racially minoritized populations are both overrepresented in these systems and disproportionately experience worse health outcomes than their White system-involved peers..
Trends in Psychotropic Medication Use, Polypharmacy, and Potential Major Drug-Drug Interactions Among US Youth.
Meng LC, Leonard CE, Candon M … +2 more , Mandell DS, Hennessy S
J Am Acad Child Adolesc Psychiatry · 2025 Dec · PMID 41423041 · Publisher ↗
OBJECTIVE: This study aims to assess trends in psychotropic medication use and polypharmacy, to investigate clinical indications for use, and to evaluate the prevalence of potential contraindicated or major drug-drug int...
OBJECTIVE: This study aims to assess trends in psychotropic medication use and polypharmacy, to investigate clinical indications for use, and to evaluate the prevalence of potential contraindicated or major drug-drug interactions (DDIs) among US residents 6 to 24 years of age. METHOD: We conducted a descriptive, repeated cross-sectional study using nationally representative data from the US National Health and Nutrition Examination Survey (NHANES) collected between 2001 and March 2020. Participants were stratified into children (6-11 years), adolescents (12-19 years), and young adults (20-24 years). Psychotropic medication use, including stimulants, antidepressants, antipsychotics, and benzodiazepine-related drugs, was assessed based on reported use within the past 30 days, and psychotropic polypharmacy as the concurrent use of 2 or more psychotropic medications. Trends were evaluated using survey-weighted linear regression across 4-year intervals, with 95% confidence intervals. Reported indications were analyzed separately for each age group. Potential DDIs among psychotropic medications were identified using Micromedex. RESULTS: Psychotropic medication use among youth increased from 5.3% in 2001-2004 to 8.3% in 2017-March 2020 (adjusted time trend: 0.7 percentage points over 4 years; 95% CI: 0.3-1.1), with statistical increases observed among children and young adults, driven mainly by stimulants. Psychotropic polypharmacy prevalence rose from 1.8% to 3.3% during the same period (adjusted time trend: 0.3 percentage points; 95% CI: 0.01-0.5). Reported indications for psychotropic medication use varied by age, with neurodevelopmental conditions more common in children, and depression, anxiety, or bipolar disorders more common in young adults. Among psychotropic medication users, 26.0% were exposed to potential contraindicated or major DDIs, mainly from antipsychotics and antidepressants. CONCLUSION: Psychotropic medication use increased in specific subgroups of US youth from 2001 to March 2020, most notably among children and young adults. A quarter of psychotropic medication users were exposed to potential contraindicated or major DDIs. These findings underscore the need for further real-world research focusing on medication safety, effectiveness, and DDI risks of psychotropic medications in youth populations to inform safer and more effective treatment strategies. 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.
Attention-Deficit/Hyperactivity Disorder Treatment Patterns and Association With Clinical Outcomes in Adolescents and Young Adults with Co-occurring Attention-Deficit/Hyperactivity Disorder and Substance Use Disorder: A Retrospective Analysis.
Baweja R, Waschbusch DA, Padilla FM … +6 more , Baweja R, Singh B, Pelham WE, Molina BSG, Wilens TE, Waxmonsky JG
J Am Acad Child Adolesc Psychiatry · 2025 Dec · PMID 41421461 · Full text
OBJECTIVE: This study evaluated the impact of co-occurring SUD on ADHD treatment patterns and examined clinical outcomes associated with ADHD treatment in adolescents and young adults with both ADHD and SUD. METHOD: This...
OBJECTIVE: This study evaluated the impact of co-occurring SUD on ADHD treatment patterns and examined clinical outcomes associated with ADHD treatment in adolescents and young adults with both ADHD and SUD. METHOD: This retrospective cohort study used TriNetX US Collaborative Network data on 1.23 million individuals 15 to 25 years of age who were diagnosed with ADHD from 2007 to 2024. About 23% (n = 288,159) had co-occurring SUD. Prescription patterns for ADHD medications and associated clinical outcomes were analyzed over 1 year. Relative risks (RRs), hazard ratios (HRs), and 95% CIs were calculated using propensity score matching and Cox proportional hazards models to adjust for confounders. RESULTS: Central nervous system (CNS) stimulant prescriptions were less frequent in the ADHD with SUD cohort (RR = 0.63, 95% CI = 0.62-0.63), whereas new bupropion prescriptions were slightly more frequent (RR = 1.05, 95% CI = 1.02-1.08) compared with ADHD without SUD. In ADHD with SUD, ADHD treatment (including prescriptions for CNS stimulants and nonstimulants) was associated with fewer hospitalizations, reduced emergency care, lower risk of suicidal ideation/attempts (range of RRs = 0.74-0.82), and continuous use of psychiatric services (RR = 1.23), but fewer methadone prescriptions (RR = 0.74). Compared with nonstimulants, stimulant treatment was associated with fewer hospitalizations, accidental overdoses, and suicidal ideation/attempts (range of RRs = 0.63-0.79). Overall, ADHD treatment was associated with a 30% lower risk of mortality (aHR = 0.70, 95% CI = 0.65-0.75). CONCLUSION: Clinicians appear to be hesitant to prescribe CNS stimulants in the context of SUD; however, these findings align with clinical trials suggesting potential benefits of ADHD medication for individuals with co-occurring SUD. Bridging the gap between clinical practice and the evidence base will require ongoing research, clinician education, and policy change.
Nonfatal Drug Overdose in a National Sample of Adolescents by Intent and Substance, Medicaid 2016-2020.
Bushnell G, Olfson M, Calello DP … +3 more , Lloyd K, Zhu Y, Samples H
J Am Acad Child Adolesc Psychiatry · 2025 Dec · PMID 41418933 · Full text
OBJECTIVE: To estimate the prevalence and patterns of drug overdoses in adolescents presenting to an inpatient or emergency department setting by substance and intent in a national sample of Medicaid enrollees. METHOD: N...
OBJECTIVE: To estimate the prevalence and patterns of drug overdoses in adolescents presenting to an inpatient or emergency department setting by substance and intent in a national sample of Medicaid enrollees. METHOD: National Medicaid administrative claims data covering publicly insured adolescent (12-18 years old) enrollees from 2016 to 2020 were analyzed. Drug overdose was defined by an inpatient or emergency department poisoning code (ICD-10-CM T36-T50) for intentional, unintentional, or undetermined intent. Per calendar year, we estimated the prevalence of adolescents with a drug overdose among all eligible adolescent enrollees (≥10 months enrollment) overall and by patient demographics, intent, and substance involvement. RESULTS: The annual sample of eligible adolescents ranged from 8.9 million (2016) to 10.9 million (2020). The average annual prevalence of any treated drug overdose was 0.41%, with minimal variation from 2016 (0.42%) to 2020 (0.40%). Prevalence varied by intent (intentional: 0.28%; unintentional: 0.17%, undetermined: 0.04%), sex, age, race and ethnicity, and, foster care status. Among adolescents with any intentional overdose claim, nonopioid analgesics (35.7%), antidepressants (21.6%), antipsychotics (9.8%), benzodiazepines (4.9%), and antiepileptics and other sedatives (6.0%) were most commonly involved. Cannabis (9.3%), benzodiazepines (8.4%), opioids (6.1%), and stimulants (5.2%) were more often involved in adolescents with any unintentional overdose claim. From 2016 to 2020, unintentional overdoses increased involving opioids (from 0.009% to 0.015%) and cannabis (from 0.012% to 0.017%). CONCLUSION: While the prevalence of treated drug overdose was relatively stable from 2016 to 2020 among adolescent Medicaid enrollees, important patterns by substance, intent, and demographics were identified that will be key to reducing overdose morbidity and mortality in this young population.
Editorial: Genetic Predisposition to Attention-Deficit/Hyperactivity Disorder Increases the Risk of Emotional and Behavioral Difficulties.
Mulligan A
J Am Acad Child Adolesc Psychiatry · 2026 Apr · PMID 41407034 · Publisher ↗
Our understanding of the clinical impact and the long-term risks of having attention-deficit/hyperactivity disorder (ADHD) has improved recently, with large-scale epidemiological studies showing that individuals with ADH...
Our understanding of the clinical impact and the long-term risks of having attention-deficit/hyperactivity disorder (ADHD) has improved recently, with large-scale epidemiological studies showing that individuals with ADHD are at increased risk of suicidal behavior, educational underachievement, substance misuse, and car accidents, as well as at increased risk of psychiatric disorders such as depression, bipolar disorder, and anxiety disorder. It may be that having ADHD predisposes to educational underachievement and adversity later in life and thus predisposes to the development of other psychiatric disorders. However, in this month's issue of the Journal, Alemany et al. report that they found an association between emotional and behavioral difficulties in childhood and the genetic risk for ADHD and that the genetic risk for ADHD was more important in determining emotional and behavioral difficulties than the genetic risk for other disorders including anxiety and depression.
Developmental Trajectories of Autistic Social Traits in Youth Born Extremely Preterm.
McFayden TC, Harrop C, Roell KR … +4 more , Joseph RM, Frazier JA, Fry RC, O'Shea TM
J Am Acad Child Adolesc Psychiatry · 2025 Dec · PMID 41344423 · Full text
OBJECTIVE: Autistic social traits (ASTs), evident in the general population, are associated with mental health challenges. ASTs have not been evaluated in youth born extremely preterm (EP), despite their increased preval...
OBJECTIVE: Autistic social traits (ASTs), evident in the general population, are associated with mental health challenges. ASTs have not been evaluated in youth born extremely preterm (EP), despite their increased prevalence of autism. The current research evaluates AST change from 10 to 17 years in a well-characterized sample of EP youth, including sex differences and associations with health and quality of life. METHOD: Participants included 527 EP youth (n = 275 female, 67.8% White), assessed at 10 and 17 years, from the Extremely Low Gestational Age Newborn (ELGAN) Study. Adolescents were born at an average of 26 weeks gestation. ASTs were parent-reported via the Social Responsiveness Scale at 10 and 17 years. Adolescents self-reported quality of life, health, and psychopathology at 17 years. AST change scores were calculated to evaluate change over time. AST change scores and increasing, decreasing, and stable trajectories were analyzed in relation to sex and quality-of-life scores. RESULTS: ASTs in EP youth increased an average of 19 raw points from age 10 to 17 years, reflecting a change of 8 standardized points and a change in qualitative description from the "normal" to "mild concern" range. The majority of youth (70%) exhibited an "Increasing" trajectory, reflecting increasing AST as a preterm phenotype. No sex differences emerged in AST change score or trajectory group. Higher AST change scores were associated with worse adolescent-reported health, self-esteem, and externalizing psychopathology. CONCLUSION: Increasing ASTs were consistent in this sample of EP youth. Increases in ASTs were not associated with child's sex or demographics, suggesting a unique preterm phenotype of social trajectories. These findings have implications for quality of life as adolescents enter young adulthood.
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