This response addresses a commentary on our original work that examined United States adolescent suicidal ideation and attempts by weight group and by perceived closeness to others at school. In this response, we clarify key aspects of our work, highlight areas of conceptual agreement with the commentary authors, and discuss future research directions for adolescent suicide prevention. This exchange emphasizes the complexity of adolescent suicide risk and highlights the importance of continued multidisciplinary discussion to advance clinical research and practice.

This commentary reviews Milligan and Kidwell's (2025) analysis of the relationship among adolescent weight status, perceived social closeness, and suicidality. The authors report higher odds of suicide consideration and attempts among adolescents with overweight and obesity compared with their healthy-weight peers, while perceived closeness to others serves as a protective factor. A limitation, however, is the absence of 95% confidence intervals (CIs) in the abstract, which limits quick appraisal of the findings' precision and clinical interpretability. Based on these findings, we argue for a shift from weight-centered narratives to weight-neutral, stigma-aware approaches that emphasize relational connection as a core target for prevention. We also outline opportunities to use digital peer-support infrastructures to enhance closeness, and we call for longitudinal, culturally responsive research to clarify causal pathways and heterogeneous effects. By centering connection and body acceptance, suicide prevention strategies for young people may become more precise and effective.

This repeat measures study assessed the progress of 45 children in a therapeutic residential school in terms of attachment, trauma/loss, affect regulation and educational attainment. The aim was to build a profile of complex trauma in severely maltreated children and estimate any changes over a two year period. Attachment, trauma and affect regulation were assessed using the Child Attachment and Play Assessment (CAPA), based on Crittenden's Dynamic Maturational Model of attachment (DMM). Based on a matrix combining attachment risk, unresolved loss or trauma and observed high or low states of physiological arousal, 51% of children improved and 33% showed deterioration. There was a general improvement in education scores but no significant gains made by children whose stories were assessed with unresolved trauma. While insecure attachment can act as a buffer against severe maltreatment, unresolved trauma or loss is pernicious and continues to affect children's development. Specific Adverse Childhood Experiences (ACEs), rather than ACE accumulation, influenced improvement compared with deterioration. In particular perinatal neglect may have had a particularly potent impact on change. DMM Type A+ attachment was more susceptible to loss of regulation than Type C+ and the two attachment patterns require different approaches. The CAPA offers a more finely calibrated analysis than that obtained by the more usual questionnaire assessment of complex trauma and is useful in devising treatment plans for individual children.

BackgroundThe Child Safety Behaviour Scale (CSBS) has been used in children and adolescents who have experienced a traumatic event and measures post-traumatic safety-seeking behaviours.ObjectiveThis study aimed to examine the rates of PTSD in children and adolescents exposed to a Turkish earthquake and to adapt the CSBS to Turkish culture and test its validity and reliability.MethodThe research sample consisted of 265 children and adolescents who experienced the 6 February 2023 earthquakes that took place in Hatay, Türkiye. Exploratory structural equation modelling (ESEM) and confirmatory factor analysis (CFA) were used to determine the construct validity of the adapted CSBS scale. In addition, direct and indirect relationships between safety-seeking behaviours and posttraumatic stress symptoms were evaluated by network analysis.ResultsWe found that more than half of the children and adolescents had moderate-high severity PTSD symptoms. The model created with CFA fits the data structure better and has high reliability values compared to ESEM, and it was concluded that the use of the scale in Turkish culture is valid and reliable. CFA and ESEM confirmed the two-factor model comprising "strategic hypervigilance" and "affective suppression" as key safety-seeking behaviours involved in PTSD. In addition, network analysis revealed that hyperarousal was the most important symptom linking PTSD symptoms and safety-seeking behaviours and was directly related to affective suppression.ConclusionsEven two years after the earthquake, the prevalence of moderate and high PTSD symptoms among children and adolescents was observed. The use of the CSBS for the assessment of safety-seeking behaviours emerging after trauma was found to be valid and reliable in Turkish culture. It was seen that hyperarousal was the central symptom among PTSD symptoms and was directly related to emotional suppression among safety-seeking behaviours.

Adolescence represents a crucial period of development, during which exposure to stress can significantly impact mental and physical health. As such, school based psychoeducational interventions aimed at reducing stress may hold promise for promoting adolescents' wellbeing. In the current study, a literature review was conducted using PubMed and PsychInfo databases to evaluate school-based psychoeducational interventions that target sub-clinical anxiety and stress in healthy adolescents. Eleven studies met the inclusion criteria, comprising six primary and five secondary studies. Cognitive-behavioural therapy demonstrated significant reductions in anxiety symptoms and improvements in emotional regulation. Mindfulness-based interventionsalleviated physiological stress, while physical activity programs such as yoga, showed potential in improving psychological well-being, albeit with limited evidence. . Findings on the duration of interventions were mixed, with some meta-analyses indicating larger effects for longer or higher intensity programs, while limited evidence suggests caregiver involvement may enhance outcomes. Future research should focus on evaluating the long-term effectiveness of these interventions and examining their applicability across diverse cultural and socioeconomic contexts. Although harms were not identified within the studies included in this review, other research has reported potential unintended effects of school-based psychological interventions in specific subgroups and therefore cautious implementation with routine monitoring is recommended.

IntroductionMental health in children is significantly influenced by socio-economic status, poverty, and income inequality. However, existing child psychiatric research focuses on clinical variables and developed nations. Hence, this study explored the impact of these factors on the psychosocial functioning of children visiting a mental health clinic in India.MethodsA cross-sectional research design was employed, with data collected from children and their parents/caregivers using the Children's Global Assessment Scale (CGAS) and Indian Disability Evaluation and Assessment Scale (IDEAS). Participants included 120 children recruited from an out-patient clinic in a tertiary mental healthcare center. Non-parametric tests were employed to examine the influence of socio-economic status and poverty on functioning among the participants.ResultsOur study observed significant differences in functioning scores related to socio-economic status, monthly family income, and sources of income, with family income source significantly affecting disability scores. A significant proportion of the participants scored below the functioning benchmark and above the disability benchmark.ConclusionSocio-economic disparities and income inequality significantly influence mental health outcomes. The findings emphasize the role of social determinants of mental health and underscore the importance of integrating mental health services with socio-economic support systems.

The increasing prevalence of digital media use among children and adolescents has raised concerns about its potential impact on attention deficit hyperactivity disorder (ADHD) symptoms. This narrative review explores the relationship between screen time and ADHD in young people, with a particular focus on the impact of different treatment approaches in the context of digital engagement. A structured search identified 147 studies published between January 2018 and December 2024, of which 14 met the inclusion criteria for detailed review.The findings indicate that excessive and unstructured screen time is consistently associated with the worsening of ADHD symptoms, particularly inattention and hyperactivity. Sleep disruption and neurobiological vulnerabilities, including altered reward processing and white matter changes, appear to mediate these associations. At the same time, certain forms of digital activity, particularly interactive or cognitively engaging tasks, may provide benefits, highlighting the complexity of this relationship.Treatment approaches reflected a similar complexity. Pharmacological interventions remain central but are most effective when complemented by behavioural therapies and lifestyle modifications, such as structured screen time reduction, improved sleep routines, and increased physical activity. This review suggests that the management of ADHD in the digital era requires a holistic approach that recognises both the risks and potential benefits of screen use. Further longitudinal research is needed to clarify long-term effects and identify which forms of digital media can be harnessed constructively in clinical care.

ObjectiveProblematic school absence (PSA) can severely impact children's mental health. Research on the prevalence of PSA in child and adolescent psychiatry is still limited. This study explores the prevalence and severity of PSA in Dutch and German young people with mental health problems.MethodsThis study included 354 patients aged 6-20 years ( = 13.0; = 3.5) from three psychiatric clinics in the Netherlands and Germany (151 Dutch and 203 German children), recruited between March and June 2019. Parents completed the Strengths and Difficulties Questionnaire and the School-Non-Attendance-ChecKlist. The study analysed PSA and associated factors.ResultsSchool absence occurred in 66.9% of the sample. Any PSA was significantly associated with inpatient treatment, conduct problems and comorbidity, while attention-deficit/hyperactivity disorder, and other behavioural disorders were negatively associated. Severe PSA (missing 8 or more of 20 school days) was associated with higher age, inpatient treatment, and phobic anxiety disorders.ConclusionThis study showed a high prevalence of PSA among children with mental health problems in an international sample. Given its impact on children's development and future prospects, addressing PSA should be a priority for mental health professionals working with young people with mental health problems.

IntroductionMentalization is one's ability to understand and predict one's own mental states and those of others. It is an important developmental capacity that fosters emotional and social functioning. Mentalization research in Iran has recently received attention; hence, findings on the development of mentalization in Iranian children are limited. Since mentalization is dependent on context and culture and develops in attachment relationships, identifying these themes in Iranian children was necessary. This study aimed to investigate the attachment-based mentalization themes in middle-aged Iranian children.MethodsSemi-structured interviews were conducted with 153 Iranian children aged 8-11 years. Interviews were used to assess children's attachment-based mentalization themes.ResultsThematic analysis revealed eight themes that described mentalization and non-mentalization in the examined children. Reported features in each theme lie on a continuum that describes high or low mentalization in children, as identified in the features and states associated with each theme.ConclusionThis study plays a crucial role in expanding our knowledge of how mentalization develops within attachment relationships.

BackgroundVoice-hearing is increasingly being recognised as a transdiagnostic experience which is common for children and adolescents. However, little is known about how young people seek help and disclose voice-hearing within mental health services.MethodThis qualitative study explored the disclosure and help-seeking experiences of nine young people (aged 14-18) receiving care from mental health services in the UK. Semi-structured interviews were conducted and analysed using thematic analysis within a critical realist framework.ResultsTwo superordinate themes were identified: barriers to accessing help; facilitators to accessing help; and the impact of practitioner response on young people's engagement. Stigma, long waiting lists for services, and practitioners' lack of knowledge often acted as barriers to disclosure and help-seeking, whereas trust and clear communication facilitated disclosure and engagement. Participants often wished to be listened to, to be offered a more personalised approach and greater flexibility from mental health services. When practitioners demonstrated empathy and allowed trust to build in the therapeutic relationship, participants felt valued.ConclusionsFindings suggest that practitioners might need to be supported to build confidence in discussing voice-hearing with young people to facilitate therapeutic conversations about these experiences, and that offering flexible, person-centred support may support young people's engagement with mental health services.

BackgroundChild psychiatric and neurodevelopmental disorders (NDDs) significantly affect children's physical and psychological well-being, while also placing substantial emotional and financial strain on families. Most existing research on the prevalence of childhood NDDs comes from urban populations, leaving rural communities underrepresented and poorly understood.MethodsThis retrospective study examined medical records of children diagnosed with psychiatric and neurodevelopmental disorders from rural areas of Assam, North-East India. Diagnoses were established according to the . Descriptive statistics were applied to summarise socio-demographic variables and diagnostic distributions.ResultsOver a 20-month study period, 300 children from rural Assam sought treatment at our hospital, of whom 214 provided consent for inclusion. Among these participants, 36% were diagnosed with a neurodevelopmental disorder, while 82% presented with a psychiatric condition.ConclusionNeurodevelopmental disorders impose a considerable burden on families. In rural areas, lack of awareness and stigma frequently delay treatment, exacerbate comorbidities such as epilepsy, and worsen long-term outcomes. These findings highlight the urgent need for community-based epidemiological studies in rural settings to better estimate the true burden of NDDs and to inform policy development and advocacy initiatives.

Primary care professionals are often the first line of support for children and adolescents with tic disorders. However, families often report feeling inadequately supported and perceive a lack of knowledge about tics. Few studies have examined primary care professionals' perspectives on managing tic disorders. This study explored how these professionals understood and managed tic disorders in a Danish region. Twelve professionals, including general practitioners and educational psychologists, participated in semi-structured interviews. Data were analysed using reflexive thematic analysis, resulting in three main themes. The first theme, , described how professionals addressed encounters with families affected by tics. The second theme, , captured reflections on managing a heterogeneous group of disorders, such as tic disorders. The third theme, Future Perspectives: , reflected professionals' understanding of the diverse group affected by tics and their evaluation of a newly developed app-based intervention. These findings offer insights into primary care perspectives on tic disorders and clarify reasons for differences in their management. This knowledge is essential when planning interventions for tic disorders, whether through digital platforms or other approaches.

Jonathan Haidt's (2024) examines the sharp rise in anxiety, depression and social difficulties among children, linking these trends to the rapid spread of smartphones and the decline of independent, play-based childhood. Drawing on developmental psychology, neuroscience, and cross-cultural research, the book argues that children's wellbeing depends on autonomy and in-person social interaction increasingly replaced by digital immersion. The book presents four foundational harms of social deprivation, sleep disruption, attention fragmentation and addiction situate youth mental-health challenges within wider socio-cultural and technological shifts. Even though The Anxious Generation provides a compelling, interdisciplinary explanation, it has certain limitations, which are critically analysed in the review section.

BackgroundMental health stigma remains a significant barrier to treatment and recovery, particularly among adolescents. This study explores perceived stigma in previously hospitalized adolescents, their perceptions of inpatient psychiatric care, and parental self-stigma.MethodsWe employed a cross-sectional, mixed-methods design with 82 adolescents (n = 67 females), aged 12-17 years (M = 15.5, SD = 1.2) and their parents. Quantitative measures included the Adolescent's Stigma Scale, Parents' Self-Stigma Scale, and Strengths and Difficulties Questionnaire. Qualitative data were collected via open-ended questions and analyzed using content analysis.ResultsFindings indicated notable perceived stigma, especially among older adolescents (15-17 years) and those two hospitalizations, with secrecy, self-stigma, and rejection associated with emotional and behavioural difficulties. Parental self-stigma correlated with child's age and length of hospitalization, and inversely with adolescent secrecy. Qualitative findings revealed that hospitalization offered emotional support and opportunities for personal growth, yet also posed challenges to autonomy, social and educational stability, and psychological well-being.ConclusionsFindings highlight the need for flexible hospital policies, improved discharge communication, mental health literacy initiatives, and peer-support programs. Future research should examine cultural influences, stigma trajectories, and effective family-based interventions for adolescents.

BackgroundExposure to traumatic events can have posttraumatic effects in young children. It is challenging to identify posttraumatic symptoms. It is necessary to directly investigate the signs of traumatization in young children. The aim of the study was to investigate the links between children's externalizing and internalizing symptoms reported by caregivers and indicators of traumatization assessed by using the young children as informants.MethodStudy used data from 110 (59.1% girls) children aged 4 to 9 years. The children have been recruited across the social and mental health services that provide support for abused children in Lithuania. Externalizing and internalizing difficulties measured using caregiver reports with the Strengths and Difficulties Questionnaire (SDQ). Indicators of traumatization were measured with the Odense Child Trauma Screening (OCTS).ResultsThe higher levels of indicators of traumatization were significantly related to higher conduct and externalizing problems. The traumatization indicators related to child mental representation of adults were a significant predictor of children's conduct problems.ConclusionsThe indicators of traumatization could be linked to externalized mental health difficulties of a child after trauma. Also, the findings might indicate that for the parents and caregivers it might be challenging to recognize internalizing symptoms, associated to traumatization.

ObjectivesTo address the gap in accessibility of mental health services for Mandarin-speaking families in Canada, this study evaluated the uptake, acceptability, and preliminary effectiveness of , a culturally-inclusive and attachment-focused parenting program designed to promote youth and family wellbeing.MethodsParticipants were 17 birth and 1 kinship immigrant parents from China to Canada (age 39-69, = 49.42, = 7.25; 14 mothers; 4 fathers) seeking support for concerns about their children's mental health problems (age 12-18, = 14.44, = 1.80; 27.8% male, 72.2% female). Parents completed self-report pre- and post-measures assessing their child's mental health and evaluated the perceived fit and helpfulness of the program in this single-arm pilot study.ResultsPreliminary evidence was found for the program's effectiveness in reducing adolescent emotional and behavioural problems and improving family satisfaction. Importantly, parent attendance and retention were high (85%), and parents reported the program was very helpful and a good fit with their cultural values.ConclusionsThis pilot study is among the first to evaluate a culturally-inclusive, attachment-based parenting intervention for Chinese immigrant families in Canada, delivered in their native language. Future research with larger samples and further adaptations to address immigrant-specific family challenges is warranted.

This paper explores how an adoptive family's feelings of blame and embarrassment shifted after receiving an accurate diagnosis for their 9-year-old child. Narratives of attachment and trauma had been used previously to explain the child's rumination and regurgitation symptoms and excessive appetite from an early age. The paper outlines the assessment that ruled the previous explanation out and gave a diagnosis of Tourette syndrome, a neurodevelopmental disorder with an evidence-based pathway of care. It also examines the theory behind this revised formulation, integrating both environmental influences, biological predispositions and their interaction. The discussion explores the negative implications of neglecting biological factors in the mental health assessments of adopted children and interpreting their presentations through the lens of past trauma and attachment disruptions only, as lack of early identification and therefore, intervention can lead to serious long-term consequences. Conducting complex assessments require multidisciplinary specialist services with professionals trained in making differential diagnoses in adopted children, that include the consideration of neurodevelopmental and mental health problems. Such services should also offer consultation and provide training to other professionals working within the children's complex systems.

This study investigated adolescents' involvement in juvenile delinquency in relation to their perceived social support and levels of social interest. Data were collected through face-to-face surveys with 402 adolescents aged 15-17 years in Adana, Türkiye. Among the participants, 118 were classified as having a history of juvenile delinquency, while 284 had no such history. The study utilized two instruments: the Social Relationship Elements Scale, which measures perceived support from family and friends, and the Social Interest Scale, which includes the subdimensions of sense of belonging, coping, helping behavior, and empathic sensitivity. Independent samples t-tests showed that: (1) adolescents involved in delinquency reported significantly lower levels of perceived family and friend support, and (2) non-delinquent adolescents scored higher on empathic sensitivity and helping behavior. Binary logistic regression analyses revealed that (1) higher levels of empathic sensitivity, helping behavior, and family/friend support significantly reduced the likelihood of involvement in delinquency, and (2) paradoxically, a stronger sense of belonging was associated with a higher likelihood of involvement in delinquency. These findings underscore the critical role of social support and social interest in shaping adolescent behavior. In particular, interventions that strengthen familial and friend relationships and promote prosocial tendencies may help prevent juvenile delinquency.

BackgroundParents can be slow to recognise that an adolescent needs help from a mental health professional, yet the factors affecting their help-seeking intentions are not well understood. The aim of this study was to test the application of the Common-Sense Model (CSM) of Illness Representations to parents' perception of adolescent distress and intentions to seek help.MethodThe study employed an experimental design using video vignettes. Parents ( = 1,176; female = 993) of adolescents (10-19 years) were asked to self-report key demographic information, an illness perceptions questionnaire, and a measure of stigma.ResultsResults demonstrated that the CSM model explained 38% of the variance in help-seeking intentions. Parents were more likely to report intentions to seek help if they believed that treatment could control the adolescent's problem (OR = 1.39), or if they believed the problem would have negative consequences (OR = 1.41). Parents who believed the problem was in the control of the adolescent, had lower help-seeking intentions (OR = .87).ConclusionThe CSM provides a useful model of help-seeking intentions to guide parental education. Perceiving treatment as controlling distress or that distress would have negative consequences for an adolescent, were key predictors of parental help-seeking intentions.

BackgroundParents play a pivotal role in recognising and managing mental health issues in children. However, stigma and stereotypes associated with mental health care may influence their intention to seek professional help. This study explored help-seeking intentions and help-seeker stereotypes among Omani parents of children with and without diagnosed mental illness.MethodA cross-sectional quantitative study was conducted among 636 Omani parents (328 with mentally ill child and 308 without). Participants were recruited from health centres, a specialised mental hospital, and a tertiary care public hospital in Muscat, Oman. Data were collected using validated versions of the Mental Health Help-Seeking Intention Scale and the Help-Seeker Stereotype Scale. Statistical analyses included Chi-squared and Maan-Whitney U tests.ResultsMean help-seeking intention scores were comparable between parents of children with (15.43 ± 4.20) and without mental illness (15.41 ± 4.05; = 0.993). In contrast, parents of children with mental illness reported significantly higher overall stereotype scores (34.7 ± 13.99 vs 31.0 ± 15.62; < 0.001). The strongest negative perceptions related to being "not in control" (mean difference [MD] = 0.84; < 0.001), "untrustworthy" (MD = 0.69; < 0.001), and "dependent" (MD = 0.26; = 0.002). Other traits such as "needy", "oversensitive", and "cowardly" also showed significant group differences.ConclusionThe findings reveal that while help-seeking intentions were similar across parent groups, those caring for a child with mental illness held stronger negative stereotypes about help-seekers. These attitudes likely reflect internalised stigma shaped by caregiving experience and societal norms. Addressing such beliefs through culturally sensitive education and caregiver-focused interventions is essential to improving mental health engagement in Oman.