European Child & Adolescent Psychiatry

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.

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.

Mental disorders represent a significant challenge for individuals and society. Many of them have a detectable onset during adolescence. Being born preterm or with low birth weight (PTB) has been emerging as a potential risk factor for developing mental health disorders in adolescence. Since PTB infants are also at an increased risk of developing cerebral visual impairment after birth and cognitive and sensory deficits throughout life, this systematic review seeks to understand the interplay between PTB, cognitive, visual, and motor abilities and their influence on mental health outcomes in adolescence. We conducted a registered systematic review following the PRISMA guidelines (PROSPERO #513150). The search strategy focused on the databases PubMed, Scopus, PsycINFO and the Cochrane Library and included publications sampling participants born in 1980 or later. We analysed 18 studies including a total of 13.655 adolescents aged 11-20 (PTB=8.813, control=4.852) published between 2004 and 2022. PTB adolescents exhibited consistent and persistent deficits in cognitive and motor domains compared to their full-term (FT) peers, including lower intelligent quotient (IQ), attention and executive function, and a higher prevalence of psychiatric disorders. Several studies demonstrate that PTB adolescents require psychiatric treatment more often and get diagnosed with more complex psychiatric disorders. Evidence for functional visual alterations is scarce. These findings highlight the multitude of challenges that PTB children face across multiple domains including their mental health. Quantifiying these challenges individually may represent potential markers for tailoring early detection and intervention to this vulnerable population and optimising their long-term outcomes.

PurposeTo identify emotional and behavioural symptoms profiles from early childhood to adolescence, their stability across development and associated factors. MethodsOur sample included 17,216 children assessed at ages 3, 5, 7, 11 and 14 years from the UK Millennium Cohort Study. We used latent profile and latent transition analysis to study their emotional and behavioural profiles from early childhood to adolescence. We included sociodemographic, family and parenting variables to study the effect on latent profile membership and transitions. ResultsThe number and specific profiles of emotional and behavioural symptoms changed with the developmental stage. We found a higher number of profiles for ages 3, 5, and 14, suggesting greater heterogeneity in the presentation of emotional and behavioural symptoms in early childhood and adolescence compared to late childhood. There was greater heterotypic continuity between ages 3 and 5, particularly in transitions from higher to lower severity profiles. Children exposed to socioeconomic disadvantages were more likely to belong or transition to any moderate or high emotional and behavioural symptoms profiles. Maternal psychological distress and harsh parenting were associated with internalizing and externalizing profiles, respectively. Higher levels of internalizing and externalizing symptoms across development were associated with lower mental wellbeing and higher rates of self-harm and substance use in adolescence. ConclusionEmotional and behavioural symptoms develop early in life, with levels of heterogeneity and heterotypic stability that change throughout development. These results call for interventions to prevent and treat paediatric mental illness that consider the heterogeneity and stability of symptoms across development.

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

IntroductionSelective Mutism (SM) is an anxiety disorder affecting some children starting school. Usual presentation is lack of speech at school, contrasting with confident speech at home. Estimated prevalence is 0.7%, rising to 2.2% for children who are second language learners. Long-term impacts include complex mental health conditions for children not receiving timely intervention. There are calls for effective treatments as part of a multi-modal care pathway. Case study research describes music therapy leading to generalised speech, but an evidenced-based approach is currently lacking. This study evaluates acceptability and feasibility of a manualised music therapy intervention for children with SM. MethodsFour children with SM in early years school settings were offered manualised music therapy over a 14-week period. In-depth qualitative interviews were conducted with the music therapist, a school staff member and a parent of each child (n=12). Interviews were analysed using a framework grounded in well-theorised constructs of acceptability and feasibility. ResultsAcceptability was high for all participant groups, with clear comprehension and confidence in an intervention viewed as appropriate for the early years population. Need for cultural competence in delivery was highlighted. Analysis of feasibility demonstrated rapid recruitment, practicality and fit with the school environment, and a strong sense of perceived effectiveness including anxiety reduction, improved emotional well-being, increased self-expression and generalised speech. DiscussionThis study has added to the methodological literature on evaluating acceptability and feasibility in music therapy interventions and has indicated the appropriateness of moving to experimental testing of the SM intervention evaluated here.

Children and adolescents commonly suffer from sleep and circadian rhythm disturbances, which may contribute to poorer mental health and wellbeing during this critical developmental phase. Many studies however rely on self-reported sleep measures. This study assessed whether accelerometry data collection was feasible within the school setting as a method for investigating the extent of sleep and circadian disruption, and associations with subjective wellbeing, in Scotland. Fourteen days of wrist-worn accelerometry data were collected from 69 pupils, aged 10-14 years. Objective measures of sleep timing, sleep duration and circadian rest-activity patterns were derived. Questionnaires assessed subjective sleep timing, depressive symptoms, and experiences of wearing the accelerometer. Pupils slept on average less than 8 hours per night, failing to meet standard age-specific recommendations. Sleep timing was later and duration longer on weekends compared to weekdays (B = 0.87, 95% confidence interval (CI) 0.70, 1.04; B = 0.49, 95% CI 0.29, 0.69), indicating social jetlag. Lower daytime activity was correlated with higher depressive symptoms (r = -0.84, p = 0.008). Compared to primary school pupils, secondary pupils had shorter sleep window duration and lower circadian relative amplitude. Over half of participants reported some discomfort/inconvenience wearing the accelerometer. These data highlight that inadequate sleep is prevalent in this sample of schoolchildren. Future, larger scale investigations will examine in more detail the associations between sleep, circadian function and physical activity with mental health and wellbeing.

BackgroundAttention deficit hyperactivity disorder (ADHD) is a neurodevelopmental disorder that is associated with risk-taking behaviors, poor self-control and interpersonal difficulties. Affected individuals have an increased probability of involvement in the criminal justice system, contributing to a higher rate of arrest and imprisonment compared with the general population. Current data on the prevalence of ADHD among prisoners reports rates of 26%, but finds them inadequately treated. AimsBecause prison staff play a central role in the identification of inmates with mental disorders, they could well be key to improving provision of care. There is however little knowledge of the conceptions, perceptions and attitudes of prison staff towards ADHD. Such information could help to identify starting points for awareness training and to further implementation of specific ADHD treatment. MethodsTo bridge this gap, we employed a qualitatively driven mixed methods design combining qualitative data collection in the form of narrative interviews with 19 prison staff from a Swiss correctional facility with quantitative data collection in the form of a survey that included the Attitudes Toward Prisoners scale. The interviews were analyzed with QSR NVIVO 11 and a qualitative content analysis approach was used to evaluate findings. ResultsPrison staff were generally aware of ADHD and its symptomology, believed it to a be "real", but "fashionable" disorder and favored hereditary-genetic or biological explanatory models for its development. They viewed inmates with ADHD rather negatively, as complicating correctional efforts, perceived them as sticking out, as tying up more resources and as frequently being involved in confrontations. Our findings suggest that difficulties in pragmatic aspects of communication and language comprehension may be perceived "as not listening or following instructions" creating additional tensions. Consequently, inmates with ADHD are more often exposed to disciplinary sanctions, such as solitary confinement - an intervention deemed "necessary" by staff. Therefore, staff training on ADHD might need to cover evidence on adverse effects. Non-pharmacological interventions for treatment were preferred and considered to be highly efficacious. Skepticism towards pharmacological treatment prevailed, even when benefits from stimulant medication were described. Acceptance of multimodal treatment among prison staff may require customized strategies.

BackgroundThe behavioural and emotional profiles underlying adolescent self-harm, and its developmental risk factors, are relatively unknown. We aimed to identify sub-groups of young people who self-harm (YPSH) and longitudinal predictors leading to self-harm. MethodsParticipants were from the Millennium Cohort Study (n=10,827). A clustering algorithm identified sub-groups who self-harmed with different behavioural and emotional profiles at age 14. Feature selection analyses were then used to identify longitudinal predictors of self-harming behaviour. FindingsThere were two distinct sub-groups at age 14: a smaller group (n = 379) who reported a long history of psychopathology, and a second group (n = 905) without. Notably, both groups could be predicted almost a decade before the reported self-harm. They were similarly characterised by sleep problems and low self-esteem, but there was developmental differentiation. From an early age, the first group had poorer emotion regulation, were bullied, and their caregivers faced emotional challenges. The second group showed less consistency in early childhood, but later reported more willingness to take risks and less security with peers/family. InterpretationOur results uncover two distinct pathways to self-harm: a psychopathology pathway, associated with early and persistent emotional difficulties and bullying; and an adolescent risky behaviour pathway, where risk-taking and external challenges emerge later into adolescence and predict self-harm. These two pathways have long developmental histories, providing an extended window for interventions as well as potential improvements in the identification of children at risk, biopsychosocial causes, and treatment or prevention of self-harm. FundingThis study was supported by the UK Medical Research Council, Templeton World Charitable Foundation, and a Gates Cambridge Scholarship awarded to SU.

BackgroundScreen time has been linked with inattention/hyperactivity symptoms, but studies often do not distinguish within-from between-person associations over long developmental periods. MethodsData were drawn from the Brazilian High-Risk Cohort for Mental Health Conditions, a school-based cohort with assessments at baseline (2010) and follow-ups in 2013-2014 and 2018-2019, 76% retention. The sample included 2,511 children (mean age = 10.2 years at baseline, 54.7% males). Daily screen time (hours spent exposed to computer, television or video games) was obtained by asking the parent or the primary caregiver (94.9% mothers). Inattention/hyperactivity symptoms were assessed with the Strengths and Difficulties Questionnaire (SDQ). Analysis was carried out using random intercept cross-lagged panel models, adjusting for sample representativeness, attrition, and demographic covariates. Sensitivity analysis was carried out using the Attention Scale of the Child and Behavior Checklist (CBCL), harmonized with the Adult Behavior Checklist (ABCL). ResultsWe found no within-person relationship between screen time and inattention/hyperactivity symptoms from childhood to early adulthood. Significant between-person associations were found in the SDQ but not in the adjusted SDQ models (respectively: {beta} = 0.25; 95%CI = 0.02, 0.45; p = 0.029, and {beta} = 0.22; 95%CI = -0.00, 0.45; p = 0.052). For instance, the history of primary caregivers psychiatric diagnoses was associated with higher average screen time ({beta} = 0.16; 95% CI, 0.07, 0.25; p < 0.001) and inattention/hyperactivity symptoms ({beta} = 0.27; 95% CI, 0.21, 0.34; p < 0.001). Findings were replicated in the CBCL-ABCL model. ConclusionWe found no longitudinal association between increasing screen time exposure beyond an individuals average and inattention/hyperactivity symptomatology. Furthermore, between-person associations were absent after covariate adjustment and results werent sensitive to the questionnaire.

Lower urinary tract symptoms (LUTS), e.g., urinary frequency, pressure, urgency, and overactive bladder syndrome, are commonly reported in children with attention-deficit/hyperactivity disorder (ADHD). Understanding the co-occurrence of these conditions has implications regarding clinical approaches, treatments, and improved quality of life. We conducted a systematic review and meta-analysis to examine the relationships between LUTS and ADHD in children. We searched for articles published between January 1990 and July 2019, in PubMed, CENTRAL, and PsycNet. Two authors independently screened all articles and extracted data. We performed random-effect meta-analyses for ADHD with pooled outcomes for LUTS. We identified 117 relevant articles in the literature and 17 articles fulfilled the inclusion criteria for the systematic review, of which, 5 articles had sufficient data for meta-analysis. Examining ADHD among individuals with LUTS, the odds ratio was 2.99 (95% CI: 1.13,7.88, P < 0.001), compared to controls. In multiple studies, the mean overall score for LUTS, using a standardized measure, was significantly higher in patients with ADHD in comparison to controls, and the severity of ADHD was positively associated with the severity of LUTS. Younger age in children was correlated with a higher LUTS score. Different subtypes of urinary incontinence demonstrated differences in behavioral problems and psychiatric comorbidity. Sex differences in LUTS were not consistent across articles. Our results indicate clinically significant associations between ADHD and LUTS in children. Because LUTS and ADHD are common disorders in children, clinicians should be aware of these associations as they inform optimal assessment and treatment strategies.

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.

BackgroundAcademic pressure is a potential contributor to adolescent mental health problems, but international evidence on this association has never been synthesised. MethodsWe conducted the first systematic review on the association between academic pressure and adolescent depression, anxiety, self-harm, suicidality, suicide attempts and suicide. We searched MEDLINE, PsycINFO, ERIC and Web of Science (core collection) up to November 24, 2022, for studies of school-going children or adolescents, which measured academic pressure or timing within the school year as the exposure and depression, anxiety, self-harm, or suicidal ideation, attempts or suicide as outcomes. Risk of bias was assessed using the Mixed Methods Appraisal Tool. We used narrative synthesis to summarise the evidence. The review was prospectively registered with PROSPERO (CRD42021232702). ResultsWe included 52 studies primarily from Asia (n=26) and Europe (n=20). Most studies assessed mixed anxiety and depressive symptoms (n=20) or depressive symptoms (n=19). Forty-eight studies found evidence of a positive association between academic pressure or timing within the school year and at least one mental health outcome. LimitationsMost studies were cross-sectional (n=39), adjusted for a narrow range of confounders or had other limitations which limited the strength of causal inferences. ConclusionsWe found evidence that academic pressure is a potential candidate for public health interventions which could prevent adolescent mental health problems. Large population-based cohort studies are needed to investigate whether academic pressure is a causal risk factor that should be targeted in school- and policy-based interventions. FundingUCL Health of the Public; Wellcome Institutional Strategic Support Fund.

This study examines the emotional and behavioural pathways to adolescent substance use and antisocial behaviour. Using a sample of 17,223 participants from the UK Millennium Cohort Study, we applied parallel-process growth mixture modelling on emotional and behavioural symptoms in those aged 3 to 14 and employed latent class analysis to identify patterns of substance use and antisocial behaviours at age 14. We then performed a multinomial regression analysis to explore the association between emotional and behavioural trajectories and patterns of adolescent substance use and antisocial behaviours, controlling for sociodemographic, family and maternal factors. We found five trajectories of emotional and behavioural symptoms and four classes of adolescence substance use and antisocial behaviour. Children and adolescents in the high externalising and internalising and moderate externalising trajectories were more likely to belong to any problematic behaviour class, especially the poly-substance use and antisocial behaviours class. Inclusion in the moderate externalising and internalising (childhood limited) class was associated with higher odds of belonging to the alcohol and tobacco class. These associations remained significant after controlling for important sociodemographic and contextual factors, such as maternal substance use, poverty, and parental status. Interventions on adolescent health promotion and risk behaviour prevention need to address the clustering of substance use and antisocial behaviour as well as the significant influence of early and chronic internalising and externalising symptoms on the aetiology of these behaviours.

BackgroundChildren diagnosed with ADHD and other comorbid mental health conditions often exhibit more severe functional impairments than those without comorbid conditions, including a tendency for their ADHD symptoms to persist into later developmental stages. We conducted a systematic review and quantitative analysis to investigate the extent to which specific childhood comorbidities (internalizing, externalizing and neurodevelopmental conditions) predict the persistence of childhood ADHD into later developmental stages. MethodsWe extracted data from 26 studies meeting the criteria for inclusion and applied multilevel random effects models to obtain pooled estimates of Cohens d for selected predictors on ADHD persistence. ResultsChildhood comorbid internalizing and externalizing conditions (d=0.19 and d=0.31, respectively), but not neurodevelopmental disorders, were significantly associated with ADHD persistence. After adjusting for covariates (sex, age and other comorbidities), this association diminished for externalizing conditions (dadj=0.24) and was no longer significant for internalizing conditions (dadj=0.05). The association between comorbid externalizing behavior problems and ADHD persistence was found only in studies that used parent-reported data to measure childhood ADHD and externalizing conditions, but not in studies that included teacher-reported childhood symptoms. ConclusionsChildhood comorbid externalizing and, to a lesser extent, internalizing conditions were associated with the persistence of ADHD, but this association may be partially due to confounders. Childhood comorbidity of neurodevelopmental disorders does not appear to increase the likelihood of ADHD persistence.

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.

BackgroundStudents define competence according to the development of their skills and understanding (mastery) or based on comparisons with their peers (performance). Students may aim to achieve the outcome of interest (approach) or to avoid failure of not meeting their definition of competence (avoidance). Achievement goals are linked to adolescents cognitions, coping, stress, and potentially depressive symptoms. We conducted the first longitudinal study of the association between achievement goals and depressive symptoms in a nationally representative adolescent sample. MethodsWe analysed data from the Longitudinal Study of Australian Children. Achievement goals were measured at age 12/13, with the primary outcome (depressive symptoms) measured at ages 14/15 and 16/17 (Kindergarten only). Analyses were linear multilevel and traditional regressions, with adjustment for confounders. OutcomesWe included 3,200 and 2,671 participants from the Kindergarten and Baby cohorts, respectively. Higher mastery-approach goals were associated with decreased depressive symptoms (Kindergarten: -0{middle dot}33 [95%CI: -0{middle dot}52 to -0{middle dot}15]; Baby: -0{middle dot}29, [95%CI: -0{middle dot}54 to -0{middle dot}03]), and higher masteryavoidance with increased depressive symptoms (Kindergarten: 0{middle dot}35, [95%CI: 0{middle dot}21 to 0{middle dot}48]; Baby: 0{middle dot}44 [95%CI: 0{middle dot}25 to 0{middle dot}66]). Higher performance-avoidance goals were associated with increased depressive symptoms in the Kindergarten cohort only (Kindergarten: 0{middle dot}26, [95%CI: 0{middle dot}11 to 0{middle dot}41]; Baby: -0{middle dot}04 [95% CI: -0{middle dot}27 to 0{middle dot}19]). We found little evidence of an association between performance-approach goals and depressive symptoms. InterpretationIf associations reflect a causal relationship, school environments that promote mastery-approach goals, could reduce adolescent depressive symptoms. FundingSir Henry Dale Fellowship jointly funded by the Wellcome Trust and the Royal Society (Grant 223248/Z/21/Z). Research in contextO_ST_ABSEvidence before this studyC_ST_ABSThe onset of depression commonly occurs in adolescence, with evidence suggesting that the rate of adolescent depression is rising in many countries. Despite the importance of prevention, very few strategies are successful. Modifications to the school environment may lead to improvements in adolescents mental health, however there is little awareness over which factors to target. Achievement goals reflect differences in adolescents motivation to learn and how they measure their own success, have been linked to adolescents cognitions, ways of coping, stress, anxiety, and self-esteem. According to the goal-orientation model of depression vulnerability, they represent a potential risk factor for adolescent depression. Evidence has shown that students achievement goal orientations are influenced by the school environment, and that they are modifiable through targeted intervention. If there is a causal relationship, changing adolescents achievement goals may reduce depressive symptoms, however there is a lack of high quality evidence. We searched MEDLINE and PsycInfo from database inception to August 1, 2023 for studies describing the association between achievement goals and depression in adolescents. We used the search terms "achievement goal*" AND "adolescen*" OR "student*" AND "depression", alongside searches in Google Scholar. We found only one longitudinal study, which used an unrepresentative convenience sample and did not adjust for confounders. Added value of this studyUsing longitudinal data of two nationally representative Australian cohorts, we examined the association between four achievement goal orientations with subsequent depressive symptoms in school-going adolescents. We found longitudinal evidence that mastery-approach, mastery-avoidance, and performance-avoidance goals were moderately associated with depressive symptoms independent of a range of confounders. Implications of all available evidenceOur study highlights that adolescents cognitions around learning and success are associated with future mental health outcomes. School environments that promote learning, development and personal growth could therefore reduce adolescent depressive symptoms, if this association were causal. School-based interventions that aim to enhance factors consistent with mastery goals (i.e., learning skills and understanding the subject, rather than assessing competence in comparison to peers) may have success in preventing depression, and trials are therefore warranted.

BackgroundBullying and the use of psychoactive substances are prevalent conditions among adolescents that appear to have some connection. However, there is no consensus in the literature regarding the association between being a victim of bullying and using psychoactive substances. Moreover, most analyses of this correlation have taken place in developed countries, possibly not reflecting the reality in Latin America. ObjectiveThis cross-sectional study investigated the association between the use of psychoactive substances and involvement in bullying situations in a representative sample of Brazilian adolescents. MethodsWe used data from the 2019 National School Health Survey (Pesquisa Nacional de Saude do Escolar), analyzing 123,261 questionnaires from youths aged 13 to 17. Questions about experiencing or engaging in bullying, lifetime use, and recent use (in the last 30 days) of tobacco, hookah, e-cigarettes, other tobacco products, alcohol, and illicit drugs were considered. Responses on the recent use (in the last 30 days) of the following substances were also analyzed: clove cigarettes, straw cigarettes, marijuana, and crack. Multivariate logistic regression models were used to determine correlations, and odds ratios (OR) were calculated. ResultsParticipation in bullying situations, whether as a victim or perpetrator, increases the likelihood of using tobacco cigarette, hookah, e-cigarettes, clove cigarettes, straw cigarettes, alcohol, illicit drugs, marijuana, and crack. The non-involved-in-bullying group has a lower chance of using any analyzed substance, followed by the group that is only a victim. Those with the highest likelihood of use are individuals who engage in bullying exclusively, followed by those who experience both situations. ConclusionIn Brazil, being a victim of bullying is associated with the use of various psychoactive substances. Our results align with findings from Latin America, partially differing from studies in developed countries, highlighting the influence of location in understanding these risk associations.

ObjectiveTo compile the available literature regarding the usefulness, methodology used, and limitations of ACEs screening in a pediatric clinical sample, to prevent adverse health outcomes. IntroductionSeveral studies have found an association between the presence of adverse childhood experiences (ACEs) and the development of negative health outcomes, however the usefulness of screening for this condition and how to do so appropriately has not been established. MethodsWe included observational, descriptive, analytical, and experimental studies, qualitative studies, systematic reviews, clinical guidelines, and health policies that include the pediatric population from 3 to 17 years of age in a clinical setting. Studies in languages other than Spanish and English, protocols, and validation studies were excluded. The search strategy was designed using the PRISMA-S protocol to locate published and unpublished studies using PubMed, EMBASE, Cochrane, LiLACS, PsycArticles and CINAHL databases and grey literature in ProQuest Dissertations and Theses Global. Studies in Spanish and English published since 2012 were included. The Rayyan platform was implemented to remove duplicates and for independent article selection by each author, with conflicts resolved through discussion. Data was extracted into an Excel database, highlighting information related to the objectives of the scoping review. After analyzing the data, we present them in different tables that summarize the findings of the review, with a narrative description. ResultsOur search yielded 8143 studies, from which 31 studies met the inclusion criteria. These studies varied in design, with most conducted in the United States, they were published between 2012 and 2024. The review identified several ACE screening tools (15), with an average response time of 15 minutes. Although some tools showed promise in identifying children at risk for adverse outcomes, significant gaps remain in the consistency and effectiveness of screening methods. Barriers such as lack of training for healthcare personnel, a lack of approach to patients with positive results, limited resources for follow-up care, and cultural differences in interpreting ACEs were often highlighted. There was no evidence of adequate standardization of screening methods, how to use them, and how to properly identify and categorize the presence of an ACE in childhood. ConclusionsThis scoping review highlights the potential of screening for ACEs in pediatric settings to prevent long-term health issues. However, the lack of standardized tools, protocols, and evidence of long-term benefits hinders its implementation. Although the association between ACEs and negative health outcomes is well-established, there is insufficient evidence demonstrating the effectiveness of screening. Cultural factors, especially in countries like Colombia, further complicate the adaptation of screening tools. The review suggests that a multidisciplinary, family-centered approach and training in trauma-informed care are essential. More research is needed to standardize ACE screening and evaluate its effectiveness in reducing health issues related to ACEs.

ImportanceThere are many concerns about the link between social media use and adolescent mental health. However, most research has studied adolescents from the general population, overlooking clinical groups. To address this gap, we synthesize, quantify and compare evidence on the relationship between social media use and internalising symptoms in adolescent clinical and community samples. Data SourcesWe searched five electronic databases for peer-reviewed publications (MEDLINE, Web of Science, PsychInfo, Scopus) and preprints (Europe PMC) published in English between 2007 and 2022. Study SelectionWe included cross-sectional and longitudinal studies quantifying the relationship between social media use and internalising symptoms, excluding experimental studies and randomised controlled trials. Two blinded reviewers initially identified 7389 studies. Data Extraction and SynthesisWe adhered to the PRISMA and MOOSE guidelines for selection and reporting. The data was pooled using a random-effect model and robust variance estimation. Two reviewers independently assessed the quality of evidence with the Quality of Survey Studies in Psychology Checklist. Main Outcomes and MeasuresWe preregistered our hypotheses and primary study outcomes on PROSPERO (CRD42022321473). Articles were included if they reported at least one quantitative measure of a) social media use: time spent, active vs. passive use, activity, content, user perception, and other; and b) internalising symptoms: anxiety, depression or both. ResultsWe reviewed 127 studies including 1,061,293 adolescents and 775 effect sizes, of which only 8% examined clinical samples. In these samples, we found a positive, significant yet small meta-correlation between social media use and internalising symptoms, both for time spent (N = 2893, r = .08, 95% CI = [.01, .15], p = .033, I2 = 57.83) and user engagement (N = 859; r = .12, 95% CI = [.09, .15], p = .002, I2 = 82.67). These associations mirrored those in community samples. Conclusions and RelevanceWe highlight a lack of research on clinical populations, a critical gap considering that public concerns centre on the increase in youth mental health symptoms at clinical levels. This paucity of evidence not only restricts the generalizability of existing research but also hinders our ability to effectively evaluate and compare the link between social media use and youth mental health.