JCPP Advances

Objective: Emotion dysregulation and irritability occur across pediatric disorders, complicating distinctions between general symptom burden and specific clinical presentations. Person-centered analyses can look at profiles of scores to identify groups with similar presentations. We examined whether modeling shared and domain-specific symptom variance identified differentiated profiles in youth. Method: Caregivers of 2,187 US youth ages 6-18 completed 87 items assessing emotion dysregulation, depression, mania-related symptoms, sleep-related impairment, and attention and behavioral problems. An ordinal bifactor model estimated one general and 13 specific factors. Latent profile analyses used standardized scores on all 14 factors, with an expanded raw-score analysis as a comparator. We examined caregiver-reported diagnoses and functioning and approximately two-week classification agreement among 166 recontacted caregivers. Results: The general factor accounted for 62% of common variance ({omega}H=.94), although model fit was mixed (CFI=.884; RMSEA=.058; SRMR=.092). A provisional four-class solution distinguished population-modal (67.4%), internalizing (11.8%), attention/hyperactivity (11.0%), and unusual-thought/elevated-mood (9.8%) profiles. Entropy was .83, but model enumeration and initialization checks did not establish a unique solution. Profiles showed overlapping diagnostic and functional correlates. Recontact agreement was 78.9% ({kappa}=.60). Irritability-specific reliability was limited, constraining interpretation of its weak profile differentiation. Conclusions: General symptom burden coexisted with differentiated residual symptom patterns. These findings support evaluating severity alongside symptom configuration, without equating profiles with diagnoses or weak residual irritability signals with limited clinical relevance. Measurement refinement, model-selection verification, and confirmation of classification-error-adjusted associations are needed before clinical application, but profiles could simplify clinical interpretation of sets of scales.

Autistic adults face considerable challenges in receiving adequate support, from both paid/formal (such as from disability services) and unpaid/informal (for example, from friends and family) sources. Having adequate support can lead to better health and well-being outcomes. However, most instruments designed to assess adequacy of support were not made specifically for/with autistic adults. This paper presents a psychometric validation of the AASPIRE Adequacy of Supports and Information Scale (AASIS), a community-informed adaptation of a previously developed instrument (the Quality of Care and Support scale; Lucas-Carrasco et al., 2011), designed to be relevant and accessible to autistic adults. We also used the AASIS to explore correlates of perceptions of support in a sample of 798 autistic adults. Our confirmatory factor analysis supported a two factor structure for the AASIS (factor one: Supports; factor two: Information). Further testing confirmed the instrument was invariant across several groups, including race/ethnicity, gender, intellectual disability, communication fluency, and self versus proxy-report. Regression analyses suggested that the way in which participants joined the study (i.e., through community advertisements or via established healthcare/disability services) impacted whether they viewed their support as adequate. Additionally, a higher number of adverse childhood events and greater experience of discrimination were related to worse perceptions of support adequacy across both factors. Our findings support the preliminary validity of the AASIS across a variety of autistic people, though further testing is warranted. Findings also point to the importance of addressing the needs of autistic people who are minoritized and/or who have complex trauma histories.

Background: Attention-deficit/hyperactivity disorder (ADHD) is a heterogeneous neurodevelopmental condition, and co-occurring autistic traits may shape its phenotypic expression. Although creativity has been discussed as a relative strength in ADHD, it remains unclear whether autistic traits are associated with different dimensions of creativity in adults with ADHD and whether large-scale brain networks contribute to these associations. Methods: We compared divergent thinking (DT) and real-life creativity between 65 adults with ADHD and 73 neurotypical controls. We used subgroup comparisons, partial correlation analyses, and multiple regression models to determine the effects of autistic traits (ATs) on creativity dimensions within the ADHD cohort. Guided by prior creativity-network research, we analyzed resting-state functional connectivity (FC) of the Default Mode Network (DMN) and Frontoparietal Network (FPN) to uncover the neural mechanisms. Results: The ADHD cohort demonstrated significantly higher scores on both DT (ps = 0.002-0.009) and real-life creativity measures (ps = 0.011-0.017) compared to the neurotypical control group. Importantly, increased ATs within the ADHD group were associated with a dissociated creativity profile, showing positive associations with DT but negative associations with real-life creativity. At the neural level, stronger right DMN FPN connectivity mediated positive associations between ATs and DT performance (ps = 0.007-0.018), but mediated a negative association between ATs and self-reported imagination (p = 0.029). Conclusions: In individuals with ADHD, co-occurring ATs exert a paradoxical effect on creativity, enhancing DT while compromising real-life creative achievement. In this subgroup with ADHD and elevated ATs, interventions should capitalize on ATs-associated ideational strengths while circumventing translational barriers, to enhance real-world creative outcomes.

Abstract Background: The 52-item Ontario Child Health Study Emotional Behavioural Scales (OCHS-EBS) has demonstrated reliability and validity evidence in Canadian population-based samples. This study evaluated an adapted item set of the Ontario Child Health Study Emotional Behavioural Scales (OCHS-EBS-A) intended to measure selected mental disorder symptoms while reducing respondent burden in population-based research. Methods: A prespecified candidate set of 21 items from selected OCHS-EBS disorder scales assessed depression (4 items), generalized anxiety (4 items), oppositional behaviour (6 items), and attention-deficit/hyperactivity (7 items). The 2023 Longitudinal Canadian Health Survey on Children and Youth (L-CHSCY; ages 5-21 years; n= 22,740) provided calibration and internal-validation samples. The Ontario Provincial Assessment and Tracking of Child and Family Health Study (ONPATH; Wave 5: n=719 parent and n=116 youth respondents) provided an independent sample for further evaluation. Analyses examined factorial validity, internal consistency reliability, convergent and discriminant validity, and measurement invariance across sex assigned at birth within age/informant groups. Findings: The analyses supported a refined 20-item OCHS-EBS-A with three correlated factors representing internalizing, oppositional behaviour, and inattention/hyperactivity symptoms. Prespecified criteria for internal consistency reliability and convergent and discriminant validity were met within the reported L-CHSCY age/informant groups. Measurement invariance across sex assigned at birth was supported in the L-CHSCY groups and for children and parents in and youth-reported internalizing symptoms in ONPATH. However, not for ONPATH youth-reported oppositional behaviour symptoms. Interpretation: Results from these population-based samples provide factorial-validity, internal-consistency, and convergent- and discriminant-validity evidence for scores from the 20-item OCHS-EBS-A among children, youth, and emerging adults aged 5-21 years.

Background: ADHD symptoms follow heterogeneous trajectories across childhood and adolescence, with important implications for later functioning. Early-life factors, including perinatal health, family environment, cognition, socioeconomic conditions, and community exposures, may contribute to this variability. The present study examined (1) early-life predictors of ADHD symptom trajectories, and (2) ADHD symptom trajectories as predictors of later substance use, suicidality, and new-onset psychiatric disorders. Methods: Growth models were used to fit longitudinal trajectories of inattention, hyperactivity, and irritability measures in two independent samples: the Oregon ADHD-1000 cohort (N=1,215; 49.17% ADHD; 39.9% female, ages 7-23) and a subsample of the Adolescent Brain Cognitive Development (ABCD) study (N=1,252; 33.3% ADHD; 31.6% female, ages 9-16). Regression analyses examined multiple risk factors as predictors of symptom growth parameters as well as associations between symptom trajectories and later adverse outcomes. Results: In both cohorts, growth models fit well (CFI > .96, RMSEA < .04), with all symptoms decreasing over time (ps < .001) and hyperactivity declining significantly faster than inattention. ADHD polygenic risk, family conflict, parenting, and cognition were associated with symptom intercepts in both cohorts (ps < .001). In Oregon ADHD-1000, poorer baseline working memory and processing speed predicted slower declines in inattention (ps < .001), but these effects did not replicate in ABCD; no other early-life factors predicted symptom trajectories. Increasing irritability trajectories predicted new disorder onset in both cohorts (ORs = 1.73 - 2.09, ps < .001), while more positive inattention slopes predicted new disorder onset in ABCD (OR = 3.07, p < .001) and showed a weaker association in Oregon ADHD-1000 (OR = 1.50, p = .007). Conclusion: While several early risk factors were associated with ADHD symptoms initially, none robustly predicted symptom trajectories over time. However, increasing irritability and inattention were robustly associated with increased risk for new disorder onsets later in adolescence.

Attention Deficit Hyperactivity Disorder (ADHD) frequently co-occurs with distinct personality profiles, but whether ADHD shapes personality (scar model) or personality influences the development of ADHD (vulnerability model) remains unclear. Leveraging genome-wide association study (GWAS) data, we examined directional associations between ADHD and the Big Five personality traits (Neuroticism, Extraversion, Openness, Agreeableness, and Conscientiousness). We estimated genetic correlations and conducted bidirectional two-sample Mendelian Randomization (MR) analyses between ADHD and the Big Five. Robustness was evaluated using multiple sensitivity tests, including MR-CAUSE, which accounts for correlated and uncorrelated pleiotropy, and colocalization analyses on fine-mapped variants. Higher genetic liability to Neuroticism and Extraversion, alongside lower liability to Conscientiousness, increased ADHD risk, consistent with the vulnerability model. Conversely, ADHD genetic liability was associated with lower Agreeableness, supporting the scar model. Associations were generally robust across sensitivity analyses, with MR-CAUSE supporting the Neuroticism and Agreeableness associations and colocalization providing variant-level support for associations between ADHD and Neuroticism, Conscientiousness, and Agreeableness. These findings provide early, population-level insight into personality-related vulnerability to ADHD and motivate further work on the role of personality traits in ADHD risk.

Objective: Parent-adolescent disagreement in ratings of attention-deficit/hyperactivity disorder (ADHD) symptoms can complicate clinical assessment. This study examined parent - adolescent agreement in ADHD symptom ratings and characteristics associated with disagreement. Method: Participants were 1,008 parent-adolescent dyads recruited from a nationally stratified U.S. community sample. Adolescents were 12--18 years old (49.6% female) and along with their parents completed measures of ADHD and depressive symptoms. Agreement on Inattention (IN), Hyperactivity/Impulsivity (HI), and Total ADHD scores was examined. Item-level agreement was assessed using weighted kappa, Gwet 's AC2, percent agreement, and polychoric correlations. Associations between age, sex, and severity of ADHD and depression with levels of agreement were analyzed. Results: Agreement for ADHD factor and total symptom scores was moderate (intraclass correlations = 0.67--0.71), with moderate-to-strong rank-order correspondence. Adolescents reported slightly higher ADHD symptom levels than parents, although the mean difference was small. Item-level agreement was moderate to high (Gwet 's AC2 = 0.79--0.95). Several HI items demonstrated the kappa's paradox, with relatively low kappa values despite high Gwet's AC2 and percent agreement. Q-correlations revealed low agreement on relative strengths and weaknesses. Age and sex were not associated with disagreement and parent-reported ADHD severity and adolescent-reported depressive symptoms were associated with disagreement. Conclusions: Parent and adolescent ratings showed moderate agreement across boys and girls ages 12-- 18; however, disagreement related to relative strengths and weaknesses. Disagreement was associated with ADHD and depressive symptom severity. Findings suggest that ratings from parents and adolescents offer unique perspectives on the assessment of ADHD symptoms.

Objective: To provide national norms, percentiles, and results of factor analyses for the ADHD symptoms and performance items on the parent-report and self-report versions of the Vanderbilt Assessment Scale (VAS) for youth ages 6 to 17. We hypothesized that symptom items would demonstrate separate inattention and hyperactivity/impulsivity factors, performance items would demonstrate interpretable latent dimensions, measurement invariance would be supported across age and sex, and symptom ratings would vary systematically by age and sex. Method: In a nationally stratified survey conducted in July 2025-March 2026, 2,230 parents of youth aged 6-17 years and 996 adolescents aged 12-17 years completed Vanderbilt Assessment Scale items. Both versions asked about the frequency of 18 ADHD symptoms and performance in 8 domains. To evaluate the psychometric properties and age-related normative curves of the VAS across parent- and youth-report forms, we conducted exploratory factor analysis, confirmatory factor analysis, and measurement invariance testing. We also generated age and sex-specific norms. Results: Factor analyses produced the expected two symptom factors and two performance factors. Developmental and sex-specific patterns of ratings of inattention and hyperactivity/impulsivity symptoms indicated that after increasing slightly during the preadolescent years, parent ratings of inattention symptoms declined and remained stable. In contrast, ratings of hyperactivity/impulsivity declined steadily with age. Normative data were generated using GAMLSS estimated centiles from fitted probability distributions. Conclusions: This study provides norms for the parent-report and adolescent self-report VAS. Findings underscore the importance of using sex- and age-based norms to better inform estimates of severity and diagnostic decision making.

Language alterations are recognized as early markers of psychopathological vulnerability, yet genetic and environmental factors underlying language-related brain regions remain unknown. We applied univariate twin analyses and risk-discordant comparisons to multimodal dataset from 31 healthy twin pairs (9-31 years) and 17 pairs discordant for psychopathological risk (10-27 years). Gray matter volume (GMV), cortical thickness (CT), and functional interactions, specifically effective connectivity (EC), were assessed in eight bilateral language-related regions, alongside linguistic, emotional-behavioural, temperamental, and personality-related phenotypes. In healthy twin pairs (27-31 pairs, depending on data completeness), genetic and environmental determinants were estimated for all phenotypes. In 17 pairs discordant for psychopathological risk, intra-pair neuroimaging differences were tested for association with psychopathological discordance and zygosity, and individual brain measures were compared across high-risk twins, their low-risk co-twins, and healthy controls. Environmental factors predominated in structural and functional brain variability, while genetic contributions were limited, region-specific. Narrative fluency and psychological traits showed stronger heritability. Findings converged on the right middle frontal gyrus, where GMV and CT alterations reflected non-shared environment and risk expression. Despite the small sample, preliminary results suggest neurobiological vulnerability in language networks arises from environmental rather than genetic factors, informing environmental susceptibility to adolescent mental illness.

Objective: Brief measures of depressive symptoms and family psychiatry history may support the identification of youth who warrant further assessment, but their interpretation requires population-based measurement evidence. This study evaluated the Very Quick Inventory of Depressive Symptomatology (VQIDS) and Family Index of Risk for Mood (FIRM) in the BENCHMARK 2025 national survey. Method: The sample consisted of 2,252 parent reports for children aged 6-18 years and 1,008 linked adolescent self-reports aged 12-18 years. Analyses examined VQIDS dimensionality, reliability, item functioning, age- and sex-based norms, and informant agreement, alongside FIRM score distributions, alternative scoring approaches, and associations with depressive symptoms. Results: VQIDS findings supported a single dimension and good internal consistency, with greatest IRT precision at elevated symptom levels and no practically meaningful differential item functioning across age or sex. Two-week stability was moderate, and parent-adolescent agreement was lower within more symptomatic subsets. FIRM totals showed stronger cross-informant agreement and retest stability. Family history scores were associated with higher VQIDS percentiles and discriminated scores at or above the 90th percentile across informants (AUROC = .670-.698). FIRMs associations were strongest with internalizing symptoms, although evidence was mixed for mood specificity. Conclusions: These findings provide a measurement and normative foundation for brief depressive symptom assessment and support family history as a complementary correlate of symptom elevation. Diagnostic and prospective prediction utility require further evaluation.

Abstract Autistic young adults experience substantial gaps in services supporting community living and participation. The Community Autism Peer Support (CAPS) program is a community-based intervention in which trained autistic peer specialists provide individualized support to autistic young adults pursuing self-determined goals related to community participation and independent living. We conducted a single-site, two-arm randomized controlled trial to evaluate the feasibility of implementing the CAPS program. Forty autistic adults aged 18 to 30 years were randomized to CAPS (n = 20) or services as usual alone (n = 20) and assessed at baseline, 3 months, and 12 months. Study findings showed that CAPS attracted autistic young adults with diverse demographic and diagnostic backgrounds, and most intervention participants remained engaged in services for extended periods. While the study was underpowered to detect statistical differences in outcomes because it was not a main focus of the research, a consistent pattern of results favored the CAPS condition across all outcomes. The largest positive signals were observed for overall and social quality of life, with additional favorable changes in internalized stigma, unmet needs, social functioning, loneliness, and positive autistic identity. Findings provide support for the feasibility and promise of an autistic-delivered peer specialist model focused on community living and participation. The consistent pattern of favorable changes supports continued development of CAPS as a person-centered approach to addressing outcomes important to autistic adults.

The brain differences of dyslexia are well described and its genetic risk is now measurable; the brain systems that connect the two are unknown. That link decides which measures complement one another in early identification and which systems intervention research should examine. Here we compared large-scale polygenic score maps of brain structure in dyslexia with normative maps of brain neurotransmitter systems. The structural signature of genetic liability aligned with the cortical distribution of neurotransmitter systems. The strongest and most consistent alignment appeared for the histamine H3 receptor, the vesicular acetylcholine transporter (VAChT) and the N-methyl-D-aspartate (NMDA) glutamate receptor. The alignment was most pronounced in cingulate, medial and superior frontal cortex and the paracentral lobule. The H3 alignment held after adjustment for cortical position and for metabolic and cognitive reference maps. Once the component common to all nineteen maps and position were removed together, no individual system remained significant, while the shared component itself aligned with liability. The signature therefore follows the topography these systems share. In 169 children, per-person alignment with the H3 map related to reading skill with the opposite sign to liability. To our knowledge, this is the first study to relate the structural signature of genetic liability for dyslexia to normative maps of neurotransmitter receptor and transporter density. It places that signature within the shared geography of the systems that set attention, arousal and synaptic plasticity during learning, and gives the genetics of dyslexia a testable biological axis.

Importance. Anorexia nervosa (AN) is a severe metabo-psychiatric disorder with heterogeneous outcomes and elevated mortality. Characterizing severity trajectories may improve early risk stratification and targeted intervention. Objective. To identify AN severity trajectories using a register-based severity index (AN-RSI) and examine their associations with polygenic scores (PGS), preceding (prior to AN diagnosis) as well as subsequent (5 years post AN diagnosis) psychiatric and somatic disorders. Design. Population-based cohort study. Setting. Nationwide study in Denmark. Participants. Individuals born between 1969 and 2013 with diagnosed AN (N = 9,534 individuals). Genetic data were available in a subsample comprising 5,126 individuals. Exposures. Forty-one PGS indexing traits relevant to AN, and psychiatric and somatic disorders prior to AN diagnosis. Main Outcomes and Measures. The main outcomes of interest were the AN-RSI trajectories and psychiatric and somatic disorders 5 years post AN diagnosis. Results. Three trajectories were identified: "low and stable" (32.6%), "medium and stable" (53.5%), and "high increasing" (14.0%). The "low and stable" group was used as the comparison group for all analyses. Each 1 standard deviation (SD) increase in AN PGS corresponded with 13% greater odds of following the "high increasing" trajectory. Increases in BMI and attention-deficit/hyperactivity disorder PGS corresponded with 15% and 14% lower odds of following the "high increasing" trajectory, respectively. No preceding psychiatric or somatic disorders were significantly associated with trajectory assignment. In contrast, psychiatric and somatic disorders were more likely to occur subsequent to an AN diagnosis in those in the "high increasing" trajectory with odds ratios (OR) ranging between 1.73 and 3.81 for psychiatric disorders and between 1.61 and 5.38 for somatic disorders with a notable exception of obesity which showed a lower OR of 0.27. Conclusions and Relevance. Our findings hold significant clinical relevance by demonstrating that individuals with AN follow distinct severity trajectories that have different genetic risk as measured by PGS and clear differences in post-diagnosis morbidity patterns but no discernable differences in pre-diagnosis psychiatric or somatic morbidity. As the eating disorders genetics field progresses, incorporating PGS into comprehensive assessments at first presentation may aid in early identification, personalized intervention, and resource allocation for individuals at higher risk of developing a severe illness trajectory.

Background Psychiatric diagnoses and psychotropic medication use among children, adolescents, and young adults have increased in high-income countries, with concerns about geographic variation. We described national trends and geographic variation in Denmark from 2010 to 2025 and developed an interactive online tool to explore these patterns. Methods We conducted a nationwide, descriptive, repeated cross-sectional register-based study of all Danish residents aged 0-24 years in 2010-2025 (n=2,930,744), using the Danish National Patient Registry and the Danish National Prescription Registry. We estimated annual incidence, prevalence, and, for selected diagnoses, lifetime prevalence, by age and sex, and age- and sex-standardised rates across regions, health councils, and municipalities. We assessed geographic variation using deviations from national means, coefficients of variation, Gini coefficients, and funnel plots. Findings Psychiatric diagnoses and psychotropic medication use increased from 2010 to 2025. The annual prevalence of attention-deficit hyperactivity disorder (ADHD) increased from 0.41 to 2.3 per 100 individuals, autism spectrum disorders from 0.20 to 1.2, and melatonin use from 0.14 to 3.0. ADHD and autism spectrum disorders were more prevalent among boys and anxiety disorders among girls. Sertraline use was also more prevalent among girls. Geographic variation was observed across diagnoses and psychotropic medications at regional, health council, and municipal levels. For example, lifetime prevalence of autism ranged from 1.3 to 5.9 per 100 across municipalities, and in 2025 regional coefficients of variation ranged from 0.11 (sertraline) to 0.41 (atomoxetine). Results can be explored in the interactive online tool (https://bupstat.sdu.dk/?lang=en). Interpretation Psychiatric diagnoses and psychotropic medication use increased among Danish children, adolescents, and young adults, with marked geographic variation. Descriptive data cannot establish the causes of this variation, but the findings identify areas for further review and support continued monitoring. Funding Best for Us project (www.bedstforos.dk), funded by the Novo Nordisk Foundation (NNF24SA0093635) and the Obel Family Foundation (69348).

Objective: To evaluate the psychometric properties, factor structure, validity, and age- and sex-specific norms of the 21- and 10-item parent-report Child Mania Rating Scale (CMRS-P) in a nationally representative U.S. sample of youth aged 6-18 years. Method: Parents of 2,229 youth aged 6-18 years [weighted M(SD)=12.0(3.3) years; 45.9% female] completed the CMRS-P and related measures between July 2025 and March 2026. Data were weighted to represent U.S. demographics. A clinical comparison sample included parents of 522 youth seeking outpatient mental health services. Complete-case analyses evaluated reliability, factor structure, item response theory, measurement equivalence, retest stability, and convergent and discriminant validity. GAMLSS estimated age- and sex-specific norms. Results: Weighted mean scores were 8.5(SD=9.0) for CMRS-P-21 and 4.0(4.3) for CMRS-P-10. Internal consistency was high ({omega}=.97/.93), and forms correlated .95. A general severity factor explained most reliable variance ({omega}H=.94). Three items differed in response thresholds across samples, with an average impact below one point on expected total scores. Both forms correlated strongly with attention problems, suicidality, depression, externalizing symptoms, and emotion dysregulation (r=.51-.63 for CMRS-P-21) and negligibly with pubertal status. Reliable-change thresholds were 14.5 (CMRS-P-21) and 6.8 (CMRS-P-10) points. Weighted GAMLSS CMRS-P-21 95th percentiles declined with age in males (30-23) and increased in females (22-30), with wide bootstrap intervals at age extremes; the female trend was not replicated without weights. Conclusions: Findings support both CMRS-P forms for assessing youth manic symptoms. The first nationally representative U.S. norms provide age- and sex-adjusted benchmarks for interpreting scores and informing further clinical assessment.

ObjectiveThe Concise Health Risk Tracking (CHRT) assessment has utility in suicide risk prediction in adults and adolescents. Because multi-informant assessment is the gold standard in pediatric populations, a parent report version of the CHRT may enhance evaluation of youth suicide risk. We adapted the self-report version of the 16-item CHRT as a parent report version (CHRT-PR16) and evaluated the psychometric properties and continuous age- and sex-specific norms in a nationally representative sample of parents. MethodParents of youth aged 6-18 years (N=2,236; 2,235 in sex-stratified analyses) completed the CHRT-PR16, enabling evaluation of both the 16- and 14-item (CHRT-PR14) version. Psychometric analyses included internal consistency, factor structure, Item Response Theory, measurement invariance, criterion validity, and continuous norming using Generalized Additive Models for Location, Scale and Shape (GAMLSS). ResultsInternal consistency was excellent for both CHRT-PR16 and CHRT-PR14 (both{omega} t =.98, =.96), although general factor variance was higher for CHRT-PR14 ({omega}H=.83) than CHRT-PR16 ({omega}H=.68). Mokken scale analysis confirmed zero monotonicity violations for CHRT-PR14. CHRT-PR16 showed a clinically trivial edge in criterion correlations with other measures of psychopathology. In GAMLSS modeling, a zero-inflated negative binomial distribution achieved optimal fit for both scales. Score trajectories diverged by age and sex around age 10, with males scoring slightly higher at upper percentiles. ConclusionsCHRT-PR16 and CHRT-PR14 demonstrate strong psychometric support, essential unidimensionality, measurement invariance, and optimal GAMLSS fit. Age- and sex-specific percentile lookup tables provide population-level benchmarks to guide measurement-based care, symptom tracking, and suicide risk stratification in pediatric settings.

Objective: The Genetic Risk for Serious Mental Illness and Development ("Paisa Kids") Study is establishing a longitudinal cohort of 3,000 youth enriched transdiagnostically for risk for serious mental illnesses (SMI; i.e., schizophrenia, bipolar disorder, and severe depression) from the Paisa region of Colombia. Its objective is to clarify the early clinical, neurobehavioral, genetic, and environmental profiles associated with later SMI and distinguish transdiagnostic from disorder-specific pathways. This paper describes the study infrastructure, recruitment streams, and baseline assessment battery, and characterizes the first two-thirds of the cohort. Method: Youth aged 6-15 years are being recruited. Youth recruited for high SMI risk either have a first or second degree adult relative with a SMI diagnosis or a psychiatric diagnosis themselves identified through electronic medical records (EMRs) associated with later SMI. Lower-risk youth have a relative without a SMI diagnosis. Baseline measures include psychiatric and developmental history, neurobehavioral functioning, environmental exposures, and genome-wide genotyping. Psychiatric EMRs provide longitudinal follow-up. Results: Among 2,384 participants enrolled thus far (mean age=11.2 years, 45.0% female), 2,211 were recruited for high SMI-risk and 173 for lower SMI-risk. Overall, 73.2% met criteria for a history of one or more psychiatric disorders. Logistic regression comparing rates of diagnoses and ACEs between recruitment streams showed elevated rates of depressive and anxiety disorders, attention-deficit/hyperactivity disorder, oppositional defiant disorder, and several ACEs among high versus lower SMI-risk youth. Conclusion: Integrating multidomain phenotyping, genomic data, and longitudinal EMR follow-up, the Paisa Kids cohort provides a unique resource for investigating pathways of risk and resilience to SMI.

Pharmacological treatments targeting core autistic features remain limited. In neurotypical adults, cannabidiol (CBD) alters mismatch negativity (MMN), an electrophysiological marker of automatic auditory deviance detection that has been associated with autistic traits. The effects of CBD on MMN, as measured using electroencephalography (EEG), in autistic children remain unknown. This secondary analysis of a pilot randomised, double-blind, placebo-controlled crossover trial examined the effects of 12 weeks of oral CBD oil on MMN during a duration-deviant auditory oddball task. We hypothesised that CBD would produce more negative MMN amplitudes and shorter peak latencies relative to placebo. Nineteen autistic children (6-12 years, 8 female) received CBD (dose) and placebo in randomised order, separated by an 8-week washout. Age-adjusted linear mixed-effects models tested Time (baseline, follow-up) x Treatment (CBD, placebo) effects on mean MMN amplitude and peak latency separately at Fz and FCz. Exploratory Spearman correlations examined baseline associations between MMN and Developmental Behaviour Checklist-2 (DBC-2) Social Relating scores. At FCz, latency decreased following CBD but increased following placebo but did not survive FDR correction (p = .029, pFDR = .058) and no other interactions were significant. Higher baseline DBC-2 Social Relating scores were associated with more negative MMN amplitude at FCz (rho = -.58, pFDR = .028) and Fz (rho = -.59, pFDR = .028). These findings provide tentative evidence that CBD may modulate MMN latency in autistic children. Larger trials should clarify CBDs effects on MMN and further examine the association between MMN amplitude and social-relating difficulties.

Family environment is a robust predictor of adolescent internalizing symptoms, yet its strength varies across adolescents. We tested whether this variation is partly captured by how similar an adolescent's cortical structure is to their parent's and whether different forms of this similarity matter in different cortical systems. In 115 parent-child dyads from two cohorts, structural MRI quantified similarity across 400 cortical parcels in two forms: phenotypic similarity in regional morphometry and architectural similarity in interregional morphometric organization. Parent-child similarity was not directly associated with symptoms, whereas its interactions with family environment were jointly significant (chi-square(4) = 14.92, P = 0.005). Phenotypic similarity in the sensory-limbic system and architectural similarity in the association system each moderated the association between family environment and symptoms (both beta = 0.22). In both cases, the association was strongest among less similar dyads. The phenotypic interaction was distributed across sensory-limbic networks and was not reproduced by similarity to unrelated adults or by the child's cortical atypicality. The architectural interaction was concentrated in the dorsal attention and default mode networks and was distinguishable from unrelated-adult similarity but not from child atypicality. Together, these findings raise the possibility that markers of environmental sensitivity need not reside in the child alone. Parent-child cortical similarity may index a dyadic component of this sensitivity, one not adequately represented by a single similarity score but distributed across forms of similarity and cortical systems.

Purpose Autistic adults have diverse communication characteristics that are not well captured by standard demographic measures. Communication affects self-determination, relationships, access to healthcare, and services. Characterizing communication differences may improve research and intervention targeting for meaningful subgroups of autistic adults. Methods The Academic Autism Spectrum Partnership in Research and Education (AASPIRE) Outcomes Project team used a community based participatory research (CBPR) approach to develop a self- or caregiver-report module to characterize communication among autistic adults. The 10-item module asks about receptive and expressive communication, literacy, speech reliability, usage of digital communication, use of alternatives to speech, and communication fluency. It can be completed directly, with or without support, or via a caregiver. We used baseline survey data from 844 autistic adults to evaluate the module and derived a five-level variable, Communication Profile, from selected module items to stratify participants. We examined completion feasibility, response consistency, and construct validity. We also assessed test-retest reliability in a 15% random subsample who completed a 2-week retest following the 6-month survey, with oversampling of caregiver-report respondents. Results The Communication Characteristics module demonstrated high completion feasibility, minimal systematic error, and strong construct validity. The Communication Profile variable stratified participants into five meaningful communication profiles and demonstrated strong construct validity and substantial test-retest reliability ({kappa} = .69). Conclusion The Communication Characteristics module and Communication Profile variable provide a valid approach for characterizing communication diversity among autistic adults for research, clinical, and service settings. The full AASPIRE Measurement Toolkit is available at https://aaspire.org/measurement. Lay Summary Autistic people communicate in many different ways, and their communication may change in different situations. We developed and tested a set of survey questions to describe an individuals communication. We also used the results to describe 5 groups of autistic people based on how they communicate, without treating these groups as different types of autism.