Editorial: Factualities – establishing empirical truths in child psychology and psychiatry

Empirical science is a fact-finding enterprise. This raises the question when we know enough about a particular topic to draw firm conclusions and can stop searching for additional evidence in order to save efforts for issues that are less well-established. Clarity on when scientific evidence has passed the stage of to-be-tested hypotheses is important, and setting up criteria for such stopping rules is a necessary as well as thought-provoking challenge. Not only over-investigating phenomena is undesirable but the opposite, falsely assuming beliefs to be facts, as well. Two common reasons for such misperceptions are that negative news is more likely to spread around than positive news (negativity instinct), and that individuals tend to look at problems from always the same perspective (single-perspective instinct). Our field is not immune to those instincts: child psychologists and psychiatrists tend to focus on messages suggesting that the burden of children´s mental health problems calls for more intervention and research, rather than on reports that the majority of children are doing quite well. This focus on problems may obscure the reality that the vast majority of children and adolescents never experience severe mental health problems, despite the challenges of growing up in a complex world.     

Editorial Perspective: Psychosis risk in adolescence – outcomes,comorbidity, and antipsychotics

Research on Clinical High-Risk for Psychosis (CHR-P) has led to a vigorous change in the field of early detection in psychiatry and is gradually expanding its focus toward early development. The Annual Research Review on psychosis risk in adolescents (Journal of Child Psychology and Psychiatry, 62, 2020 and 657) offers a wide-angle meta-analytical picture of such emerging trends in all areas relevant to CHR-P Research, that is, detection, prognosis, and intervention. This editorial perspective is meant to expand the clinical and conceptual reach of these meta-analytic findings in relation to (a) the influence of age on transition rate and scalability of the early detection model across the child–adolescent vs adult periods; (b) potential latent heterogeneity of the pathogenetic trajectories leading to CHR-P as suggested by comorbid psychopathologies; (c) controversial (or at least problematic) prognostic significance of antipsychotic exposure in CHR-P subjects, especially in children and adolescents.     

Editorial: 'Safety in numbers'? Big data discovery strategies in neuro-developmental science – contributions and caveats

In the last 10 years, we have seen a shift toward the use of big data hypothesis-free discovery strategies in studies of neuro-development and mental health. In this editorial, I discuss the reasons for their popularity, their potential contribution as well as some limitations and pitfalls. I conclude with a call for methodological pluralism where big data approaches are strategically integrated into cycles of hypothesis generation and testing.     

Editorial Perspective: Misaligned incentives in mental health research – the case for Registered Reports

Current incentive structures reward mental health researchers for producing positive, novel, and clean results. This can promote questionable research practices which contribute to a distorted evidence base, in turn limiting progress in mental health research. Registered Reports (RRs) offer a solution to realign the incentives towards conducting high-quality, rigorous, and accurate studies, by preventing publication and reporting biases. However, the uptake of RRs in mental health research has so far been limited. This editorial perspective highlights the advantages of RRs for mental health research, before discussing potential challenges and how they can be addressed. Greater uptake of RRs in mental health research could help to promote a fairer research culture, limit publication bias and questionable research practices, and ultimately, improve understanding of mental health.     

Editorial Perspective: Childhood maltreatment – the problematic unisex assumption

Childhood maltreatment (CM) is a heterogeneous group of childhood adversities that can range from different forms of abuse (physical, sexual, emotional) or neglect (physical, emotional, cognitive), to severe bullying by peers. With an annual estimated cost of $500 billion in the United States alone, CM is recognized as one of the most significant risk factors for a range of psychiatric and medical conditions (White and Kaffman, 2019). Further, rates of numerous psychiatric, neurological, and medical conditions differ significantly between males and females (Gillies and McArthur, 2010), inspiring decades of research on how sex moderates consequences of CM (Gershon et al., 2008). Although vulnerability to CM has been reported to vary by sex, very few findings have been consistent across studies. Moreover, most work to date has focused on how sex alters the frequencies of different psychopathologies in maltreated individuals, with little attention to whether different developmental processes may underlie these psychopathologies in males and females (White and Kaffman, 2019). The primary goal of this editorial was to advocate for more effective research strategies to address these questions. We first examine the rationale for studying sex as an important moderator of consequences of CM, briefly summarize some of the most consistent clinical findings, and discuss the implications of sex in treatment response. We then highlight important obstacles that contribute to the large number of inconsistent findings and make five recommendations on how to move forward.     

Congenital duodenal obstruction – Advances in diagnosis,surgical management,and associated controversies

Congenital duodenal obstruction (CDO) occurs due to intrinsic and extrinsic mechanisms but is most often caused by intrinsic duodenal atresia and stenosis. This review will summarize the history, epidemiology, and etiologies associated with the most common causes of CDO. The clinical presentation, complex diagnostic considerations, and current surgical repair options for duodenal atresia and stenosis will also be discussed. Finally, both historical and recent controversies which continue to affect the surgical decision-making in the management of these patients will be highlighted.     

Editorial: Let's talk about sex – the gender binary revisited

Sex refers to biological differences and gender to socioculturally delineated masculine and feminine roles. Sex or gender are included as a covariate or effect modifier in the majority of child psychology and psychiatry studies, and differences found between boys and girls have inspired many researchers to postulate underlying mechanisms. Empirical tests of whether including these proposed explanatory variables actually reduces the variance explained by gender are lagging behind somewhat. That is a pity, because a lot can be gained from a greater focus on the active agents of specific gender differences. As opposed to biological sex as such, some of the processes explaining why a specific outcome shows gender differences may be changeable and so possible prevention targets. Moreover, while the sex binary may be reasonable adequate as a classification variable, the gender binary is far from perfect. Gender is a multidimensional, partly context-dependent factor, and the dichotomy generally used in research does not do justice to the diversity existing within boys and girls.     

Editorial: Something special – the scientific challenges of rare risks

Globalization has sparked international collaboration in our field, and this trend is expected to continue in the years to come. This offers excellent opportunities to learn more about the influence of children’s sociocultural environments on their development and mental health. A particular challenge when studying risk factors across cultures and populations is that the risk associated with a particular exposure may depend on its prevalence: rarity tends to aggravate impact. This phenomenon complicates not only comparisons across cultures, but also those across subpopulations and time periods within a population. Moreover, it may counteract the effectiveness of risk-reducing public health efforts. On the bright side, the extent to which the impact of a risk factor is determined by its rarity provides researchers with valuable tools to deepen and sharpen theories about the nature and working mechanisms of that risk factor, with prevention and treatment strategies that also benefit youth in exceptional conditions as a likely consequence.     

Editorial: Polygenic scores in child and adolescent psychiatry – strengths,weaknesses, opportunities and threats

Polygenic scores estimate an individual’s genetic liability for a particular disorder or trait. They are based on current knowledge of the trait’s genetic architecture and focus on common genetic variants. In this editorial, I will discuss some of the strengths, weaknesses, opportunities and threats (SWOT) to polygenic scores within the context of child and adolescent psychiatry. I consider how the potential application of polygenic scores in health settings has some parallels with existing practices, but that polygenic scores also undoubtedly raise unique challenges. This SWOT analysis is accompanied by discussion of some new findings using polygenic scores in this issue of Journal of Child Psychology and Psychiatry.     

Editorial Perspective: Neurodiversity – a revolutionary concept for autism and psychiatry

Should we continue to refer to autism as a ‘disease’ or ‘disorder’, or is the framework of ‘neurodiversity’ a more humane and accurate lens through which to view people with autism? Evidence at the genetic, neural, behavioural and cognitive levels reveals people with autism show both differences, and signs of disability, but not disorder. Disability requires societal support, acceptance of difference and diversity, and societal “reasonable adjustment”, whilst disorder is usually taken to require cure or treatment. These are very different frameworks. It will be important to see how the concept of neurodiversity is applied to the 300 diagnoses in DSM-5, and if it revolutionizes both the science and the practice of psychiatry.     

Editorial: The role of digital technology in children and young people's mental health – a triple-edged sword?

The rapid expansion of access to, and engagement with, the Internet and digital technology over the past 15 or so years has transformed the social, educational and therapeutic space occupied by children and young people in contemporary society in remarkable ways. First, it has created previously unimaginable opportunities for learning and development and personal exploration and growth. Second, it seems that the very same qualities and characteristics of the Internet that make these positive contributions possible, such as its immediacy, portability, intimacy, unconstrained reach and lack of supervision and regulation of content, has opened children and young people up to a range of serious social, intellectual and mental health risks. Finally, over and above these 'effects', the digital space is increasingly successfully being harnessed for the identification and treatment of mental health problems. Accordingly, the Internet is not so much a double-, as a triple-edged sword, with regard to children’s mental health.