J Am Acad Child Adolesc Psychiatry [JOURNAL]
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200 papers
Editorial: Early Metabolic Drivers of Neurodevelopmental Disorders: Potential Pathways to Early Detection and Novel Interventions.
Frye RE
J Am Acad Child Adolesc Psychiatry · 2026 Jul · PMID 41338336 · Publisher ↗
The origins of neurodevelopmental disorders (NDDs) such as autism spectrum disorder (ASD) and attention-deficit/hyperactivity disorder (ADHD) remain complex and incompletely understood. ASD, for instance, is paradoxicall...
The origins of neurodevelopmental disorders (NDDs) such as autism spectrum disorder (ASD) and attention-deficit/hyperactivity disorder (ADHD) remain complex and incompletely understood. ASD, for instance, is paradoxically both highly heritable and strongly associated with de novo (ie, non-inherited) genetic mutations, with hundreds of genes implicated to date. This pattern suggests that broader, system-level mechanisms may contribute to the pathophysiology of NDDs and their heritability. Emerging evidence indicates that disruptions in critical cellular biochemical pathways may represent shared biological foundations across these disorders..
Editorial: Early Identification of Developmental Delays: Are Two-Stage Screeners the Next Logical Step?
Cibralic S, Eapen V
J Am Acad Child Adolesc Psychiatry · 2026 Jul · PMID 41319727 · Publisher ↗
Early detection of developmental delays along with early intervention and supports offer the most promise for better outcomes for children, including improved motor, cognitive, and socioemotional outcomes. The terms deve...
Early detection of developmental delays along with early intervention and supports offer the most promise for better outcomes for children, including improved motor, cognitive, and socioemotional outcomes. The terms developmental delay and developmental vulnerability (hereafter developmental delay) are frequently used to refer to children who show delay in achieving one or more milestones in the developmental domains of fine and gross motor, speech and communication, and cognitive skills, and socioemotional competence. Although developmental delays disproportionately affect children from the most disadvantaged backgrounds, appropriate intervention and supports are known to improve outcomes and to be cost-effective. With strong evidence supporting early identification and intervention, the American Academy of Pediatrics introduced the Brighter Future guidelines, recommending that developmental surveillance and screening be implemented at routine well-child visits, which has since been adopted by policy bodies internationally..
Enhancing Emotion Regulation and Brain Connectivity in Adolescent Girls Through Parental Emotion Socialization: A Randomized Controlled Trial.
Zhao J, Pozzi E, Lin SC … +5 more , Kehoe CE, Havighurst SS, Schwartz OS, Yap MBH, Whittle S
J Am Acad Child Adolesc Psychiatry · 2025 Nov · PMID 41318087 · Publisher ↗
OBJECTIVE: Parental emotion socialization is theorized to influence adolescent emotion regulation. However, the causal nature of this relation and the underlying neural mechanism have not been investigated. METHOD: An em...
OBJECTIVE: Parental emotion socialization is theorized to influence adolescent emotion regulation. However, the causal nature of this relation and the underlying neural mechanism have not been investigated. METHOD: An emotion-focused parenting intervention targeting emotion socialization was used to experimentally manipulate parental emotion socialization and investigate its effect on emotion regulation and emotion regulation-related neural functional connectivity in early adolescent girls with elevated internalizing symptoms. This study recruited 70 adolescent girls 10 to 12 years old with elevated internalizing symptoms and their mothers. Mothers were randomized to the intervention group (n = 35) or the waitlist control group (n = 35). The Tuning in to Teens emotion-focused parenting intervention was delivered in eight 1-hour weekly sessions to mothers. Adolescent emotion regulation was assessed using mother and adolescent reports at preintervention and at 6-month follow-up. Adolescent emotion regulation-related brain functional connectivity during functional magnetic resonance imaging tasks was measured at the same time points. RESULTS: Analysis included 60 dyads (intervention: n = 30; waitlist: n = 30). Relative to control adolescents, adolescents in the intervention group showed increased insula-supplementary motor area and insula-precuneus functional connectivity from preintervention to 6-month follow-up and improved mother-reported adolescent emotion regulation. CONCLUSION: Findings provide causal evidence that parental emotion socialization enhances emotion regulation capacity in adolescent girls at risk of internalizing disorders. CLINICAL TRIAL REGISTRATION INFORMATION: Using a Parenting Program Intervention (Tuning into Teens (TINT)) to Investigate the Causal Effect of Parenting Behaviour on the Neurodevelopmental Correlates of Emotion Regulation in Adolescents; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=382000&isReview=true. 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 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. 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.
Editorial: Rigorous Methods Matter: Reassessing Acetaminophen Safety in Pregnancy.
Coghill D
J Am Acad Child Adolesc Psychiatry · 2026 Apr · PMID 41308734 · Publisher ↗
Bérard and colleagues have conducted a very well-designed and carefully conducted systematic review and meta-analysis evaluating acetaminophen use in pregnancy and child neurodevelopment risk in the offspring. From a sci...
Bérard and colleagues have conducted a very well-designed and carefully conducted systematic review and meta-analysis evaluating acetaminophen use in pregnancy and child neurodevelopment risk in the offspring. From a science perspective, this is an important topic, as acetaminophen (paracetamol in many countries) is used by up to 70% of women during pregnancy. Politically, the focus has been ramped up following an announcement by the US Food and Drug Administration (FDA) that they had initiated the process for a safety label change for acetaminophen because of a potential association between acetaminophen use during pregnancy and adverse neurodevelopmental outcomes..
A Prospective Examination of the Predictive Validity of Three Transdiagnostic Assessments of Risk for Suicidal Behavior: Psychache, the Interpersonal Theory of Suicide, and Reasons for Living.
Paul BT, Greeno C, Ryan ND … +5 more , Tsui FR, Gibbons RD, Porta G, Joiner T, Brent D
J Am Acad Child Adolesc Psychiatry · 2025 Nov · PMID 41308733 · Publisher ↗
OBJECTIVE: To assess the predictive validity (PV) of Psychache, the Interpersonal Theory of Suicide (IPTS), and Reasons for Living (RFL) regarding future suicide attempts (SA) in youth. METHOD: A total of 827 youth, aged...
OBJECTIVE: To assess the predictive validity (PV) of Psychache, the Interpersonal Theory of Suicide (IPTS), and Reasons for Living (RFL) regarding future suicide attempts (SA) in youth. METHOD: A total of 827 youth, aged 12 to 24 years, were assessed at baseline; 652 had at least 1 follow-up a mean of 27 weeks after intake. Participants were patients at the University of Pittsburgh Medical Center who sought mental health care within the previous month. Of the participants, 78% presented with suicidal ideation or behavior. The primary outcome was an SA during follow-up. Participants were administered scales for Psychache, the 3 constructs of the IPTS (Thwarted Belongingness, Perceived Burdensomeness, Acquired Capability for Suicidal Behavior), and RFL. The PV of each construct was assessed using the area under the receiver operating characteristic curve (AUROC), after adjusting for age and sex, and then additionally controlling for past SA/suicidal behavior (SA/SRB) and the Kiddie Computerized Adaptive Test-Suicide Scale (K-CAT-SS, a computerized adaptive test for SA risk) score. RESULTS: Age, sex, history of SA/SRB, and the K-CAT-SS were the most parsimonious set of demographic and clinical predictors of SA (AUROC = 0.844). The age and sex-adjusted PVs for all 3 transdiagnostic frames were also high (AUROCs from 0.813 to 0.830), not significantly different from the clinical predictors' AUROC, and predicted SA after adjusting for history of SA/SRB. After adding the K-CAT-SS to the regression, only Acquired Capability for Suicidal Behavior still predicted SA. SA/SRB history and the K-CAT-SS added to predictive power of IPTS and RFL, but not Psychache. CONCLUSION: Measures of Psychache, IPTS, and RFL are strongly predictive of SA, and delineate malleable treatment targets for suicidal youth.
Cross-Setting Replication of the Associations Between Maternal Health and Autism.
Khachadourian V, Anderson M, Arildskov ES … +7 more , Grove J, Reichenberg A, Sandin S, Schendel D, Hansen SN, Croen LA, Janecka M
J Am Acad Child Adolesc Psychiatry · 2025 Nov · PMID 41275908 · Full text
OBJECTIVE: Autism spectrum disorder (ASD) is a neurodevelopmental condition with early-life origins. Maternal health conditions during pregnancy have been linked to autism risk, but most studies have focused on single po...
OBJECTIVE: Autism spectrum disorder (ASD) is a neurodevelopmental condition with early-life origins. Maternal health conditions during pregnancy have been linked to autism risk, but most studies have focused on single populations, thus limiting generalizability. We examined whether associations previously reported in a Danish registry-based study were similar in a US cohort. METHOD: We analyzed electronic health records of children born between 2010 and 2017 at Kaiser Permanente Northern California (KPNC), along with their mothers. Maternal diagnoses were classified as chronic or non-chronic. Associations with ASD in the child were assessed using Cox models, adjusting for sociodemographic factors, health care use, and comorbid maternal diagnoses. Methods were aligned with the Danish study for comparability. RESULTS: Among 224,353 children in the KPNC cohort, 5,448 (2.4%) were diagnosed with autism. Of the 42 maternal diagnoses significantly associated with autism in Denmark, 38 were evaluable in KPNC, and 18 remained statistically significant after adjustment. Most associations had point estimates consistent with the Danish study, particularly psychiatric and cardiometabolic conditions. CONCLUSION: Despite demographic and health care differences, 35 of the 38 associations found in the Danish study replicated qualitatively (direction of effect) in the US cohort, suggesting robust cross-setting relevance. Further research is needed to explore underlying mechanisms and effect modifiers.
Editorial: Recognizing Atypical Depression in Youth: Advancing Precision Diagnosis.
Singh B
J Am Acad Child Adolesc Psychiatry · 2026 May · PMID 41274553 · Full text
Depression is a growing public health crisis, affecting millions worldwide. Recent data indicate that 13% of individuals aged 12 and older experience depression, with the prevalence highest in adolescents aged 12 to 19 y...
Depression is a growing public health crisis, affecting millions worldwide. Recent data indicate that 13% of individuals aged 12 and older experience depression, with the prevalence highest in adolescents aged 12 to 19 years. Its marked heterogeneity-spanning symptoms, clinical courses, and biological mechanisms-drives variability in treatment response. Addressing this challenge requires identifying precise phenotypes or biologically informed subtypes. The Research Domain Criteria (RDoC) framework, developed by the National Institute of Mental Health, offers a strategy to define such subtypes, revealing distinct biological signatures and differential treatment responses and advancing the promise of precision psychiatry..
Comparative BMI-z Changes With Initiation and Adherence to Antidepressant Medications Among Youth.
Rifas-Shiman SL, Young JG, Yu H … +11 more , Daley MF, Heerman WJ, Janicke DM, Jones WS, Lewis KH, Lin PD, Prentice C, Bailey LC, Toh S, Petimar J, Block JP
J Am Acad Child Adolesc Psychiatry · 2025 Nov · PMID 41274552 · Publisher ↗
OBJECTIVE: To estimate effects of initiating and subsequently adhering to different antidepressant medications on average BMI-z (a standardized measure of BMI relative to peers of the same age and sex) changes among yout...
OBJECTIVE: To estimate effects of initiating and subsequently adhering to different antidepressant medications on average BMI-z (a standardized measure of BMI relative to peers of the same age and sex) changes among youth by emulating a target trial. METHOD: We analyzed electronic health records (2010-2019) from 11 US health care systems, including 67,039 patients aged 5 to <19.5 years. Using prescription data, we assessed initiation and adherence to sertraline, fluoxetine, escitalopram, citalopram, or bupropion. The primary outcome was mean 12-month BMI-z change; the secondary outcome was 6-month change. We applied inverse probability weighting of marginal structural models to estimate population-level effects, adjusting for baseline and time-varying covariates. We estimated both absolute and sertraline-relative BMI-z changes. Secondary analyses evaluated effects of medication initiation alone, regardless of adherence. RESULTS: At 12 months, we estimated a mean BMI-z gain of 0.10 units (95% CI = 0.02, 0.16) for sertraline, 0.18 (95% CI = 0.01, 0.32) for citalopram, 0.18 (95% CI = 0.07, 0.27) for escitalopram, 0.18 (95% CI = 0.11, 0.23) for fluoxetine, and -0.06 (95% CI = -0.23, 0.09) for bupropion, had all patients initiated and adhered to these medications. When compared to sertraline, initiation and adherence to bupropion resulted in a lower mean BMI-z of -0.15 (95% CI = -0.32, 0.02). No other medications were associated with statistically significantly different BMI-z changes compared to sertraline. The results were similar for 6-month outcomes. Results of initiation-only analyses were consistent with these results, although the effect estimates were attenuated. CONCLUSION: Among youth, initiation and adherence to bupropion was not associated with 12-month BMI-z change, although 4 other most common antidepressants were associated with small increases in BMI-z over this time. Clinicians should consider these differences when prescribing antidepressants to youth, alongside US Food and Drug Administration approvals, clinical guidelines, and evidence of safety and efficacy.
Editorial: Elevating the Evidence and Promoting Accessibility of Parent-Child Interaction Therapy-Emotion Development for Preschool Age Children.
Stewart SM, Dieste S
J Am Acad Child Adolesc Psychiatry · 2026 May · PMID 41274551 · Publisher ↗
Parent-Child Interaction Therapy (PCIT) was developed for externalizing disorders in school-aged children and was influenced both by social learning theory and attachment theory. Taking a 2-step approach, it aims to deve...
Parent-Child Interaction Therapy (PCIT) was developed for externalizing disorders in school-aged children and was influenced both by social learning theory and attachment theory. Taking a 2-step approach, it aims to develop parental management skills such as clear communication and limit setting to reduce behavior problems, and relationship skills to enhance nurturance. PCIT has been adapted for various internalizing disorders and for preschool-aged children. Joan Luby and her colleagues developed PCIT-ED, which condensed the original 8-session PCIT program to 6 sessions and added an 8-session Emotion Development (ED) module targeting the child's emotional awareness and regulation. Consistent with the tenets of PCIT, this program equips parents with tools to support the emotional development of their children. In this month's issue of the Journal, Elansary et al. investigated the long-term outcomes of PCIT-ED among a sample of 105 preschool-aged children. Earlier investigations of the same cohort demonstrated higher remission rates and reduced depression symptoms compared to waitlist controls, as well as decreased parenting stress and parental depression at the end of treatment. Treatment gains were sustained in many areas at 3-month follow-up. Our comment is focused on the following: (1) the next steps for establishing the efficacy of PCIT for preschool depression, (2) how the challenges of dissemination of the intervention to a larger population might be met, and (3) considerations for the next generation of early life interventions.
Altered Processing of Auditory Distractions Under Competing Inputs in Children With Attention-Deficit/Hyperactivity Disorder.
Kong Y, Yuan X, Sun L … +6 more , Dang C, Wang Y, Huang J, Guo J, Jensen O, Song Y
J Am Acad Child Adolesc Psychiatry · 2026 Jul · PMID 41241082 · Full text
OBJECTIVE: Children with attention-deficit/hyperactivity disorder (ADHD) have difficulties filtering irrelevant information, particularly when faced with competing inputs. These challenges may affect auditory distraction...
OBJECTIVE: Children with attention-deficit/hyperactivity disorder (ADHD) have difficulties filtering irrelevant information, particularly when faced with competing inputs. These challenges may affect auditory distraction processing, especially under varying demands on visual attention. This study investigated the neural mechanisms underlying auditory distraction processing under these conditions in ADHD. METHOD: We recorded electroencephalography (EEG) signals from 51 children with ADHD and 48 typically developing (TD) children during the performance of a visual detection task with simultaneous irrelevant auditory stimuli under varying demands on visual attention. RESULTS: TD children presented a significant decrease in mismatch negativity (MMN) amplitude with increasing visual attention demands. However, this effect was absent in children with ADHD, who instead exhibited an enhanced P3a response and earlier MMN and P3a latencies in response to auditory changes. Moreover, a shorter MMN latency predicted more severe inattention symptoms, whereas a larger MMN amplitude predicted more severe hyperactivity/impulsivity symptoms in children with ADHD. Time-frequency analysis revealed greater frontal theta intertrial phase coherence (ITPC) and power in response to task-irrelevant auditory changes in children with ADHD than in TD children. CONCLUSION: The absence of attention-demand modulation in MMN amplitude and an increased P3a response indicate atypical auditory distractibility in children with ADHD, with earlier MMN and P3a latencies suggesting excessive sensitivity to auditory distractions. Increased frontal theta ITPC and power reflect stronger neural synchronization and response to auditory distractions. Importantly, MMN amplitude and latency are linked to different aspects of ADHD symptoms. These findings provide new neurophysiological insights into altered auditory distraction processing in children with ADHD. PLAIN LANGUAGE SUMMARY: Children with attention-deficit/hyperactivity disorder (ADHD) have difficulties filtering irrelevant information when faced with competing signals. In this study, the authors recorded brain activity from 51 children with and 48 without ADHD while they focused on a visual task with distracting sounds. Children without ADHD showed reduced brain responses to sounds when the visual task became more demanding, whereas children with ADHD showed strong and faster responses that increased with symptom severity. These findings suggest children with ADHD struggle to adjust focus when faced with competing information, explaining their distractibility in daily life. 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. 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.
Perspectives on Psychodynamic Psychotherapy Training and Future Directions: A National Survey of Child and Adolescent Psychiatry Fellowship Directors.
Herkert D, Race JN, Lafont E … +2 more , Lynch ST, Rice T
J Am Acad Child Adolesc Psychiatry · 2026 Jul · PMID 41232828 · Publisher ↗
Psychodynamic psychotherapy is deeply rooted within the child and adolescent psychiatry (CAP) training tradition, though its future is uncertain. Competency in psychodynamic psychotherapy remains an Accreditation Council...
Psychodynamic psychotherapy is deeply rooted within the child and adolescent psychiatry (CAP) training tradition, though its future is uncertain. Competency in psychodynamic psychotherapy remains an Accreditation Council for Graduate Medical Education (ACGME) requirement, and most CAP program directors (PDs) highlight the importance of preserving and promoting psychotherapy training. However, significant challenges, including limited psychodynamic supervisor availability, strain opportunities for the next generation of learners. Regardless of interest in psychodynamic psychotherapy, all child and adolescent psychiatrists should be interested in what is essential to the identity and function of a child and adolescent psychiatrist as established through training. Given trends eschewing psychotherapy training-specifically psychodynamic psychotherapy-despite continued interest in preserving and promoting these skills by CAP PDs, we assessed psychodynamic psychotherapy training practices in CAP programs across the United States.
Editorial: Centanafadine for Adolescents With Attention-Deficit/Hyperactivity Disorder: Is a Broader Mechanism of Action Better?
Stein MA
J Am Acad Child Adolesc Psychiatry · 2026 Jun · PMID 41207614 · Publisher ↗
Attention-deficit/hyperactivity disorder (ADHD) is among the most prevalent disorders in adolescents. A recent survey found that 13.6% of 12- to 17-year-olds in the United States have a diagnosis of ADHD. Many children w...
Attention-deficit/hyperactivity disorder (ADHD) is among the most prevalent disorders in adolescents. A recent survey found that 13.6% of 12- to 17-year-olds in the United States have a diagnosis of ADHD. Many children who are diagnosed with ADHD continue to meet ADHD diagnostic criteria as teenagers; other youth are diagnosed later due to a variety of factors, including prominent comorbid conditions, stigma, and limited awareness or detection in youth who show only inattention. More than half of adolescents with ADHD are treated with medication, with many receiving medication alone. Multimodal treatment is recommended because of the complementary benefits of pharmacotherapy on core ADHD symptoms and cognitive-behavioral interventions that target impairments. Compared with children, maintenance of pharmacotherapy is more difficult in adolescents due to nonadherence or early discontinuation. As a result, a new medication with an improved risk-to-benefit ratio, especially one that addresses more than core ADHD symptoms and adolescent-specific issues, represents a significant advance.
Editorial: Persistent Challenges in Addressing the Mental Health Needs of Autistic People and a Suggested Way Forward.
Witwer AN, Wallace JN
J Am Acad Child Adolesc Psychiatry · 2025 Oct · PMID 41177355 · Publisher ↗
It is well documented that autistic people are at an increased risk for co-occurring mental health challenges and suicide. There is also a robust and ever-growing body of literature delineating the challenges of meeting...
It is well documented that autistic people are at an increased risk for co-occurring mental health challenges and suicide. There is also a robust and ever-growing body of literature delineating the challenges of meeting the varied mental health needs of autistic children, adolescents, and adults-most notably, access to efficacious treatments. For those who are able to access services, there are concerns about ableism and the failure of clinicians to understand how autistic characteristics may interact with mental health presentation and treatment response. Access difficulties are exacerbated by the general lack of disability- and autism-related content in curricula of preprofessional programs, resulting in a workforce who report being ill prepared to work with this population. It is imperative to have evidence-based mental health treatments. Equally important is the method by which such treatments are developed, studied, and disseminated. The autism community has identified key considerations for researchers who study treatment development, implementation, and dissemination. Most notable is the inclusion of and collaboration with autistic people, from all stages of research, treatment conceptualization through dissemination, and examining outcomes that matter to them. The emergence of rigorous randomized controlled trials (RCTs) such as those by White et al. are a strong step forward in addressing issues about efficacious treatment, as well as inclusion of the autistic community. As such, the White et al. study can serve as a model for others. Furthermore, the research community needs to diversify the composition of study participants, and as a field we need to turn more focus toward dissemination and training, both of which are imperative for improving access.
Systematic Review and Meta-Analysis: The Associations of Prenatal Exposure to SARS-CoV-2 Infection and COVID-19 Vaccination With Child Neurodevelopment.
Rizzo M, Tubassum R, Kaplan CA … +6 more , Konde M, Martin L, Gigase F, de Witte L, Bergink V, Rommel AS
J Am Acad Child Adolesc Psychiatry · 2025 Oct · PMID 41173090 · Full text
OBJECTIVE: To systematically review and meta-analyze evidence on the associations between prenatal exposure to severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection or COVID-19 vaccination and child neur...
OBJECTIVE: To systematically review and meta-analyze evidence on the associations between prenatal exposure to severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection or COVID-19 vaccination and child neurodevelopmental outcomes. METHOD: MEDLINE, EMBASE, PsycINFO, Web of Science, Scopus, and Cochrane CENTRAL databases were searched for original research on neurodevelopmental outcomes in children prenatally exposed to SARS-CoV-2 infection and COVID-19 vaccination published in any language before November 8, 2024. Meta-analyses were performed on any outcome reported in ≥3 controlled studies. RESULTS: A total of 70 studies were identified on neurological (7), neuroimaging (12), motor (3), audiological (29), and neurodevelopmental (35) assessments and neurodevelopmental disorders (2) with median sample sizes of 117 (interquartile range: 44-340) and follow-up ≤36 months. Meta-analyses of neonatal auditory screenings (10), Ages and Stages Questionnaire, 3rd Edition (9), and Ages and Stages Questionnaire: Social-Emotional (3) data suggested a higher risk of transient hearing impairment (risk ratio 2.01, 95% CI 1.39-2.91) and delays in fine motor (risk ratio 1.55, 95% CI 1.14-2.10) and problem-solving (risk ratio 1.32, 95% CI 1.01-1.74) skills in children prenatally exposed to SARS-CoV-2 compared with unexposed children. CONCLUSION: Prenatal SARS-CoV-2 exposure was associated with early impairments in hearing, fine motor skills, and problem-solving skills, which appear to resolve with time. No associations were identified with atypical neurological or neuroimaging outcomes. No adverse neurodevelopmental effects were reported in 2 studies that examined prenatal COVID-19 vaccination. Study quality was generally moderate, with small sample sizes, inappropriate control groups, and unmeasured confounding. Taken together, the current body of research does not support a causal relation between prenatal exposure to SARS-CoV-2 infection or COVID-19 vaccination and adverse neurodevelopmental outcomes. STUDY REGISTRATION INFORMATION: The Association of Intrauterine Exposure to SARS-CoV-2 and the COVID-19 Vaccine With Child Neurodevelopment: A Systematic Review; https://www.crd.york.ac.uk/PROSPERO/view/CRD42023451206.
Supporting Clinicians in Caring and Advocating for LGBTQ+ Youth and Families in an Evolving Sociopolitical Landscape.
Clark KA, Rajah B, Shafer HL … +2 more , McKay T, Cyperski M
J Am Acad Child Adolesc Psychiatry · 2025 Oct · PMID 41135739 · Publisher ↗
In recent years, there has been a marked increase in legislation across United States aimed at restricting the rights and visibility of lesbian, gay, bisexual, transgender, queer, and other sexual and gender minority (LG...
In recent years, there has been a marked increase in legislation across United States aimed at restricting the rights and visibility of lesbian, gay, bisexual, transgender, queer, and other sexual and gender minority (LGBTQ+) individuals, with a focus on youth. These laws include prohibitions on discussing LGBTQ+ topics in educational settings, bans on gender-affirming care, and restrictions on participation in activities aligned with an individual's gender identity. Since the beginning of the second Trump administration in January 2025, a wave of federal executive actions has further threatened the health and rights of LGBTQ+ populations. These actions include efforts to reduce or eliminate federal funding for gender-affirming care, including coverage through the Affordable Care Act, and to eliminate recognition of gender identity across federal agencies and programs. As of this writing, several of these actions are facing legal challenges and are held up in court. The cumulative effect of these state and federal policies poses significant and immediate threats to the mental health and well-being of LGBTQ+ youth and their families.
Sex/Gender Differences in Internalizing Problems of Autistic Children and Young People: A Systematic Review and Meta-Analysis.
Suominen EH, Chen CA, Dunlop A … +2 more , Saunders R, Mandy W
J Am Acad Child Adolesc Psychiatry · 2025 Oct · PMID 41125201 · Publisher ↗
OBJECTIVE: Findings on the presence and direction of a sex/gender difference in internalizing problems for autistic children and young people (CYP) are inconsistent. This systematic review investigated whether autistic b...
OBJECTIVE: Findings on the presence and direction of a sex/gender difference in internalizing problems for autistic children and young people (CYP) are inconsistent. This systematic review investigated whether autistic boys and girls differ in internalizing problem severity. METHOD: Studies comparing internalizing problems (including depression and anxiety) in autistic boys and girls using validated, continuous measures were included. Medline, Embase, PsycINFO, ASSIA, and Web of Science databases were searched. The Joanna Briggs Institute appraisal checklist for cross-sectional studies was used to assess risk of bias. Random-effects meta-analyses estimated effect size differences for overall internalizing, anxiety symptoms, and depression symptoms between autistic boys and girls. Moderation effects of age, IQ, and study methodology were examined through meta-regression. RESULTS: From 4,093 nonduplicate records, 56 studies were identified (autistic CYP: N = 13,410; girls: n = 3,657; boys: n = 9,753). Autistic girls experienced more anxiety symptoms than boys (Hedges' g = 0.14, 95% CI [0.04, 0.25], p = .010). This effect was larger in community (vs clinic) samples (β = .22, p = .027) and in samples with higher average age (β = .039, p = .010) and IQ (β = .015, p = .001). Autistic girls also showed higher overall internalizing (Hedges' g = 0.10, 95% CI [-0.04, 0.23], p = .148) and depression (Hedges' g = 0.12, 95% CI [-0.01, 0.25], p = .067) symptoms, but these differences did not reach significance. Heterogeneity for all pooled sex/gender differences was high. CONCLUSION: In autistic CYP, girls show more anxiety symptoms than boys, and this is most pronounced in older girls and those with higher IQ. This systematic review did not find strong evidence for sex/gender differences in overall internalizing problems or depression symptoms. However, the high heterogeneity cautions against drawing conclusions with certainty. STUDY REGISTRATION INFORMATION: Systematic Review and Meta-analysis of Sex Differences in Internalising Problems of Autistic Children and Adolescents; https://www.crd.york.ac.uk/PROSPERO/view/CRD42023466929.
Multisystem Environmental Factors Elucidate Shared and Distinct Associations With Brain and Behavior in Adolescents.
Ramduny J, Paskewitz S, Brazil IA … +1 more , Baskin-Sommers A
J Am Acad Child Adolesc Psychiatry · 2025 Oct · PMID 41106490 · Full text
OBJECTIVE: Environmental factors have long been shown to influence brain structure and adolescent psychopathology. However, almost no research has included environmental factors spanning micro-to-macro-systems, brain str...
OBJECTIVE: Environmental factors have long been shown to influence brain structure and adolescent psychopathology. However, almost no research has included environmental factors spanning micro-to-macro-systems, brain structure, and psychopathology in an integrated framework. Here, we assessed the ways and degree to which multisystem environmental factors during late childhood are associated with subcortical volume and psychopathology during early adolescence. METHOD: We used baseline, 2-year follow-up, and 3-year follow-up data from the Adolescent Brain Cognitive Development℠ Study (n = 2,766). A Bayesian latent profile analysis was applied to obtain distinct multisystem environmental profiles during late childhood. The profiles were used in a path analysis to derive their direct and indirect effects on subcortical volume and psychopathology during early adolescence. RESULTS: Bayesian latent profile analysis revealed 9 environmental profiles. Two distinct profiles were directly associated with greater externalizing psychopathology in adolescents: (1) adversity across family, school, and neighborhood systems, and (2) family conflict and low school involvement. In contrast, a profile of family and neighborhood affluence was directly associated with lower externalizing psychopathology. Furthermore, family/neighborhood affluence was associated with higher subcortical volume, which in turn was associated with lower externalizing and internalizing psychopathology; conversely, a family economic and neighborhood adversity profile was associated with lower subcortical volume, which in turn was associated with higher externalizing and internalizing psychopathology. CONCLUSION: We identified environmental and brain-related equifinal pathways associated with externalizing and internalizing psychopathology. This work highlights the importance of considering the role of multiple systems and factors in the conceptualization and treatment of adolescent psychopathology. DIVERSITY & INCLUSION STATEMENT: 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 received support from a program designed to increase minority representation in science. We actively worked to promote sex and gender balance in our author group. 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.
Editorial: Maps Across Development: From Genetic Risk to Psychiatric Disorders.
Sørensen JØ, LaBianca S, Schork AJ
J Am Acad Child Adolesc Psychiatry · 2026 Feb · PMID 41101689 · Publisher ↗
Psychiatric disorders have modest to high heritability, implying an important role for inherited liability carried in DNA sequences present from conception. However, it may take years or decades before this liability man...
Psychiatric disorders have modest to high heritability, implying an important role for inherited liability carried in DNA sequences present from conception. However, it may take years or decades before this liability manifests as behaviors and inner experiences that meet criteria for a psychiatric diagnosis. In between, developmental processes unfold under genetic influence and in dynamic interaction with environments, exposures, and experiences. As a result, early life development presents a landscape of changing neural structures, evolving cognitive, socioemotional, and behavioral repertoires, and period-specific environments. Genetic liability to psychiatric disorder is not dormant within this landscape. Rather, genome-wide association studies (GWAS) for essentially all psychiatric disorders implicate early neurodevelopmental processes that may alter developmental trajectories. These findings emphasize the importance of a developmental perspective in psychiatric genetics. To understand the genetic etiology of psychiatric disorders and detect emerging psychopathology is to understand how genetic liability is expressed over the course of development..
Editorial: Considerations for the Long Game: Attention Bias Modification Training for Anxious Youth.
Croarkin PE
J Am Acad Child Adolesc Psychiatry · 2025 Oct · PMID 41077346 · Publisher ↗
Anxiety disorders often emerge early in life but are frequently overlooked and insufficiently treated, leading to significant academic, social, and psychiatric challenges that can persist throughout adulthood. Although s...
Anxiety disorders often emerge early in life but are frequently overlooked and insufficiently treated, leading to significant academic, social, and psychiatric challenges that can persist throughout adulthood. Although selective serotonin reuptake inhibitors (SSRIs) and cognitive-behavioral therapy (CBT) are standard treatments for childhood anxiety, these interventions do not always provide adequate relief, underscoring the need for more personalized and effective interventions. Over the past 2 decades, Attention Bias Modification Training (ABMT) has been studied as a possible intervention for anxiety disorders. Interventions with ABMT use a computer-based adaptation of the dot-probe task. Some patients with anxiety disorders have an implicit tendency to focus on threatening or negative stimuli. With ABMT, patients view a pair of images or words-one threatening and one neutral. A dot or other symbol then replaces the neutral stimulus, thereby training the brain to shift attention away from the negative threatening stimulus.
Editorial: Stimulant-Evoked Neural Trajectories Reveal Distinct Neurobiological Phenotypes for Attention-Deficit/Hyperactivity Disorder Based on Familial Risk.
Padilla LE, Cullen KR
J Am Acad Child Adolesc Psychiatry · 2026 Jul · PMID 41077345 · Publisher ↗
Some of the greatest challenges in understanding and treating attention-deficit/hyperactivity disorder (ADHD) stem from its heterogeneity and high rates of comorbidity. In particular, disentangling ADHD from early sympto...
Some of the greatest challenges in understanding and treating attention-deficit/hyperactivity disorder (ADHD) stem from its heterogeneity and high rates of comorbidity. In particular, disentangling ADHD from early symptoms of bipolar disorder has been a long-standing challenge for the field of child psychiatry. This issue is particularly thorny because of concerns about treatment-emergent mania when treating ADHD with psychostimulant medication in youth with comorbid bipolar disorder, and possibly even in those at familial risk for bipolar disorder. In this context, the field stands in need of reliable biomarkers to guide treatment selection. Advances in this area will require a better understanding of how neural circuits vary across different subtypes of clinical disorders and, in particular, how interventions might affect these circuits differently across subtypes. In this issue of the Journal, Qin and Pan et al. address this knowledge gap by comparing how the brain changes after psychostimulant treatment in ADHD youth with vs without familial risk for bipolar disorder.
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