J Am Acad Child Adolesc Psychiatry [JOURNAL]
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200 papers
Editorial: Pragmatic Precision Child Psychiatry: An Opportunity to Advance Quality of Child Mental Health Care.
Zima BT, Edgcomb JB
J Am Acad Child Adolesc Psychiatry · 2026 May · PMID 40885252 · Publisher ↗
The quality of publicly funded child mental health care is chronically poor. In this edition of the Journal, the largest study to date examining antidepressant medication adherence among US Medicaid-enrolled youth both v...
The quality of publicly funded child mental health care is chronically poor. In this edition of the Journal, the largest study to date examining antidepressant medication adherence among US Medicaid-enrolled youth both validates prior concerns and prompts a critical examination of how we assess the quality of child mental health care. The study by Fontanella et al. is a retrospective longitudinal cohort study of 196,364 youth aged 9 to 24 years with a new episode of major depression who were prescribed antidepressant medication. The analysis used Medicaid claims data from 46 states and the District of Columbia, spanning January 1, 2016, to February 28, 2019. The study design is rigorous, with clearly defined time intervals for pretreatment and treatment periods and a requirement for continuous enrollment. The authors applied a well-established method to identify new episodes of depression and used study variables that reflect real-world clinical workflows (eg, ≤60 days for the first antidepressant prescription after diagnosis), as well as reasonable thresholds for gaps between prescription fills (acute: ≤30 days; continuation: ≤51 days). Consistent with the Healthcare Effectiveness Data and Information Set (HEDIS) quality measure for antidepressant medication management, the main outcomes were as follows: (1) the total days' supply of filled antidepressant prescriptions during the acute (12 weeks) and continuation (6 months) phases; and (2) at least 3 outpatient visits during the acute phase. Independent variables included sociodemographic and clinical characteristics from the 180 days prior to study entry. Using the county of residence, data were also linked to the Social Vulnerability Index-a composite of 16 social determinants of health-and categorized into quartiles to rank probable youth social vulnerability. During the acute phase, approximately half (49.6%) of the youth met criteria for antidepressant medication adherence, and 55.2% had at least 3 outpatient mental health visits. By 6 months, only 26.5% had likely received continuous antidepressant treatment. Young adults (aged 18-24 years), youth from minoritized racial/ethnic groups, and individuals who had 1 inpatient or 2 outpatient substance use disorder claims had lower odds of adherence compared to younger youth (aged 9-13 years), those who were White and non-Hispanic, and those who had no psychiatric comorbidities. Together, these findings signal poor quality and persistent disparities in depression care among US Medicaid-enrolled youth.
Examining Features of Atypical Depression in Youth From the Texas Youth Depression and Suicide Research Network Research Registry.
Ayvaci ER, Lamers F, Gorman A … +10 more , Minhajuddin A, Nandy K, Goodman LC, Trinh AT, Farias R, Shahidullah JD, Storch EA, Wakefield SM, Emslie GJ, Trivedi MH
J Am Acad Child Adolesc Psychiatry · 2026 May · PMID 40882868 · Publisher ↗
OBJECTIVE: Atypical depression is a depression subtype characterized by atypical and energy-related symptoms such as hypersomnia, weight gain, fatigue, and leaden paralysis. Limited research has examined its clinical cha...
OBJECTIVE: Atypical depression is a depression subtype characterized by atypical and energy-related symptoms such as hypersomnia, weight gain, fatigue, and leaden paralysis. Limited research has examined its clinical characteristics in youth. This study investigates the prevalence, sociodemographic and clinical correlates, and 6-month depression trajectories of atypical depression in a statewide youth depression registry. METHOD: Data from youth 11 to 20 years of age from the Texas Youth Depression and Suicide Research Network (TX-YDSRN), a registry of youth with depression or suicidal ideation, were analyzed. Atypical depression was defined using the Atypical Energy-Related Symptom (AES) Scale (score of ≥6). Sociodemographic data, body mass index (BMI), depression and anxiety severity, suicidality, trauma history, and physical functioning were compared between individuals with atypical and non-atypical depression. Mixed-effects models were used to assess depressive symptom trajectories over 6 months. RESULTS: Of 1,445 participants (mean age = 15.8 years, 72.8% female), 22.4% had atypical depression. Atypical depression was associated with greater baseline depression, anxiety, suicidality, and suicide attempts compared with non-atypical depression. Atypical depression was associated with female sex, trauma history, and obesity. Youth with atypical depression also had poorer physical functioning. Over 6 months, individuals with atypical depression exhibited persistently higher depressive severity compared with those with non-atypical depression. CONCLUSION: Atypical depression in youth is associated with more severe clinical profiles and worse depression trajectories relative to non-atypical depression. Future studies should investigate the temporal relationships between variables such as trauma, obesity, and the onset of atypical depression to better understand how these factors may precede or exacerbate atypical depression. PLAIN LANGUAGE SUMMARY: Data were collected from youth aged 11 to 20 years enrolled in the Texas Youth Depression and Suicide Research Network (TX-YDSRN) registry study. In the sample of 1,445 youth, 22.4% had atypical depression. Experiencing atypical depression in youth was associated with more severe clinical features and worse depression trajectories over 6 months relative to non-atypical depression. Identifying distinct clinical profiles can inform the design of targeted clinical trials for youth with atypical features and potentially lead to improved treatment outcomes.
Preadolescent Family Conflict, Parental Depression, and Neural Circuitry Interact to Predict Adolescent Symptoms.
Holt-Gosselin B, Basol EZ, Keding TJ … +3 more , Rodrigues K, Joormann J, Gee DG
J Am Acad Child Adolesc Psychiatry · 2026 Jun · PMID 40882867 · Publisher ↗
OBJECTIVE: Youth whose parents have depression histories are at elevated risk for psychopathology. Familial depression-related patterns of neurodevelopment and environmental stress (eg, family conflict) likely contribute...
OBJECTIVE: Youth whose parents have depression histories are at elevated risk for psychopathology. Familial depression-related patterns of neurodevelopment and environmental stress (eg, family conflict) likely contribute to heightened risk. However, knowledge remains limited due to few studies, small sample sizes, and cross-sectional designs. We sought to identify how neural circuitry, familial risk for depression, and family conflict interact during preadolescence to predict adolescent psychopathology. METHOD: Participants included healthy (no lifetime psychiatric diagnoses) youth at high (HR, n = 794; at least one parent with a depression history) and low (LR, n = 1,708; no parental history of psychopathology) familial risk for depression, aged 9 to 10, from the Adolescent Brain Cognitive Development℠ (ABCD) Study. We tested whether functional connectivity (FC) among 12 resting-state networks interacted with risk status and family conflict at ages 9 to 10 to predict psychiatric symptoms at ages 12 to 13. RESULTS: Risk status significantly interacted with family conflict and cingulo-parietal network (CPN) FC at ages 9 to 10 to predict total problems and internalizing symptoms at ages 12 to 13 (R = 0.349, ΔR = 0.017, η = 0.005; R = 0.254, ΔR = 0.023, η = 0.004, respectively). Specifically, among youth in low (but not high) family conflict environments, there was a significant negative association between CPN FC at ages 9 to 10 and psychiatric symptoms at ages 12 to 13 for HR youth, whereas this association was significantly positive for LR youth. CONCLUSION: Findings suggest that CPN connectivity and family conflict in preadolescence may be prognostic risk markers for future symptoms related to parental depression. These markers may shed light on brain-based processes by which environmental adversity relates to heightened familial risk for psychopathology, although small effect sizes necessitate future investigation to better understand the potential clinical relevance. PLAIN LANGUAGE SUMMARY: This study followed over 2,500 children from ages 9 to 10 to examine how brain connectivity and family conflict relate to later mental health symptoms at the ages of 12 to 13 in youth with and without a parental history of depression. The authors found that connections in the cingulo-parietal brain network (CPN), together with levels of family conflict, predicted later emotional and behavioral problems differently for high‑risk (parent with depression) and low‑risk youth. In low‑conflict families, stronger connectivity in this network at ages 9 to 10 predicted fewer later symptoms for high‑risk youth, but more later symptoms for low‑risk youth. These findings suggest that being in a low family conflict environment may be protective, but its effects depend on brain connectivity and parental mental health.
Using a Cognitive Behavioral Family Therapy Model to Join Caregivers of Transgender and Gender Expansive Youth.
McDowell MJ, Henin A, Kim HH
J Am Acad Child Adolesc Psychiatry · 2026 Jun · PMID 40876507 · Publisher ↗
Building a supportive home environment is a key psychiatric intervention for reducing negative outcomes and increasing resilience in transgender and gender expansive (TGE) youth. TGE youth experience significant negative...
Building a supportive home environment is a key psychiatric intervention for reducing negative outcomes and increasing resilience in transgender and gender expansive (TGE) youth. TGE youth experience significant negative health outcomes due to numerous proximal and distal stressors as summarized in the gender minority stress framework, including internalized transphobia and discrimination, respectively. Cognitive behavioral family therapy (CBFT) is an integrative therapeutic approach that emphasizes the family as a system, in which changes in behavior or thought processes of one member can influence the entire family unit. CBFT offers a framework to work with families of TGE youth at all levels of acceptance, including families in which caregivers are ambivalent or unsupportive of their TGE children.
A Dialectical Behavior Therapy-Oriented Approach to Gender-Affirming Eating Disorder Care for Youth With Gender Dysphoria.
Townsend L, Pham A
J Am Acad Child Adolesc Psychiatry · 2026 Jul · PMID 40876506 · Full text
Sam is a 15-year-old, transmasculine teen who reports gender dysphoria since early elementary school. He was referred for psychotherapy following hospitalization for a suicide attempt secondary to bullying. Clinical hist...
Sam is a 15-year-old, transmasculine teen who reports gender dysphoria since early elementary school. He was referred for psychotherapy following hospitalization for a suicide attempt secondary to bullying. Clinical history revealed long-standing major depressive disorder, social anxiety, gender dysphoria, and anorexia nervosa-restricting type (AN-R). His family exhibits gender-affirming beliefs and language publicly but has struggled significantly with accepting that their assigned female at birth (AFAB) child does not perceive himself as female; they worry about social repercussions for their family. Sam's mother expressed grief at losing opportunities to do traditionally female activities with her child. Sam disclosed disordered eating behaviors (DEBs) during his clinical assessment for therapy. DEBs included periods of fasting, limiting meals to low-calorie foods, refusing to consume food or water prior to physical activity, and exercising with weights and kettlebells for 2 hours daily. He is frequently late for school because choosing his clothing takes a significant amount of time. He expressed discomfort with clothing that has waistbands or components that he can feel pressing on him because they accentuate the curves of his body. Sam is on the wrestling team and wants to be more muscular like his teammates. Although his menstrual cycles have become more irregular in the past year, Sam notes significant distress with menstrual bleeding. This is a fictional vignette based on the combined clinical experience of the authors.
Editorial: Ambient Heat and Brain Function in Children: New Insights and Promising Directions for the Study of Climate-Mental Health.
Wortzel JR, Lawrance EL, Minor K … +2 more , Yaggi HK, Pearlson G
J Am Acad Child Adolesc Psychiatry · 2025 Nov · PMID 40865795 · Publisher ↗
The association between local fluctuations in ambient temperature and poor mental health outcomes has been observed globally. A meta-analysis of 19 studies found that suicide incidence increases 1.7% and 1.5% per 1°C inc...
The association between local fluctuations in ambient temperature and poor mental health outcomes has been observed globally. A meta-analysis of 19 studies found that suicide incidence increases 1.7% and 1.5% per 1°C increase in average daily and monthly temperatures, respectively, and mental health hospital presentations are 9.7% higher during heatwaves compared to non-heatwave periods. Children are particularly vulnerable given their higher volume-to-surface area ratio, immature sweat production, and still-developing adaptive capacity that render them more susceptible to heat stress than adults..
Gamified Attention Bias Modification Training to Augment Cognitive-Behavioral Therapy for Youth Anxiety Disorders: A Randomized Controlled Trial.
Byrne ME, Haller SP, Linke JO … +13 more , Lewis KM, Berman ED, Henry LM, Pagliaccio D, Quezada D, Meyer M, Abend R, Kircanski K, Silverman WK, Lazarov A, Bar-Haim Y, Brotman MA, Pine DS
J Am Acad Child Adolesc Psychiatry · 2025 Aug · PMID 40850530 · Full text
OBJECTIVE: Augmenting cognitive-behavioral therapy (CBT) with attention bias modification training (ABMT) may maximize therapeutic benefit for anxiety through targeting different underlying processes. Yet, corresponding...
OBJECTIVE: Augmenting cognitive-behavioral therapy (CBT) with attention bias modification training (ABMT) may maximize therapeutic benefit for anxiety through targeting different underlying processes. Yet, corresponding neural mechanisms are unclear. This preregistered double-blind, randomized controlled trial assigned youth with anxiety disorders receiving CBT to active or sham gamified ABMT. Group differences in clinical efficacy, and associations between amygdala connectivity and treatment outcomes, were examined. METHOD: Pediatric patients (N = 121; 8-17 years of age) with anxiety disorders were randomized to active or sham gamified ABMT alongside 12 weeks of manualized CBT. Primary outcomes were clinician-rated Pediatric Anxiety Rating Scale (PARS) and Clinical Global Impression-Improvement (CGI-I) Scale scores. Amygdala seed-based connectivity during a functional magnetic resonance imaging (fMRI) dot-probe attention bias task was measured before and after treatment in patients, and across the same time interval in healthy controls. RESULTS: Over treatment, PARS decreased significantly in both groups (F = 82.84; p < .001, η = 0.44). Contrary to hypotheses, active ABMT did not enhance symptom reductions (F = 0.61; p=.54, η < 0.01). There was no difference in the proportion of CGI-I treatment responders vs nonresponders between active and sham (χ = 0.76, p = .38) treatments. Amygdala connectivity is reported, but should be interpreted with caution because of poor observed test-retest reliability in healthy controls (intraclass correlation coefficient [3,1] < 0.4). Lower posttreatment anxiety was associated with weaker left amygdala connectivity with several cortical regions on threat-congruent trials. CONCLUSION: Hypotheses that youth receiving active gamified ABMT+CBT would show greater improvement were not supported. Findings highlight the need to explore alternative attention bias modification strategies for augmenting the clinical response to CBT for anxiety. Future research should continue to examine reliability of attention bias tasks adapted for fMRI. CLINICAL TRIAL REGISTRATION INFORMATION: A Clinical Trial of a Gamified Attention Bias Modification Training in Anxious Youth; https://clinicaltrials.gov/study/NCT03283930. STUDY REGISTRATION INFORMATION: The Nature of the Effect; https://osf.io/fxc54github.
Reflections: The Weight of Words.
Yusuf M
J Am Acad Child Adolesc Psychiatry · 2026 Jan · PMID 40850529 · Publisher ↗
I sat across from a teenage girl, her eyes fixed on the floor. The glow of the computer screen cast a soft light on her face as we connected over telehealth. She twisted the sleeves of her sweatshirt; words caught somewh...
I sat across from a teenage girl, her eyes fixed on the floor. The glow of the computer screen cast a soft light on her face as we connected over telehealth. She twisted the sleeves of her sweatshirt; words caught somewhere between her heart and her mouth.
Editorial: The Promise of Precision Medicine in Pediatric Attention-Deficit/Hyperactivity Disorder.
Baweja R, Waxmonsky JG
J Am Acad Child Adolesc Psychiatry · 2026 May · PMID 40848947 · Publisher ↗
Attention-deficit/hyperactivity disorder (ADHD) is one of the most prevalent and well-studied neurodevelopmental disorders, affecting an estimated 5% to 10% of children and adolescents worldwide. It significantly impairs...
Attention-deficit/hyperactivity disorder (ADHD) is one of the most prevalent and well-studied neurodevelopmental disorders, affecting an estimated 5% to 10% of children and adolescents worldwide. It significantly impairs functioning across academic, social, and family domains, with symptoms often persisting into adulthood. Despite decades of research and numerous evidence-based treatments, the profound heterogeneity of the disorder continues to complicate effective intervention.
Editorial: Neurodevelopmental Outcomes of Prenatal Antipsychotic Medication Exposure.
Charoensook J
J Am Acad Child Adolesc Psychiatry · 2026 Mar · PMID 40846200 · Publisher ↗
The use of antipsychotic medications during pregnancy is a very important topic for all physicians-the adult psychiatrist maintaining care for their pregnant patient, the child psychiatrist answering questions that paren...
The use of antipsychotic medications during pregnancy is a very important topic for all physicians-the adult psychiatrist maintaining care for their pregnant patient, the child psychiatrist answering questions that parents pose about their child, the knowledgeable obstetrician and pediatrician caring for their respective patients. Unfortunately, there is limited high-quality evidence regarding the safety of the use of psychotropic medications in general during pregnancy. At the same time, antipsychotic medication use continues to grow. Between 2001 and 2010, more than 1.5 million pregnant women on Medicaid filled an atypical antipsychotic medication prescription, with an increase from 0.4% to 1.3% over the 10-year study period, with the leading diagnosis being bipolar disorder and most dispensed medications being quetiapine and aripiprazole..
Family-Based Strategies for Healthy Screen Use and the Role of Motivational Interviewing.
Vidal C, Rosenfeld A, Deister D … +1 more , Jackson P
J Am Acad Child Adolesc Psychiatry · 2026 May · PMID 40840627 · Publisher ↗
Nearly all American adolescents own a smartphone. Smartphones facilitate access to "apps" that are commonly used by adolescents to communicate with peers. Gender differences show a preference for social media (SM) use in...
Nearly all American adolescents own a smartphone. Smartphones facilitate access to "apps" that are commonly used by adolescents to communicate with peers. Gender differences show a preference for social media (SM) use in girls and gaming in boys, but digital media use (DMU) has increased across genders. Adolescents are now online "almost constantly" at rates that have doubled in the last decade. For most, it would be hard to give up their use. When spending time online, adolescents most frequently have continuous contact with close friends, suggesting that giving up DMU individually, in an environment of almost universal use, would be difficult.
Clinical Practice Guideline: Assessment and Treatment of Adolescents and Young Adults With Substance Use Disorders and Problematic Substance Use (Excluding Tobacco).
Rockhill CM, Ramtekkar U, Becker TD … +7 more , Greenhill L, Hayek M, Vasa RA, Abright AR, Diamond JM, Rodríguez LN, Walter HJ
J Am Acad Child Adolesc Psychiatry · 2026 Feb · PMID 40819708 · Publisher ↗
OBJECTIVE: To enhance the quality of care and clinical outcomes for adolescents with substance use disorder (SUD) and problematic substance use (PSU). The aims are 2-fold: (1) to summarize empirically based guidance abou...
OBJECTIVE: To enhance the quality of care and clinical outcomes for adolescents with substance use disorder (SUD) and problematic substance use (PSU). The aims are 2-fold: (1) to summarize empirically based guidance about the psychosocial, behavioral, and psychopharmacologic treatment of SUDs and PSU in adolescents and young adults; and (2) to summarize expert-based guidance about the assessment and clinical management of these disorders. METHOD: Statements about the treatment of SUD/PSU are based upon empirical evidence derived from a critical systematic review of the scientific literature conducted by the Brown Evidence-Based Practice Center under contract with the Agency for Healthcare Research and Quality (AHRQ). To update the AHRQ/Brown findings, a subsequent literature search of meta-analyses was conducted and critically reviewed by the American Academy of Child and Adolescent Psychiatry (AACAP) Committee on Quality Issues (CQI). Evidence that each studied intervention resulted in benefits that outweighed the harms was assigned a Strength of Evidence (SOE) rating as follows: A (high), B (moderate), C (low), or insufficient. Interventions with an SOE rating of C or higher were eligible to be assigned a category of Recommendation (1) or Suggestion (2). Guidance about the assessment and clinical management of treatments for SUD/PSU was informed by expert opinion and consensus as presented in previously published clinical practice guidelines, chapters in leading textbooks of child and adolescent psychiatry, the DSM-5-TR, and government-affiliated prescription drug information websites. RESULTS: Suggested (2C) safe and effective short-term treatments for SUD/PSU in adolescents and young adults include brief (1-2 sessions) motivational interviewing for alcohol use; non-brief (>2 sessions) motivational interviewing, family therapy, or cognitive-behavioral therapy for alcohol use or disorder with or without other drug use; motivational interviewing plus cognitive-behavioral therapy for illicit drug disorders; behavioral interventions for college students with problematic alcohol use; and longer-term buprenorphine treatment and slower buprenorphine taper for opioid use disorder. The SOE was insufficient to support suggestions or recommendations for the pharmacological or behavioral treatment of any other adolescent SUD/PSU. CONCLUSION: Substance use in adolescents and young adults is known to cause dependence, overdose, accidents while intoxicated/under the influence, physical and mental health problems, academic and vocational failure, and premature death. This document highlights 4 empirically supported treatment suggestions for SUD/PSU in youth. Despite the magnitude of the problem, there is a paucity of safe and effective treatments for adolescents and young adults with SUD/PSU, suggesting the urgent need for additional research.
Reevaluating Suicide Risk Screening in Preadolescents: Beyond Safety Toward Strategic Integration-Authors' Reply.
Hennefield L, Thompson RJ, Barch DM … +2 more , Luking KR, Luby JL
J Am Acad Child Adolesc Psychiatry · 2026 Mar · PMID 40818601 · Publisher ↗
We thank Zou et al. for their thoughtful letter in support of our recent article demonstrating the relative safety of suicide-risk screening in preadolescents. Their Letter to the Editor, "Reevaluating Suicide Risk Scree...
We thank Zou et al. for their thoughtful letter in support of our recent article demonstrating the relative safety of suicide-risk screening in preadolescents. Their Letter to the Editor, "Reevaluating Suicide Risk Screening in Preadolescents: Beyond Safety Toward Strategic Integration," underscores the importance of not only considering safety but also prioritizing the strategic and developmentally appropriate integration of suicide-risk screening into pediatric settings.
Reevaluating Suicide Risk Screening in Preadolescents: Beyond Safety Toward Strategic Integration.
Zou Z, Liu J, Fu L … +2 more , Huang B, Wang S
J Am Acad Child Adolesc Psychiatry · 2026 Mar · PMID 40818600 · Publisher ↗
We read with great interest the recent article by Hennefield et al., titled "Asking Preadolescents About Suicide Is Not Associated With Increased Suicidal Thoughts." The study's nuanced design and rigorous analysis provi...
We read with great interest the recent article by Hennefield et al., titled "Asking Preadolescents About Suicide Is Not Associated With Increased Suicidal Thoughts." The study's nuanced design and rigorous analysis provide reassuring evidence that repeated suicide-risk screening-whether monthly in lower-risk or weekly in higher-risk 8- to 12-year-olds-does not appear to induce suicidal ideation in this vulnerable population. This finding helps to dismantle long-standing hesitation in pediatric practice regarding the potential iatrogenic effects of introducing suicide-related language during mental health screening. However, the implications of this research stretch beyond the issue of safety, inviting broader discussion on how such screenings might be strategically deployed within real-world pediatric care systems.
Balancing Strength and Strain: A Clinical Perspective on John Henryism and Campus Engagement in Transition-Aged Black Youth.
Onyewuenyi AC, Herres J, Obilor TI … +2 more , Villareal LG, Defreitas SA
J Am Acad Child Adolesc Psychiatry · 2026 Apr · PMID 40784604 · Publisher ↗
John Henryism (JH), a high-effort coping strategy often employed by Black people to navigate systemic adversity, plays a significant yet paradoxical role in the mental health outcomes of Black transition-aged youth (18-2...
John Henryism (JH), a high-effort coping strategy often employed by Black people to navigate systemic adversity, plays a significant yet paradoxical role in the mental health outcomes of Black transition-aged youth (18-24 years old). While JH reflects resilience and determination in the face of racialized stressors, it is also associated with adverse outcomes such as emotional dysregulation, allostatic load, and mental health challenges when deployed without sufficient support systems. For Black students in campus settings, particularly predominantly White institutions (PWIs), JH can exacerbate the strain of racial discrimination, isolation, and pressures to overperform, leading to elevated risks of anxiety, depression, and physical stress. However, campus engagement, such as participation in Black student organizations, mentorship programs, and cultural spaces, can serve as a protective factor, fostering a sense of belonging, validation, and emotional support. This clinical perspective outlines key strategies for mental health practitioners (MHPs) to recognize and address the dual nature of JH while promoting healthy, balanced coping mechanisms. By integrating culturally responsive assessments, emotion regulation interventions, and systemic advocacy, clinicians can support Black students in managing JH while encouraging campus environments that alleviate rather than reinforce racialized stressors. This approach emphasizes the need for holistic collaboration among clinicians, educators, and policymakers to create equitable and supportive spaces that enable Black youth to thrive academically, emotionally, and personally.
Beyond Nonverbal Learning Disability: The Case for and Against Developmental Visual-Spatial Disorder as a Distinct Diagnosis.
Poletti M
J Am Acad Child Adolesc Psychiatry · 2025 Dec · PMID 40750086 · Publisher ↗
Fisher and colleagues reported results from the iterative process that led to DSM-like diagnostic criteria for nonverbal learning disability (NVLD) as a distinct neurodevelopmental disorder, defined as developmental visu...
Fisher and colleagues reported results from the iterative process that led to DSM-like diagnostic criteria for nonverbal learning disability (NVLD) as a distinct neurodevelopmental disorder, defined as developmental visual-spatial disorder (DVSD). The establishment of clear diagnostic criteria may facilitate the identification of individuals with clinically significant visual-spatial deficits and associated functional impairments, thereby advancing research in this area. As acknowledged by the authors, the literature on NVLD is relatively scarce compared to that on other neurodevelopmental disorders included in the DSM. Moreover, the quality of the existing evidence is a matter of debate, as highlighted in state-of-the-art reviews.
Beyond Nonverbal Learning Disability: The Case for and Against Developmental Visual-Spatial Disorder as a Distinct Diagnosis-Authors' Reply.
Fisher PW, Litwin HD, Riddle MA … +1 more , Margolis AE
J Am Acad Child Adolesc Psychiatry · 2025 Dec · PMID 40750085 · Publisher ↗
We were pleased by the interest in our report of the process used to formulate a DSM-style criteria set for developmental visual-spatial disorder (DVSD). A reconceptualization of nonverbal learning disability (NVLD), DVS...
We were pleased by the interest in our report of the process used to formulate a DSM-style criteria set for developmental visual-spatial disorder (DVSD). A reconceptualization of nonverbal learning disability (NVLD), DVSD is defined by persistent deficits in processing or integrating visual and spatial information, which are captured in 8 behavioral subcriteria and can co-occur with other neurodevelopmental disorders, including, for example, but not limited to, autism spectrum disorder and developmental coordination disorder (DCD). DVSD differs from NLVD in the following important ways: it singularly focuses on visual-spatial deficits; it does not require a discrepancy from verbal skills; it does not require neuropsychological or education test results; and, although it requires impairment, it does not require impairment in a specified area of functioning (eg, social, motor, attention, etc).
Efficacy of the Emotion Awareness and Skills Enhancement (EASE) Program in Autism: A Randomized Controlled Trial.
White SW, Conner CM, Beck K … +1 more , Mazefsky CA
J Am Acad Child Adolesc Psychiatry · 2025 Jul · PMID 40750084 · Publisher ↗
OBJECTIVE: Autistic adolescents and adults often struggle with emotion dysregulation, and advocates consistently encourage more research on mental health. This study aimed to establish efficacy for psychotherapeutic inte...
OBJECTIVE: Autistic adolescents and adults often struggle with emotion dysregulation, and advocates consistently encourage more research on mental health. This study aimed to establish efficacy for psychotherapeutic intervention for emotion dysregulation for autistic adolescents and young adults. METHOD: In this multisite randomized controlled trial, a primarily mindfulness-based intervention called the Emotion Awareness and Skills Enhancement (EASE) Program, developed to improve emotion dysregulation in autistic adolescents and young adults, was compared to a rigorous active control condition (ACC) that allowed for personalized and evidence-based intervention as long as it did not include EASE core elements. It was hypothesized that the EASE group would demonstrate a steeper decline in emotion dysregulation, as well as decreased mental health problems, compared to those in ACC. A total of 109 participants were randomized, 102 began treatment, 89 participants completed all treatment sessions. intent-to-treat (ITT; n = 109) analyses were conducted, with supplemental per protocol analyses (PP; n = 76). RESULTS: Primary outcomes included emotion dysregulation severity and its interference with daily functioning, whereas secondary outcomes assessed mental health symptoms. Condition-naive interviews, which gauged impairment related to dysregulation, showed that the EASE group had more treatment responders (63%) compared to ACC (44%) (p = .052, odds ratio = 2.85), but this difference was not statistically significant. EASE participants demonstrated greater declines in emotion dysregulation than those in ACC (Reactivity, b = -0.168, p = .017; Dysphoria, b = -0.182, p = .010) at endpoint. EASE participants demonstrated improvement in internalizing and externalizing symptoms, relative to baseline, based on self- and caregiver-report, whereas ACC participants showed improvement only in caregiver-reported externalizing symptoms. All effects were stronger in PP analyses, suggesting the possible importance of treatment dosage. CONCLUSION: Findings suggest that EASE improves emotion dysregulation for autistic adolescents and young adults. CLINICAL TRIAL REGISTRATION INFORMATION: Emotion Awareness and Skills Enhancement Program (EASE; https://clinicaltrials.gov/study/NCT03432832 DIVERSITY & INCLUSION STATEMENT: We worked to ensure that the study questionnaires were prepared in an inclusive way. We worked to ensure race, ethnic, and/or other types of diversity in the recruitment of human participants. One or more of the authors of this paper self-identifies as living with a disability.
Bridging the Leadership Gap in Autism Care: A Global Imperative for Effective Implementation-Authors Reply.
Stahmer AC, Brookman-Frazee L
J Am Acad Child Adolesc Psychiatry · 2026 Jan · PMID 40714295 · Publisher ↗
We appreciate the thoughtful letter by Widiastuti and colleagues on our article examining the effectiveness of multilevel implementation strategies for autism interventions across public service systems. We are encourage...
We appreciate the thoughtful letter by Widiastuti and colleagues on our article examining the effectiveness of multilevel implementation strategies for autism interventions across public service systems. We are encouraged by their recognition of the critical role of leaders in supporting the adoption and fidelity of evidence-based interventions (EBIs), particularly in settings that face systemic and resource challenges. This response discusses potential extensions of leadership training to LMICs and the need for further study in the context of those settings.
Bridging the Leadership Gap in Autism Care: A Global Imperative for Effective Implementation.
Widiastuti AA, Atmoko A, Eva N … +4 more , Ervina I, Leylasari HT, Rustam HK, Juraidin I
J Am Acad Child Adolesc Psychiatry · 2026 Jan · PMID 40714294 · Publisher ↗
We read with great interest the article by Brookman-Frazee et al. "Effectiveness of Multilevel Implementation Strategies for Autism Interventions: Outcomes of Two Linked Implementation Trials," which presents compelling...
We read with great interest the article by Brookman-Frazee et al. "Effectiveness of Multilevel Implementation Strategies for Autism Interventions: Outcomes of Two Linked Implementation Trials," which presents compelling evidence on the role of leadership in promoting the fidelity and effectiveness of evidence-based interventions (EBIs) for autistic children. The study underscores the critical role of leader-focused strategies in ensuring the successful adoption of EBIs across multiple public service systems, a finding with profound implications for global autism care.
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