Search Results (250)

Autism spectrum disorder (ASD) is increasingly associated with microbial and metabolic disturbances, including the altered production of gut-derived uremic toxins. We investigated urinary concentrations of five representative uremic toxins—indoxyl sulfate (IS), p-cresyl sulfate (PCS), trimethylamine N-oxide (TMAO), asymmetric dimethylarginine (ADMA), and symmetric dimethylarginine (SDMA)—in 161 children with ASD and 71 healthy controls. Toxins were measured using LC-MS/MS and were normalized to creatinine. Subgroup analyses were performed by sex, age group (2–5.9 vs. 6–17 years), and autism severity based on the Childhood Autism Rating Scale (CARS). In addition to individual concentrations, we calculated the total toxin burden, proportional contributions, and functional ratios (IS/PCS, PCS/TMAO, and IS/ADMA). While individual toxin levels did not differ significantly between groups, stratified analyses revealed that PCS was higher in girls and in severe cases of ASD, whereas IS and TMAO were reduced in younger and more severely affected children. The functional ratios shifted consistently with severity—IS/PCS declined from 1.69 in controls to 0.99 in severe cases of ASD, while PCS/TMAO increased from 12.2 to 20.5. These patterns suggest a phenolic-dominant microbial signature and an altered host–microbial metabolic balance in ASD. Functional toxin profiling may offer a more sensitive approach to characterizing metabolic disturbances in ASD than concentration analysis alone. Full article

Individuals with Autism Spectrum Disorder (ASD) often experience sensory hyperreactivities that interfere with daily life activities. White noise, characterized by its uniformity and its ability to mask environmental sounds, may serve as a tool to improve sensory and emotional regulation in children with ASD. The primary objective was to evaluate the response to white noise in improving self-regulation in minors with ASD. As a secondary objective, the study assessed whether there were differences in the response to white noise between patients with ASD and those with ASD and Intellectual Disability (ID). This study was conducted in the Child and Adolescent Psychiatry and Psychology Department of Hospital Clínic of Barcelona. A total of 54 patients, aged between 7 and 17 years, were included. The patients were divided into two groups: Group 1 consisted of patients diagnosed with ASD (n = 21), and Group 2 included patients diagnosed with ASD and ID (n = 33). White noise was offered to the patients, and their response was evaluated before and after the exposure using the Conners Teacher Rating Scale. Overall, the response to white noise in the sample was positive, with a significant difference in scores on the Conners Teacher Rating Scale (p < 0.001). When dividing the sample into the ASD group and the ASD + ID group, it was observed that the ASD + ID group tolerated white noise better and had a longer exposure time, although both groups showed improved scores on the Conners Teacher Rating Scale. White noise may be a valuable tool to enhance well-being in individuals with ASD, reduce motor restlessness, and increase attention span and emotional stability. However, its effectiveness varies across individuals. It is recommended to tailor its use to individual needs and to extend future research by incorporating physiological measures and larger sample sizes. Full article

Background/Objectives: The pediatric mental health crisis in the United States has reached unprecedented levels. Severe shortages in specialized health care professionals, particularly child and adolescent psychiatrists (CAPs), exacerbate the challenge of delivering timely and quality mental health care, especially in rural areas like Kansas. Innovative models such as Pediatric Mental Health Care Access (PMHCA) programs and School-Based Health Clinics (SBHCs) aim to integrate mental health expertise into primary care settings to address this gap. Methods: This paper examines an integrated care model to support SBHCs developed by the Kansas PMHCA. The Interprofessional Child-Centered Integrated Care Model (ICX2) was implemented within an SBHC in Haysville, KS. ICX2 utilizes biweekly collaborative team meetings (CTMs) via zoom involving primary care, psychology, child psychiatry, social work, and school resource coordinators to discuss patient cases and enhance the primary care management of pediatric mental health. This descriptive study analyzes data from January 2023 to June 2023, focusing on patient demographics, case characteristics discussed during CTMs, and recommendations made by the interprofessional team. Results: Findings illustrate the complex biopsychosocial needs of patients seen and define themes of case consultation and recommendations. Conclusions: Integrated care programs like ICX2 can be feasibly implemented through PMHCA programs and may be an efficient intervention to bridge resource gaps. Full article

Background: Schizotypal traits are considered to be clinical and cognitive features of Schizotypal Disorder in children (SDc). These traits are also seen in children and adolescents with high-functioning Autism Spectrum Disorder (ASD). This study examines the influence of schizotypal traits (and their severity) on the capacity of children with ASD to manage emotions, develop relationships with others, and adapt in school and family life. Methods: The Schizotypal traits of 63 children (6–12 years old) with High Functioning ASD were measured by the Melbourne Assessment of Schizotypy in Kids (MASK). Parents and teachers of the participating children completed the Child Behavior Checklist (CBCL) and Teachers’ Report Form (TRF) from the Achenbach System of Empirically Based Assessment and the Aberrant Behavior Checklist (ABC). Results: Overall, the results indicated correlations between the MASK scores and problems recorded by teachers, such as Internalizing problems (i.e., Anxious/Depressed, Withdrawn/Depressed, and Other problems score) according to TRF and Inappropriate speech scores, according to teacher’s ABC scales. Schizotypal traits impact the social, emotional, and behavioral functioning of children with ASD at home and school environments. Conclusions: The assessment of schizotypal traits in children with ASD provides critical information about a child’s functionality and cognitive development, also leading to the identification of potential cognitive-neuropsychological endophenotypes within ASD with characteristics of both Autism and Schizophrenia spectra. Τhe development of a valid assessment tool is required, as well as the design of targeted interventions to prevent the loss of functionality. Full article

Background/Objectives: Parental emotion socialization is a key influence on children’s emotional regulation and psychosocial development. This study examined how supportive and non-supportive parental responses to children’s negative emotions are associated with internalizing and externalizing problems and social competence among Greek children aged 6–12 years. Methods: A non-experimental, cross-sectional correlational study using convenience sampling was conducted with 100 Greek parents who completed the Coping with Children’s Negative Emotions Scale and the Child Behavior Checklist. Correlation and multiple regression analyses were used to examine associations between parenting responses and child outcomes, controlling for child age, child gender, and parent gender. Results: Minimization/devaluation responses were significantly associated with higher internalizing problems (β = 0.396, p = 0.009), externalizing problems (β = 0.264, p = 0.048), and total problems (β = 0.320, p = 0.012). Punitive responses significantly predicted externalizing (β = 0.383, p = 0.003) and total problems (β = 0.304, p = 0.004). Supportive strategies (e.g., emotion-focused and problem-focused responses) did not significantly predict lower problem scores but were positively correlated with social competence (e.g., problem-focused response: ρ = 0.25, p = 0.017). Parent gender predicted minimization/devaluation responses, with mothers scoring higher than fathers (β = 0.308, p = 0.006). Conclusions: Non-supportive parental responses—especially punitive and dismissive behaviors—are robustly associated with increased behavioral and emotional difficulties in children. While supportive strategies may contribute to social competence, their benefits appear diminished in the presence of negative parenting practices. These findings highlight the importance of culturally sensitive interventions tailored to Greek family dynamics. Despite limitations such as the use of self-report measures and a non-representative sample, this study contributes valuable insights into emotion socialization and child adjustment in a specific cultural context. Full article

Background/Objectives: Pediatric obstructive sleep apnea (OSA) is a prevalent medical condition, affecting 1–5% of non-syndromic children and 30–90% of children with Down syndrome. Given the severity of the condition and the associated health risks, early and effective treatment is crucial. However, current treatment modalities are often invasive or suffer from poor patient adherence. Additionally, adenotonsillectomy, the first-line treatment in pediatric OSA, seems not to be effective in every child, leaving children with residual OSA postoperatively. These challenges are particularly pronounced in high-risk populations, such as children with Down syndrome, highlighting the need for alternative therapeutic strategies. Therefore, a protocol is presented to evaluate the effectiveness of orofacial myofunctional therapy (OMT) as a treatment for OSA in two pediatric populations: (1) Non-syndromic children aged 4–18 years: 10 weeks of OMT. (2) Children with Down syndrome aged 4–18 years: 20 weeks of OMT. Effects of the OMT program will be evaluated on: sleep parameters (e.g., obstructive Apnea–Hyponea Index (oAHI), snoring frequency); orofacial functions (e.g., breathing pattern, tongue position at rest); quality of life outcomes. Methods: A pretest–posttest design will be used to evaluate the effectiveness of OMT in both children with and without Down syndrome and OSA. Both objective measures and patient-reported outcomes are being collected. Results: OMT is expected to improve orofacial functions, reduce OSA severity and symptoms, and enhance quality of life in both non-syndromic and syndromic children. Conclusions: This multidisciplinary research protocol, involving collaboration between ENT specialists and speech-language pathologists, aims to provide a comprehensive understanding of the potential benefits of OMT in treating OSA. Full article

Background and Objectives: Although psychiatric disorders in early childhood are increasingly recognized, comprehensive clinical data from large samples in this age group remain limited. This study presents one of the largest and longest-term evaluations in Türkiye of children aged 0–72 months referred to child psychiatry. It aims to identify the most common presenting complaints, diagnostic patterns, and key predictors of psychotropic medication initiation in a previously understudied age group. Materials and Methods: This retrospective analysis included 3312 children aged 0–72 months who presented to the outpatient child psychiatry clinic of Trakya University Medical Faculty Hospital in Edirne, Türkiye. Clinical records were reviewed to extract data on presenting complaints, psychiatric diagnoses, psychotropic medication initiation, and demographic details, including age and sex. Results: The most common presenting complaints were “delayed speech development”, “irritability/frustration”, “hyperactivity”, “requests for medical reports”, and “stuttering.” These complaints were more prevalent among children who received psychiatric diagnoses. Psychiatric diagnoses were more common in boys. Boys also presented at older ages and had longer follow-up durations. Psychotropic medications were initiated in 26.9% of the cases. The most frequently reported side effects were loss of appetite and drowsiness. Logistic regression analysis revealed that specific complaints were significantly predictive of initiating medication. These included “inability to speak”, “irritability/frustration”, “hyperactivity”, “lack of eye contact”, “aggression”, “school refusal”, “sleep problems”, and “fears.” Conclusions: This study revealed that some early childhood complaints, such as “inability to speak”, “restlessness”, “hyperactivity”, and “not making eye contact”, are strong predictors of both psychiatric diagnosis and initiation of psychotropic medication. The findings highlight the usefulness of structured assessment protocols in early childhood psychiatric services. The implementation of systematic screening for risk symptoms may facilitate early diagnosis and support more appropriate and timely treatment approaches, especially in resource-limited regions. Full article

Adolescents’ pervasive use of social media has been increasingly linked to aggression, including cyberbullying and hostile online interactions. While this association is well documented, the psychological and contextual mechanisms that mediate or moderate it remain unclear. This scoping review maps quantitative evidence on mediators and moderators between social media use and aggression among adolescents. A comprehensive search using ProQuest’s Summon platform was conducted across PsycINFO, Scopus, PubMed, and Web of Science, following the PRISMA 2020 guidelines. Eligible studies, published between January 2020 and March 2025, included adolescents aged 11–18 and reported at least one statistical mediation or moderation analysis. Forty-four studies from 19 countries (N > 90,000) were thematically synthesized. Key mediators included problematic use, moral disengagement, depression, attention-seeking, and risky digital behaviors. Moderators included gender, body satisfaction, cultural setting, school type, and family attachment. Most of the studies used structural equation modeling or PROCESS macro, although cross-sectional designs predominated. Limitations included reliance on self-reports and inconsistent social media measures. The findings suggest that social media–aggression links are indirect and shaped by emotional, cognitive, and ecological factors. Multi-level interventions targeting digital literacy, moral reasoning, and resilience are needed. This review was not registered and received no external funding. Full article

Background: Earthquake exposure has been linked with high rates of posttraumatic stress symptoms (PTSS) and comorbid conditions. Familial factors play critical roles in modulating these outcomes. This study examined youth trauma and parental influence following the twin earthquakes in Kefalonia, Greece, in 2014; Methods: A cross-sectional study was conducted with 502 adolescents (aged 11–18 years) and 474 parents from three regions categorized by proximity to the earthquake epicenter. Standardized self-report measures were administered. Data were analyzed using descriptive statistics, correlation analyses, and multiple hierarchical regression analyses to identify key predictors of adverse outcomes; Results: Among children, 5.2% exhibited probable PTSD, with girls reporting significantly higher symptom levels than boys. Higher earthquake exposure was associated with elevated PTSS and anxiety. In parents, 44.3% met criteria for probable PTSD, and those in the epicenter group reported significantly higher levels of stress, anxiety, and sleep disturbances. Earthquake exposure was identified as the strongest predictor of adverse outcomes, with parental psychopathology and diminished social support further contributing to increased symptom severity in children; Conclusions: The study demonstrates that both direct earthquake exposure and familial factors—particularly parental mental health and social support—play critical roles in shaping posttraumatic outcomes in youth, underscoring the need for integrated, family-centered mental health interventions in post-disaster settings. Full article

This study aimed to validate the usefulness of the Simplified Computerized Comprehensive Learning Ability Screening Test (SCLST) in schools and homes, to facilitate early detection and intervention for children with reading disorder (RD), math disorder (MD), or attention-deficit hyperactivity disorder (ADHD). Participants included 207 children and adolescents diagnosed with ADHD, RD, or MD and the healthy control group that was matched 1:1 by gender, age, and educational years. Higher rates of omission errors, commission errors, and standard deviation of response times were observed in the ADHD group (p < 0.001) in the SCLST-ADHD. The accuracy rates of the SCLST-RD and SCLST-MD were lower in the RD (p < 0.001) and MD group (p < 0.01), respectively. The mean response times were higher in the MD group (p < 0.001). In addition, the optimal sensitivity and specificity values were 84.6% and 88.5%, and the positive and negative predictive values were 88.0% and 85.2%, respectively, in the SCLST-ADHD. In the SCLTS-RD, the sensitivity and specificity values were 81.1% and 85.6%, and the positive and negative predictive values were 84.9% and 81.9%, respectively. In the SCLST-MD, the sensitivity and specificity values were 97.4% and 76.9%, and the positive and negative predictive values were 80.9% and 96.8%, respectively. Thus, by supporting timely assessment and intervention, this tool can support clinicians and educators in early-stage learning disabilities screening and reduce long-term psychosocial impairments. Full article

Munchausen Syndrome by Proxy (MSBP) is recognized as a form of child abuse in which a caregiver induces or fabricates illnesses in their child to gain medical and social attention. MSBP represents one of the most complex and insidious forms of child abuse, characterized by an ambiguous clinical presentation that poses significant challenges for physicians, psychiatrists, and social workers. However, this condition raises critical questions regarding its diagnosis, management, and forensic implications. Traditionally, MSBP has been framed as an individual pathological manifestation of the mother, overlooking the role of the healthcare and legal systems in its identification and management. In this article, we propose a critical reflection on MSBP, emphasizing how the issue is not merely a “parental failure” but rather a systemic failure of healthcare, social, and judicial institutions in recognizing, preventing, and effectively managing such cases. Full article

Adolescent externalizing problems are commonly linked to maternal psychological distress and family functioning, but these associations remain underexplored in the Greek sociocultural context. This study examined how maternal symptoms of depression, anxiety, and stress, along with adolescent-perceived family functioning, predict externalizing behaviors in Greek adolescents. A total of 563 adolescent–mother dyads (63.4% girls; M_age = 15.03 and SD = 0.83) participated. Mothers completed the Child Behavior Checklist (CBCL), the Depression Anxiety Stress Scales (DASS-21), and the Family Assessment Device (FAD–GF), while adolescents completed the Youth Self-Report (YSR) and FAD–GF. Hierarchical regression analysis showed that adolescent-perceived family functioning was the strongest predictor of externalizing behavior (β = 0.24 and p < 0.001), even after accounting for demographic and maternal mental health variables. The final model explained 18% of the variance in adolescent externalizing problems. Mediation analysis confirmed that family functioning partially mediated the relationship between maternal depression and adolescent externalizing problems, with a significant indirect effect (a × b = 0.088, Sobel z = 2.90, and p = 0.004). Gender differences were found for self-reported aggressive behavior (t = −2.40, p = 0.017, and d = 0.20), with girls scoring higher than boys. These findings highlight the indirect impact of maternal depression through family dynamics and underscore the importance of culturally sensitive, family-centered interventions to reduce adolescent externalizing problems. Full article

This commentary explores the innovative introduction of English Problem-Based Learning (PBL) scenarios into child and adolescent psychiatry at Nagoya University, Japan. Recognizing the increasing need for multicultural competence and English proficiency among Japanese medical students, our initiative aims to enhance clinical problem-solving skills and cultural awareness. Developed in collaboration with the Norwegian University of Science and Technology, these PBL scenarios address the unique challenges of treating patients from diverse cultural backgrounds. Implemented since 2018, our curriculum integrates these scenarios for fourth-year medical students, fostering an environment of active learning and intercultural communication. Surveys conducted in 2019 and 2021 reveal positive student attitudes towards this approach. This commentary highlights the significance of English PBL in modernizing medical education in Japan, promoting global readiness among future medical professionals and addressing the demographic challenges faced by Japanese universities. Full article

Functional somatic symptoms (FSSs) in children—such as headaches, stomachaches, and muscle pain without clear medical explanations—pose a significant clinical challenge, often leading to repeated healthcare visits and impairments in daily functioning. While the role of parental psychological factors in shaping children’s FSSs has been suggested, empirical evidence remains limited and fragmented. This study addresses this gap by systematically examining the associations between parents’ reflective functioning, emotion regulation, alexithymia, and physical and mental health, and the frequency and severity of children’s FSSs. A total of 339 parents of children aged 6–12 completed surveys assessing their capacity to understand mental states, regulate emotions, and identify or describe feelings, as well as their self-reported physical and mental health. They also indicated whether their child experienced FSSs (e.g., headaches, stomachaches) more than once per week. Results revealed that parents of children with FSSs reported significantly lower levels of reflective functioning (lower certainty, higher uncertainty), higher alexithymic traits, and greater emotion regulation difficulties, alongside poorer physical and mental health indices. Logistic regression analyses demonstrated that emotion regulation difficulties and poorer mental health significantly increased the likelihood of a child exhibiting FSSs, while lower reflective functioning also emerged as a significant predictor. Furthermore, multiple linear regression indicated that emotion regulation challenges and poor mental health predicted greater severity of FSSs. These findings offer novel insights into how parents’ psychological and health characteristics can shape children’s somatic symptom expression, highlighting the need for family-focused interventions. By identifying and addressing parental emotional and cognitive difficulties, clinicians may be able to mitigate the intergenerational transmission of maladaptive stress responses, ultimately reducing the burden of FSSs in children. Full article

Bullying poses significant challenges to adolescent health and well-being. This time-trend study examined the impact of the COVID-19 pandemic on bullying behaviors and associated emotional and behavioral difficulties among Greek adolescents. Data were collected from two cross-sectional surveys in 2016 (n = 1574) and 2023 (n = 5753) conducted in Greece. Both samples comprised students aged 12–16 years, with near-equal gender distribution (2016, 53.4% girls; 2023, 54.5% girls) and a predominance of urban residents (approximately 73% in both samples). Traditional and cyberbullying experiences were assessed via structured questionnaires, while mental health outcomes were measured using the Strengths and Difficulties Questionnaire (SDQ). Post-pandemic findings revealed substantial increases in bullying involvement; traditional bullying victimization rose from 12.4% to 21.7%, and cyberbullying victimization increased from 4.0% to 11.6%. Correspondingly, mean SDQ total scores increased significantly from 8.59 to 14.16, reflecting heightened emotional and behavioral problems. Logistic regression analyses identified male gender, urban residence, and non-traditional family structures as significant predictors of bullying involvement. These results underscore the amplified burden of bullying and mental health difficulties in the post-pandemic era, highlighting the urgent need for targeted prevention and intervention strategies to address both traditional and cyberbullying within diverse sociodemographic contexts. Full article