European Child & Adolescent Psychiatry

This study identified latent trajectories of physical aggression from infancy to preschool age and tested for (a) early parent, parenting and child predictor effects on trajectory membership and (b) trajectory-effects net of parent, parenting, and child predictor effects on Grade 2 social, behavioral and academic functioning. We used data from the Behavior Outlook Norwegian Developmental Study (BONDS), comprising 1,159 children (559 girls). Parents reported on risk and protective factors, and on physical aggression from 1 to 5 years; teachers reported on Grade 2 outcomes. We employed latent class growth curve analyses to identify nine aggression trajectories. In fully adjusted models testing simultaneously all associations among predictors, trajectories, and outcomes, maternal and paternal harsh parenting, child gender, and sibling presence predicted trajectory membership, which significantly predicted Grade 2 externalizing. Child gender had a pervasive influence on all outcomes as well as on trajectory membership. This is the first trajectory study that attempts to sort out which predictors are most proximal, more distal, or just confounded, with their relative direct effect sizes, and to link early paternal as well as maternal harsh parenting with childrens development of physical aggression from infancy to preschool age. Our findings underscore the need to include fathers in developmental research and early prevention and intervention efforts.

Background: Body-focused repetitive behaviours (BFRBs), including hair pulling, skin picking and nail biting, are common but under-recognised behaviours that often emerge during adolescence. Their prevalence, associated distress, and relationship with mental health and social factors remain poorly characterised. Methods: 5,437 adolescents aged 11-18 years reported engagement in BFRBs, associated distress, and functional interference as part of the 2025 OxWell Student Survey. Participants. Problematic BFRBs were defined as at least one BFRB with moderate or high distress. Associations with gender, neurodivergence, bullying, and internalising symptoms were examined using multivariable logistic regression. Results: Overall, 58.5% of participants reported at least one BFRB. Nail biting was most common (43.6%), followed by skin picking (31.3%) and hair pulling (14.5%). Among those with BFRBs, 22.2% reported moderate-to-high distress, and 3.3% of the total sample reported the highest level of distress. Co-occurrence was common: more than half of those with BFRBs reported multiple behaviours. BFRBs were more common and more distressing in girls and trans/gender-diverse participants than in boys. Problematic BFRBs showed strong associations with internalising symptoms (6.3% in the normal range vs 34.2% in the clinical range) and bullying (9.6% with no bullying vs 27.1% with >weekly bullying). Internalising symptoms were the strongest predictor in multivariable models (OR 1.97 per 10-point increase), alongside independent contributions from gender and frequent bullying. Conclusions: BFRBs are common in adolescents, frequently co-occur, and are strongly associated with emotional distress and social adversity. Recognition of distress, rather than behaviour alone, may be important for identifying unmet need and guiding intervention.

BackgroundA study conducted in Norway showed that the association between pupil mental health diagnoses and educational attainment has weakened over time. One possible explanation is that earlier detection of mental health problems in recent years has facilitated earlier treatment, intervention, and educational support that might improve academic outcomes. We investigated whether the weakening association between mental health and attainment could be replicated in England, and explained by earlier age at first diagnosis. MethodsThis was a secondary longitudinal data analysis of de-identified records from a secondary mental healthcare provider in England, which have been linked to the Department for Educations National Pupil Database. We included n=149,841 pupils residing in South East London, born 1993-2003, who completed their end-of-school exams 2009-2019. The main exposure variables were ADHD and internalising disorder diagnosis. In linear regressions, we investigated their associations with Year 11 attainment (typically assessed age 15-16 years), whether this was modified by birth year, and the role of age at first diagnosis. ResultsOn average, ADHD (n=844, 0.6%) and internalising disorder (n=2,523, 1.7%) were associated with lower Year 11 attainment. However, significant interactions between diagnosis and birth year suggested that pupils with these disorders showed increases in standardised exam scores over successive birth cohorts, resulting in a closing attainment gap over time. While age at first diagnosis became younger over the period, this did not confound the observed associations. ConclusionsWe replicated findings from Norway that suggest a narrowing attainment gap between those with and without ADHD and internalising disorder diagnoses. Building on this, we ruled out earlier age of diagnosis as a possible explanation for this phenomenon. With administrative data research growing internationally, we are increasingly able to replicate mental health and education trends in different countries, opening more opportunities for international collaboration.

BackgroundThe present study examines the link between DNA methylation at the nerve growth factor-induced protein A (NGFI-A) binding domain of the NR3C1 1F promoter and later cognitive functions in children from families living in disadvantaged psychosocial conditions. MethodsParticipants were 132 children who took part in a Swiss Parents as Teachers (PAT) randomized controlled trial (72 in the intervention group, 60 in the control group). DNA methylation was quantified from saliva samples collected at age three using sodium bisulfite next-generation sequencing (NGS). Cognitive functions were assessed at age five using the SON-R 2.5-7 Intelligence Test. Results(a) DNA methylation at age three predicted lower IQ at age five through increased concentration problems; (b) participation in the three-year PAT program predicted lower methylation levels at the end of the intervention; and (c) early life stressors predicted lower IQ through increased methylation and concentration problems with descriptively stronger effects in the control group. ConclusionsThese findings demonstrate a link between early DNA methylation at the NGFI-A binding site of the NR3C1 1F promoter and later cognitive functions in children and highlight the role of early life stressors and the PAT intervention in shaping these associations.

BackgroundResearch suggests a link between acquired head injury and signs of conduct disorder, with a majority of findings based on retrospective reports and comparison samples. The relationship between head injuries and conduct problems and how they may influence one another during development is currently unclear. This study aimed to investigate direct and indirect associations between head injury and conduct problems through to early adolescence. MethodsData from the UK Millennium Cohort Study was used to investigate the relationship between conduct problems as assessed by the Strengths and Difficulties Questionnaire and parent reported head injury over time, at ages 9 months, 3, 5, 7, 11 and 14 years, using a cross-lagged path analysis. This is data from 18,552 children, participating in a UK cohort study that is representative of the UK population. We included 7,041 (3,308 male) children, who had full information about head injuries and conduct problems at age 14. ResultsWe found a mutual association between childhood head injuries and conduct problems but with distinct timings: Head injury between 5-7 years predicted greater chance of conduct problems at age 11 and 14 years, while greater conduct problems at 5 years predicted a significantly greater chance of a head injury at age 7-11 years. ConclusionsThese findings have important implications for the timing of preventive and ameliorative interventions. Prior to school entry, interventions aiming to reduce conduct problems would appear most effective at reducing likelihood of head injuries in future years. However, equivalent interventions targeting head injuries would be better timed either as children are entering formal primary education, or soon after they have entered.

BackgroundYouth adversity (e.g., abuse and bullying victimisation) is robust risk factor for later mental health problems (e.g., depression and anxiety). Research shows the prevalence of youth adversity and rates of mental health problems vary by individual characteristics, identity or social groups (e.g., gender and ethnicity). However, little is known about whether the impact of youth adversity on mental health problems differ across the intersections of these characteristics (e.g., white female). This paper reports on a component of the ATTUNE research programme (work package 2) which aims to investigate the impact and mechanisms of youth adversity on depressive and anxiety symptoms in young people by intersectionality profiles. MethodsThe data are from 4 UK adolescent cohorts: HeadStart Cornwall, Oxwell, REACH, and DASH. These cohorts were assembled for adolescents living in distinct geographical locations representing coastal, suburban and urban places in the UK. Youth adversity was assessed using a series of self-report questionnaires and official records. Validated self-report instruments measured depressive and anxiety symptoms. A range of different variables were classified as possible social and cognitive mechanisms. Results and analysisStructural equation modelling (e.g., multiple group models, latent growth models) and multilevel modelling will be used, with adaptation of methods to suit the specific available data, in accord with statistical and epidemiological conventions. DiscussionThe results from this research programme will broaden our understanding of the association between youth adversity and mental health, including new information about intersectionality and related mechanisms in young people in the UK. The findings will inform future research, clinical guidance, and policy to protect and promote the mental health of those most vulnerable to the negative consequences of youth adversity.

BackgroundChildren with conduct problems are at high risk of a wide range of mental health problems in later life, making them a priority for early intervention. Group-based parent-training is known to be effective but with a substantial failure rate. Based on evidence on the value of involving children, we developed Reflective Interpersonal Therapy for Children and Parents, (RICAP). We report here, feasibility and outcomes from the first trial of an intervention for children with conduct problems persisting after parent training. In contrast to most other studies, we used both parent and teacher report. MethodsThe sample comprised 105 children and their parents aged 5-10 years referred to UK Child and Adolescent Mental Health Services (CAMHS) with conduct problems. All were offered the Incredible Years (IY) parent training intervention, and parents provided pre- and post-treatment measures (including CBCL, SDQ). Children still above clinical threshold after IY were randomized either to RICAP or to usual CAMHS treatment (CTAU) with follow up 8 months later. Trial Registration Number: ISRCTN25252940. ResultsFeasibility was supported by high retention through the initial IY (102/105) and subsequent RCT phases of the study (58/70 eligible for randomization). The majority of those randomized to RICAP attended for 11/14 or more sessions, reflecting its high acceptability to both children and parents. By parent report RICAP was superior to CTAU on CBCL externalising (d=0.32) and internalising (d=0.42) problems, while by teacher report CTAU was superior on SDQ total problems (d=0.32) and reactive aggression (d = 0.27). ConclusionsWe provide first evidence of the acceptability and effectiveness of a novel intervention for children with persisting conduct problem following parent training. We also find differences between parent and teacher reported outcomes, pointing either to reporter or social context effects, both of which need to be addressed in future research.

Background Although an expansive body of evidence exists on children's mental health during the COVID-19 pandemic, it is largely restricted to the early phases and lockdowns. This study examines longitudinal changes in child and youth mental health symptoms across two years of the COVID-19 pandemic, with data collection strategically timed to capture variability in pandemic restrictions. Methods A population-based longitudinal study of 1,261 children and youth aged 4-17 years followed prospectively from January 2021 to December 2022, with five waves of data collected in Ontario, Canada. Latent growth curve modelling was used to estimate trajectories of parent-reported mental health symptoms and identify baseline and time-varying covariates associated with variable trajectories. Findings Mental health symptoms were elevated and stable during lockdowns, followed by significant reductions as pandemic restrictions loosened, particularly for oppositional defiant and inattention/hyperactivity symptoms compared to internalizing symptoms. Children without pre-existing clinician diagnosed physical, mental or neurodevelopmental conditions and those not in lockdown at baseline demonstrated relative increases in mental health symptoms during lockdowns; and girls, compared to boys, demonstrated smaller reductions in internalizing symptoms as restrictions loosened. Concurrent and lagged associations between parental distress and children's mental health symptoms varied across the pandemic. Interpretation Variation in symptom trajectories by mental health domain, gender, pandemic restrictions and pre-existing diagnosed conditions underscores the need for tailored, equity-informed pandemic planning and response. Policies designed to optimize the balance between the need to reduce viral community transmission whilst limiting pandemic lockdowns may mitigate adverse impacts on child and youth mental health. Funding Ontario Ministry of Health

BackgroundAttention Deficit Hyperactivity Disorder (ADHD) is increasingly recognized as a major problem for children and their families in China. However, its influence on parental stress has been seldom explored. ObjectiveTo examine the prevalence of attention deficit hyperactivity disorder in a community sample of children aged 6-13 years, and the extent to which it impacts parental depression. MethodCross-sectional study of primary school pupils (number=2497) in Deyang, Sichuan Province, South-West China. We used standardized instruments to identify children with ADHD symptoms and parent depression. ResultsThe prevalence of ADHD was 9.8%. Factors associated with the likelihood of ADHD, included family environment(P=0.003), time spent with children(P=0.01), parenting style(P=0.01), and parental relationship, pupils self-harm and lower academic ability (P=0.001). After controlling for other factors, having a child with ADHD increased the likelihood of parents depression (OR=4.35, CI=2.68[~]7.07), additional factors included parent relationship. ConclusionsADHD may be a common disorder among Chinese children, the symptoms of which may increase the likelihood of parent depression. There is a need for greater detection of ADHD in schools and an acknowledgement of the challenges the disorder creates for academic success and family wellbeing.

IntroductionEarly life adversity (ELA) is associated with increased internalizing and externalizing behavior in high-income cohorts. It is unclear to what extent these associations generalize to low- and middle-income countries (LMICs). We examined the association between ELA and internalizing and externalizing behaviors in children across three LMIC cohorts. MethodsData from three LMIC cohorts, the Brazilian High-Risk Cohort (BHRC; n = 1111), Sustainable Programme Incorporating Nutrition and Games (SPRING; n = 601), and Drakenstein Child Health Study (DCHS; n = 708) were pooled. Children (7-10 years) were assessed using the Strengths and Difficulties Questionnaire (SDQ). ELA (first 24 months) was assessed using a cumulative index. Ordinary Least Squares linear regression models were run to examine the associations of adversity with internalizing and externalizing behaviors while adjusting for child age, sex, and cohort, and to test interactions with child age and cohort. ResultsMeasurement invariance did not hold across cohorts, necessitating within-cohort analyses. 2420 children (53.9% boys) were included in analyses. ELA was associated with higher SDQ total scores (B = 1.97, 95% CI: 1.16, 2.78, p < .001), internalizing (B = 0.84, 95% CI: 0.41, 1.27, p < .001), and externalizing behaviors (B = 1.13, 95% CI: 0.62, 1.64, p < .001) in the full sample. Cohort-specific associations were strongest in the BHRC, with attenuated effects in SPRING and DCHS. Girls and older children exhibited fewer behavior problems. Interaction analyses indicated that the associations of adversity with behavior were stronger at younger ages and varied across cohorts. ConclusionIn cohorts from the Global South, while there is an association between early life adversity and psychopathology, there are also important context-dependent differences across cohorts.

BackgroundBoth prospective and retrospective measures of child maltreatment predict mental health problems, despite their weak concordance. Research remains largely based on retrospective reports spanning the entire childhood due to a scarcity of prospectively completed questionnaires targeting maltreatment specifically. ObjectiveWe developed a prospective index of child maltreatment in the Quebec Longitudinal Study of Child Development (QLSCD) using prospective information collected from ages 5 months to 17 years and examined its concordance with retrospective maltreatment. Participants and SettingThe QLSCD is an ongoing population-based cohort that includes 2,120 participants born from 1997-1998 in the Canadian Province of Quebec. MethodsAs the QLSCD did not have maltreatment as a focal variable, we screened 29,600 items completed by multiple informants (mothers, children, teachers, home observations) across 14 measurement points (0-17 years). Items that could reflect maltreatment were first extracted. Two maltreatment experts reviewed these items for inclusion and determined cut-offs for possible child maltreatment. Retrospective maltreatment was self-reported at 23 years. ResultsIndicators were derived across preschool, school-age and adolescence periods and by the end of childhood and adolescence, including presence (yes/no), chronicity (re-occurrence), extent of exposure and cumulative maltreatment. Across all developmental periods, the presence of maltreatment was as follows: physical abuse (16.3-21.8%), psychological abuse (3.3-21.9%), emotional neglect (20.4-21.6%), physical neglect (15.0-22.3%), supervisory neglect (25.8-44.9%), family violence (4.1-11.2%) and sexual abuse (9.5% in adolescence only). ConclusionsIn addition to the many future research opportunities offered by these prospective indicators of maltreatment, this study offers a roadmap to researchers wishing to undertake a similar task. HighlightsO_LIIn this longitudinal cohort, maltreatment experts retained 251 of 29,600 items available C_LIO_LIProbable maltreatment indicators were derived: presence, chronicity, extent of exposure, and cumulative maltreatment C_LIO_LIPrevalence rates vary from 3.3% and 44.9% across developmental periods, and 16.5-67.3% by the end of adolescence C_LIO_LIProspective and retrospective maltreatment identify different groups of individuals C_LIO_LIAs most studies use retrospective data, findings suggest that the representation of child maltreatment is incomplete and retrospective reports should be complimented by prospective data, whenever possible C_LI

IntroductionOne of the purported underlying causal mechanisms of attention deficit hyperactivity disorder (ADHD) is altered motivational processes. Questionnaires have been used to identify the characteristics of reward and punishment sensitivity in individuals with ADHD. However, these questionnaires were initially developed to measure individual traits related to anxiety (inhibitory) and impulsivity (approach) tendencies or differences in pleasure-seeking. These reward and punishment sensitivity questionnaires are useful but might not capture all relevant aspects of altered motivational processes in ADHD. The proposed scoping review aims to: 1) examine which aspects of hypothesized altered reward and punishment sensitivity correspond to constructs measured by existing questionnaires, 2) characterize the relationships between ADHD symptomatology and reward and punishment sensitivity as measured by existing questionnaires, and 3) evaluate the consistency between the altered reward and punishment sensitivity as measured by existing questionnaires and experimental task performance. Methods and analysisThis scoping review will adhere to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) Extension for Scoping Reviews and the Joanna Briggs Methodology for Scoping Reviews. Published English language literature will be searched in three electronic databases, with no restriction on the year of publication. Two researchers will independently screen all identified titles/abstracts and review the method sections of the identified papers to confirm their eligibility before proceeding to full-text review and data extraction. Methods, results, and conclusions will be tabulated by research questions. A narrative review, and summary conclusions will be presented. The evidence will be summarized as descriptive data in the Excel table. Ethics and disseminationThis study reviews existing publications with ethical approval in place. Therefore, ethical approval is not required. Review results will be disseminated through academic conferences and peer-reviewed manuscripts. Scoping review results will also inform future research to measure and identify altered motivational processes in ADHD. Strengths and limitations of this studyO_LIThis scoping review is the first study to identify which aspects of ADHD reinforcement sensitivity have been measured by existing reward and punishment scales and comprehensively review studies reporting relationships between experimental task results and reward and punishment scales in ADHD. (strengths) C_LIO_LIThis study will be conducted according to PRISMA guidelines for systematic reviews. (strength) C_LIO_LIResults will be summarized separately for children/adolescents and adults. (strength) C_LIO_LIThis review includes only published peer-reviewed English language studies. (limitation) C_LI

BackgroundThe COVID-19 pandemic had serious effects on the mental health of children and adolescents. However, it is unclear how the pandemic may have affected treatment effects and outcomes in youth care. We investigated if treatment effects and externalizing and internalizing problems of children and adolescents receiving youth care were affected by the COVID-19 pandemic. MethodsWe used data from children and adolescents in youth care (N = 1,090, Mage = 12.85 (SD = 2.83; range = 8-18 years)). Internalizing and externalizing problems were assessed at the start and end of treatment using the Child Behavior Checklist. We inspected change in internalizing and externalizing problems and clinical status at the end of treatment to investigate treatment effects, and the level of problems at the start and end of treatment. Outcomes were compared between three groups: children treated entirely before the COVID-19 pandemic, children who experienced the transition into COVID-19 measures during treatment, and children treated entirely during the pandemic. ResultsWe did not find evidence that the pandemic affected treatment effectiveness. However, fewer children who were treated during the pandemic recovered from externalizing problems compared to children treated before the pandemic. Children who received treatment entirely during the pandemic also showed more internalizing and externalizing problems at both the start and end of their treatment, and children who experienced the transition into the pandemic showed elevated externalizing problems at both timepoints. ConclusionsAlthough the change in internalizing and externalizing problems from start to end of treatment was not affected by the pandemic, our findings that children are entering and leaving care with more problems suggest that child mental health has deteriorated since the pandemic.

ObjectivesWe investigated the feasibility and validity of establishing a nationwide e-cohort of individuals with a diagnosis of ADHD and/or ASD for future longitudinal research. DesignIndividuals with a childhood diagnosis of ADHD/ASD as recorded on routinely available healthcare datasets were compared with matched controls and a sample of directly assessed individuals with ADHD. SettingThis study utilised data from the Welsh Secure Anonymised Information Linkage (SAIL) Databank in Wales, UK. Routinely collected data from primary care, Emergency Department and hospital admissions were linked at person level. ParticipantsAll individuals in Wales, UK born between 01/01/1991 and 31/12/2000. Individuals with a recorded diagnosis of ADHD and/or ASD by age 18 years were identified using ICD-10 and NHS Read codes and matched to three controls each and 154 individuals with ADHD recruited from an established research study. Outcome measuresRecorded service use for anxiety and depression, alcohol and drug use and self-harm including Emergency Department use in young adulthood (age 16 years to 25). Results7726 individuals had a recorded diagnosis of ADHD (80% male) and 5001 of ASD (79% male); % and 0.9% of the population respectively. Coxs regression analyses showed ADHD was associated with increased risks of anxiety/depression (HR:2.36, 95% CI:2.20,2.53), self-harm (HR: 5.70, 95% CI:5.07,6.40), alcohol (HR:3.95, 95%CI:3.42,4.56), drug use (HR:5.88, 95%CI:5.08,6.80) and Emergency department service use (HR:1.36, 95%CI:1.31,1.41). Those with ASD were at increased risk of anxiety/depression (HR:2.11, 95%CI: 1.91,2.34), self-harm (HR:2.93, 95%CI: 2.45,3.50) and drug use (HR:2.21, 95%CI: 1.66,2.95) but not alcohol use. The ADHD e-cohort were similar to the directly assessed cohort. ConclusionsOur identification strategy demonstrated the feasibility of establishing a large e-cohort of those with ADHD/ASD with expected patterns of poorer early adult outcomes, demonstrating a valid method of identifying large samples for future longitudinal studies without selective attrition. Article summaryO_ST_ABSStrengths and limitations of this studyC_ST_ABSO_LIThis study used population wide administrative data from a well-established and comprehensive databank C_LIO_LIData from both primary and secondary care was combined C_LIO_LIThe study utilised a directly assessed sample of those with ADHD to help validate the establishment of the administratively identified sample C_LIO_LINot all individuals had passed through the whole follow up period at the end of the study C_LIO_LIStudies utilising administrative data is dependent upon that data having been collected an recorded. C_LI

BackgroundFood insecurity (FI) is associated with overall poorer mental health in childhood and adolescence and negatively impacts longer-term health. However, less is known about how differential exposure to FI may shape the development of different mental health symptoms over this period. MethodsWe used data from two population-based UK birth cohorts: the Avon Longitudinal Study of Parents and Children (ALSPAC; n=6,182; born 1991-1992) and Growing Up in Scotland (GUS; n=3,167; born 2004-2005). FI severity at age [~]5 years (No FI/Low FI/High FI) was determined from parent-reported difficulties affording food. Mental health symptoms were parent-reported over the following 10 years using the conduct, emotional, hyperactivity/inattention and peer problem subscales of the Strengths and Difficulties Questionnaire (SDQ). Trajectories were characterised using multilevel growth curve models adjusted for child sex, household income, maternal mental health and multiple deprivation index. FindingsHigh FI at age [~]5 years was associated with worse trajectories of conduct, emotional, hyperactivity/inattention and peer problems over the following 10 years in both cohorts (vs. No FI). In ALSPAC, differences in conduct and hyperactivity/inattention scores were most pronounced at ages 7 (0.31 [0.11,0.51], padj<.001) and 9 (0.44 [0.09,0.79], padj=.008), respectively; these occurred at ages 13 (0.26 [0.04,0.48], padj=.014) and 15 (0.43 [0.04,0.81], padj=.023) in GUS. For emotional (ALSPAC: 0.46 [0.22,0.69], padj<.001; GUS: 0.38 [0.16,0.59], padj<.001) and peer problems (ALSPAC: 0.34 [0.13,0.55], padj<.001; GUS: 0.25 [0.05,0.45], padj=.01), differences between High and No FI groups were most pronounced at age 9 instead. Low FI was also associated - to a lesser degree - with higher peer problem trajectories (vs. No FI); this was most pronounced at age 13 in ALSPAC (0.13 [0.00,0.27], p=.031) and age 15 in GUS (0.28 [0.04,0.52], p=.016). InterpretationChildren who experienced more severe FI had greater levels of mental health symptoms over the next 10 years, even after adjusting for sociodemographic confounders. FI severity may also display a dose-response effect for peer problems. While replication using more robust FI measures remains necessary, we provide further evidence of the persistent negative impact of FI on youth mental health - particularly during late childhood and mid-adolescence. FundingUniversity of Edinburgh, Wellcome Trust, University of Bristol Research in contextO_ST_ABSEvidence before this studyC_ST_ABSWe searched PubMed for studies examining youth mental health trajectories after early food insecurity (FI) using the following terms: (food) AND (insecur*) AND ((child*) OR (youth) OR (young people) OR (adolescen*)) AND (("mental health") OR (distress) OR (emotion*) OR (behavio*) OR (internali*) OR (externali*)) AND ((trajectory) OR (trajectories)). Three studies investigated the relationship between FI and youth mental health trajectories using data from South Africa, USA and Canada; none investigated the potential impact of marginal food security. Two studies found an association between FI and persistently high depressive and hyperactivity/inattention symptoms over 1-3.5 years of follow-up. The third study used latent growth curve analysis to investigate eight patterns of FI exposure (based on binary FI status over three timepoints) and teacher-reported behaviour problems, reporting no associations. This study, however, only examined linear changes in behavioural problems which typically follow a non-linear trajectory - i.e. age-related differences in rates of change were not considered. Added value of this studyTo our knowledge, this is the first study to investigate trajectories of mental health symptoms in two generations of UK children and adolescents following exposure to different levels of FI severity. Across two large, population-based birth cohorts, we found that high FI at age 5 was associated with worse 10-year trajectories of emotional, conduct, hyperactivity/inattention and peer problems compared to the no FI group. Low FI - reflecting marginal food security - also associated with heightened peer problems, suggesting a dose-response relationship. Greatest differences between food-secure and food-insecure children in this study occurred in late childhood and mid-adolescence. Findings additionally highlight that the impact of FI has remained consistent for UK children born in the early 1990s and mid-2000s, despite secular changes in youth mental health problems. Implications of all the available evidenceChildhood food insecurity casts a long shadow on mental health and well-being outcomes throughout the lifespan, as demonstrated by substantial work from the 20th and 21st centuries. Here, we also see that the impact of FI on children and young peoples mental health has remained consistent over two generations of UK youth. If left unchecked, the growing prevalence of FI in the UK will only intensify concerns for the long-term mental health of the nations young people - especially those from low-income and marginalised backgrounds who already face a widening gap in health inequalities.

Females receive an attention deficit hyperactivity disorder (ADHD) diagnosis at an older age than males. We examined the antecedents and outcomes of later (age 12+) diagnosis in females using data from a Welsh nation-wide electronic cohort of 13,593 individuals (N=2,680 (19.7%) females) with ADHD and 578,793 individuals (N=286,734 (49.5%) females) without ADHD. We compared females with later diagnoses (ages 12-25) to those with earlier, timely diagnoses (ages 5-11) and no diagnosis, in terms of childhood (ages 5-11) antecedents and adolescent/adult (ages 12-25) outcomes. We also tested for sex differences. Females with later diagnosed ADHD used more adolescent/adult healthcare services and had worse mental health, educational and socioeconomic outcomes than females diagnosed earlier. Health and educational difficulties were already evident in childhood in this group. Many outcomes were exacerbated in females compared to males. Timely childhood ADHD diagnosis is necessary to mitigate later risks, especially for females.

BackgroundAttention-Deficit Hyperactivity Disorder (ADHD) is a neurodevelopmental condition whose social challenges can be as impairing as its core symptoms. Social thinning (reduction in the number and quality of relationships) and stress generation (increased likelihood of experiencing interpersonal stressors) are key mechanisms underlying psychiatric vulnerability, and might be central to the social challenges in childhood ADHD. We aim to map the existing longitudinal evidence on the interplay between ADHD, these two social processes, and the subsequent psychopathological risk. MethodsThis systematic review was conducted in line with PRISMA guidelines (PROSPERO: CRD42023467876). We searched Embase, Medline, CINAHL, and APA PsycINFO from inception to 23 April 2025 for longitudinal observational studies enrolling participants younger than 18 with a formal ADHD diagnosis. The primary outcomes were quantitative associations between ADHD and social thinning or stress generation. Methodological quality was appraised using the Joanna Briggs Checklist for Cohort Studies. FindingsEleven studies, including 26,177 participants, met inclusion criteria. The overall methodological quality was high, with risk of bias rated as low-to-minimal for ten of the eleven studies. ADHD was consistently associated with social thinning, demonstrated by lower peer acceptance (OR = 5.1) and indirectly by poorer social competence (OR = 7.3), and to stress generation, showing positive associations with aggression ({beta} = 0.28) and involvement in bullying (OR = 3.6). These social challenges were associated with a higher incidence of psychiatric disorders, including conduct disorder and major depression. InterpretationThe extant evidence indicates that childhood ADHD is prospectively associated with persistent social thinning and stress generation, from childhood into early adulthood. These mechanisms likely compound the psychosocial impairment from core ADHD traits, contributing to the heightened vulnerability for psychiatric disorders across the lifespan. Clinical interventions for ADHD should adopt a holistic approach that targets social functioning to mitigate long-term adverse outcomes. FundingNone

Health professionals in Greece face barriers in assessing child and adolescent mental health conditions due to the lack of instruments with evidence of validity in local samples. This study addresses this gap by evaluating the psychometric properties and establishing common norms for six globally recognized mental health tools in Greece: the Child and Adolescent Trauma Screen-2 (CATS-2), Pediatric Symptoms Checklist-17 (PSC-17), Revised Childrens Anxiety and Depression Scale-25 (RCADS-25), Swanson, Nolan, and Pelham Scale (SNAP-IV), Modified Checklist for Autism in Toddlers-Revised (MCHAT-R/F), and Child Autism Spectrum Test (CAST). We drew on a nationwide Greek survey comprising 1,756 caregivers and 1,201 children and adolescents (age groups: 1 to 18 years). Using Item Response Theory, we assessed internal consistency and factor models according to Consensus-based Standards for the Selection of Health Measurement Instruments (COSMIN) criteria for unidimensionality, local independence, monotonicity, and global model fit. Normative references were calculated using standardized metrics recommended by the Patient-Reported Outcomes Measurement Information System (PROMIS). Final sample sizes ranged from 1,356 (PSC-17, caregiver version) to 198 (CATS-2, caregiver version). Internal consistency was rated as good to excellent across all scales. Factor analyses supported all scales except the MCHAT-R/F (failing monotonicity) and CAST (failing monotonicity and unidimensionality). Local normative references were usually consistent with international samples. This toolkit provides essential evidence-based resources for child and adolescent mental health in Greece, offering a scalable model for other underserved settings. Further research with national probabilistic samples is recommended to enhance risk stratification accuracy.

Background Despite growing evidence that interventions targeting parental distress are associated with improved outcomes in families of children with life-threatening conditions, mental health research is limited for parents of NICU graduates treated for non-cardiac congenital anomalies. Aims To examine the prevalence and severity of mental health difficulties and post-traumatic stress, including subthreshold trauma-related distress, in these parents. Method Participants were 103 parents (n=86 female) of children, aged 5-16 years, who were treated in the NICU for non-cardiac congenital anomalies (e.g., congenital diaphragmatic hernia [CDH], tracheo-oesophageal fistula and/or oesophageal atresia [TOF-OA], abdominal wall defects) at a large tertiary-level paediatric hospital in Australia. Validated measures of mental health (DASS-21) and post-traumatic stress (PCL-5) were administered using an online cross-sectional survey. Whole group and diagnostic subgroup scores were compared with normative data. Comparisons between parents of primary school and high school-aged children enabled the examination of differences in unmet support needs according to their child's developmental stage. Results Seventy-four percent of parents reported experiencing mental health difficulties since their child's congenital anomaly diagnosis, yet only 44.7% had accessed professional mental health support. The mean DASS-21 'Stress' score was significantly elevated relative to Australian population norms (p<0.0005). Scores on the PCL-5 indicated that 9.4% met DSM-5 criteria for provisional PTSD diagnoses and a further 20.8% met subthreshold PTSD criteria. Importantly, 50% of parents reporting subthreshold PTSD had not accessed professional psychological support. Mental health concerns appeared more prominent among parents of children with TOF-OA and CDH, as well as parents of high school-aged children. Conclusions Parents report elevated stress and clinically meaningful subthreshold PTSD symptoms long after their child's NICU discharge, yet many do not access formal support. These findings highlight the importance of trauma-informed approaches to ongoing mental health surveillance and support for parents of NICU graduates with non-cardiac congenital anomalies.

Background: Attention Deficit Hyperactivity Disorder (ADHD) is characterized by persistent inattention, hyperactivity, and impulsivity. While documented in children, research on its persistence into young adulthood in Jordan remains scarce. This gap is critical given the cognitive demands of higher education. This study estimated attention deficit hyperactivity disorder (ADHD) symptom prevalence among Jordanian university students, examined associations with gender and academic performance, and identified barriers to mental health service accessibility. Methods: A descriptive cross-sectional study using web-based sampling recruited 389 university students (aged [&ge;] 18 years) from various Jordanian universities. Participants completed an online survey, incorporating the validated English and Arabic versions of the Adult ADHD Self-Report Scale (ASRS-v1.1) to assess symptom prevalence, alongside inquiries regarding demographics, academic history, and barriers to care. Results: The prevalence of probable ADHD was 37.5% (n=146). Males constituted a significantly higher proportion of positive cases (69.9%) compared to females (30.1%). A strong statistical association was found between positive ADHD screening and negative academic impact (p<0.001), as well as negative effects on emotional well-being (p<0.001). Comorbidities including anxiety disorders and emotional abuse were significantly linked to probable ADHD (p=0.019). Notably, positive-screened participants were significantly more likely to cite social stigma as a primary barrier to seeking professional help (p=0.024). Conclusion: Self-reported ADHD symptoms are highly prevalent among Jordanian university students, correlating with substantial academic underachievement and emotional dysfunction. These findings highlight an urgent need for targeted university-based screening programs, academic accommodations, and de-stigmatization campaigns to facilitate early intervention and improve educational outcomes in this population.