Adolescent Psychiatry - Volume 13, Issue 1, 2023

Background: Sleep disorders in autism spectrum disorders (ASD/SD) are distinct, broad, and highly variable clinical entities that ubiquitously affect core symptomatology, development of comorbid disorders, and overall quality of life for affected children and families. High genetic predisposition and the presence of co-occurring disorders present significant challenges in assessment and appropriate interventions.

Objective: The study aimed to review the best available evidence and address the clinical gaps in the knowledge about sleep disorders in children and adolescents with autism spectrum disorders.

Methods: The review provides a comprehensive literature search of 1622 articles and summarizes 110 selected for empirical evidence to methodically consider critical aspects of sleep disorders in ASD for informing clinicians of useful information.

Results: Clinicians have insufficient guidance and support to effectively manage sleep disruptions in ASD youth in practice. Prevalence of sleep disruption in ASD, close to 80%, is characterized by unique subtypes, including but not limited to obstructive sleep apnea, circadian rhythm disorders, and sleep-related movement disorders. Greater awareness of sleep disruption, its neurodevelopmental basis, scope, and impact allows for improved treatment and prevention efforts of these conditions, and is critical for clinical practice and future research. The bidirectional nature of disruptive sleep and ASD is considered a major area requiring further clarification.

Conclusion: Clinician-friendly screening tools are needed for everyday office practice to identify ASD/SD conditions and interventions, and mitigate harmful effects. Psychoeducational and cognitive-behavioral approaches for improving and supporting healthy sleep hygiene, considered the first line of treatment, are detailed. The weak database for the use of psychopharmacologic agents is summarized, and the strength of prescribing prolonged-release melatonin for optimal results is described. The promise of other medications is discussed.

Background: In the current opioid epidemic, little is known about differences in treatment structure for youth with opioid use disorder (OUD) and youth with other substance use disorders.

Objective: This study analyzed baseline characteristics and outcome data comparing youth who suffer from OUD vs. those with other substance use disorders in an urban Denver, Colorado clinic.

Methods: A retrospective cohort review was conducted, analyzing clinical data between February 2017 and March 2021. Two groups were created and compared: those with OUD (n = 59) and those with other substance use disorders (n = 417). The primary outcome variable was achieving a negative urine drug screen within 16 weeks of baseline assessment. We hypothesized that there would be no difference between the groups in the primary outcome variable.

Results: Youth with OUD were slightly older and had more co-morbid stimulant use disorder. No difference between the groups was observed in achieving a negative urine drug screen within 16 weeks.

Conclusion: A multimodal, generalized treatment approach yielded similar outcomes for those suffering from OUD compared to those with other substance use disorders. There might not need to be significant variances in treatment approach depending on the specific substance use disorder.

Background and Objective: Patients aged 12 – 18 years presenting to Community Eating Disorders Services (CEDS) commonly describe problematic use of the internet (PUI). Time spent on the internet, internet experiences of social comparison, looking at food and sites offering weight and shape and fitness advice are all described during the onset of eating disorders and continue through treatment. We found that there is a lack of a clinical tool to assess PUI and its role in the development of eating disorders, and thus developed the Eating Disorder Online Activity Questionnaire (EDOAQ).

Methods: This qualitative study involved 10 adolescents accessing community treatment for eating disorders, who were invited to engage in a brief semi-structured interview inquiring about their completion of the EDOAQ and experiences of the internet. Five clinicians working with the patients were also invited to participate in a similar process. Interview data was thematically analysed.

Results: All participants described high use of the internet. Patient and clinician experience was generally positive regarding the clinical use of the EDOAQ, and modifications for the questionnaire were suggested. Participants also reported the necessity of online activity and the easy access to harmful content. Participants found the EDOAQ improved self-awareness of this and led to healthier online use.

Conclusions: Patients presenting with eating disorder need to be screened for PUI. Assessing clinicians found a questionnaire inquiring about the use of the internet useful in assessment and treatment for eating disorder. Most patients found completing a questionnaire less intrusive and easier than talking.

Introduction: Radicalization among adolescents is a rising phenomenon that has become a public health concern in Europe. According to some authors, violent radicalization by resorting to self-violence could be a form of suicidal behavior. However, evidence-based studies to support this assertion are lacking.

Objective: The aim of this study was to investigate the issue of suicidality among adolescents engaged in violent radicalization.

Methods: We compared a group of radicalized adolescents convicted of criminal association to commit terrorism (AMT) in France (N=15) with hospitalized adolescents who have attempted to end their lives (N=320). This comparative study is based on two samples from two studies that used the same instruments to assess psychiatric diagnoses, suicide risk, reasons for living, and coping.

Results: AMT adolescents were significantly less suicidal and less depressive/ hopeless than adolescents with suicide attempts (SAs). AMT adolescents showed fewer instances of depressive and borderline personality disorders but more manic and psychotic episodes than SA adolescents. They also had much more efficient coping strategies than SA adolescents, especially for the following strategies: seeking professional help, relational support and spiritual support. All the subscores of the reasons for the living scale were significantly higher for AMT adolescents than for SA individuals, apart from the subscore on peer acceptance and support.

Conclusion: Adolescents engaged in violent radicalization cannot be considered suicidal adolescents who have found an opportunity to end their lives through the process of radicalization. Understanding this phenomenon within a social, political and cultural context is necessary.