Research Appraisals
Evidence-based critical appraisals of the latest medical research, systematically evaluated using Oxford CEBM methodology.
Showing 33 appraisals
Current opinion in pediatrics
Clinical implementation of artificial intelligence in adolescent mental healthcare
PURPOSE OF REVIEW: This review aims to summarize recent literature on artificial intelligence (AI) tools for adolescent mental health, including the types of tools available, their clinical applications, effectiveness, and safety, as well as relevant ethical considerations. RECENT FINDINGS: For clinicians, AI can facilitate clinical documentation, enhance therapy, and support the diagnosis process. Adolescents show interest in using AI for their mental healthcare and can benefit from AI-guided therapy apps and chatbots. Most studies that show effectiveness focus on depression treatment. Many tools are only in the prototyping stage, not tested on clinical samples, or lack safety measures, highlighting the need for further safety evaluation before specific app recommendations can be made. SUMMARY: AI is increasingly being implemented in pediatric health systems and adolescents' daily lives. Adolescent medicine practitioners should recognize the growing potential for certain AI applications to enhance access and support adolescents, review and utilize those applications that have empirical support of efficacy, and that provide guardrails for safe and ethical use.
1 Aug 2026
Read appraisal →Journal of pediatric endocrinology & metabolism : JPEM
Beyond A1c: a narrative review of mental health integration in pediatric type 1 diabetes care
Background Youth with type 1 diabetes (T1D) experience substantially higher rates of depression, anxiety, diabetes distress, attention-deficit/hyperactivity disorder (ADHD), and disordered eating behaviors (DEB) than peers. These conditions may impair self-management and contribute to worsened glycemic outcomes.ContentWe synthesize prevalence and consequences of common comorbidities; summarize International Society for Pediatric and Adolescent Diabetes (ISPAD) and American Diabetes Association (ADA) guidance on psychosocial assessment; and appraise integrated models: co-located behavioral health, stepped care, and telehealth integration. We map barriers (workforce, workflow, stigma, fragmented communication, digital inequities) to concrete actions.SummaryPsychological morbidity and glycemic outcomes may be connected through behavioral and neuroendocrine pathways and family dynamics. Programs embedding behavioral health in pediatric diabetes care facilitate routine psychosocial screening and are associated with improved engagement and quality of life, and in some models, improved glycemic outcomes.OutlookTo close the implementation gap, teams should standardize routine psychosocial screening, embed trained mental-health professionals, use stepped-care models matching interventions to symptom severity, track referral follow-through, and leverage hybrid telehealth. Policy levers include reimbursement for integrated visits and investment in the behavioral-health workforce. The consistent associations between psychological and glycemic outcomes in youth with T1D support integrating psychosocial care as a core component of comprehensive diabetes management.
25 July 2026
Read appraisal →Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer
Psychosocial interventions for families with minor children affected by parental cancer: An umbrella review
PURPOSE: Research on psychosocial interventions for families with minor children affected by parental cancer has expanded over recent decades; however, the evidence remains fragmented across multiple systematic reviews. This umbrella review aims to gather and synthesize the existing systematic reviews, with a particular focus on intervention characteristics, implementation, effectiveness, methodological limitations, and implications for future research and clinical practice. METHODS: A comprehensive search of CINAHL, MEDLINE, PubMed, Web of Science, Scopus, PsycINFO, PsycArticles, Epistemonikos, and the Cochrane Database of Systematic Reviews was conducted in September 2025, including gray literature. Eligible reviews were published between 1990 and 2025 in English, Portuguese, or Spanish and had full-text availability. Methodological quality was assessed using AMSTAR-2. The review was registered in PROSPERO (ID 1139397). RESULTS: Eight systematic reviews met inclusion criteria and were synthesized narratively due to substantial clinical and methodological heterogeneity. Across these reviews, 46 distinct psychosocial interventions were identified. Overall, interventions were associated with preliminary beneficial outcomes for children, adolescents, parents, and families, particularly in improving children's understanding of parental illness, enhancing family communication and functioning, strengthening parenting skills, and promoting psychological well-being. However, confidence in these findings was limited by the generally low methodological quality of the included reviews and the high overlap of primary studies. CONCLUSIONS: Current evidence suggests that psychosocial interventions may support families with minor children affected by parental cancer, but conclusions remain tentative due to methodological limitations. There is a clear need for the development and rigorous evaluation of developmentally and disease-stage-sensitive interventions, supported by high-quality research and institutional collaboration. Strengthening the evidence base in this area is essential to inform clinical practice, guide supportive care services, and support policy development in psycho-oncology.
13 July 2026
Read appraisal →PloS one
Optimizing treatment for depressed parents of children with emotional and behavioral disorders: A multi-site feasibility trial.
BACKGROUND: Behavioral parent training (BPT) programs are effective for reducing disruptive behavior of many children with emotional and behavioral disorders (EBD) and improving skills and competencies of their parents. However, these interventions are not sufficiently effective for parents who themselves have depression. This study assessed the feasibility of the Addressing Depression and Positive Parenting Techniques (ADAPT) Program-a novel BPT that includes aspects of cognitive behavioral therapy and dialectical behavior therapy. We identified whether recruitment was possible, attendance was acceptable, participants were satisfied, and facilitators adhered to the protocol. Additionally, we measured trends in changes in parent and child outcomes with intervention. METHODS: Participants were 28 parents and their children with EBD, referred to two hospital-based clinics. Parents were eligible if they (1) had a child aged 6-10 experiencing emotional and behavioral difficulties and (2) were experiencing elevated depressive symptoms. ADAPT took place virtually over 10 weeks. Participants completed measures before, weekly and after treatment. Clinicians recorded attendance and completed weekly treatment fidelity checklists. RESULTS: We found that recruitment was possible, the intervention showed high parental satisfaction, and facilitators reported high program fidelity. Further, secondary outcome measures showed evidence of sensitivity to change in the intended direction. CONCLUSION: Given that a priori progression criteria were met and we found preliminary indication of efficacy, we conclude that an RCT of ADAPT to determine efficacy is warranted.
11 July 2026
Read appraisal →European journal of psychotraumatology
Assessment of functional impairment related to post-traumatic stress in children and adolescents: a systematic review
Background: Post-traumatic stress disorder (PTSD) often impairs children's and adolescents' functioning across different life domains. Significant functional impairment is a diagnostic criterion for PTSD in both the DSM-5 and the ICD-11, but the methods in terms of domains covered and scoring rules to assess functional impairments are quite inconsistent.Objective: This systematic review evaluates instruments specifically designed to assess post-traumatic stress symptoms (PTSS), PTSS modules within diagnostic interviews, and generic functional impairment measures used to capture PTSS-related functional impairment in children and adolescents.Method: A systematic search was conducted across six databases for studies published between January 2010 and November 2025. Eligible papers included the development or psychometric evaluation of PTSS-specific measures, PTSS modules in diagnostic interview, and generic functional impairment measures validated in samples exposed to trauma or adverse childhood experiences. Data were extracted and categorized based on assessed content domains, scoring methods, and psychometric properties, with results stratified by age group (6 years and younger versus 7 years and older).Results: From 3519 records, 30 papers met the inclusion criteria. Thirteen PTSS-specific instruments, one diagnostic interview module, and one generic functional impairment measure were identified. Together, these instruments assessed 11 different life domains, although considerable variation existed in the domains covered across tools. Scoring methods also varied, with approximately half using dichotomous response formats and the remainder using multi-categorical scales. Psychometric properties of the functional impairment scales were reported in only 20.7% of publications.Conclusion: Current tools for assessing PTSS-related functional impairment in youth lack standardization. There is a critical need for well-validated instruments that comprehensively capture the presence and severity of PTSS-related functional impairment. This systematic review identified and evaluated 15 instruments, comprising PTSS-specific measures, diagnostic interview modules, and generic functional impairment tools, used to assess PTSS-related functional impairment in children and adolescents.The instruments collectively assessed 11 different life domains; however, substantial variability existed in the domains covered, and scoring methods ranged from dichotomous formats to Likert-type scales.Only 20.7% of papers reported psychometric properties for functional impairment items, highlighting the critical need for standardized, developmentally appropriate tools with robust validation in children and adolescents with potentially traumatic experiences.
8 July 2026
Read appraisal →Child and adolescent psychiatric clinics of North America
Technology-Enabled Crisis Care for Youth: Bridging the Gap
The article discusses technological advancements in mental health care for youth in crisis, addressing workforce shortages and enhancing care delivery. Technologies like remote patient monitoring, telehealth, mobile health applications, virtual reality therapy, and artificial intelligence improve symptom tracking, communication, and treatment accessibility. Clinical decision support systems and therapy chatbots enhance crisis assessment and management. Various settings employ telepsychiatry and extend reach, while digital therapeutics and monitoring ensure ongoing support. Challenges include regulatory compliance, data privacy, and technological limitations. Future directions emphasize interoperability, safeguards for new and adapting technologies, patient-centered care, and integrated digital health systems.
3 July 2026
Read appraisal →PloS one
Long-term effects following prenatal cocaine exposure: A systematic review.
Cocaine use represents a global public-health concern, and children's exposure to this substance is receiving growing attention. Despite the importance of this phenomenon, efforts to isolate cocaine-specific long-term effects are affected by the limited availability of human cohorts followed into adulthood and by the influence of environmental factors and co-exposures. Addressing ongoing debates in the literature, this systematic review synthesizes human evidence on long-term outcomes following prenatal cocaine exposure (PCE), from infancy to early adulthood. A comprehensive search of PubMed and Scopus from inception to August 2025 identified 26 eligible studies. Results suggest that across maturational stages, PCE is consistently associated with early developmental effects (including smaller head circumference and motor delays), deficits in visuospatial, language and executive functions, focal neuroimaging alterations (white-matter microstructure and task-related functional recruitment), growth deficits, and elevated externalizing behaviours. However, evidence is characterised by heterogeneity in exposure assessment, frequent prenatal polysubstance exposure, socioeconomic confounding, caregiving instability and small neuroimaging samples. Overall, this review suggests that PCE is linked to a broad spectrum of detrimental effects and that some biological vulnerabilities associated with PCE may persist. Nonetheless, supportive postnatal environments may mitigate developmental disadvantages and promote better trajectories for affected children. These findings underscore the need for integrated public-health and clinical strategies that combine prevention of prenatal substance use with family-focused postnatal supports.
28 June 2026
Read appraisal →JMIR mental health
Coproduction Without Youth? Closing the Participation Gap in Digital Mental Health Research
Young people are among the most intensive users of digital and generative artificial intelligence (GenAI)-enabled mental health tools, yet they remain underrepresented in the research and design processes that shape these technologies. Although participatory approaches such as co-design and patient and public involvement are widely endorsed as best practices, youth involvement in digital youth mental health (DYMH) research is often inconsistent, superficial, or limited to late-stage consultation. This participation gap risks producing interventions that are misaligned with young people's lived experiences, priorities, and vulnerabilities, particularly in the context of rapidly evolving and scalable GenAI systems. This Viewpoint aims to reexamine the underlying drivers of the participation gap in DYMH research; clarify how participation is conceptualized and implemented across disciplines; and propose concrete, actionable recommendations to support more meaningful and consistent youth involvement across the research life cycle. We draw on interdisciplinary literature from digital mental health, human-computer interaction, child-computer interaction, and health research policy. Our Viewpoint integrates conceptual frameworks (eg, Lundy's model of participation), existing reviews of co-design practices, and emerging evidence on GenAI in mental health. We adopt a life cycle-oriented perspective to examine how youth participation is distributed across stages of research and development, including problem formulation, design, implementation, and evaluation. We identify 3 interrelated drivers of the participation gap. First, conceptual and linguistic fragmentation obscures what participation entails in practice, with terms such as co-design, participatory design, user-centered design, and patient and public involvement used inconsistently across disciplines. Second, youth involvement is uneven across the research life cycle, with participation often concentrated in early ideation or usability testing but largely absent from upstream decision-making and downstream evaluation. Third, institutional barriers-including ethics review processes, consent requirements, funding constraints, and adult-centric research norms-systematically limit meaningful youth partnership. These challenges are amplified in the context of GenAI, where opaque "black box" systems, simulated therapeutic interactions, and rapid deployment cycles introduce distinct risks if youth perspectives are not integrated. We propose a set of minimum expectations to address these gaps, including explicit specification of participatory models, life cycle mapping of youth involvement, reporting of youth influence on decisions, dedicated funding for participation, proportional ethics frameworks, and mechanisms for youth-informed governance of GenAI systems. Closing the participation gap in DYMH research is both an ethical imperative and a practical necessity. Moving beyond aspirational commitments requires embedding youth participation as a standard, resourced, and accountable component of research, design, and governance. In the context of rapidly evolving digital and GenAI technologies, failure to do so risks producing interventions that are scalable but not safe, credible, or responsive to the needs of young people.
27 June 2026
Read appraisal →PloS one
Factors associated with resilience among parents of children with autism spectrum disorder: A systematic review
Parents of children with autism spectrum disorder (ASD) experience ongoing caregiving demands and challenges that may contribute to their general well-being. Research has shown that resilience enables parents to adapt to these challenges; however, existing evidence on associated factors toward resilience among these parents remains fragmented. This systematic review aimed to identify factors associated with resilience among parents of children with ASD. We conducted a PRISMA 2020-guided systematic review on studies published between January 2019 and May 2025 using Web of Science, Scopus, and PubMed by applying predefined search terms and Boolean operators. Studies examining factors associated with resilience among parents of children with ASD aged under 18 years were included in this review. We also used the Mixed Methods Appraisal Tool 2018 to assess the quality of these studies. Findings were synthesised narratively using thematic analysis. From the 13 selected studies, five themes were identified as determinants of resilience among parents, i.e., sociodemographic and economic factors; child-related characteristics; parenting well-being and distress; psychological factors and coping styles; and social support and family relationships. Most included studies were cross-sectional and utilised different measurement tools, which may limit causal inference and comparability. As a conclusion, parental resilience was found to be influenced by psychological, social, and contextual factors. Strengthening coping resources and social support may enhance parental adaptation and family well-being. Along these lines, multi-level and culturally sensitive interventions are thus needed to inform strategies to foster resilience among parents of children with ASD. The review was registered with PROSPERO (CRD420251034348). The author(s) received no specific funding for this work.
23 June 2026
Read appraisal →Current psychiatry reports
Artificial Intelligence in Child and Adolescent Psychiatry: A Narrative Review of Recent Clinical Applications and Ethical Considerations
PURPOSE OF REVIEW: This narrative review examines recent literature of artificial intelligence (AI) in child and adolescent psychiatry. With increasing mental health disorders in young people along with persistent workforce shortages, AI has emerged as a potential tool to improve efficiency and support clinical decision making. However, using AI raises important ethical concerns which are summarized in our review. RECENT FINDINGS: Most AI applications in child and adolescent psychiatry remain early in development and are not ready for routine clinical use. AI scribes are likely impractical in many child psychiatry settings because of multiparty visits, consent concerns, and sensitive clinical discussions. Many multimodal diagnostic tools using machine learning still require further testing and can be impractical when relying on costly diagnostics like neuroimaging. Similarly, AI-assisted therapeutics requiring physical hardware like robotics and virtual or augmented reality devices can also be prohibitively expensive. One of the few exceptions includes AI-enabled video and eye-tracking approaches for autism diagnosis. Chatbots and robot companions may provide modest improvements for depression, but evidence remains limited in the pediatric population with risk of serious harm. Concerns of AI include misinformation, algorithmic biases, privacy risks, crisis mismanagement, and excessive emotional attachments to chatbots. AI may eventually support child and adolescent psychiatry, but current evidence supports cautious, supervised use rather than broad clinical adoption. Clinicians should help families understand AI's limits, encourage digital literacy, and ensure that AI remains an adjunct to human care rather than a substitute.
22 June 2026
Read appraisal →European journal of pediatrics
Subtypes in developmental coordination disorder: what do we know so far? A systematic review.
UNLABELLED: Developmental coordination disorder (DCD) is a highly heterogeneous disorder. This systematic review examined whether statistically derived clusters can effectively distinguish subgroups of children with DCD. Web of Science, Scopus, PubMed, Embase, and PsycInfo were systematically searched (CRD420251237685) using controlled terminology and free-text terms. Studies were eligible if they included children (aged 0-18 years) with DCD with(out) comorbidities and employed statistical clustering to identify subtypes. Methodological quality was assessed using an adapted version of the Critical Appraisal Skills Programme and certainty of the evidence with the Grading of Recommendations Assessment, Development and Evaluation. Ten of the 1719 search results were included, three of which included both children with DCD and typical development. Two studies explored clusters unidimensionally (motor-only and mental health-only). Eight studies included multiple domains of functioning: motor (n = 8), sensory functions (n = 5), fitness (n = 3), cognitive functions (n = 3), executive functions (n = 2), mental health (n = 1), and participation (n = 1). Studies identified between four (n = 4) and six (n = 1) subtypes, which primarily reflected gradients of severity rather than distinct domain-specific profiles. The overall certainty of evidence for distinct subtypes in DCD was rated low to very low. CONCLUSION: Evidence suggests that DCD is better conceptualized as a spectrum of pervasiveness rather than discrete subtypes. Existing findings lack consistency across studies due to methodological shortcomings and variable measurement domains. Although evidence-based clinical subtypes cannot yet be recommended, future research should prioritize subtyping studies focused on primary symptoms to better identify potential phenotypes within the DCD population. WHAT IS KNOWN: • DCD is a heterogeneous condition, and identifying discrete subtypes is a long-standing research goal to improve clinical support. • Researchers have proposed various motor and non-motor profiles, but no consensus exists on a definitive subtyping model. WHAT IS NEW: • This review found no consistent discrete subtypes, suggesting DCD is better viewed as a spectrum of pervasiveness rather than categories. • Future research should focus on subtyping primary motor symptoms to determine whether distinct, stable subgroups exist within the broader DCD population.
22 June 2026
Read appraisal →Progress in neuro-psychopharmacology & biological psychiatry
Neural correlates of late talking: A systematic review of electrophysiological and neuroimaging studies.
BACKGROUND: Late talking (LT), a delay in expressive vocabulary in early childhood, affects a significant minority of toddlers and can be a precursor to persistent language and literacy impairments. While behavioral profiles are well-documented, a systematic synthesis of its underlying neurobiology is lacking. This systematic review aimed to identify, evaluate, and synthesize evidence from electrophysiological (EEG) and neuroimaging (MRI) studies on the neural correlates of late talking in children. METHODS: We conducted a systematic search of Scopus, Web of Science, and PubMed from inception to September 2025, following PRISMA guidelines. Studies investigating children formally identified as late talkers without comorbid neurological or global developmental conditions, using EEG/ERP or MRI modalities, were included. Risk of bias was assessed using the Joanna Briggs Institute (JBI) critical appraisal tool. RESULTS: Sixteen studies (8 EEG, 8 neuroimaging) comprising 231 LT children in EEG studies and 315 in neuroimaging studies were included. EEG studies revealed a neurodevelopmental cascade, beginning with atypical oscillatory activity (increased frontal gamma power) and deficits in auditory discrimination (reduced Mismatch Negativity), progressing to higher-order impairments in phonological (absent PMN) and lexical-semantic (altered N400) processing. Neuroimaging studies consistently identified structural and functional anomalies within a distributed perisylvian network, including reduced gray matter in left temporal regions, atypical right-hemispheric lateralization, reduced activation in cortical-subcortical circuits, and altered white matter connectivity. These neural markers demonstrated significant predictive value for later language outcomes. CONCLUSION: Late talking is a clear neurodevelopmental disorder with a cascading pattern of neural dysfunction. The identified neural signatures are not just findings but have strong clinical potential as biomarkers for early identification and prognosis. This evidence advocates for a shift to a precision medicine approach, opening the door to novel, neurobiologically-informed interventions like neuromodulation that target the underlying brain circuits.
20 June 2026
Read appraisal →Journal of affective disorders
Interventions to reduce loneliness in children and adolescents (4-18 years): A systematic review and meta-analysis with narrative synthesis of study-level characteristics
Loneliness in youth is linked to poor mental and physical health, yet the effectiveness of interventions remains unclear. Given its distinct developmental presentation, this meta-analysis synthesises interventions targeting loneliness in individuals aged 4-18 to inform age-appropriate strategies. It examines the effects of interventions on loneliness and includes a narrative synthesis of intervention and sample characteristics. We conducted a systematic literature review and meta-analysis of quantitative studies up to March 2024, focusing on interventions where loneliness was the primary target in school-aged youth. Nineteen studies were included in the SLR, of which 18 were included in the meta-analysis (6 RCTs, 6 multi-cohort, and 6 single-cohort studies). RCTs showed a small, non-significant reduction in loneliness (Hedges' g = -0.20, 95% CI [-0.42, 0.02], p = .07), with social and emotional skills training interventions being most effective. Multi-cohort studies showed a negligible effect (Hedges' g = -0.01, 95% CI [-0.08, 0.07], p = .84). Single-cohort studies indicated a moderate, non-significant effect (Hedges' g = -0.55, 95% CI [-1.29, 0.18], p = .14). Interventions targeting loneliness show promise in reducing loneliness, particularly when they incorporate social and emotional learning. Future research should integrate qualitative approaches and consider loneliness within broader mental health and well-being frameworks to support the development of more comprehensive, youth-centred interventions.
16 June 2026
Read appraisal →Journal of affective disorders
Multiple peripheral inflammatory markers in adolescents with major depressive disorder treated with repeated esketamine infusions: results from a randomized controlled trial
OBJECTIVE: While inflammatory dysregulation is well-documented in major depressive disorder (MDD), its response to esketamine treatment in adolescents remains poorly understood. We aimed to examine the effects of esketamine on the inflammatory cytokines in adolescent MDD. METHODS: This randomized, double-blind trial assigned 49 adolescents with MDD to receive three infusions of esketamine or midazolam over five days between December 2020 and April 2022. Suicidal ideation (measured by Columbia Suicide Severity Rating Scale, C-SSRS), depressive symptoms (measured by Montgomery-Åsberg Depression Rating Scale, MADRS) and plasma levels of 10 inflammatory markers were assessed at baseline, Day 6, and Day 12. RESULTS: Linear mixed model revealed significant time effects for all markers, but no significant drug main effect was observed. In esketamine group, alterations in IL-8 were associated with the reduction of C-SSRS Intensity at Day 6 (r = 0.444, p = 0.026), and alterations in IFN-γ were correlated with the reduction of MADRS (r = 0.399, p = 0.048) and C-SSRS Intensity (r = 0.427, p = 0.033) at Day 12. Baseline C4 negatively related to the reductions of MADRS and C-SSRS Ideation at Day 6 and 12 (all p < 0.005). CONCLUSIONS: Our study found no significant drug main effects for inflammatory markers, with most changes representing time effects observed in both groups. Exploratory results indicate that IL-8, IFN-γ, and C4 may warrant further investigation as potential biomarkers of esketamine response in adolescent MDD.
15 June 2026
Read appraisal →International journal of medical informatics
Machine learning approaches to identifying neurodevelopmental disorders using social media data: a systematic review
BACKGROUND: Neurodevelopmental disorders (NDDs), such as autism spectrum disorder (ASD) and attention-deficit/hyperactivity disorder (ADHD), often emerge in early childhood and can significantly impact social, academic, and emotional functioning. Early identification is critical to improving long-term outcomes, yet traditional diagnostic processes are time-consuming and resource-intensive. As social media becomes an integral part of daily life, user-generated content offers a novel source of behavioral and linguistic data that may support early detection. Advances in artificial intelligence (AI) and machine learning (ML) now make it possible to analyze these large-scale data streams for clinical insights. METHODS: A comprehensive search was performed across five databases-PubMed, Scopus, Web of Science, IEEE Xplore, and ACM Digital Library-from inception up to July 2025. Studies were included if they used AI or ML methods to analyze social media data for detecting NDDs. Data extraction focused on platform type, targeted disorder, dataset size, ML technique, and diagnostic performance. RESULTS: Nineteen studies met the inclusion criteria. Most focused on ASD and ADHD, using platforms such as Reddit, Twitter, YouTube, and Facebook. ML models achieved moderate to high classification performance, with F1-scores ranging from approximately 0.48 to 0.89 depending on the data type and disorder. Video-based models showed particular promise in identifying nonverbal behavioral markers. However, research on other NDDs remains limited, and methodological heterogeneity, small sample sizes, and ethical challenges persist. CONCLUSION: AI-driven analysis of social media data holds significant promise for scalable, non-invasive screening of neurodevelopmental disorders. While current work largely focuses on ASD and ADHD, future research should extend to underrepresented NDDs and address concerns related to data validity, bias, and privacy. With continued advancement, these tools may serve as valuable complements to traditional diagnostic methods.
15 June 2026
Read appraisal →BMJ open
Feasibility and acceptability of therapist-guided, asynchronous, internet-delivered trauma-focused CBT for adolescents with PTSD: a single-group feasibility trial in Sweden
OBJECTIVES: Trauma-focused cognitive behavioural therapy (TF-CBT) is the established first-line treatment for paediatric post-traumatic stress disorder (PTSD), but access to evidence-based care remains limited. This study aimed to evaluate the feasibility and acceptability of a therapist-guided, 12 week, internet-delivered TF-CBT (iTF-CBT) programme for adolescents with PTSD and to explore preliminary changes in PTSD symptoms. DESIGN: Single-group feasibility trial. SETTING: Save the Children, Sweden. PARTICIPANTS: Twenty-two adolescents (13-17 years, 82% female) with primary PTSD. INTERVENTIONS: A 12 week, therapist-guided, asynchronous, internet-delivered TF-CBT comprising eight modules and parallel caregiver modules with joint adolescent-caregiver activities. OUTCOMES: Feasibility measures included recruitment pace, participant retention, treatment adherence (module completion) and therapist time. Acceptability was evaluated through satisfaction, credibility, negative effects and reported adverse events. Within-group changes in PTSD severity using independent evaluator-rated Clinician-Administered PTSD Scale (CAPS-CA-5) and the self-reported Child and Adolescent Trauma Screen 2 (CATS-2) were used as indicators of potential clinical change. Assessments occurred at baseline, during treatment, post-treatment and at 1 month follow-up (primary endpoint). RESULTS: Recruitment was completed after 7 months of active enrolment. Retention and adherence were high, satisfaction and credibility ratings were favourable, and no intervention-related serious adverse events occurred. Within-group improvements were observed at the primary endpoint, with large reductions on CAPS-CA-5 (Cohen's d=1.27) and CATS-2 (Cohen's d=1.51). At follow-up, 47.6% of participants no longer met criteria for PTSD. CONCLUSIONS: Therapist-guided iTF-CBT for adolescents with PTSD was safe, feasible, acceptable and associated with potentially meaningful symptom improvements. These findings support further evaluation in larger, controlled trials to determine efficacy, cost-effectiveness and long-term outcomes. TRIAL REGISTRATION NUMBER: NCT06185244.
30 May 2026
Read appraisal →Journal of medical Internet research
Training Clinicians in Private Practice in Family-Based Treatment for Anorexia Nervosa: Randomized Controlled Trial Comparing Two Online Approaches
BACKGROUND: There is a critical need to disseminate efficacious psychosocial treatments for mental disorders because there is a significant gap between evidence-based treatment (EBT) approaches and usual clinical practice. To address this gap, cost-effective, efficient, and scalable methods of training mental health clinicians in EBT are needed. One example of the need to improve dissemination and implementation of psychosocial treatments is for adolescents with anorexia nervosa (AN), a serious mental disorder with an incidence rate of about 1% that can become life-threatening. Based on outcomes from a series of randomized controlled trials (RCTs), an EBT for adolescents with AN is family-based treatment (FBT); however, few therapists are trained in the approach. Some studies suggest that online training is feasible for training clinicians treating eating disorders, including pilot data related to FBT specifically, but RCTs examining different training formats for FBT to improve fidelity and patient outcomes are needed. OBJECTIVE: This study compared 2 different formats for delivering online training in FBT to therapists treating adolescents with AN and planned to assess the feasibility of the 2 training formats, as well as to examine whether either approach was superior in improving fidelity to FBT or patient outcomes. METHODS: Participants were 123 mental health therapists licensed in the United States in private practice with no previous FBT training. Therapists were randomized to either (1) a webinar training lecture series or (2) an interactive e-training on-demand program (ET-FBT) with an additional focus on key FBT interventions. Both groups were offered up to 12 one-hour group-based clinical case consultation (CCC) sessions posttraining. We examined the feasibility and acceptability of the online training programs and posttraining outcomes in fidelity to key components of FBT, self-efficacy, and working alliance. We explored rates of patient early response (weight gain of 2.4 kg at session 4) in adolescent patients with AN treated after FBT training during CCC. RESULTS: Both online trainings had a high completion rate of 95% (117/123), with CCC completion at 38% (47/123). Both programs showed significant improvements within randomized groups in therapists' fidelity, self-efficacy, and working alliance. Working alliance improved significantly more in the ET-FBT group, but there were no other significant differences between training groups. Early response rates doubled posttraining and CCC (16%-34%), regardless of randomized training format, a rate that is similar to that achieved by therapists in RCTs examining FBT treatment outcomes. CONCLUSIONS: It is feasible to deliver online training in FBT to clinicians in private practice in 2 different formats, and both trainings led to significant improvements in fidelity, self-efficacy, working alliance, and patient outcomes. Future studies should address challenges in patient recruitment for posttraining CCC and refine CCC implementation to maximize training effects and efficiency.
26 May 2026
Read appraisal →BMC public health
Little All Children in Focus (Little ACF) - evaluation of a parenting support programme for parents of children aged 1-2 years in Sweden: a randomised controlled trial
INTRODUCTION: The first two years of life affect health over the life course. Universal parenting support programmes may promote child health during these years but there is a lack of such evidence-based programmes. Our aim was to study the direct effects of a structured 4 sessions universal parenting programme for parents with children 1-2 years old, Little All Children in Focus, in Sweden. METHODS: A two-arm parallel randomised controlled superiority trial with 832 Swedish-speaking parents was conducted to evaluate the effectiveness of the Little All Children In Focus programme in comparison with an active control receiving four digital lectures on child development and parenthood. The participants completed questionnaires at baseline and post intervention measuring the primary outcomes: parenting self-efficacy and stress, coparenting quality, emotion regulation for parents and emotion regulation strategies for their children, and secondary outcome: child socioemotional development. A third research question concerned whether the intervention could engage and retain parents in groups. An intention-to-treat approach was applied using linear mixed models for analysing the effectiveness of the programme. RESULTS: Parents who participated in the programme demonstrated greater improvements in supportive emotion regulation strategies compared to the active control (β = 3.0, CI = 0.9 - 5.0), while no notable group differences emerged across the remaining outcome measures. The program demonstrated high levels of parental engagement and retention in group settings. CONCLUSIONS: Little All Children in Focus demonstrates potential in promoting supportive parenting emotion regulation strategies among Swedish speaking parents to 1-2-year-olds. The intervention also seems to have potential to engage parents. However, further evaluations must be conducted to provide a deeper understanding of the long-term impact of this universal parenting support programme. TRIAL REGISTRATION: The study protocol https://rdcu.be/eAxn2 was published at www. CLINICALTRIALS: gov with registration number: NCT05445141 (registered on July 06, 2022).
21 May 2026
Read appraisal →The Journal of clinical psychiatry
Systematic Review and Meta-Analysis of Mood Stabilizers in the Treatment of Adolescent Patients With Nonsuicidal Self-Injury in China
Objective: Nonsuicidal self-injury (NSSI) refers to deliberate, repeated acts of damaging one's own body tissue without suicidal intent. The aim of this systematic review and meta-analysis was to explore the effectiveness of mood stabilizers in treating depressive adolescent patients with NSSI in China. Data Sources: Literature published before June 30, 2025, was included. Chinese databases searched included CBM (Chinese Biomedical Database), CNKI (China National Knowledge Infrastructure), WANFANG (Wanfang Database), and CSSCI (Chinese Social Sciences Citation Index); English databases included MEDLINE, Embase, and the Cochrane Library. Searches used the following keywords: [Bipolar disorder OR depression OR NSSI] AND [Mood stabilizer OR Lithium OR Valproate OR Carbamazepine OR Oxcarbazepine OR Lamotrigine OR Antipsychotic OR Antidepressant]. Study Selection: Chinese and English literature related to the treatment of NSSI with mood stabilizers in adolescent patients in China was searched. Editorials, comments, letters, reviews, and case reports were excluded. Randomized controlled trials conducted in China comparing mood stabilizer augmentation of basic therapy versus basic therapy alone for treating NSSI were included, and studies evaluating mood stabilizer treatment for NSSI using pre-post designs were also included. A total of 9 studies were included, 4 comparative studies by control group and 5 comparative studies of before and after treatment. Data Extraction and Synthesis: Indices of depression, anxiety, impulsivity, self-injury severity, and treatment response were synthesized and analyzed. Mean differences or standardized mean differences and 95% confidence intervals (CIs) were used for symptom change. Odds ratios and their 95% CIs were also used for binary outcomes. Results: Severity of anxiety, depression, impulsivity, and self-injury was significantly reduced following treatment with mood stabilizers. Compared to treatment without mood stabilizers, anxiety, depression, and self-injury were also significantly reduced, and the response rate was significantly improved in adolescents with depression and NSSI. The incidence of self-injury in these patients was significantly reduced by mood stabilizers. Conclusion: These results demonstrate the important role of mood stabilizers in treating NSSI and suggest that mood stabilization may be more critical than mere improvement of affective symptoms.
21 May 2026
Read appraisal →Journal of affective disorders
Intolerance of uncertainty and depression in children and adolescents: Systematic review and meta-analysis
BACKGROUND: Intolerance of uncertainty (IU) is a development and maintenance factor for depression and anxiety. Previous reviews found that it associated with anxiety in children and adolescents. However, there was insufficient evidence at the time to review its association with depression in this population. METHOD: 20 studies investigating the relationship between IU and depression in children and adolescents were identified. Random effects meta-analysis was used to aggregate cross-sectional associations, with age, gender, and measure as moderators. A narrative review of longitudinal findings from relevant studies (K = 6) was also conducted. RESULTS: Meta-analysis of cross-sectional associations found an overall effect size of r = 0.47. There was limited evidence that age or gender moderated the effect, however there was a significant moderating effect of measure. Namely, when including studies using 'child-friendly' measures (i.e., developed and normed with children as opposed to adults), the effect size was r = 0.37. Another analysis revealed that the inhibitory IU subscale was more strongly associated with depression than prospective IU. Longitudinal findings suggested that the association between IU and depression persists over time. LIMITATIONS: Studies were limited to those published in English and including general population samples (e.g., typically developing, without significant medical needs). CONCLUSIONS: There is a medium-strong association between IU and depression symptoms in children and adolescents. However, it may be overestimated by the use of IU measures that are not child-friendly. Future research can further extend the evidence-base through careful measure selection, as well as longitudinal and experimental designs.
17 May 2026
Read appraisal →Current psychiatry reports
The Type of Providers Delivering Practice Elements Used in Child Mass Trauma Interventions: A Systematic Review
PURPOSE OF REVIEW: This review identified the relative frequency of use of various types of providers delivering practice elements in 130 child mass trauma interventions and compared the use of these providers across events, populations, and settings. RECENT FINDINGS: Mental health professionals (MHPs) more frequently delivered cognitive, self-monitoring, exposure, and narrative elements than other providers while non-specialist providers (NSPs) and teachers and school personnel (TSPs) delivered support networking and social skills training more frequently. MHPs administered interventions to targeted populations more frequently, and TSPs administered interventions to universal populations more frequently. Only MHPs administered interventions at clinical facilities; NSPs delivered a majority of interventions at community sites. Understanding the specific practice elements delivered by providers with different backgrounds and training can inform efforts to enhance the reach and impact of mass trauma services. Future publications should report greater detail about providers and their training and about specific practice elements used.
14 May 2026
Read appraisal →PloS one
Comparing machine and deep learning models for pediatric anxiety classification using structured EHRs and area-based measures of health data
OBJECTIVE: This retrospective, case-control study with internal validation evaluates the performance of machine learning (ML) and deep learning (DL) models in classifying pediatric patients at risk for anxiety disorders using structured electronic health records (EHRs) and area-based measures of health (ABMH). The aim is to enable proactive care by monitoring potential anxiety onset across developmental stages. METHODS: We trained a series of ML models (Logistic Regression, Decision Tree, Random Forest, K-Nearest Neighbors, XGBoost) and DL models (LSTM, GRU, RETAIN, Dipole) using structured EHR data from 30-day windows prior to diagnosis. Two datasets were used per age group: one with structured EHR data only, and another including both EHR and ABMH data. ML models were trained using short-term cross-sectional features, while DL models leveraged full longitudinal patient histories. Performance was assessed using AUROC, AUPRC, PPV, NPV, F1 score, and accuracy. Due to differences in input scope, model performance reflects both algorithmic and temporal design differences and is not intended as a direct comparison between ML and DL. RESULTS: ML models offered strong baseline performance, with XGBoost achieving AUROC scores of 0.817 (EHR) and 0.816 (EHR+ABMH) for 8-year-olds. Adding ABMH features did not significantly improve performance. DL models, particularly RETAIN and Dipole, achieved the highest AUROC values (e.g., Dipole: 0.853 with EHR, 0.857 with EHR+ABMH for 8-year-olds), outperforming other DL and ML models within their respective design constraints. CONCLUSION: Both ML and DL models successfully identified likely anxiety onset using structured EHR data. DL models using longitudinal data achieved the highest performance, while XGBoost provided a robust ML baseline. The minimal impact of ABMH features highlights integration challenges, and performance variation across ages emphasizes the need for age-stratified modeling approaches.
14 May 2026
Read appraisal →American journal of epidemiology
Predicting first onset of suicide attempt among children with suicidal ideation or non-suicidal self-injury using machine learning: a prospective population-based cohort study
While children with suicidal ideation or non-suicidal self-injury (NSSI) are at high risk of suicide, most do not attempt suicide. This study aims to identify predictors of first suicide attempts among children with suicidal thoughts or NSSI. We utilized longitudinal data from the Adolescent Brain and Cognitive Development study to examine a broad range of risk factors in children reporting suicidal ideation (N = 344, mean age = 9.93) or NSSI (N = 261, mean age = 9.88) at baseline, predicting first attempt of suicide during a 4-year follow-up. Predictive models were developed through bivariate feature selection followed by Discrete-Time Random Survival Forest machine learning, identifying predictors of subsequent suicide attempts. During the follow-up, 40 of 344 children (11.6%) with suicidal ideation, and 32 of 261 children (12.3%) with NSSI at baseline initiated suicide attempts. For suicidal ideation, risk for attempting suicide increased with caregiver-reported NSSI, witnessing domestic violence, severity of suicidal thoughts, being female, online social screen use, and less parental supervision. For NSSI, risk of suicide attempt increased with witnessing domestic violence, anxiety disorders, caregiver-reported NSSI, being female, and disruptive, impulse control, and conduct disorders. Our findings shed light on the development of population-based suicide prevention strategies for children.
11 May 2026
Read appraisal →European journal of pediatrics
The effect of motivational interviewing on internet addiction and digital game addiction in adolescents: a randomized controlled trial
UNLABELLED: The purpose of this study was to measure the effect of motivational interviewing on both reducing internet addiction and digital game addiction in adolescents. A parallel-group randomised controlled trial was adopted. The study population consisted of ninth-grade (14-15 years of age) high school students in a city in Turkiye. The study was completed by 88 participants (experimental: 44; control: 44). The data were collected using a Personal Information Form, the Young Internet Addiction Test, and the Digital Game Addiction Scale. The experimental group received a preparatory session and five weekly motivational interviewing sessions. Instruments were administered to both groups before (pre-test) and after the intervention (post-test), and at follow-up tests 3 and 6 months after the final session. The data were analysed using the two-way mixed design and the Bonferroni Comparison Test. The mean scores of internet addiction and digital game addiction decreased significantly after the motivational interviewing in the experimental group compared to the control group (p < 0.001) in both the post-test and follow-up tests. CONCLUSION: The present study concluded that motivational interviewing may be associated with reductions in mitigating symptoms of internet addiction and digital game addiction behaviours among adolescents. Motivational interviewing could be implemented to reduce internet addiction and digital game addiction behaviours. Trial registration: The study was registered on a clinical trial database (NCT06721702). The study started on December 11, 2023 (actual date on which the first participant was enrolled). WHAT IS KNOWN: • Internet addiction and digital game addiction are two increasingly important problems among adolescents. • Digital games and online activities negatively affect adolescents' physical, social, and psychological health. WHAT IS NEW: • Motivational interviewing was an effective technique to reduce online gaming and internet addiction. • A motivational interviewing program comprising at least six sessions could be implemented to promote behavioural change in adolescents.
10 May 2026
Read appraisal →IEEE transactions on bio-medical engineering
Multilevel Correlation-Aware and Modal-Aware Graph Convolutional Network for Diagnosing Neurodevelopmental Disorders
OBJECTIVE: Graph-based methods using resting-state functional magnetic resonance imaging demonstrate strong capabilities in modeling brain networks. However, existing graph-based methods often overlook inter-graph relationships, limiting their ability to capture the intrinsic features shared across individuals. Additionally, their simplistic integration strategies may fail to take full advantage of multimodal information. To address these challenges, this paper proposes a Multilevel Correlation-aware and Modal-aware Graph Convolutional Network (MCM-GCN) for the reliable diagnosis of neurodevelopmental disorders. METHODS: At the individual level, we design a correlation-driven feature generation module that incorporates a pooling layer with external graph attention to perceive inter-graph correlations, generating discriminative brain embeddings and identifying disease-related regions. At the population level, to deeply integrate multimodal and multi-atlas information, a multimodal-decoupled feature enhancement module learns unique and shared embeddings from brain graphs and phenotypic data and then fuses them adaptively with graph channel attention for reliable disease classification. RESULTS: Extensive experiments on two public datasets for Autism Spectrum Disorder (ASD) and Attention Deficit Hyperactivity Disorder (ADHD) demonstrate that MCM-GCN outperforms other competing methods, with an accuracy of 93.11% for ASD and 76.41% for ADHD. CONCLUSION: The MCM-GCN framework integrates individual-level and population-level analyses, offering a comprehensive perspective for neurodevelopmental disorder diagnosis, significantly improving diagnostic accuracy while identifying key indicators. SIGNIFICANCE: These findings highlight the potential of the MCM-GCN for imaging-assisted diagnosis of neurodevelopmental diseases, advancing interpretable deep learning in medical imaging analysis.
6 May 2026
Read appraisal →Psychiatry research
Physiological correlates of emotional dysregulation in youth with psychopathology: an exploratory study using wearable technology
The failure to regulate one's own emotions, defined as Emotional Dysregulation (ED), has become a diagnostic challenge in the last decades. Peripheral indexes of functioning of the autonomic nervous system (ANS) activity emerged as reliable transdiagnostic biomarkers of psychopathology. The present study aimed to evaluate the feasibility of wearable sensors in capturing ANS correlates of affective reactivity to emotionally salient videoclips in a stimulation protocol conducted in a clinical sample of youths. Thirty subjects (mean age: 13.93 ± 11.74) were recruited and presented with videoclips showing emotional content (joy, fear, anger, sadness, and anger). Before (Baseline), during (Task), and after (Recovery), the registration, electrocardiogram (ECG), and electrodermal response (EDR) were recorded using wearable technologies. Several indices related to the activation of sympathetic and parasympathetic nervous system were extracted. These indices were compared among the different phases and emotions and correlated with clinical measures. Preliminary results showed that some emotions are more able to elicit ANS response than others, and there is a correlation between physiological activation and clinical profile. These preliminary findings could help to explore the mechanisms of ED in psychopathology and can be useful to guide behavioral and pharmacological treatment. This study supports the success of wearable-based protocols for monitoring emotional reactivity in youth with psychopathology.
6 May 2026
Read appraisal →BMJ mental health
Using electronic health records to evaluate a children and young people's social prescribing service: challenges and implications for research and practice
BACKGROUND: Preliminary evidence indicates that social prescribing (SP) can improve children and young people's (CYP) well-being but is limited by small non-representative samples and often relies on descriptive statistics. Given the wide implementation of SP in the UK, administrative records provide a unique opportunity to understand current practice and assess impacts on well-being. OBJECTIVES: (1) To understand the quality of data captured in SP administrative records. (2) To explore which CYP are currently receiving SP and what SP entails in practice. (3) To assess the impact of SP on well-being. METHODS: We used administrative records from one CYP SP service in England. Records were extracted from Joy, an online platform for managing SP. Over 18 months, 770 age-eligible CYP were referred to SP, 203 of whom were successfully discharged and completed two pre-post measures of well-being (the short Warwick-Edinburgh Mental Wellbeing Scale; SWEMWBS) at least 7 days apart. We used descriptive statistics, a paired t-test to assess changes in well-being and linear regressions with interactions to test effect modification. FINDINGS: Missing data was the largest issue, with ethnicity missing for 94% of CYP. A lack of detail and inconsistent recording for both individual characteristics and SP practices also presented challenges. Despite this, we identified that most CYP were referred by their GP, followed by their school, with 97% referred because of their mental health. The most common pathway was to receive SP for around 90 days, with 10-15 link worker contacts and 6 contact hours. Following SP, SWEMWBS scores improved by 3.72 points (t(202)=17.50, 95% CI 3.30 to 4.14, p<0.001), a 20% relative increase. Exploratory analyses suggested that this increase was greater for those with lower baseline well-being. CONCLUSIONS: Despite numerous challenges with missing data and data quality, we found that CYP well-being increases following SP (as it is currently implemented). The moderate effect size was consistent with larger studies of adults. CLINICAL IMPLICATIONS: Further development of online platforms is needed to monitor access to, nature of and efficacy of SP. For those working in SP, we recommend more training, implementation of standardised guidelines and designated time to update records.
27 Apr 2026
Read appraisal →Journal of affective disorders
What retrospective and dynamic assessments tell us about youth depression: A network analysis perspective.
PURPOSE: Traditional assessments of depressive symptoms often rely on retrospective self-reports, which may be affected by cognitive and memory biases. Few studies have compared retrospective and dynamic (real-time) assessments to examine the consistency and structure of depressive symptom reporting. This study aimed to compare retrospective and dynamic assessments of depressive symptoms in youth using network analysis to explore symptom-level associations and clustering. METHODS: Ninety Brazilian adolescents and young adults (mean age = 18 years), with and without depression, completed the Short Mood and Feelings Questionnaire (SMFQ) every other day for 14 days via a smartphone-based chatbot (dynamic assessment). At the end of the 2-week period, they completed the same questionnaire retrospectively. Network analyses were conducted using Exploratory Graph Analysis (EGA) and Dynamic Exploratory Analysis (DEA) to identify symptom communities and compare network structures across both assessment methods. RESULTS: Both retrospective and dynamic assessments revealed three symptom communities; however, the composition and structure of these communities differed. Retrospective assessments showed stronger connections among cognitive symptoms, while dynamic assessments displayed a more balanced distribution, with stronger associations between somatic and affective symptoms. IMPLICATIONS: Findings highlight significant differences in depressive symptom networks between retrospective and dynamic assessments. Dynamic methods may offer less biased and more ecologically valid insights into youth depression, underscoring the importance of real-time data collection in clinical assessment and research.
16 Apr 2026
Read appraisal →Psychological medicine
Cost-utility and cost-effectiveness of SELFIE, a transdiagnostic ecological momentary intervention for improving self-esteem in youth aged 12-26 years exposed to childhood adversity: Findings from a multicenter randomized controlled trial
BACKGROUND: A novel transdiagnostic blended Ecological Momentary Intervention (EMI) for improving self-esteem in youth who experienced childhood adversity has shown beneficial effects. However, evidence on the cost-effectiveness of SELFIE and EMIs overall is lacking. METHODS: In this RCT-based economic evaluation, participants aged 12-26 years with low self-esteem (<26 on the Rosenberg Self-Esteem Scale [RSES]) and experienced childhood adversity were recruited from specialized mental health services and the general population and randomly allocated to CAU (control condition) or CAU + SELFIE (experimental condition). The Trimbos/iMTA Questionnaire for Costs Associated with Psychiatric Illness (TiC-P), the RSES, and EQ-5D-5L were assessed at baseline, post-intervention, and 6-, 18-, and 24-month follow-up. Incremental cost-effectiveness (ICER) and cost-utility (ICUR) ratios, and acceptability curves, were generated. Sensitivity and subgroup analyses assessed robustness. RESULTS: From a societal perspective, the ICER presented €1,219 per improved point of self-esteem, and the ICUR presented €53,986 per QALY gained. The probability of cost-effectiveness was 26% at a willingness-to-pay (WTP) threshold of €20,000/QALY and 49% at €50,000/QALY. At €50,000/QALY, the probability of cost-effectiveness was 77% from a healthcare perspective (ICUR €15,671/QALY gained) and 87% for participants recruited from specialized mental health services (ICUR €-14,567/QALY gained). CONCLUSIONS: At the societal level, the SELFIE intervention exceeded the WTP threshold. Tests for robustness showed higher probabilities of cost-effectiveness from a healthcare perspective, likely reflecting the absence of educational productivity loss costs in the societal perspective, and in youth recruited from specialized mental health services. The innovative field of blended EMIs yields encouraging first results, urging more cost-effectiveness research.
14 Apr 2026
Read appraisal →Brain : a journal of neurology
Distinct cerebellar networks underpin clinical improvement in adolescent Tourette disorder.
Adolescence is frequently called the second period of brain maturation. In Tourette disorder (TD), the clinical trajectory of tics and associated psychiatric co-morbidities varies significantly across individuals during the transition from adolescence to adulthood. In this study, we aimed to identify patterns of resting-state functional connectivity that differentiate adolescents with Tourette disorder from their neurotypical peers, and to monitor symptom-specific functional changes over time. We employed a multivariate analysis based on a support vector machine (SVM) to predict patterns of resting-state functional connectivity in 64 adolescents with Tourette disorder and 61 sex- and age-matched healthy controls. Fifty-seven patients with Tourette disorder participated twice, with an interval of 15 months. Based on the results of the multivariate analysis, we implemented a general linear model to test within-group differences in resting-state functional connectivity over time, as well as their correlation with changes in severity of tics, depressive, obsessive-compulsive (OCD) and attention deficit and hyperactivity (ADHD) symptoms. The SVM significantly discriminated Tourette disorder from healthy controls with above-chance accuracy, specificity and sensitivity. The most discriminative connections were prefrontal, striatal and cerebellar networks. Between the visits, adolescents with Tourette disorder showed decreased functional connectivity between vermis 3 and the bilateral supplementary motor area and between vermis 4, 5 and the occipital cortex. The correlation analysis revealed that (i) an improvement between the visits in the severity of tics was associated with increased connectivity between the pre-supplementary motor cortex, anterior cingulate and inferior frontal gyrus; (ii) an improvement of ADHD was associated with decreased connectivity of the anterior cingulate cortex with the inferior temporal cortex; (iii) an improvement of OCD correlated with decreased cerebellar (lobule 8 and vermis 8, 9) connectivity with fronto-polar, superior temporal and superior frontal cortices, and increased cerebello-parietal connectivity, as well as fronto-parietal and fronto-frontal connectivity; and (iv) an improvement of depressive symptoms correlated with decreased connectivity of the cerebellum (lobules 4, 5 and vermis 6) with the precuneus. Our findings support pathophysiological models of Tourette disorder, in which aberrant patterns of functional connectivity are associated with specific comorbidities that may evolve differently throughout adolescence. Resting-state functional connectivity may provide unique endophenotypes, with developmental changes potentially linked to modifications in the severity of comorbid conditions. Distinct regions of the cerebellum and their connectivity with various frontal cortical regions emerge as candidate biomarkers to monitor, and possibly predict, the clinical trajectory of Tourette disorder symptoms, offering insights into disorder pathogenesis and likely guiding clinical decision-making.
9 Apr 2026
Read appraisal →JMIR formative research
Real-World Data From a Group Parent Management Training Program Enhanced Using Artificial Intelligence: Qualitative Study
BACKGROUND: Parent management training (PMT) is an evidence-based intervention for children with disruptive behavior problems. However, access to care is often limited by cost, availability of clinicians, scheduling, and transportation barriers. Integrating artificial intelligence (AI) into group PMT may improve accessibility, personalization, and adherence, while preserving therapeutic quality. OBJECTIVE: This study explored caregivers' experiences with a hybrid PMT program that combined live therapist-led group sessions with asynchronous support from Pat, an AI conversational agent designed to augment the therapists' support to caregivers. METHODS: A total of 88 caregivers of children aged 3-14 years (mean 7.98, SD 2.45 years) from Argentina and Paraguay participated in eight weekly online group sessions led by human therapists and supplemented by Pat. Caregivers were asked to provide the net promoter score (NPS) and their perceived contribution of their experience in remote group sessions and with Pat. Caregiver perspectives were analyzed using thematic analysis by multiple coders with consensus and interrater reliability assessment. RESULTS: The average NPS was 76.92, indicating excellent satisfaction. Regarding participants' perceptions of the overall program, the most frequent theme was useful strategies (73/202, 36.1%), reflecting the value placed on clear, structured, and practical tools to address everyday parenting challenges. Most comments about Pat were positive (156/164, 95.1%), particularly highlighting its 24/7 accessibility and constant availability (69/164, 42.1%). Recommendations for improvement mainly focused on enhancing the user experience and incorporating additional functionalities. Regarding perceived contribution to progress, caregivers attributed, on average, 61% to Pat and 46% to the group sessions. CONCLUSIONS: Combining therapist-led PMT group sessions with AI support appears feasible, acceptable, and valued by caregivers and may expand reach without sacrificing quality. Overall, caregivers valued the useful strategies and the professional and peer support and reported positive changes. Regarding Pat, the most valued aspect is the constant and immediate support. This model integrates human expertise with the accessibility and continuity provided by AI, reducing barriers, such as time, cost, and clinician availability.
8 Apr 2026
Read appraisal →Global public health
Link between housing and community factors and mental health and psychological well-being of refugee parents and children in high-income countries: A systematic review
Whilst forced migration is known to significantly increase the risk of mental health problems, the influence of post-migration factors for refugee children and parents in high-income countries remains understudied. However, systemic post-migration factors have the potential to be modified by policy and practice to improve outcomes. This systematic review identifies the housing and community factors examined in research and their link to the mental health and psychological well-being of refugee parents and children in high-income countries. Adhering to the PRISMA guidelines, we searched the databases of PubMed, PsycINFO and Embase for studies published in peer-reviewed journals until the 17th of October 2025. Of the 11,588 studies identified, 30 were eligible for inclusion in this review. Our findings particularly suggest favourable mental health outcomes among those living with their families/relatives or foster care as opposed to reception centres, as well as those with social support. Perceived discrimination consistently showed an association with negative mental health outcomes. The findings suggest a gap in the evidence base focusing on parents, education and school-related factors. We recommend that policy makers provide family-based living arrangements and improve access to spaces for social support. Future research in this field will benefit from further sub-group analyses.
8 Apr 2026
Read appraisal →Psychological medicine
The effect of managed transition on the proportion of young people transitioning from CAMHS to AMHS: Analysis of the Milestone Cluster Randomised Clinical Trial
BACKGROUND: Transition from Child and Adolescent Mental Health Services (CAMHS) to Adult Mental Health Services (AMHS) is poorly managed, with discontinuity of care commonplace, leading to poorer outcomes, while evidence-based interventions to improve transition are scarce. This study is a secondary analysis of the MILESTONE trial, aiming to determine whether managed transition increases the proportion of young people who appropriately transition from CAMHS to AMHS. METHODS: The MILESTONE trial was a multicenter, two-arm, cluster-randomized controlled trial across eight countries at 40 CAMHS sites to compare usual care (UC) to managed transition (MT). MT consisted of training, identification, and assessment of transition readiness and appropriateness. Eligible participants were receiving CAMHS care, IQ ⩾ 70 and within 1 year of their service transition boundary. CAMHS sites were randomized 2:1 between UC and MT. The main outcome was whether participants were receiving care from AMHS at 15 months follow up. RESULTS: The MILESTONE study included 793 participants, 552 receiving UC and 241 receiving MT. In the MT group, 24.9% transitioned to AMHS at 15 months compared to 14.2% in the UC group (p = 0.002), and appropriate transitions (in those with a need for transition at baseline or ongoing clinical need at 15 months) were 32.3% in the MT group compared to 16.4% in the UC group (p < 0.001). CONCLUSIONS: A higher proportion of the MT group transitioned to AMHS at 15 months, and there was a higher proportion of appropriate transitions compared to UC. Clinicians and services should consider the incorporation of MT into routine clinical care.
7 Apr 2026
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