J Am Acad Child Adolesc Psychiatry [JOURNAL]
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200 papers
The Time has Come to Improve the Quality of Pediatric Behavioral Health Care.
Hulvershorn LA, Burns A, Baskfield H … +1 more , Margolis PA
J Am Acad Child Adolesc Psychiatry · 2025 Oct · PMID 41077344 · Publisher ↗
In pursuit of improved health outcomes, health services researchers have long sought to monitor quality of care and drive continuous improvements in the health care system. As defined by Donabedian in 1966, quality of ca...
In pursuit of improved health outcomes, health services researchers have long sought to monitor quality of care and drive continuous improvements in the health care system. As defined by Donabedian in 1966, quality of care may be thought of as "a reflection of values and goals current in the medical care system and in the larger society of which it is a part." Although pediatric behavioral health (PBH; ie, psychiatry, psychology, behavioral pediatrics, developmental pediatrics, addiction) quality improvement has advanced considerably in the past few decades, the PBH field lags far behind other specialties in terms of large-scale, coordinated efforts to monitor and improve quality of care. For example, US News and World Report (USNWR) has published indices of hospital quality for more than 30 years, but only collected PBH data for the first time in 2023.
A Prospective Birth Cohort Study on the Association Between Cord Blood Acylcarnitine Profile and Childhood Risk of Attention-Deficit/Hyperactivity Disorder and Autism Spectrum Disorder.
Qu X, Li M, Augustyn M … +6 more , Pearson C, Vernon HJ, Wang G, Hong X, Wang X, Volk HE
J Am Acad Child Adolesc Psychiatry · 2026 Jul · PMID 41075976 · Full text
OBJECTIVE: Mitochondria have been implicated in the etiology of autism spectrum disorder (ASD), but evidence for attention-deficit/hyperactivity disorder (ADHD) remains limited. Given the early onset of both ASD and ADHD...
OBJECTIVE: Mitochondria have been implicated in the etiology of autism spectrum disorder (ASD), but evidence for attention-deficit/hyperactivity disorder (ADHD) remains limited. Given the early onset of both ASD and ADHD and high degree of comorbidity, this study sought to examine the prospective association of 20 acylcarnitines in cord blood-a group of metabolites involved in mitochondrial fatty acid metabolism-with childhood risk of ASD, ADHD, and other neurodevelopmental disorders (NDDs). METHOD: This study includes 995 children (55% male participants, 58% non-Hispanic Black) from the Boston Birth Cohort. Acylcarnitines in cord blood were profiled using liquid chromatography-tandem mass spectrometry. Logistic regressions examined individual acylcarnitines and their 3 principal components (PC) in relation to childhood ADHD (n = 285), ASD (n = 86), and other NDDs (n = 246) compared to those in typically developing children (n = 378), with adjustment of maternal and child characteristics. RESULTS: Children with higher levels of short-chain and long-chain acylcarnitines in cord blood (including C2, C3, C3-DC-CH3, C14, C16, C18, and C18:1) had a greater risk of childhood ADHD. The highest tertile of long-chain acylcarnitine PC scores was associated with 1.98 times odds of ADHD (adjusted OR = 1.98; 95% CI = 1.29-3.06), compared to the lowest tertile. A 1-unit increase in medium-chain PC scores was associated with 1.38 times odds of ASD (adjusted OR = 1.38; 95% CI = 1.01-1.90). CONCLUSION: This prospective birth cohort study found that cord blood acylcarnitines were associated with childhood risk of ASD, ADHD, and other NDDs, highlighting the important role of mitochondrial fatty acid metabolism in NDDs and potential targets for investigation and interventions. PLAIN LANGUAGE SUMMARY: Altered mitochondrial function has been associated with autism spectrum disorder (ASD), but evidence for attention-deficit/hyperactivity disorder (ADHD) remains limited. This prospective study of a racially diverse birth cohort (N = 995) found associations between increased levels of cord blood acylcarnitines-a group of metabolites involved in mitochondrial fatty acid metabolism-and a higher likelihood of ADHD and ASD diagnosis. These findings highlight the potential role of mitochondrial fatty acid metabolism in neurodevelopmental disorders and potential targets for investigation and interventions.
Systematic Review and Meta-Analysis: Acetaminophen Use During Pregnancy and the Risk of Neurodevelopmental Disorders in Childhood.
Bérard A, Cottin J, Leal LF … +20 more , Picot C, Pleau J, Friedman JM, Damkier P, Cucherat M, Alwan S, Jurek L, Winn LM, Carleton BC, Bertoldi AD, Grandi SM, Masarwa R, Dodin P, Ceulemans M, Platt RW, Nourredine M, Gram EB, Veroniki AA, Massardier J, Tricco AC
J Am Acad Child Adolesc Psychiatry · 2026 Apr · PMID 41062061 · Publisher ↗
OBJECTIVE: To explore the association between acetaminophen use during pregnancy and the risk of neurodevelopmental disorders (NDDs) in children. METHOD: We conducted a comprehensive search of major bibliographic databas...
OBJECTIVE: To explore the association between acetaminophen use during pregnancy and the risk of neurodevelopmental disorders (NDDs) in children. METHOD: We conducted a comprehensive search of major bibliographic databases and gray literature to identify human studies evaluating the association between prenatal acetaminophen exposure and the risk of NDDs in offspring. Pooled odds ratios (OR) with 95% confidence intervals were calculated in random-effects meta-analysis by type of NDD. We performed sensitivity analysis including a bounding method (E-value) and probabilistic bias analysis. RESULTS: Of 2,002 studies retrieved, 16 studies met eligibility criteria, and were included in the meta-analysis. The majority of studies assessing the risk of NDDs associated with gestational exposure to acetaminophen were on attention-deficit disorders with or without hyperactivity (ADHD, 6 studies, N = 2,668,689), followed by language disorders (5 studies, N = 31,104) and psychomotor developmental disorders/delay (3 studies, N = 30,824). Acetaminophen use during pregnancy was associated with an increased risk of ADHD, when ADHD was assessed with a physician-based diagnosis or psychometric tests (OR = 1.17, 95% CI = 1.08-1.27). The estimated E-value of 1.61 suggests that the observed association may be partly due to unmeasured confounders. Non-differential exposure misclassification biased results toward the null and differential misclassification potentially biased them away from the null. Similar results were observed when assessing outcome misclassification. Acetaminophen use during pregnancy was not associated with the risk of autism spectrum disorder (ASD) when considering physician-based diagnoses (OR = 1.10, 95% CI = 0.98, 1.24; 2 studies; ASD 69,611, n exposed 222,096, E-value = 1.43). No significant increase in the risk of other NDDs was observed. CONCLUSION: Gestational exposure to acetaminophen was associated with a small increased risk of ADHD, which was attenuated in sensitivity analyses. Further studies are needed to examine this association more robustly. PLAIN LANGUAGE SUMMARY: Concerns have been raised about the possible risk of neurodevelopmental disorders in children exposed to acetaminophen in utero. This study conducted a systematic review and meta-analysis of 16 studies with over 2.5 million participants and found a small increased risk of attention-deficit/hyperactivity disorder (ADHD), though this may be due to unmeasured factors or reporting errors. No increased risk was found for other neurodevelopmental disorders, including autism. Findings suggest cautious interpretation for clinical guidance. STUDY REGISTRATION INFORMATION: Acetaminophen use during pregnancy and the risk of neurodevelopmental disorders (NDDs) in childhood: A Systematic Review and Meta-Analysis Protocol; https://www.crd.york.ac.uk/PROSPERO/view/CRD42024566964; https://osf.io/7rcqe 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. 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.
Intensive Psychotherapy Treatment Options for Pediatric Obsessive-Compulsive Disorder.
Steuber E, McGuire J
J Am Acad Child Adolesc Psychiatry · 2025 Oct · PMID 41047105 · Publisher ↗
Obsessive-compulsive disorder (OCD), affecting ∼1% of the population, is characterized by intrusive thoughts and compulsive behaviors that cause significant distress and impairment. Following an evidence-based assessment...
Obsessive-compulsive disorder (OCD), affecting ∼1% of the population, is characterized by intrusive thoughts and compulsive behaviors that cause significant distress and impairment. Following an evidence-based assessment to identify OCD and to differentiate co-occurring conditions, the front-line treatment is outpatient cognitive-behavioral therapy (CBT) with exposure and response prevention (ERP), with or without serotonin reuptake inhibitors (SRIs). In severe cases, augmentation with neuroleptics is often used. Although standard outpatient treatment reduces OCD symptoms, many youth do not fully respond and require more intensive care, such as intensively delivered ERP. This article aims to guide clinicians in referring patients with severe and/or treatment-refractory OCD-defined as a failure of 2 SRI trials of adequate dose and duration and an adequate ERP trial-to appropriate intensive psychotherapeutic treatment.
Evaluation of an Information Guide on Pediatric Psychiatric Hospitalization to Improve Parent Satisfaction With Care.
Stephens JJ, Talbot A, Zhou A … +3 more , Ryan ND, Walker CJ, Gopalan P
J Am Acad Child Adolesc Psychiatry · 2026 Jun · PMID 41047104 · Publisher ↗
Parent satisfaction is a desired outcome of care provided to pediatric patients in medical settings and has been associated with reductions in parent stress and child problematic behavior, significant improvements in chi...
Parent satisfaction is a desired outcome of care provided to pediatric patients in medical settings and has been associated with reductions in parent stress and child problematic behavior, significant improvements in child functional impairment, and willingness to seek future care. Inpatient psychiatric settings inherently pose barriers to satisfaction, as patients may not voluntarily agree to hospitalization, treatment options can be associated with stigma, and improvement in symptoms may take prolonged amounts of time. These challenges are intensified in pediatric psychiatric settings, as caregiver perceptions can influence facilitation of care and treatment outcomes..
Editorial: Parsing Youth Substance Use Trends in a Dynamic Milieu.
Gray KM
J Am Acad Child Adolesc Psychiatry · 2026 May · PMID 41016626 · Publisher ↗
Substance use is highly heterogeneous in adolescence, ranging from non-use to experimentation to more serious involvement associated with morbidity and mortality. Recent developments in illicit drug supply, including con...
Substance use is highly heterogeneous in adolescence, ranging from non-use to experimentation to more serious involvement associated with morbidity and mortality. Recent developments in illicit drug supply, including contamination of products with fentanyl, have increased the risks of harm associated with use, including lethal overdose. Although longitudinally tracking overall substance use and related attitudes is critical to informing public health measures, the emergence of large electronic health record datasets creates novel opportunities to elucidate trends in substance involvement warranting serious clinical attention. The COVID-19 pandemic upended many aspects of young people's lives, such as schooling, socialization, and interactions with family, with a wide array of potential implications for substance use and use-related consequences; to date, surveillance findings regarding youth substance use during the pandemic have been mixed. In "A Nationwide Analysis of Pediatric Substance Use Trends Before, During, and Following the COVID-19 Pandemic," Kelly et al. leveraged Epic's Cosmos database to quantify emergency room and inpatient clinical encounters associated with substance use and involving patients between ages 6 and 17 years. This approach offered the chance to retrospectively assess pandemic-era changes in the proportion of substance-related clinical presentations, potentially informing future tailored programming to mitigate substance-related harms.
A Randomized Controlled Trial of N-acetylcysteine for Adolescent and Young Adult Alcohol Use Disorder.
Squeglia LM, Tomko RL, Baker NL … +3 more , Kirkland AE, McClure EA, Gray KM
J Am Acad Child Adolesc Psychiatry · 2025 Sep · PMID 41016625 · Full text
OBJECTIVE: The aim of this study was to evaluate the efficacy of N-acetylcysteine, compared to placebo, in reducing alcohol use among treatment-seeking adolescents and young adults with alcohol use disorder (AUD). METHOD...
OBJECTIVE: The aim of this study was to evaluate the efficacy of N-acetylcysteine, compared to placebo, in reducing alcohol use among treatment-seeking adolescents and young adults with alcohol use disorder (AUD). METHOD: Between March 2019 and February 2024, a fully powered, double-blind, parallel, randomized, placebo-controlled, intent-to-treat clinical trial was conducted in an outpatient setting among treatment-seeking young people 15 to 25 years of age who met criteria for AUD. Participants (N = 126; mean [SD] age, 21.0 [2.4] years; 78 [62%] female) were randomized in a 1:1 ratio to an 8-week course of 2,400 mg/day (administered as 1,200 mg twice daily) of N-acetylcysteine (n = 65) or placebo (n = 61) and were followed for 6 months total. All participants received weekly clinician-led alcohol intervention sessions, including elements of motivational interviewing and goal setting. Adverse events were assessed by the medical clinician, and medication adherence videos were observed asynchronously by study staff to confirm medication taking. The primary efficacy endpoint was reduction in alcohol use (total standard drinks during the last 4 weeks of treatment), compared between the N-acetylcysteine and placebo groups. Secondary outcomes included number of drinking days, heavy drinking days, and drinks per drinking day during the last 4 weeks of treatment. RESULTS: Video-confirmed medication adherence (overall, 82.7%) and rates of adverse events did not differ between groups. There were no overall differences in primary or secondary alcohol use outcomes between participants in the N-acetylcysteine versus placebo group (primary efficacy endpoint: 37.9 [SE = 3.8] standard drinks over the last 4 weeks of treatment in the N-acetylcysteine group vs 42.6 [6.3] in the placebo group; risk ratio = 1.19, 95% CI = 0.89, 1.61, p = .24); however, baseline AUD severity modified treatment efficacy. In participants with moderate to severe AUD, N-acetylcysteine significantly reduced alcohol consumption compared to placebo (31.7 vs 44.4 standard drinks over the last 4 weeks of treatment, p = .01) but not frequency of alcohol use. In participants with mild AUD, N-acetylcysteine did not significantly reduce alcohol use compared to placebo. CONCLUSION: N-acetylcysteine may be a useful adjunctive treatment for moderate to severe AUD, but it is potentially less suitable for mild cases. In exploratory analyses, N-acetylcysteine was effective in reducing alcohol consumption among youth with moderate to severe AUD, but not among those with mild AUD; nor was there an effect on frequency of alcohol use for any group. This could be especially relevant for adolescents, who typically drink less often than adults but tend to consume larger amounts of alcohol when they do drink; thus, changes in alcohol consumption may be more impactful than changes in frequency. These findings highlight the importance of considering AUD severity in both clinical treatment planning and the design of youth AUD trials. Because individuals with more severe AUD are the most likely to seek treatment, trials may consider oversampling youth with moderate to severe AUD to improve the relevance and effectiveness of interventions. Future studies should consider similar stratified approaches to evaluate other potential treatments for adolescents and young adults with AUD. CLINICAL TRIAL REGISTRATION INFORMATION: N-Acetylcysteine for Adolescent Alcohol Use Disorder; https://clinicaltrials.gov/study/NCT03707951.
Editorial: Autism Spectrum Disorder and Obsessive-Compulsive Disorder.
Greenberg E, Joshi G, Geller D
J Am Acad Child Adolesc Psychiatry · 2026 Feb · PMID 41015339 · Publisher ↗
In this issue of the Journal, Pereira et al. conduct a systematic review, exploring the complex, often confusing, association between autism spectrum disorder (ASD) and obsessive-compulsive disorder (OCD), 2 commonly occ...
In this issue of the Journal, Pereira et al. conduct a systematic review, exploring the complex, often confusing, association between autism spectrum disorder (ASD) and obsessive-compulsive disorder (OCD), 2 commonly occurring neuropsychiatric disorders affecting youth, using cognitive, genetic, and neurobiological data to map shared and unique features. We applaud this effort to extract and analyze the limited extant literature in these domains in these cohorts precisely because the shared and unique features of each are a frequently encountered dilemma for clinicians. This review is both timely and therapeutically relevant. Meta-analytic data suggest that 9% to 12% of autistic individuals meet criteria for OCD compared with approximately 2% in the general population. Conversely, ASD is present in approximately 10% of youth with OCD. The poor response of autism-related repetitive behaviors to selective serotonin reuptake inhibitors-despite their well-established efficacy in treating OCD-underscores the importance of distinguishing restricted repetitive behaviors (RRBs) of autism from those in OCD. Given the clinical challenge of parsing these overlapping symptoms, the identification of neural and genetic biomarkers may facilitate more accurate differentiation and guide appropriate therapeutic interventions.
Individual Participant Data Meta-Analysis: Moderators of Response to Stimulants for Preschool Attention-Deficit/Hyperactivity Disorder.
Farhat LC, Sugaya LS, Bloch MH … +6 more , Childress A, Cortese S, Fatori D, Salum GA, Rohde LA, Polanczyk GV
J Am Acad Child Adolesc Psychiatry · 2026 Jun · PMID 40975435 · Publisher ↗
OBJECTIVE: This study aimed to identify moderators of efficacy of stimulants against placebo to inform personalized recommendations for treatment in preschool children (<6 years of age) with attention-deficit/hyperactivi...
OBJECTIVE: This study aimed to identify moderators of efficacy of stimulants against placebo to inform personalized recommendations for treatment in preschool children (<6 years of age) with attention-deficit/hyperactivity disorder (ADHD). METHOD: We acquired individual-level participant data from 2 randomized placebo-controlled trials (RCTs) of preschool ADHD: namely, MAPPA (8-week methylphenidate, 102 participants, Brazil) and SPD489-347 (6-week lisdexamfetamine, 148 participants, United States). We evaluated the moderator and predictor effects of baseline demographic (age, sex, race, ethnicity, maternal educational level) and baseline clinical (ADHD symptom severity, intelligence quotient, number of psychiatric comorbidities) characteristics, as available, on endpoint ADHD symptom severity scores. Data from each study were analyzed separately with linear mixed-effects model for repeated measures. For categorical variables, we also computed treatment effects (ie, stimulants vs placebo) within subgroups and, when possible, pooled them alongside subgroup data from the Preschoolers with Attention-Deficit/Hyperactivity Disorder Treatment Study (PATS) (5-week methylphenidate, 165 participants, United States) in random-effects meta-analyses. RESULTS: Stimulants had greater efficacy against placebo in White children compared to Black children when considering data from US studies. Older age was not a moderator of greater efficacy of stimulants against placebo, nor was it associated with worse ADHD symptom severity at endpoint. Greater baseline ADHD symptom severity was associated with higher ADHD symptom severity at endpoint independently of the assigned treatment group. CONCLUSION: Race, but not older age or baseline ADHD symptom severity, may moderate the efficacy of stimulants for preschool ADHD. Given the post hoc nature of subgroup analyses, the findings should be interpreted as exploratory and viewed as hypotheses for confirmation in future studies. PLAIN LANGUAGE SUMMARY: In this individual participant meta-analysis, the authors obtained data from 2 clinical trials of psychostimulants for preschool children (aged 6 years or younger) with attention-deficit/hyperactivity disorder (ADHD) to investigate associations between demographic, clinical characteristics, and treatment effects. One study was focused on methylphenidate and was conducted in Brazil with 102 participants. The other study focused on lisdexamfetamine and was conducted in the United States with 148 participants. Some analyses also included subgroup data from a study focused on methylphenidate and was conducted in the US with 165 participants. In the US studies, stimulants appeared to work better in White children than in Black children, while older age or clinical severity was not associated with effectiveness of stimulants. The authors emphasize that these findings are exploratory and should be confirmed in future studies before guiding clinical decisions. CLINICAL TRIAL REGISTRATION INFORMATION: Safety and Efficacy Study in Preschool Children Aged 4-5 Years With Attention-deficit/Hyperactivity Disorder (ADHD); https://clinicaltrials.gov/study/NCT03260205; Early Interventions in Children With Attention Deficit/Hyperactivity Disorder; https://clinicaltrials.gov/study/NCT02807870.
Umbrella Review and Meta-Analysis: Screening Tools for the Identification of Developmental Delay in Early Childhood.
Arefadib N, Stewart B, Crespo-Gonzalez C … +4 more , Coghill D, Hunt RW, Lingam RP, Mulraney M
J Am Acad Child Adolesc Psychiatry · 2026 Jul · PMID 40975434 · Publisher ↗
OBJECTIVE: This systematic review and meta-analysis aimed to identify the range of developmental screening tools used globally, and to assess their pooled accuracy in identifying developmental delay among children aged 0...
OBJECTIVE: This systematic review and meta-analysis aimed to identify the range of developmental screening tools used globally, and to assess their pooled accuracy in identifying developmental delay among children aged 0 to 6 years. METHOD: PubMed, MEDLINE, PsycINFO, and Google Scholar were searched up to March 2025, with no language restrictions. Systematic or scoping reviews published within the last 10 years were included if they reported any information on the accuracy of a screening tool designed to identify delay in ≥2 domains. Meta-analyses were conducted to pool estimates of sensitivity, specificity, and area under the curve (AUC). Certainty of evidence for each tool was assessed using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) approach. Quality was assessed using A MeaSurement Tool to Assess systematic Reviews (AMSTAR 2) tool. RESULTS: Thirteen reviews reporting on 38 distinct tools were identified. Nine tools had sufficient data for meta-analysis, of which only the Ages and Stages Questionnaire (ASQ), Parents' Evaluations of Developmental Status (PEDS), and Denver Developmental Screening Test (DDST) were informed by more than 2 independent samples. Although most tools demonstrated good discriminative ability (AUC 0.66-0.89), the majority failed to meet minimal accepted thresholds for both sensitivity (0.8) and specificity (0.8). Wide confidence intervals and high heterogeneity were observed for most tools across both estimates. CONCLUSION: None of the currently available screening tools demonstrate sufficient accuracy for clinical use or population screening, underscoring the need for more nuanced implementation strategies that account for the known limitations of accuracy. PLAIN LANGUAGE SUMMARY: In this systematic review and meta-analysis, the authors aimed to identify developmental screening tools used globally and assess their accuracy in identifying developmental delays. The authors identified 38 distinct tools, but only 9 had enough evidence to assess their accuracy through meta-analysis. Overall, none of the available screening tools demonstrated sufficient accuracy for clinical or population screening, and information about participants' gender and ethnicity was often missing, highlighting the need for more nuanced implementation strategies that account for these limitations in accuracy. STUDY REGISTRATION INFORMATION: Screening tools for the identification of developmental delay in early childhood: an umbrella review; https://www.crd.york.ac.uk/PROSPERO/view/CRD42024577375.
A Way With Words: Do Clinicians Talk Differently When Assessing Autism in Boys vs Girls?
Parish-Morris J, Cola M
J Am Acad Child Adolesc Psychiatry · 2026 Apr · PMID 40947093 · Publisher ↗
Autism is a complex, heterogeneous neurodevelopmental condition that affects 1 in 31 children, and is characterized by social communication challenges and the presence of restricted and/or repetitive patterns of behavior...
Autism is a complex, heterogeneous neurodevelopmental condition that affects 1 in 31 children, and is characterized by social communication challenges and the presence of restricted and/or repetitive patterns of behaviors and interests. Autism is diagnosed at a significantly lower rate and at later ages in autistic female individuals than in autistic male individuals. These sex-based diagnostic discrepancies may be due, in part, to a poor understanding of how autism presents in female individuals, underrecognition of autistic traits that have an impact on female individuals' likelihood of being referred for an autism evaluation, and a paucity of diagnostic tools that are sensitive to sex-specific behavioral presentations. Notably, gold-standard diagnostic tools were developed on disproportionately male samples, leading to concerns that autistic in female individuals could be underdiagnosed when using these measures..
2025 Annual Report: JAACAP's Work to Advance Science Regarding the Impacts of Structural and Social Determinants of Health on Children's Mental Health: JAACAP Journals.
J Am Acad Child Adolesc Psychiatry · 2025 Dec · PMID 40945844 · Publisher ↗
In 2020, we wrote to you about our dedication and vision for JAACAP "to be antiracist at every level." Over the last 5 years, we've pursued initiatives "to reshape the Journal to pursue this vision." And earlier this yea...
In 2020, we wrote to you about our dedication and vision for JAACAP "to be antiracist at every level." Over the last 5 years, we've pursued initiatives "to reshape the Journal to pursue this vision." And earlier this year, we wrote of our recommitment to publishing "outstanding science on the impacts of structural and social determinants of health, including multiple forms of racism and minoritization (such as marginalization and discrimination based on gender and sexual identity) on the mental health of children and adolescents." In this article, we provide an update on these goals and initiatives (Figure 1). These initiatives include both scientific journals in the JAACAP family, JAACAP and JAACAP Open. Through this work, we aspire to be a leader among mental health journals in our intentional pursuit of antiracist policies and practices.
Editorial: The Value of and Need for School Mental Health Services.
Green JG, Johnson RM
J Am Acad Child Adolesc Psychiatry · 2026 Jul · PMID 40935287 · Publisher ↗
The United States has an overburdened and fragmented mental health services system. Because of challenges in accessing care, the needs of most adolescents experiencing psychiatric disorders go unmet. Schools play an impo...
The United States has an overburdened and fragmented mental health services system. Because of challenges in accessing care, the needs of most adolescents experiencing psychiatric disorders go unmet. Schools play an important role in filling gaps in services and, for many youth, schools are the first-and often the only-point of access for mental health services. School-based mental health services are particularly important for adolescents in low-income families or living in urban neighborhoods, who, because of social and structural factors, are more likely to report psychiatric symptoms and less likely to have access to community-based behavioral health care. As such, schools are uniquely well positioned to support the mental health needs of youth. School-based mental health services can provide immediate and contextually relevant support to youth as needs arise, and may be less constrained by structural barriers that limit access to community-based services (eg, cost, transportation). Therefore, it is important for researchers and practitioners to critically evaluate the question: How can schools best support the mental health of young people?
An Interview Tool for Identifying Sexual Orientation or Gender Identity and Expression Change Efforts in Queer Youth.
Yu L, Dalke K, Eckstrand K
J Am Acad Child Adolesc Psychiatry · 2025 Sep · PMID 40912505 · Full text
Sexual orientation, gender identity, and gender expression change efforts (SOGIECE), including, but not limited to, conversion therapy, describe explicit attempts to suppress or change someone's sexual orientation, gende...
Sexual orientation, gender identity, and gender expression change efforts (SOGIECE), including, but not limited to, conversion therapy, describe explicit attempts to suppress or change someone's sexual orientation, gender identity, and/or gender expression (SOGIE) from a minoritized identity status to a cisgender and/or heterosexual identity status. Research consistently demonstrates that SOGIECE are detrimental to the mental health of sexual and gender minority (SGM) youth. Whereas conversion therapy is a denounced medicalized practice, SOGIECE include broad efforts to pressure or change someone's sexuality or gender identity. SOGIECE not only may occur in a medical context, but also may occur in other social contexts, including the home, religious institutions, or school. Identifying exposure to SOGIECE broadly is critical to identifying risk factors associated with poorer mental health in SGM youth. As of 2023, 22 states and Washington, DC, have enacted state-level legislation that bans conversion therapy practices for minors. However, these laws do not prevent all forms of SOGIECE from being practiced informally within families or by unlicensed practitioners or clergy, and formal conversion therapy practices by both licensed mental health professionals and religious practitioners is believed to occur within 48 states. Though more public health research is needed, estimates of exposure to SOGIECE have ranged from 2% to 34% among SGM samples, with higher rates among transgender and minoritized racial groups. Mental health professionals who treat children and adolescents must be capable of screening for and addressing exposure to SOGIECE to reduce the risk of this harmful practice and effectively support SGM youth. The goal of this article is to discuss current practices and research regarding the effects of SOGIECE and to introduce an interview tool to assist with screening adolescents who may have experienced SOGIECE.
Supporting Patients Who Self-Injure: A Youth-Centered Approach.
Lewis SP, Hasking P
J Am Acad Child Adolesc Psychiatry · 2025 Sep · PMID 40907887 · Publisher ↗
Nonsuicidal self-injury (NSSI), the deliberate damage to body tissue without suicidal intent and for reasons that are not socially or culturally sanctioned, is a growing concern worldwide, with up to 20% of adolescents e...
Nonsuicidal self-injury (NSSI), the deliberate damage to body tissue without suicidal intent and for reasons that are not socially or culturally sanctioned, is a growing concern worldwide, with up to 20% of adolescents engaging in the behavior. Although it is used primarily as a means of coping with intense or unwanted emotion, NSSI is also associated with a range of psychological difficulties and psychiatric disorders. Of most concern is the consistent finding that NSSI is the most reliable predictor of suicidal behavior. NSSI typically precedes suicidal thoughts and behaviors by an average of 3 years, providing a critical window of opportunity for early intervention if the NSSI is disclosed. Yet, with stigma being a primary barrier to NSSI disclosure, youth often go to great lengths to conceal NSSI and are especially apprehensive about discussing it in clinical settings. This Clinical Perspective therefore offers a youth-centered approach that can foster communication when working in acute settings with youth who self-injure.
Review and Developmental Model: Early Childhood Emotion Regulation and Co-Regulation in Autism.
Northrup JB, Nuske HJ, Hipwell AE … +1 more , Mazefsky CA
J Am Acad Child Adolesc Psychiatry · 2026 Apr · PMID 40907886 · Full text
OBJECTIVE: Emotion regulation (ER) and dysregulation (ED) have significant impacts on the mental health and quality of life of autistic individuals and their families, yet little is known about ER development in early ch...
OBJECTIVE: Emotion regulation (ER) and dysregulation (ED) have significant impacts on the mental health and quality of life of autistic individuals and their families, yet little is known about ER development in early childhood autism. This paper proposes a developmental model of disruptions to early ER development, emphasizing parent-child co-regulation, to guide future research and clinical care. METHOD: Empirical research on ER, ED, and parent-child co-regulation in young autistic children (mean age <6 years) was summarized. Insights from theoretical and empirical work on typical ER development, with a focus on parent-child co-regulation, were integrated with autism research to propose a novel developmental model. RESULTS: Research on ER and ED in young autistic children remains limited and lacks a developmental framework. Parent-child co-regulation is identified as a key mechanism in ER development, operating across micro (moment-by-moment) and macro (long-term) time scales. Autism-specific challenges, such as pervasive and idiosyncratic triggers, reduced emotional awareness, and ambiguous emotional communication, can disrupt parent-child co-regulation. These disruptions reduce opportunities for teaching and internalizing effective ER strategies and can lead parents and children to rely on "quick fix" strategies (eg, avoidance), ultimately hindering long-term ER development and negatively affecting mental health. CONCLUSION: Understanding disruptions to ER development in autism within parent-child interactions offers a framework for research and clinical care. Developing autism-specific measurement tools and using longitudinal, ecological, and "measurement burst" designs will be critical to uncovering disrupted dyadic processes. Future research and clinical efforts must address the unique experiences and needs of autistic children and their families. PLAIN LANGUAGE SUMMARY: Difficulties managing big emotions affect many parts of life for children with autism and their families. This paper summarizes what is known-and what is not known-about how young children with autism manage emotions and how parents support them. The authors proposed a new framework for understanding how autism-specific challenges can disrupt parent-child emotional interactions, making it harder for families to build coping strategies. This framework can guide future research and clinical interventions.
Teachers' Reports of Attention-Deficit/Hyperactivity Disorder Medication Changes During Stimulant Shortages: National Survey Results.
Stein BD, Mahler AC, Smart R
J Am Acad Child Adolesc Psychiatry · 2026 Apr · PMID 40902822 · Full text
Attention-deficit/hyperactivity disorder (ADHD), a common childhood-onset disorder, is associated with impulsivity, impaired attention and executive function, and poor academic performance. Stimulants, the first-line med...
Attention-deficit/hyperactivity disorder (ADHD), a common childhood-onset disorder, is associated with impulsivity, impaired attention and executive function, and poor academic performance. Stimulants, the first-line medication treatment for ADHD, are associated with better academic functioning and decreased injury risk..
Implementing Evidence Into Child and Adolescent Psychiatry Service Planning: Reforming the Turkish Health System.
Dursun OB, Turan B, Tufan AE
J Am Acad Child Adolesc Psychiatry · 2026 Jul · PMID 40885255 · Publisher ↗
One of the major challenges in child and adolescent mental health (CAMH) is the difficulty of structuring health service delivery based on scientific evidence. For evidence-based service planning, it is essential to gene...
One of the major challenges in child and adolescent mental health (CAMH) is the difficulty of structuring health service delivery based on scientific evidence. For evidence-based service planning, it is essential to generate country-specific scientific data; to effectively communicate these findings and associated projects to policy makers and health administrators; to implement successful pilot programs; and to develop services adapted to the local conditions. Unfortunately, such integration has not been achieved in many countries, owing to deficiencies or coordination issues in these processes. Although it might seem functional for CAMH academics to actively participate as planners in health systems, international experience in this field remains limited. This Commentary summarizes the key pillars of an innovative approach initiated when the Turkish health system invited CAMH academics to engage directly in service planning. It also reflects on the reformative impact of this process on CAMH services.
Editorial: Cautious Optimism for Noninvasive Brain Stimulation in Attention-Deficit/Hyperactivity Disorder: What Does the Evidence Show?
Leffa DT
J Am Acad Child Adolesc Psychiatry · 2026 Mar · PMID 40885254 · Publisher ↗
For centuries, understanding the fundamental workings of the brain has been among humankind's most compelling pursuits, closely intertwined with our ongoing search for effective treatments for disorders of the mind. Cent...
For centuries, understanding the fundamental workings of the brain has been among humankind's most compelling pursuits, closely intertwined with our ongoing search for effective treatments for disorders of the mind. Central to this scientific journey has been the exploration of electrical phenomena. Luigi Galvani's landmark discovery of intrinsic "animal electricity" in frog muscles, Alessandro Volta's invention of the voltaic pile, and Giovanni Aldini's ambitious attempts to apply electric stimulation to humans in an effort to treat neuropsychiatric disorders laid foundational insights for modern neural electrophysiology. Later, Michael Faraday, James Clerk Maxwell, and others clarified the intricate relationship between electricity and magnetism, collectively paving the way for the development of contemporary noninvasive brain stimulation (NIBS) techniques. Today, methods such as transcranial magnetic stimulation (TMS), transcranial direct current stimulation (tDCS), and external trigeminal nerve stimulation (eTNS) represent both established and emerging approaches for the treatment of several psychiatric conditions, including attention-deficit/hyperactivity disorder (ADHD).
Editorial: Beyond the Clinics: Strategies to Support Sustained Mental Health Well-Being.
Kalra S, Kalra D, Hlaing WM
J Am Acad Child Adolesc Psychiatry · 2026 Apr · PMID 40885253 · Publisher ↗
For decades, the field of child and adolescent psychiatry has rightly prioritized the identification, diagnosis, and treatment of mental illness. This is understandable: mental disorders are among the leading causes of d...
For decades, the field of child and adolescent psychiatry has rightly prioritized the identification, diagnosis, and treatment of mental illness. This is understandable: mental disorders are among the leading causes of disability in youth worldwide, and early intervention is essential. A second, equally urgent question, however, remains: what enables some children to thrive emotionally and behaviorally over time? Although emerging evidence suggests a role for parental education, academic achievement, and child-reported well-being in shaping emotional health, the impact of these factors on long-term outcomes remains an open question.
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