Attention deficit hyperactivity disorder (ADHD) is characterised by impulsivity, inattention and hyperactivity.1,2 Although usually first diagnosed in childhood, ADHD symptoms often persist into adulthood, with an estimated 7.6% prevalence in childhood, 5.6% in adolescence, and 3.1% in adulthood.1,2 ADHD is often comorbid with psychiatric conditions such as substance use disorder (SUD), mood, anxiety, and personality disorders, of which depression is one of the most common.3 Individuals with ADHD are about 5.5 times more likely to develop depression compared to those undiagnosed, with an estimated prevalence of 18% experiencing depression by age 18, increasing to 44% by age 30.

JAACAP welcomes original artwork by children, adolescents, and young adults. The art may be an expression of mental health challenges, fun images, comics, or scenes from everyday life. Please review our Guide for Authors for more information on how to submit your artwork, or email support@jaacap.org.

Pediatric PTSD is a common and debilitating condition, affecting 5% of youth by age 18.1 Trauma focused psychotherapies, particularly trauma-focused cognitive behavioral therapy (TF-CBT) and eye movement desensitization and reprocessing (EMDR) have shown evidence of effectiveness in clinical trials and meta-analyses.2 Yet, it has been difficult to translate these studies into meaningful estimates of their effectiveness that can be communicated to providers and patients alike.

This month’s Media Forum features 2 authors who are also child and adolescent psychiatrists. In medical school, residency, and fellowship, we are rarely taught how to write. There might be a focus on how to write a scientific journal article, but seldom is there any discussion about how to write a full book, especially a novel. Those who do write either have had previous experiences or learn on their own how to write and how to get published. This limits the number of child and adolescent psychiatrists who feel comfortable sharing their experience through writing. There are many ways in which this writing can occur, such as through books, blog posts, letters to the editor in one’s local paper, and so much more. Writing can not only be a way to teach, but it can serve as advocacy for our patients, reducing stigma and providing a more realistic view of what the needs of our families are. Many who do write share how it can be fulfilling and fun. It is important to remember that there is no perfect age or level of training to write, either. You can share your experiences as a trainee or reflect on aspects of your career during retirement. Hopefully, this month’s Media Forum can serve as an inspiration for child psychiatrists that to be able to write is not out of reach. There are some really interesting stories and experiences to share with colleagues, patients, and families.

We evaluated three new features of Media Smart Targeted (MST), an 8-module internet, self-guided, indicated prevention and early intervention for disordered eating (DE): a broader audience; optimal rate of program delivery; impact on social media (SM) behaviours.

Youth suicide is an urgent and complex public health crisis, among the leading causes of death for young people aged 10 to 17.1 Suicide rates have been trending upward, highlighting critical gaps in both our understanding of the factors leading to suicide and the efficacy of current intervention strategies, many of which are designed around adult-centric research.2,3 Prevention programs based on such research typically emphasize the detection and treatment of mental health conditions, such as depression and anxiety disorders, which are indeed associated with elevated suicide risk across the lifespan.

To examine the within-person relations between objectively measured physical activity and clinically assessed symptoms of depressive disorders from childhood to late adolescence.

Youth depression disrupts the social and vocational transition into adulthood. Most depression burden is caused by recurring or chronic episodes. Identifying young people at risk for relapsing, recurring, or chronic depression is critical. We systematically reviewed and meta-analyzed the literature on prognostic factors for relapsing, recurrent, and chronic depression in young people.

Over the last 5 years, our family of journals have made a concerted effort to publish outstanding science on the impacts of structural and social determinants of health, including multiple forms of racism and minoritization (such as marginalization and discrimination based on gender and sexual identity) on the mental health of children and adolescents. We have built an editorial team with the requisite skills to critically assess and strengthen such manuscripts and create a collaborative and supportive home for experts with a broad range of expertise and backgrounds to contribute to our mission.

Obsessive Compulsive Disorder (OCD) affects approximately 1-2% of youth1. Patients with OCD may present with varying degrees of insight into the excessiveness of their compulsive behaviors. This is certainly true among youth, where 20-45% are thought to have poor or absent insight2. Scrupulosity OCD – characterized by intrusive guilt and fear about moral or religious wrongdoing – is associated with worse symptom severity and insight3. This form of OCD involves obsessive fear about offending a deity or acting immorally, leading to compulsions like excessive praying, reassurance-seeking, and avoidance of perceived immoral activities.

Pediatric obsessive-compulsive disorder (OCD) is a common (2% prevalence) and potentially debilitating condition.1 Early identification and intervention are critical because they may improve outcomes for children and adolescents with OCD and prevent long-term morbidity. The individual participant data (IPD) meta-analysis by Cohen and colleagues2 explores the efficacy of short-term trials of selective serotonin reuptake inhibitors (SSRIs) compared to placebo for treating children and adolescents with OCD. It also investigates the moderating effects of baseline patient variables on treatment outcome.

Pediatric obsessive-compulsive disorder (OCD) is a common neuropsychiatric disorder for which genetic factors play an important role. Recent studies have demonstrated an enrichment of rare de novo DNA single nucleotide variants in OCD cases compared to controls, and larger studies have examined copy-number variants (CNVs) using microarray data. Our study examines rare de novo CNVs using whole-exome sequencing (WES) data to provide additional insight into genetic factors and biological processes underlying OCD.

Although advances in neurodevelopmental sciences and clinical care have progressed at lightning speed, our headway at addressing the long history of racism in science and medicine has been notably slower and muddled. Only recently has there been widespread acknowledgement in the scientific community that race is a social construct1—with greater genetic variability between categorical groups than within—spurring contemporary guidance from NASEM2 confirming “race” is not biologically-based and analyses suggesting otherwise are “misleading and harmful.” Others have illuminated the problematic use of race-based diagnostic algorithms and practice guidelines given their contributions to health inequities.

Poverty and systemic racism within rare intertwined. Children of marginalized racial and ethnic identities experience higher levels of poverty and adverse psychiatric outcomes. Thus, in models of poverty and neurodevelopment, race and ethnicity—as proxies for exposure to systemic disadvantage—are regularly considered confounders. Recently, however, some researchers claimed that using race and ethnicity as confounders is statistically dubious, and potentially socially damaging. Instead, they argue for the use of variables measuring other social determinants of health (SDoH).

Despite the prevailing perception that preadolescent children do not experience suicidal thoughts and behaviors, 13.2% of children aged 9 to 10 years report that they have experienced suicidal thoughts at some point in their life, 9.1% report a history of nonsuicidal self-injury (NSSI), defined as deliberate self-harming behavior without suicidal intent, and 1.3% report making a suicide attempt.1 In addition, suicide rates for children aged 8 to 12 years have been increasing since 2008, and suicide is now the fifth leading cause of death in this age group.2 However, relatively little is known about risk and protective factors for self-injurious thoughts and behaviors (SITBs) among preadolescents. The biological underpinnings of suicidal ideation, suicidal behavior, and NSSI have been studied extensively (see Mann and Currier for a review3). Importantly, these studies focus almost exclusively on adolescent and adult samples, and translation of biologically based findings into clinical practice remains a challenge. Across clinical settings, suicide risk screening is increasingly being implemented with preadolescents, but there is a relative lack of developmentally sensitive screening and intervention tools,4 and detecting child suicide risk as completely and efficiently as possible remains a challenge. Thus, finding ways to bridge biological findings and suicide risk screening is a promising, yet underutilized, approach with great potential. With the emergence of more large, longitudinal studies that capture a combination of biological, psychological, and social risk factors for SITBs, it is becoming increasingly possible to examine an array of risk and protective factors simultaneously and evaluate the relative strength of these predictors.

In the 2024 Scientific Proceedings supplement to JAACAP, New Research Poster 4.11, “Factors Influencing the Treatment Effect of Family-Based Practice of Loving-Kindness Meditation and Mindfulness of Breathing on the Adolescent With Nonsuicidal Self-Injury,” (2024;63:S234), author Buddhavamsa (Yang Li)'s name appeared incorrectly.

Motor stereotypies (MS) are repetitive, rhythmic actions varying in complexity and presentation. Parents and teachers often notice these movements in children at home or in the classroom, prompting clinical attention. Concerns typically arise regarding the potential adverse consequences of these movements on the child, their impact on others, and whether they signal chronic neurodevelopmental conditions such as autism spectrum disorder (ASD). This Clinical Perspective emphasizes MS as a common, transdiagnostic phenotype. It is crucial for clinicians and families to understand their characteristics, typical course, and potential co-occurring conditions, and that MS do not always signify a neurodevelopmental disorder nor always require intervention.

"I keep picturing all these little kids playing some game in this big field of rye and all. Thousands of little kids, and nobody’s around—nobody big, I mean—except me. And I’m standing on the edge of some crazy cliff. What I have to do, I have to catch everybody if they start to go over the cliff… That’s all I'd do all day. I’d just be the catcher in the rye and all. I know it's crazy, but that’s the only thing I'd really like to be.”— JD Salinger, Catcher in the Rye1

Self-harm and suicide are a major public health problem, particularly among adolescents. Suicide is the third leading cause of death in adolescents in the United Kingdom and the United States, and nonsuicidal self-injury (NSSI) remains a significant source of morbidity and mortality in this population.1,2 Despite relative consensus about the acuity of this public health problem, we lack evidence-based treatments for patients struggling with self-harm. This scarcity of effective treatments for self-harm in adolescents is highlighted by an important meta-analysis in this issue of the Journal.3 Wright-Hughes and colleagues identified 39 randomized control trials (RCTs) comparing a therapeutic intervention for self-harm to control with 26 studies providing individual patient data (IPD; 3,448 participants) and 7 providing only aggregate data (698 participants). Their 2-stage random-effects meta-analysis of studies with IPD found no significant difference in efficacy between therapeutic interventions and control treatment for preventing self-harm at 12 months. Secondary analyses incorporating aggregate data similarly showed no difference in efficacy and no strong evidence regarding moderators of treatment effect.

For children with autism spectrum disorder, early intervention is crucial for maximizing the benefit of autism-specific therapies. However, from the time that a child’s signs and symptoms of autism are recognized, families experience average delays of nearly 3 years until a diagnosis is made.1 Delays in diagnosis often further delay access to evidenced-based services covered by insurance. A 2023 study conducted by Kraft and colleagues demonstrated that autism specialty centers experienced comprehensive autism diagnostic evaluation (CADE) wait times of more than 4 months.

To evaluate the efficacy, safety, and tolerability of esketamine nasal spray versus psychoactive placebo (oral midazolam) in rapidly reducing depressive symptoms in adolescents with major depressive disorder at imminent risk for suicide.

Although the classroom is meant to be a space for learning and growth, decades of research has shown it to be a battleground for many Black youth, as disparities in school disciplinary actions continue to fuel cycles of academic failure, impaired development, and psychological distress.1 Studies have found that Black youth face significantly higher rates of detention and suspension than their White peers and this disparity is rarely due to individual level characteristics like externalizing symptoms “acting out”, special education, or familial characteristics.