Editorial: Something new – what's next for child and adolescent psychiatry?

The start of a new decade is often the moment when people pause to reflect on what they have accomplished in the past 10–20 years and where they would like to be at the start of the next decade. Although not designed as such, the 2020 Annual Review issue engages in exactly this sort of a backwards and forwards look at the field of child and adolescent psychiatry and psychology. In doing so, it covers topics that are at the core of the field and have preoccupied researchers and clinicians for decades. It also covers research endeavors that have only more recently captured the attention of the field and that build bridges to disciplines that have not historically been involved in the study of neurodevelopment. In every case, the authors who have contributed to the 2020 Annual Research Review highlight exciting new directions for research and make novel recommendations for how to advance the state of our science.     

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: The times they are a-changin’: paradigm shifts in child and adolescent psychology and psychiatry

The world is a different place than it was more than 2 years ago, at the start of the COVID-19 pandemic. The times are always changing, but events of the recent past have radically shifted how we work, when and how we interact with each other, and how we understand our history. The papers in the current issue echo this spirit of change, challenging us to fundamentally re-think how we conceptualize psychopathology, where we define boundaries between ‘normal’ and ‘abnormal’ (and, who gets to define those boundaries), and whether our current conceptual models are generalizable to ever more diverse groups. These challenges represent healthy and timely critiques of dominant paradigms. Collectively, the authors who contributed to the current Annual Research Review make the case that these new frameworks will have big pay-offs in terms of improving clinical practice and policy.     

Editorial: The psychopathology p factor: will it revolutionise the science and practice of child and adolescent psychiatry?

The psychopathology p factor has emerged from a series of strong empirical studies, largely in the adult psychiatry literature. Here, some of the recent findings relating to the p factor in children and adolescents are considered and the implications for child and adolescent psychiatry are discussed. Is it essential to covary for ‘p’ when we study specific domains of psychopathology? Do neurodevelopmental conditions make up part of the psychopathology p factor? How do we treat the ‘p factor’ in clinics? This editorial considers some of the contributions from this issue of Journal of Child Psychology and Psychiatry together with the wider literature that speak to these issues.     

Editorial: ‘It's a family affair’ – the social drivers of child and adolescent resilience

Studies of risk and vulnerability processes may provide important ways of identifying new treatment targets – based on the principle that mending something is much easier if you know in what way it is broken. However, in our field, knowing its source may not always tell us about how to remediate impairment. Studies focusing on resilience may be more informative from this perspective. In this editorial I discuss four papers that highlight the value of resilience studies from a translational perspective – in particular contrasting the strengths and limitations of observational and experimental designs.     

Commentary to “Translational machine learning for child and adolescent psychiatry”

In this commentary on ‘Translational Machine Learning for Child and Adolescent Psychiatry,’ by Dwyer and Koutsouleris, we summarize some of the main points made by the authors, which highlight the importance of emerging applications of machine learning for psychiatric disorders in youth but also emphasize principles of good practice. We also offer complementary insights regarding large-scale training, harmonization, and the ability of these artificial intelligence models to adapt to new datasets, which is critical for their stability across imaging centers, and hence for their widespread clinical adoption.     

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: Placing research in context – what participant and study characteristics should be routinely reported in studies of child and adolescent mental health?

This editorial argues that research findings in child and adolescent psychopathology need to be contextualized with demographic information and location in order to help with interpretation of findings and implications for the services that are available and/or potentially effective. For developmental psychopathology and child and adolescent mental health treatment, the demographic information should include key factors known to influence etiology, treatment effectiveness and service availability. These factors include, but may not be limited to, sex and age, location including country (and city or urban area), socioeconomic class, culture and minoritized status. Including such information, in addition to helping us understand why findings might not generalize, can draw attention to the exclusion of certain groups from research and so drive attempts to increase the representativeness of research in child and adolescent mental health.     

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.     

Finding genes in child psychology and psychiatry: When are we going to be there?

BACKGROUND: The seven papers in this special section chart where we are in the quest for quantitative trait loci (QTLs) in key areas of child psychology and psychiatry such as reading and hyperactivity. But we are not there yet. METHODS: This commentary considers some new developments that are likely to accelerate the journey towards the identification of QTLs. RESULTS: The single most important factor is the need for very large samples to attain adequate power to detect and replicate QTLs of very small effect size. Another important development is the microarray, which makes it possible to genotype hundreds of thousands of SNPs simultaneously. Using microarrays in association studies allows SNPs across the whole genome to be genotyped. Microarrays will boost power even more when they contain all functional polymorphisms in the genome, including functional non-coding DNA. CONCLUSIONS: Once replicable QTLs are identified in areas such as reading and hyperactivity, the real journey will begin. Future studies will use sets of QTLs as genetic risk indicators in top-down behavioural genomic research, leading to gene-based diagnoses, gene-based treatments tailored to the individual, and early warning systems and interventions. These discoveries will eventually help to prevent or at least ameliorate childhood disorders before they cast their long shadow over development.     

The conundrums of human development – implications for the study of child and adolescent disorder

The conundrums inherent in the study of child and adolescent development are likely never far from the minds of the readers of JCPP. The complexity of development is flagged clearly in this issue. Included papers remind us that the link between associations (here maternal depression and child internalising problems) can change over short time periods. Even when the magnitude of associations stay consistent over time (here between the home environment and depression), there may be different aetiological processes underlying these links. Going forward, we should not lose sight of the significance of small changes in study designs, whether concerning the age range of participants, stipulated reporting periods and data analysis decisions (such as combining data from different age groups). The value of longitudinal data in addressing these questions remains paramount.     

Commentary: Ecology momentary assessment as a tool for understanding dynamic patterns in child and adolescent health and development – reflections on Russell and Gajos (2020)

Ecological momentary assessment (EMA) has served as a methodological tool across subdisciplines in psychology, shedding light on family, personality, and affective processes, and physical and mental health. In their review, Russell and Gajos demonstrate how EMA can overcome several limitations of traditional methods in developmental psychopathology to answer questions about mental and behavioral health in youth. They also provide thoughtful future directions on integrating sensor technology, advancing modeling techniques for temporally dense data, and employing EMA for delivering interventions. This commentary similarly advocates for the use of EMA but extends Russell and Gajos’s review by emphasizing EMA’s utility for understanding and revealing dynamic changes and processes along micro timescales that have relevance for youth’s health and development. We discuss how EMA can be especially fruitful for advancing theory and practice when administered in bursts and when combined with traditional assessments and longer-term longitudinal designs. Because such studies are resource-intensive, we also consider how extant EMA studies can be leveraged and subjected to meta- and mega-analytic techniques to inform theories and future EMA designs. We conclude that EMA is a promising tool for elucidating dynamic fluctuations in experiences and intra- and interpersonal processes that contribute to child and adolescent development and risk.     

‘Paediatric surgical research in the UK – Challenges and opportunities’

Academic pediatric surgery faces challenges and opportunity. The author provides a brief overview of the landscape of academic surgery from a UK perspective and based on his considerable experience, makes suggestions for present and future directions.     

Apgar scores reported in personal child health records: Validity for epidemiological studies?

Aim: In epidemiological studies on children, information in the neonatal period that might affect children's long‐term health could be extracted from the personal child health record (PCHR), because the booklet exists in most countries. We aimed to assess, in individual children, the validity of Apgar scores reported in the PCHR using maternity medical records as the gold standard. Methods: In two French hospitals, 435 women who had a child in January 2006 were recruited and 90% filled in a postal questionnaire 6 weeks after delivery, copying neonatal information (including Apgar scores) from the PCHR. This information was compared with data independently recorded at birth by physicians in maternity medical records. Results: We found that the proportion of missing Apgar scores in the PCHR was higher when scores in the medical records were lower. Moreover, Apgar scores reported in the PCHR were overestimated when scores in the medical records were low. Using medical records as the gold standard, specificity for PCHR‐reported 1‐min Apgar score was 100% and sensitivity 33%. Similar trends were found for the 5‐min score. This supports the hypothesis that information considered as ‘socially sensitive’ by physicians may be intentionally altered in PCHRs. Conclusions: Apgar scores reported in PCHRs may not yield reliable information for epidemiological studies. When the PCHR is the only source of information for the neonatal period in an epidemiological study, it would be preferable to use a composite neonatal indicator rather than the Apgar score.     

Commentary: Challenges and opportunities in autism assessment – a commentary on Kanne and Bishop (2020)

Kanne and Bishop’s (2020) Editorial Perspective ‘The Autism waitlist crisis and remembering what families need’ offers a strong argument to provide greater access to high-quality assessments for Autism Spectrum Disorder (ASD). They note, correctly, that due to increasing numbers of referrals practitioners are under increasing pressure to provide quicker or abbreviated evaluations, that some cases are extremely complex and require considerable expertise to assess, and that a good assessment is a good investment in effective intervention. I agree with these points but also want to highlight some difficulties and dilemmas associated with the assessment of ASD; and to argue that improving access to assessments and interventions through the use of nonspecialists and new technologies may be a promising direction.