Fanelli G, Chatwin H, Holde K
… +9 more, Demontis D, Børglum AD, Mortensen PB, Vilhjalmsson B, Bulik C, Serretti A, Fabbri C, Petersen LV, Dalsgaard S
J Am Acad Child Adolesc Psychiatry
· 2026 Jun · PMID 42392531
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OBJECTIVE: Educational attainment (EA) is a major determinant of well-being and is influenced by genetic and environmental factors. This study investigated whether polygenic scores for EA (EA-PGS) relate to school perfor...OBJECTIVE: Educational attainment (EA) is a major determinant of well-being and is influenced by genetic and environmental factors. This study investigated whether polygenic scores for EA (EA-PGS) relate to school performance in adolescents with and without psychiatric disorders, and whether associations vary by parental education and sex. METHOD: We analyzed 86,122 individuals (36,659 with psychiatric disorders) from the Danish iPSYCH2015 case-cohort. Associations between EA-PGS, psychiatric diagnoses, and ninth-grade examination outcomes (passing rates and Danish and mathematics grades) were assessed using regression models, adjusting for covariates. RESULTS: Higher EA-PGS was associated with lower odds of several psychiatric disorders, including attention-deficit/hyperactivity, attachment, neurotic, oppositional defiant/conduct, and substance use disorders, and intellectual disability. Regardless of case status, individuals with higher EA-PGS were more likely to pass the examination and achieve higher grades. At comparable EA-PGS values, adolescents with psychiatric disorders performed worse than controls. For pass/fail, EA-PGS effects differed between cases and controls in attachment, eating, neurotic, mood, substance use, and tic disorders, and intellectual disability (q<0.05), being larger in cases for all groups except intellectual disability, where effects were attenuated. Parental education, but not sex, modified the association between EA-PGS and passing (interaction p=0.008), with differences by parental education evident at lower EA-PGS levels. CONCLUSION: Higher EA-PGS was associated with better school performance, but adolescents with psychiatric disorders performed worse than controls after accounting for EA-PGS. Performance differences persisted after accounting for EA-PGS. Both EA-PGS and parental education were associated with educational outcomes, indicating that genetic and familial factors are related to variation in school performance.
van Leuven L, Enebrink P, Lalouni M
… +1 more, Forster M
J Am Acad Child Adolesc Psychiatry
· 2026 Jun · PMID 42379513
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OBJECTIVE: Child abuse is associated with lifetime risks for psychiatric disorders. This study evaluated 30-month effects of Safer Kids, a parenting program designed for rapid implementation following suspected child abu...OBJECTIVE: Child abuse is associated with lifetime risks for psychiatric disorders. This study evaluated 30-month effects of Safer Kids, a parenting program designed for rapid implementation following suspected child abuse. METHOD: In an open-label, randomized controlled trial, families reported for child abuse to 26 Swedish child welfare agencies were randomized to Safer Kids or intervention as usual (IAU). Primary outcomes were official child abuse reports (time to first new report and total number of reports) and caregiver abuse risk (the Brief Child Abuse Potential Inventory [BCAP]). The secondary outcome was child mental health (the Strengths and Difficulties Questionnaire [SDQ]). The trial was pre-registered at Clinicaltrials.gov (NCT04163367). RESULTS: The trial included 112 families (194 parents). The cumulative number of new child abuse reports was lower for Safer Kids compared to IAU (IRR = 1.79, 95% CI=1.06, 3.02, p = 0.028), although there was no difference in time to first new report (HR = 0.74, 95% CI=0.31, 1.76, p = 0.50). At 30 months, SDQ showed a consistent effect favoring Safer Kids across analytical approaches (non-imputed data: d = 0.60, 95% CI=0.11, 1.09, p = .001). For BCAP, an effect was observed in non-imputed analyses (d = 0.41, 95% CI=0.08, 0.89, p = .044), but was not supported in sensitivity analyses. CONCLUSION: Safer Kids did not reduce the time to the first new abuse report but was associated with somewhat fewer total reports and better child mental health at 30 months, suggesting preventive effects in families with suspected abuse. CLINICAL TRIAL REGISTRATION INFORMATION: A Randomized Controlled Study of Safer Kids: A Manualized Intervention to Prevent Child Abuse; https://clinicaltrials.gov/study/NCT04163367 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.
Tang L, Buneviciute J, Morton K
… +4 more, Anderson J, Smith S, Lopez LV, Gerber N
J Am Acad Child Adolesc Psychiatry
· 2026 Jun · PMID 42373068
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OBJECTIVE: This quality improvement initiative aimed to increase adherence to the Choosing Wisely recommendation by increasing compliance with medical screening recommendations for pediatric patients undergoing psychiatr...OBJECTIVE: This quality improvement initiative aimed to increase adherence to the Choosing Wisely recommendation by increasing compliance with medical screening recommendations for pediatric patients undergoing psychiatric evaluation in the emergency department (ED) from 70% to 95% between October 2024 and August 2025, thereby reducing unnecessary screening. METHOD: We conducted an observational study with sequential interventions in an urban tertiary care pediatric ED. Eligible patients were those with a psychiatry consult order. Laboratory testing was considered clinically indicated if documented by the physician. Interventions included operational changes, staff education, and monthly feedback. The primary outcome was compliance with indication-based testing (either no testing or testing with documented indication). Process measures included compliance among discharged and admitted patients; the balancing measure was missed diagnoses. Data were collected via chart review and analyzed using p-charts. RESULTS: Among 756 encounters, 216 required inpatient psychiatric admission. Before implementation, all admitted patients received screening labs. After implementation, 50 of 101 admitted patients (50%) had no laboratory testing. Overall compliance improved from 71.4% to 96.3%, with discharged patients increasing from 80.1% to 100% and admitted patients from 42.9% to 85.6%. No patients required transfer back to medical services for missed diagnoses or complications. CONCLUSION: Implementing Choosing Wisely recommendations was associated with a significant increase in compliance and reduction in unnecessary screening without compromising safety. Findings support indication-based medical clearance, improving efficiency, reducing costs, and aligning ED practice with evidence-based standards. 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. 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.
Zhong M, Zhang M, Wang F
… +4 more, Wang Y, Chen Z, Liu Z, Yang J
J Am Acad Child Adolesc Psychiatry
· 2026 Jun · PMID 42349780
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OBJECTIVE: Early-onset schizophrenia (EOS), defined as onset before age 18, is associated with more severe symptoms, higher genetic load, and poorer functional outcomes compared to adult-onset schizophrenia (AOS). Altera...OBJECTIVE: Early-onset schizophrenia (EOS), defined as onset before age 18, is associated with more severe symptoms, higher genetic load, and poorer functional outcomes compared to adult-onset schizophrenia (AOS). Alterations in brain network organization have been widely reported in EOS and may contribute to its distinct clinical profile, although interactive effects of age and disease on connectome topology remain poorly understood. METHOD: This study included 45 first-episode drug-naïve patients with EOS, 47 first-episode drug-naïve patients with AOS, and 79 age-matched healthy controls (29 younger, 50 older), with additional exploration in medicated groups (91 EOS and 79 AOS). Using resting-state fMRI and graph theory analysis, we compared topological properties of whole-brain and subnetworks across groups. RESULTS: We identified significant diagnosis × age-stratum interactions specifically on clustering coefficients of the somatosensory-motor network (SMN) and auditory network (AN). EOS showed increased normalized clustering coefficients (gamma), whereas AOS exhibited reduced gamma. Crucially, these aberrant patterns in SMN persisted after antipsychotic treatment. CONCLUSION: These findings suggest that EOS and AOS may differ in the topological organization of brain networks, particularly within SMN and AN. The persistence of SMN abnormalities after antipsychotic treatment further supports the possibility that EOS has a distinct network-level pathophysiology. 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. We worked to ensure sex balance in the selection of non-human subjects. 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.
J Am Acad Child Adolesc Psychiatry
· 2026 Jun · PMID 42336134
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OBJECTIVE: Executive function (EF) deficits are observed in externalizing disorders. However, research has yet to explore the specificity of these associations for externalizing symptom dimensions and their potential uti...OBJECTIVE: Executive function (EF) deficits are observed in externalizing disorders. However, research has yet to explore the specificity of these associations for externalizing symptom dimensions and their potential utility in identifying subgroups of youth at risk for persistent problems. The current study leverages unsupervised learning methods to investigate longitudinal relationships between EF domains of inhibitory control and working memory and externalizing dimensions of hyperactivity, impulsivity, and aggression. METHOD: We include 5,501 youth from the Adolescent Brain Cognitive Development Study who participated in the baseline through 3- year follow-up (T0-T3) assessments. Youth EF was assessed with the Stop Signal and Emotional N-Back tasks. Externalizing problems were captured with the Child Behavior Checklist (CBCL) and parent-report Kiddie Schedule for Affective Disorders and Schizophrenia. RESULTS: A 2-cluster k-means solution optimally fit the data at T0 and T2. At both timepoints, the largest cluster (n= 2,927; n=3,089) was characterized by higher EF, while the smaller cluster (n= 2,574; n=2,412) was characterized by lower EF. Temporal stability of group membership was moderate (Cohen's k=0.41). Membership in the lower EF group at both timepoints was significantly associated with greater CBCL attention problems concurrently (T0, T2) and longitudinally (T0-T3; qs<0.05, Rank Biserial rs=0.6-0.11), and was associated with a greater proportion of ADHD diagnoses at T1 (qs≤0.001, Odds Ratios=1.65-1.71). Associations were not observed for aggressive or rule-breaking behaviors. CONCLUSION: These findings suggest multifaceted and specific cognitive performance deficits in youth attention problems that may inform tailoring and development of personalized treatment and cognitive interventions.
J Am Acad Child Adolesc Psychiatry
· 2026 Jun · PMID 42331313
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The impact of early parental loss is a well-known and well-documented risk factor for adverse mental health outcomes. Approximately 5% of children will lose a parent before the age of 18 years. Depression, acute stress d...The impact of early parental loss is a well-known and well-documented risk factor for adverse mental health outcomes. Approximately 5% of children will lose a parent before the age of 18 years. Depression, acute stress disorder, post-traumatic stress disorder, behavioral disorders (including delinquency), substance abuse, and increased rates of suicide have all been correlated with parental deaths during childhood. Although the greatest risk occurs during the first 2 years following the loss, the risks continue. Decreased school achievement, and higher rates of divorce and unemployment, have all been correlated with parental loss up to 34 years later..
Salazar de Pablo G, Laherran-Cantera N, Aymerich C
… +12 more, Galvañ J, Palacios-Garrán R, Armyra E, Pedruzo B, Lahera G, Catalán A, Díaz-Caneja CM, Calvo A, Arango C, Di Forti M, Murray RM, Correll CU
J Am Acad Child Adolesc Psychiatry
· 2026 Jun · PMID 42331312
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OBJECTIVE: To quantify the prevalence of cannabis use (CU) and cannabis use disorders (CUD) in Early-Onset Psychosis (EOP; <18 years) and examine their correlates, clinical and functional impact. METHOD: This PRISMA-comp...OBJECTIVE: To quantify the prevalence of cannabis use (CU) and cannabis use disorders (CUD) in Early-Onset Psychosis (EOP; <18 years) and examine their correlates, clinical and functional impact. METHOD: This PRISMA-compliant systematic review and meta-analysis (CRD420251070701) searched six databases until 1/7/2025, for studies evaluating CU/CUD in EOP. Data were extracted by independent researchers, and quality assessment was conducted using the Newcastle-Ottawa Scale. Heterogeneity, publication bias, subgroup and meta-regression analyses were performed. A narrative synthesis was conducted. RESULTS: Forty studies (N=3,473; age=16.2±1.6 years; male=59%) were included. In EOP, pooled prevalence was for current CU 32.8% (95%CI=18.5-51.2), for lifetime CU 40.2% (95%CI=31.3-49.7), and for lifetime CUD 36.6% (95%CI=18.2-59.9). In meta-regression analyses, current CU was associated with male sex (β=0.012, p=0.021) and hospitalization rates (β=0.006, p=0.021), but with less severe negative symptoms (β=-0.191, p=0.001) and lower proportion of schizophrenia diagnosis (β=-0.026, p=0.049). Lifetime CU was associated with cocaine use (β=0.101, p=0.003) and again less severe negative symptoms (β=-0.173, p=0.030). Our narrative synthesis indicated that CU commonly preceded psychosis onset, and was linked to negative outcomes (e.g. longer duration of untreated psychosis and higher hospitalization rates) in EOP. Study quality was mostly fair (67.5%); GRADE certainty ranged from low to moderate. CONCLUSION: CU and CUD are common in EOP and relate to clinical presentation. Screening and integrated substance use care should be embedded in primary care and clinical settings. Further longitudinal studies and randomized clinical trials to evaluate the efficacy of interventions to reduce CU and CUD are needed.
J Am Acad Child Adolesc Psychiatry
· 2026 Jun · PMID 42314986
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Noncommunicable or chronic illness accounts for the greatest proportion of global morbidity and mortality (burden of disease) over the past 3 decades. Many of the risk factors for noncommunicable diseases, such as diabet...Noncommunicable or chronic illness accounts for the greatest proportion of global morbidity and mortality (burden of disease) over the past 3 decades. Many of the risk factors for noncommunicable diseases, such as diabetes, cancers, and mental illness including substance misuse, can be traced to environments and exposures in early life. Understanding the harms associated with air pollutants, ultra-processed foods (UPFs), excessive screen time and social media exposure, poor sleep and stress, and other factors affecting child development and well-being requires large-scale, longitudinal studies with comprehensive phenotypic characterization and the capabilities to process and make the data available to researchers. Currently, 2 studies funded by the National Institutes of Health are poised to answer pressing questions about early life exposures and vulnerability to chronic illness.
Lee H, Castillo WC, Qato DM
… +3 more, Rose R, Reeves G, dosReis S
J Am Acad Child Adolesc Psychiatry
· 2026 Jun · PMID 42309316
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OBJECTIVE: To investigate antidepressant regimen change after an initial selective serotonin reuptake inhibitor (SSRI) trial in children and adolescents with depression, and to identify associated factors. METHOD: This p...OBJECTIVE: To investigate antidepressant regimen change after an initial selective serotonin reuptake inhibitor (SSRI) trial in children and adolescents with depression, and to identify associated factors. METHOD: This population-based cohort study included children and adolescents aged 8 to 18 years with depression initiating SSRI monotherapy, using the 2010-2022 IQVIA PharMetrics Plus for Academics database (25% random sample). Eligible individuals received ≥8 weeks of SSRI treatment without switching or augmentation during the initial 12-week treatment. We estimated regimen change after week 12 and used a Cox proportional hazards regression model to identify factors associated with the change. Sensitivity analyses tested allowable treatment gaps and extended follow-up periods. RESULTS: Of 20,708 individuals (mean age 15.4 years, 66.8% female), 11,067 (53.4%) changed their regimen: 9,369 (45.2%) discontinued, 1,137 (5.5%) switched, and 561 (2.7%) augmented. Older age (hazard ratio = HR 1.05, 95% CI = 1.04-1.06), substance use disorder (HR = 1.24, 95% CI = 1.14-1.34), psychiatric hospitalization (HR = 1.38, 95% CI = 1.19-1.61), and psychiatric emergency department visits (HR = 1.18, 95% CI = 1.04-1.35) were associated with an increased risk of regimen change. Anxiety disorder (HR = 0.89, 95% CI = 0.86-0.93) and psychotherapy (6-10 visits: HR = 0.90, 95% CI = 0.84-0.95; >10 visits: HR = 0.78, 95% CI = 0.73-0.82 vs none) were associated with a lower risk of regimen change. Individuals without a health maintenance organization (HMO) had a lower risk (HR = 0.92; 95% CI = 0.88-0.96) than those with an HMO. An extended follow-up identified additional regimen changes. CONCLUSION: Our findings showed that over half of children and adolescents initiating antidepressant use do not continue treatment beyond 12 weeks.
J Am Acad Child Adolesc Psychiatry
· 2026 Jun · PMID 42309315
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Catatonia was first mentioned as a subject of interest in Karl Kahlbaum's 1874 monograph "Catatonia or Tension Insanity." The German psychiatrist described catatonia as a neuropsychiatric syndrome involving motor symptom...Catatonia was first mentioned as a subject of interest in Karl Kahlbaum's 1874 monograph "Catatonia or Tension Insanity." The German psychiatrist described catatonia as a neuropsychiatric syndrome involving motor symptoms, and identified what are now described as hypo- and hyperactive subtypes. Over the ensuing 150 years, the recognition and understanding of catatonia has evolved, and it is now appreciated as a syndrome associated with different psychiatric and medical diagnoses, including neurodevelopmental disorders (NDDs). NDDs are conditions originating in childhood that have an impact on social, personal, and academic function; they include autism spectrum disorder (ASD), intellectual disability (ID), and many genetic disorders with autistic phenotypes. Individuals with NDDs are particularly vulnerable to the development of catatonia because of shared neurobiological factors including gamma-aminobutyric acid (GABA) dysfunction. However, diagnosing catatonia in NDDs is challenging because of similarities in baseline developmental symptoms and core features of catatonia. Despite the acknowledgement of the association between catatonia and NDDs, catatonia continues to be underrecognized and underdiagnosed in this population, with resulting morbidity and mortality.
J Am Acad Child Adolesc Psychiatry
· 2026 Jun · PMID 42309314
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Historically minoritized youth presenting to inpatient psychiatric units (IPUs) for emotional and behavioral difficulties are disproportionately subjected to restrictive interventions, such as seclusion and restraint, wh...Historically minoritized youth presenting to inpatient psychiatric units (IPUs) for emotional and behavioral difficulties are disproportionately subjected to restrictive interventions, such as seclusion and restraint, which can cause or exacerbate trauma, undermine crisis stabilization, erode trust in the health care system, and negatively affect skill development and long-term well-being. Positive Behavior Interventions and Supports (PBIS) is a multitiered system of support that organizes evidence-based practices, focuses primarily on prevention, and promotes the use of least-restrictive interventions. Although it was originally developed for schools, PBIS has been adapted to IPU settings; it is a framework with great potential for improving health equity by emphasizing systematic, data-based decision making rather than reactive, implicit racial bias-influenced responses to patients' psychiatric presentations. Implementation of PBIS on IPUs may contribute to reductions in seclusion, restraint, and PRN medication use for aggression as well as insignificant differences in these restrictive practices across racial and vulnerable population groups. Although research on PBIS in the IPUs is still emerging, this article highlights key practices that can advance health equity.
J Am Acad Child Adolesc Psychiatry
· 2026 Jun · PMID 42309312
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The mother of a 14-year-old with autism asked softly, "What will happen when she graduates? There are no jobs for individuals like her."The mother of a 14-year-old with autism asked softly, "What will happen when she graduates? There are no jobs for individuals like her."