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The aim of the current study was to identify which subgroups of children with Attention Deficit Hyperactivity Disorder (ADHD) benefitted the most from playing a Serious Game (SG) intervention shown in a randomized trial to improve behavioral outcomes. Pre-intervention characteristics [i.e., gender, age, intellectual level of functioning, medication use, computer experience, ADHD subtype, severity of inattention problems, severity of hyperactivity/impulsivity problems, comorbid Oppositional Defiant Disorder (ODD) and Conduct Disorder (CD) symptoms] were explored as potential moderators in a Virtual Twins (VT) analysis to identify subgroups for whom the SG intervention was most effective. Primary outcome measures were parent-reported time management, planning/organizing and cooperation skills. Two subgroups were identified. Girls (n = 26) were identified as the subgroup that was most likely to show greater improvements in planning/organizing skills as compared to the estimated treatment effect of the total group of participants. Furthermore, among the boys, those (n = 47) with lower baseline levels of hyperactivity and higher levels of CD symptoms showed more improvements in their planning/organizing skills when they played the SG intervention as compared to the estimated treatment effect of the total group of participants. Using a VT analysis two subgroups of children with ADHD, girls, and boys with both higher levels of CD and lower levels of hyperactivity, were identified. These subgroups mostly benefit from playing the SG intervention developed to improve ADHD related behavioral problems. Our results imply that these subgroups have a higher chance of treatment success.

Background This study examines the effectiveness of the culturally adapted Dutch version of The Program for the Education and Enrichment of Relational Skills (PEERS®), utilizing a randomized control trial (RCT) with an active treatment control condition. Methods 106 adolescents with ASD, aged 12–18 years, were randomly assigned to one of two group interventions: the experimental condition (PEERS®; n  = 54) or the active treatment control condition (Regulation, Organization and Autonomy Didactics; ROAD; n  = 52). Effects of interventions on social skills were primarily assessed using an observational measure (CASS – Contextual Assessment Social Skills). Secondary indices of social skills were self, parent and teacher reported questionnaire data (i.e., Social Responsiveness Scale; SRS, and Social Skills Improvement System; SSIS). Treatment satisfaction was also obtained from adolescents and their parents. Results Results on the observational measure of social skills revealed improvements in positive affect, overall quality of rapport, as well as starting and ending a conversation, irrespective of condition. Compared to ROAD, PEERS® participants showed increased overall self-reported social skills (SSIS). Parent reports showed decreased overall social skill impairment (SRS) as well as improved social communication (SSIS subscale), with significantly more progress in the PEERS® group. Furthermore, parents of adolescents in the PEERS® group were significantly more satisfied with the intervention (M = 8.20, SD = 1.46) than parents of adolescents in the ROAD group (M = 7.52, SD = 1.45). The self-reported treatment satisfaction of adolescents did not differ between conditions. Teacher data showed decreased social skill impairment as measured with the SRS, irrespective of condition. Conclusions This study reveals promising indications that the Dutch version of PEERS® enhances social skills in adolescents with ASD. Yet, further research is needed into how effectiveness can be optimized. Trial registration Dutch trail register NTR6255 (NL6117) 08/02/2017 https://www.trialregister.nl/trial/6117

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.

BackgroundYoung people are at risk of falling through the care gap after leaving child and adolescent mental health services (CAMHS) despite an ongoing need for mental health support. Currently, little is known about the predictors of transitioning to adult mental health services (AMHS), and associated healthcare and societal costs as young people cross the transition boundary.ObjectiveTo conduct a secondary data analysis exploring predictors of transitioning or falling through the gap and associated costs.MethodsData were used from a longitudinal study, which followed young people from seven European countries for 2 years after reaching their CAMHS boundary. Predictors of transitioning (including sociodemographic and clinical variables) and longitudinal resource use were compared for 488 young people who transitioned to AMHS versus those who fell through the gap.FindingsYoung people were more likely to transition to AMHS if they were severely ill. Those from Italy, the Netherlands and the UK were more likely to fall through the gap than transition to AMHS. Healthcare costs fell for all young people over the study, with a sharper decrease for those who fell through the gap.ConclusionsTotal healthcare costs fell for all participants, indicating that the intensity of mental health support reduces for all young people as they cross the CAMHS boundary, regardless of clinical need.Clinical implicationsIt is important that alternative forms of mental health support are available for young people who do not meet the AMHS care threshold but still have mental health needs after leaving CAMHS.

Background Healthcare policy and academic literature have promoted improving the transitional care of young people leaving child and adolescent mental health services (CAMHS). Despite the availability of guidance on good practice, there seems to be no readily accessible, coherent ethical analysis of transition. The ethical principles of non-maleficence, beneficence, justice and respect for autonomy can be used to justify the need for further enquiry into the ethical pros and cons of this drive to improve transitional care. The objective of this systematic review was therefore to systematically search for existing ethical literature on child- to adult-orientated health service transitions and to critically appraise and collate the literature, whether empirical or normative. Methods A wide range of bioethics, biomedical and legal databases, grey literature and bioethics journals were searched. Ancestral and forward searches of identified papers were undertaken. Key words related to transition, adolescence and young adulthood, ethics, law and health. The timeframe was January 2000 to at least March 2016. Titles, abstracts and, where necessary, full articles were screened and duplicates removed. All included articles were critically appraised and a narrative synthesis produced. Results Eighty two thousand four hundred eighty one titles were screened, from which 96 abstracts were checked. Forty seven full documents were scrutinised, leading to inclusion of two papers. Ancestral and forward searches yielded four further articles. In total, one commentary, three qualitative empirical studies and two clinical ethics papers were found. All focused on young people with complex care needs and disabilities. The three empirical papers had methodological flaws. The two ethical papers were written from a clinical ethics context rather than using a bioethical format. No literature identified specifically addressed the ethical challenges of balancing the delivery of transitional care to those who need it and the risk of pathologizing transient and self-limited distress and dysfunction, which may be normal during adolescence. Conclusions There is very little research on ethical aspects of transitional care. Most existing studies come from services for young people with complex care needs and disabilities. There is much scope for improvement in the amount and quality of empirical research and ethical analysis in this area.

Students exhibiting challenging externalizing behaviors may benefit from supportive interactions with teachers. However, if students show high levels of externalizing behaviors, this may negatively impact on student-teacher interactions, and vice versa. We therefore examined bidirectional developmental links between student-teacher interactions and externalizing behavior of male adolescents placed in special education because of psychiatric disabilities. Participants were 584 adolescents (M age = 15.0 years, SD = 1.7) and their teachers from 14 Dutch special education schools. At 3 time points, student-reports of student-teacher interactions and teacher-reports of adolescents' externalizing behavior were collected. Using autoregressive cross-lagged models, results indicate that externalizing behavior predicted decreases in supportive interactions (β = −.09, p = .02), but not in negative interactions. Student-teacher interactions did not show a significant influence on externalizing behavior. Our results highlight externalizing behavior as an important target for interventions intended to improve student-teacher interactions.

BackgroundThe boundary between services for children and adolescents and adults has been identified as problematic for young people with mental health problems.AimsTo examine the use and cost of healthcare for young people engaged in mental healthcare before and after the child/adolescent and adult service boundary.MethodData from 772 young people in seven European countries participating in the MILESTONE trial were analysed. We analysed and costed healthcare resources used in the 6-month period before and after the service boundary.ResultsThe proportion of young people engaging with healthcare services fell substantially after crossing the service boundary (associated costs €7761 pre-boundary v. €3376 post-boundary). Pre-boundary, the main cost driver was in-patient care (approximately 50%), whereas post-boundary costs were more evenly spread between services; cost reductions were correlated with pre-boundary in-patient care. Severity was associated with substantially higher costs pre- and post-boundary, and those who were engaged specifically with mental health services after the service boundary accrued the greatest healthcare costs post-service boundary.ConclusionsCosts of healthcare are large in this population, but fall considerably after transition, particularly for those who were most severely ill. In part, this is likely to reflect improvement in the mental health of young people. However, qualitative evidence from the MILESTONE study suggests that lack of capacity in adult services and young people's disengagement with formal mental health services post-transition are contributing factors. Long-term data are needed to assess the adverse long-term effects on costs and health of this unmet need and disengagement.

Background Foster children are at higher risk of the development of behavior and emotional problems, which can contribute to the development of insecure attachment bonds with their foster parents and (subsequently) to placement breakdown. Sensitive parenting might minimize the adverse effects of the behavior and emotional problems. Video-feedback Intervention to promote Positive Parenting and Sensitive Discipline in Foster Care (VIPP-FC) is an adaptation of the evidence-based Video-feedback Intervention to promote Positive Parenting and Sensitive Discipline (VIPP-SD) and aims at increasing sensitive parenting and the use of sensitive discipline strategies of foster parents. The current study is the first to examine the effectiveness of VIPP-FC. Methods A randomized controlled trial is used with 60 foster parent-child dyads (intervention group n  = 30, control group n  = 30). The primary outcomes are parental sensitivity, parental disciplining, and parental attitudes towards parenting. Data about attachment (in)security, behavioral and emotional problems, neurobiological parameters, and possible confounders is additionally collected. Discussion Examining the effectiveness of VIPP-FC contributes to the knowledge of evidence-based prevention and intervention programs needed in foster care practice. Trial registration NTR3899 .

A randomized, 13-weeks, placebo-controlled double-blind study in 125 subjects aged 2–17.5 years with Autism Spectrum Disorder or Smith-Magenis syndrome and insomnia demonstrated efficacy and safety of easily-swallowed prolonged-release melatonin mini-tablets (PedPRM; 2–5 mg) in improving sleep duration and onset. Treatment effects on child behavior and caregiver’s quality of life were evaluated. PedPRM treatment resulted in significant improvement in externalizing but not internalizing behavior (Strengths and Difficulties questionnaire; SDQ) compared to placebo (p = 0.021) with clinically-relevant improvements in 53.7% of PedPRM-treated versus 27.6% of placebo-treated subjects (p = 0.008). Caregivers’ quality of life also improved with PedPRM versus placebo (p = 0.010) and correlated with the change in total SDQ (p = 0.0005). PedPRM alleviates insomnia-related difficulties, particularly externalizing behavior in the children, subsequently improving caregivers’ quality of life.

A recent double-blind randomized placebo-controlled study demonstrated 3-month efficacy and safety of a novel pediatric-appropriate prolonged-release melatonin (PedPRM) for insomnia in children and adolescents with autism spectrum disorder (ASD) and neurogenetic disorders (NGD) with/without attention-deficit/hyperactivity disorder comorbidity. Long-term efficacy and safety of PedPRM treatment was studied. A prospective, open-label efficacy and safety follow-up of nightly 2, 5, or 10 mg PedPRM in subjects who completed the 13-week double-blind trial (51 PedPRM; 44 placebo). Measures included caregiver-reported Sleep and Nap Diary, Composite Sleep Disturbance Index (CSDI), caregiver's Pittsburgh Sleep Quality Index (PSQI), Epworth Sleepiness Scale, and quality of life (WHO-5 Well-Being Index). Ninety-five subjects (74.7% males; mean [standard deviation] age, 9 [4.24]; range, 2-17.5 years) received PedPRM (2/5 mg) according to the double-blind phase dose, for 39 weeks with optional dose adjustment (2, 5, or 10 mg/day) after the first 13 weeks. After 52 weeks of continuous treatment (PedPRM-randomized group) subjects slept (mean [SE]) 62.08 (21.5) minutes longer (  = 0.007); fell asleep 48.6 (10.2) minutes faster (  < 0.001); had 89.1 (25.5) minutes longer uninterrupted sleep episodes (  = 0.001); 0.41 (0.12) less nightly awakenings (>50% decrease;  = 0.001); and better sleep quality (  < 0.001) compared with baseline. The placebo-randomized group also improved with PedPRM. Altogether, by the end of 39-week follow-up, regardless of randomization assignment, 55/72 (76%) of completers achieved overall improvement of ≥1 hour in total sleep time (TST), sleep latency or both, over baseline, with no evidence of decreased efficacy. In parallel, CSDI child sleep disturbance and caregivers' satisfaction of their child's sleep patterns (  < 0.001 for both), PSQI global (  < 0.001), and WHO-5 (  = 0.001) improved in statistically significant and clinically relevant manner (  = 72) compared with baseline. PedPRM was generally safe; most frequent treatment-related adverse events were fatigue (5.3%) and mood swings (3.2% of patients). PedPRM, an easily swallowed formulation shown to be efficacious versus placebo, is an efficacious and safe option for long-term treatment (up to 52 weeks reported here) of children with ASD and NGD who suffer from insomnia and subsequently improves caregivers' quality of life.