Clinical Child Psychology and Psychiatry

Multiple complex developmental disorder (MCDD) seems to have covered in the past years a grey area between autism and schizophrenia with onset in childhood, as it includes some symptoms usually observed in the former condition (dysregulation of affectivity, impairment in social interactions) and some in the latter (behavioral disorganization and thought problems, such as bizarre ideas, paranoid concerns, or magical thinking). This systematic review aims at summarizing the published scientific literature about the MCDD, wondering whether it is worth reconsidering its current relevance. In over 20 years (from 1993 to 2015) only 16 studies dealt with the topic, with a great heterogeneity in terms of country of investigation, study design, and clinical groups. Most of the studies compared MCDD with autism, trying to outline clinical differences between the two conditions. This information may help child psychiatrists and other mental health professionals reflect about those “weird” young patients they usually visit in their practice, and whose diagnosis appears not centered because they do not completely fulfill the diagnostic criteria of autism or schizophrenia.

Raising your child with attention deficit hyperactivity disorder (ADHD) in Jordan is a challenge due to the prevailing behavioral concerns, low availability of specialized care, and generalized feelings of social stigma. This phenomenological study involved twelve Jordanian parents of children aged 4–14 years, all diagnosed with ADHD according to DSM-IV-TR criteria. Participants were recruited through purposive sampling, and semi-structured interviews were conducted. Thematic analysis revealed three key themes: “The Journey through ADHD,” in which parents recognized the abnormalities of their children, reported suffering during the diagnosis, and described a wide range of uncertainty regarding the diagnosis and treatments. The second theme was “Disease as part of life,” where parents reported the impact on family dynamics and social life. The third theme was “Caregiving burden,” reflecting physical and emotional exhaustion and financial burden. Jordanian parents caring for children with ADHD face several challenges, including physical, emotional, economic, and social challenges and limited access to specialized services. Identifying their unique needs and challenges is essential in supporting them, providing appropriate services and resources, and developing policies and guidelines for culturally competent quality services.

Raising a child with ADHD in Jordan presents significant challenges due to behavioral issues, limited access to specialized care, and social stigma. This study involved interviews with twelve Jordanian parents of children aged 4 to 14 who were diagnosed with ADHD. The findings revealed three key themes. First, parents faced difficulties in recognizing the signs of ADHD and experienced uncertainty during the diagnosis and treatment process. Second, the condition had a profound impact on family life, disrupting relationships and daily routines, and leading to social isolation in many cases. Third, parents expressed the heavy burden of caregiving, highlighting the emotional, physical, and financial strain they endured while managing their child’s condition. These challenges underscore the importance of providing better support, resources, and culturally sensitive policies to help families raising children with ADHD in Jordan.

Few studies have examined how the personal characteristics of students, together with factors from their local social environments and communities, affect students living in generally high levels of social disruption. We examined the influence that personal characteristics as well as factors from the local social environments and communities may have on Colombian students’ levels of depressive symptoms shortly after the end of the of armed conflict. Data were collected from 710 students attending the fifth grade in a random sample of elementary schools in the province of Sucre in Colombia. Information was gathered on the students’ ages and gender as well as characteristics of their parents, school factors, and community factors. A five-level hierarchical regression model was used to determine the extent to which all these variables predicted depression scores, as measured by the Adolescent Depression Rating Scale. While personal, parental, school and community factors were all found to predict depression scores, the category, parental factors had the most impact. That was followed by school factors, community factors and finally personal characteristics. Multiple social and environmental factors were associated with the level of depression experienced by Colombian students.

Few studies have examined how the characteristics of students, together with their local social environments and communities, affect students living in generally high levels of social disruption. We examined the influence that personal characteristics as well as factors from the local social environments and communities may have on Colombian students’ levels of depressive symptoms shortly after the end of the of armed conflict. Data were collected from 710 students attending the fifth grade in a sample of Colombian, elementary schools. Information was gathered on the students’ ages and gender as well as characteristics of their parents, schools, and communites. We used regression analyses to determine the extent to which all these variables predicted students' levels of depression. While the personal, parental, school and community characteristics of students were all found to predict depression scores, how students were parented had the most impact. That was followed by characteristics of their schools, communities and their personal characteristics. We concluded that multiple social and environmental factors were associated with the level of depression experienced by Colombian students.

Sleep problems are diverse and pervasive among the adolescent population. Current sleep health interventions are ill-equipped to address the sleep crisis. We developed DOZE (Delivering Online Zzz’s with Empirical Support), which is a self-management evidence-based app for sleep disturbances. In an initial study, we found that DOZE was perceived as an acceptable and effective support for teen sleep. In a qualitative follow-up study, we engaged with students and other stakeholders to understand their experiences with implementing, disseminating, and using DOZE. The study employed a combination of qualitative surveys and semi-structured interviews to students (n = 21) and stakeholders (teachers, social workers, and researchers; n = 5), respectively. Reflexive thematic analysis was used to identify themes related to experiences implementing and engaging with the app. Students reported increased sleep regularity and sleep duration after using DOZE. Facilitators included greater integration of the app with school curriculum, timing of implementation, and researcher involvement in supporting knowledge dissemination and engagement. Barriers included worries about phone use at night and normalized poor sleep patterns among adolescents. There is need to identify ways to support implementation and engagement in different communities. Researchers continue to engage with stakeholders to support timely access to sleep health interventions for adolescents.

High school students struggle with many sleep problems, which then causes problems in their health and ability to do well in school. However, regular solutions to improving sleep in teens ask them to go bed early, which is not helpful because teens tend to be 'night-owls'. To tackle this problem, we developed a teen sleep app based on sleep science (DOZE) that is free and accessible for high school students to use. We found that students found this app to be enjoyable to use and helpful in supporting sleep health. Our next step was to use survey questions and interviews to learn more from teachers, social workers, and students about their experience getting DOZE into the school and experiences using the app. We wanted to know what individuals liked about the app, what made it easier/harder to bring DOZE into the school, and how we can continue to support sleep health in adolescents. We found that students were more likely to use DOZE when the app was placed within the school curriculum (e.g., physical education courses) and when the researchers were more involved - such as by giving talks. On the other hand, some individuals were worried about the use of phones during the night time and some students figured that poor sleep is a normal part of the high school experience. Overall, individuals generally found DOZE to be helpful and social workers noted that they will continue to suggest DOZE for students that struggle with poor sleep. In terms of policy recommendations, we need to continue thinking about ways to support sleep health, such as by delaying school start times to give adolescents more time to sleep. We continue to work with teachers and social workers in Canadian high schools to understand how to support teen sleep.

Online self-assessments are becoming more popular particularly with young people. They can serve as a screening tool to assess mental health. We developed a new online self-assessment tool for young people 12 to 30 years of age (Link: redcap.hmri.org.au/surveys/?s=MK7RCELJ79). It covers key symptoms of mood and psychotic disorders and risk factors, such as eating issues, substance use, suicidality, and deliberate self-harming behaviours. The tool also asks for a self-assessment of their level of functioning, their access to professional help, and their satisfaction with the help received. The assessment concludes with recommendations how to seek help dependent on the severity of their mental health problems and level of risk. We had 303 young people visiting the tool and 114 gave permission to analyse their data. Young people with anxiety symptoms, panic attacks, suicidal ideation, and urges to self-harm were considered at high risk. They more likely to report psychotic or depression symptoms and recreational substance use and low day-to-day functioning. Ongoing treatment and the satisfaction with it were not determined by the severity of mental health problems. These preliminary results suggest that the online self-assessment tool reaches the intended young audience, particularly those with mental health problems.

Purpose: Increased mental health (MH) needs during the COVID-19 pandemic led to the implementation of a novel pediatric Emergency Department Virtual Care (EDVC) service. Our study aimed to describe the pediatric MH patient population that used EDVC by comparing patient-specific factors of those who obtained services virtually to those seen in-person. Method: This retrospective chart review was conducted at a pediatric hospital in Eastern Ontario. Children and youth (aged 3–17) who received virtual or in-person emergency MH services from May to December 2020 were included. Patient demographics, clinical presentation details and disposition were compared between the virtual and in-person groups. Data was analyzed using descriptive statistics. Results: 1104 youth (96.1%) utilized the in-person ED for MH concerns; 45 (3.9%) used EDVC. In-person youth had a higher level of perceived risk (78.9% vs. 41.9%) and were more likely to present with concerns of depression, suicidal ideation, self-harm, or laceration (46.1% vs. 35.6%). Anxiety/situational crises or behavioural issues were more likely to present virtually. Eight patients (17.8%) were redirected to the ED from EDVC. Conclusions: Several patient-specific factors varied between youth seen in-person or virtually for MH concern. Study results can assist with the design and implementation of virtual MH care platforms.

Study comparing children and youth who used a virtual emergency mental health (MH) care service to those that went to the emergency department during the early COVID-19 pandemic to help with the development of similar platforms in the future: Why was the study done? Isolation measures during the COVID-19 pandemic left many children and youth struggling at home with mental health concerns. Limited in-person services led to the quick expansion of virtual care (VC) models in healthcare, including the introduction of Canada’s first pediatric emergency department virtual care (EDVC) service. So far, a description of patients who used this new model for emergency MH issues has not been reported. Understanding this may help with determining who is most appropriate for a virtual emergency MH visit and guide the development of safe, and effective, future virtual MH care models. What did the researchers do? Patient charts were reviewed for all patients who received virtual or in-person emergency MH care from May to December 2020. Several characteristics were then compared, including individual patient demographics and information about their visits (presenting issue, urgency of their concern, visit outcome, etc) to identify differences between these groups. What did the researchers find? A total of 1104 in-person and 45 EDVC patients were included in the study. In-person patients were identified as higher risk and were more likely to have concerns of depression or self-harm. Youth who used the VC model were more likely to present with anxiety or behavioural issues and reported more emotional distress. Eight patients were sent from EDVC to the ED, almost all (7/8, 88%) were sent for medical tests or due to safety concerns. While most patients did not have another ED visit for emergency MH issues during this period, those that did were more likely to have first used EDVC. What do the findings mean? There are several important differences between patients who used the in-person and EDVC services that could be applied to the development of future triaging and VC models. This study also explores several important limitations to VC to consider when creating similar models in the future.

In India, due to its diverse cultural, social environments and limited child mental health facilities, it becomes important to understand the factors which restrict the recovery and optimal functioning of children with severe mental illness and making use of that information clinical practice and developing interventions. Over the years, various research reports, papers and commissions have highlighted the relationship of social and cultural factors and mental disorders. However, very little has been done to study the interplay of psychosocial factors that affect the recovery and normal functioning of children with severe mental illness. To our best knowledge, this study is a first attempt to understand the psychosocial factors affecting the children with severe mental disorders based on qualitative content analysis of individual case files.

The present study examines insecure attachment styles in female adolescents, who are at risk for developing eating disorders. A second goal was to investigate whether attachment styles differentiate between high risk for anorexia and high risk for bulimia. A total of 150 adolescents were divided into four risk groups: High risk for anorexia, high risk for bulimia, medium risk and control group. The attachment styles were assessed using the Experience in Close Relationships Scale and the Relationship Questionnaire. Anxiety Attachment, but not Avoidance Attachment, was found to characterize those adolescents who are at risk for ED (AN + BN), and especially for those at high-risk for BN. The present results do not support the notion of an avoidance of emotional intimacy, characterizing the avoidant attachment style of those presenting with AN. Preoccupied Attachment style was found to characterize high-risk for BN, but not high-risk for AN, while the Insecure, Fearful, and Dismissing Attachment types did not differentiate between these two high-risk groups. This study highlights the dominant attachment style in adolescents at high risk for developing ED: The Anxiety Attachment style for AN and BN, and the Preoccupied Attachment style for BN but not for AN.

The present study examines to what degree insecure attachment styles characterize pre-clinical female adolescents, who are at risk for developing eating disorders (EDs). A second goal was to investigate whether attachment styles differentiate between high risk for anorexia (AN) and high risk for bulimia (BN). The main contribution of this study is in highlighting the dominant attachment style of the preclinical adolescent who is at high risk for developing ED. This is the Anxiety Attachment style for AN and BN, and the Preoccupied Attachment style for BN but not for AN.

Measuring satisfaction with psychological health services is important in clinical settings to evaluate the benefits of treatment. Past research has shown that relationship with therapist is at the core of satisfaction reports. However, measurement tools focusing on patients’ psychological health care experiences are rather scarce. The objective of this study is to adapt the Experience of Service Questionnaire (ESQ) Parent form and examine its psychometric properties in a Turkish population. ESQ Parent form was presented to parents (N = 265) of children who have received treatment at a university’s psychological counseling center. Child Behavior Checklist (CBCL) was gathered from parents pre- and post-treatment to measure symptomatic gains and investigate their associations with satisfaction with treatment. Confirmatory factor analysis comparing two different constructs showed that the 2-factor structure had a better fit. In addition, participants showing higher therapeutic gains showed significantly higher satisfaction in ESQ. This study is the first to measure satisfaction in psychological health care settings in Turkey, and therefore aims to contribute to a gap in the field. Results indicate a significant association between treatment outcome and satisfaction levels. Also, adapted measurement tool demonstrates adequate reliability and validity scores supporting its use in clinical settings.

Measuring Satisfaction in Mental Health Care: Measuring satisfaction in psychological health services could improve the quality of treatment and provide feedback to therapists. We aimed to adapt a questionnaire for measuring satisfaction in clinical settings in Turkey. We asked 265 parents whose children received psychological treatment at a university’s counseling center to fill out a satisfaction questionnaire to evaluate their experiences with the services they received. Our findings show that the quality of patient-therapist relationship is a main factor that affects satisfaction in psychological health services. Moreover, environmental factors such as location and facilities may also be important factors in satisfaction with health services. Lastly, we showed that satisfaction was associated with better treatment outcome; patients who showed more clinical improvement in treatment also reported higher satisfaction with the services received. Our study has underlined factors that affect satisfaction levels (relationship with therapist and environmental arrangements) in mental health care settings. We also identified how measuring satisfaction with psychological health services could be of use in clinical settings. We hope that our study would help mental health workers to take notice of the relationship between satisfaction and therapeutic progress.

The 48-item Healthy Habits Questionnaire (HHQ-48) was developed to (1) monitor positive changes in family lifestyles following engagement in the Parents Plus Healthy Families (PP-HF) parent training programme and (2) be utilised as a standalone measure in clinical settings to identify and track problematic influential behaviours amongst families of children in weight-management services. This study aimed to develop and validate a brief version of the HHQ-48. The scale was administered to a cross-sectional community sample (n = 480), and on two occasions to a control sample (n = 50) and an experimental sample (n = 40) from a randomised controlled trial (RCT) of the PP-HF programme to assess test-retest reliability and sensitivity to change respectively. Exploratory and confirmatory factor analysis showed that a 23-item, 4-factor version of the HHQ (i.e., the HHQ-23) best fit the data. The scale and factor subscales had good internal consistency and test-retest reliability. They also had good concurrent and construct validity shown by significant correlations with another scale that assessed lifestyle issues, and scales that assessed parenting satisfaction, family functioning, and children’s strengths and difficulties. The HHQ-23 was sensitive to change following parents completing the PP-HF programme. The HHQ-23 may, therefore, be used to monitor positive changes in family lifestyles following engagement in the PP-HF parent training programme. The HHQ-23 also shows promising potential as a standalone screening measure or as part of a larger battery of screening assessments in paediatric weight-management services.

This study aimed to develop a brief version of the 48-item Healthy Habits Questionnaire (HHQ-48), which assesses how parents encourage healthy lifestyles in their children and evaluates the effectiveness of the 8-session Parents Plus – Healthy Families (PP-HF) program aimed at preventing childhood obesity. The HHQ-48 items are grouped into eight categories reflecting the PP-HF sessions: empowering parents, family connection, healthy food routines, healthy meals, active play, managing technology, restful sleep, and a happy, healthy mind. To create a shorter version of the HHQ, 480 parents completed the HHQ-48 and additional family life questionnaires online. Factor analysis identified 23 items grouped into four clusters: Screens and Routines, Activity, Parent-Child Connection, and Healthy Food & Good Example, forming the HHQ-23.The HHQ-23 showed strong correlations with the HHQ-48 and moderate correlations with other established questionnaires on children's lifestyles, parenting satisfaction, family functioning, and children's strengths and difficulties. In a test with 50 parents over eight weeks, HHQ-23 scores were stable. Scores increased for 41 parents who completed the HHQ-23 before and after the PP-HF program, demonstrating the HHQ-23's sensitivity to change.

The assessment of anxiety symptoms in children and adolescents requires a valid and reliable single instrument able to detect various anxiety symptoms early and systematically collect data from other informant such as parents. The present study aimed to test the one-factor structure of the SCAS-P-8 and to examine its psychometric properties and invariance across sex and age in an Italian sample of 769 parents of children and adolescents aged 3–18 years (50.8% females). Confirmatory factor analysis confirmed the one-factor structure of the SCAS-P-8, which showed good reliability and invariance by sex and age. When examining mean differences by sex and age, results showed that female schoolchildren had higher anxiety scores than males and other age groups. A strong correlation with emotional problems demonstrated convergent validity, while discriminant validity resulted from the weak correlations with externalizing symptoms and relationship problems with peers. Overall, findings support the SCAS-P-8 as a valid brief instrument to assess anxiety symptoms in children and adolescents for clinical and research purposes and demonstrate its invariance across sex and age.

Anxiety symptoms are very common among children and adolescents. Clinicians and researchers are increasingly focusing on the need for a valid and reliable tool to detect various anxiety symptoms early, as reported by informants such as parents. In the present study, we aimed to test the structure of the Spence Children’s Anxiety Scale for parents (SCAS-P-8), which includes only 8 questions regarding the anxiety symptoms of their children and adolescents. The study involved 769 parents and their children and adolescents, aged 3-18 years (half of whom were female). The data analysis confirmed the structure of the SCAS-P-8 demonstrating good reliability and stability across sex and age. We also found that on average, girls showed higher anxiety levels than boys during late childhood compared to other age groups. In addition, our results confirmed that SCAS-P-8 is a valid measure of anxiety, as it is strongly related to an instrument that measures emotional problems, while it is weakly related to measures of externalizing symptoms and peer relationship problems. Overall, our results support the SCAS-P-8 as a valid brief instrument for measuring anxiety symptoms in children and adolescents for both clinical and research purposes.