Journal of child and adolescent psychopharmacology最新文献

{"title":"Psychopathological Severity Across the Cognitive Continuum: A Comparative Study of Adolescents with Average Intelligence, Borderline Intellectual Functioning, and Intellectual Disability.","authors":"Roberto Averna, Gianluca Sesso, Massimo Apicella, Milena Labonia, Azzurra Rausa, Elena De Rosa, Maria Pontillo, Stefano Vicari","doi":"10.1177/10445463261471388","DOIUrl":"10.1177/10445463261471388","url":null,"abstract":"<p><strong>Objective: </strong>Borderline intellectual functioning (BIF), defined by intelligence quotient (IQ) scores between 71 and 84, is associated with increased psychiatric vulnerability but remains poorly characterized in terms of clinical severity and treatment complexity. This study aimed to compare psychopathological burden, adaptive functioning, suicidality, and psychopharmacological treatment patterns among hospitalized adolescents with BIF, average intellectual functioning, and intellectual disability.</p><p><strong>Methods: </strong>A retrospective chart review was conducted on adolescents aged 12-18 years admitted to a tertiary child and adolescent neuropsychiatry inpatient unit. Participants were classified into three groups based on full-scale IQ. Standardized assessments of cognitive functioning, psychiatric diagnoses, symptom severity, adaptive behavior, global functioning, and suicidality were integrated with clinical indicators derived from medical records, including emergency service utilization and psychotropic medication at discharge. Group differences were examined using nonparametric statistical analyses.</p><p><strong>Results: </strong>The sample included 194 adolescents. Adolescents with BIF showed significantly poorer adaptive functioning across conceptual and practical domains compared with peers with average intellectual functioning, despite comparable global functioning. Overall psychiatric symptom severity at admission and discharge did not differ across groups; however, the BIF group displayed a mixed clinical profile with both internalizing and externalizing symptoms and persistent behavioral dysregulation. Compared with adolescents with average intellectual functioning, those with BIF demonstrated more frequent emergency psychiatric admissions and a higher likelihood of antipsychotic prescription at discharge. Suicidality differed qualitatively across cognitive groups: adolescents with cognitive impairment showed lower rates of suicide attempts, characterized by precipitation (i.e., falling from height) or defenestration (i.e., jumping from a window) as the only suicidal modality observed in this group.</p><p><strong>Conclusions: </strong>BIF in adolescence is associated with a distinct pattern of functional impairment and clinical complexity, characterized by adaptive difficulties and increased reliance on psychopharmacological treatment. These findings highlight the importance of considering cognitive functioning when planning treatment strategies in inpatient child and adolescent psychiatry.</p>","PeriodicalId":15277,"journal":{"name":"Journal of child and adolescent psychopharmacology","volume":" ","pages":"642-648"},"PeriodicalIF":1.8,"publicationDate":"2026-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148561976","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Utility of ADHD Medications in Children and Adolescents with Trauma-Related Presentations: A Systematic Scoping Review.","authors":"Athif Ilyas, Geetika Kumar, Mark Addison","doi":"10.1177/10445463261470300","DOIUrl":"10.1177/10445463261470300","url":null,"abstract":"<p><strong>Background: </strong>Post-traumatic stress disorder and trauma-related presentations in children and adolescents frequently co-occur with attention deficit hyperactivity disorder (ADHD), compounding functional impairment. Because evidence-based pediatric treatment options for trauma-related presentations remain limited and symptoms can overlap with ADHD, optimizing the choice of ADHD medications is of clinical importance.</p><p><strong>Objective: </strong>This review aimed to map and synthesize the available evidence for the utility of different ADHD medications in children and adolescents with trauma-related presentations.</p><p><strong>Methods: </strong>A systematic scoping review was undertaken following the Joanna Briggs Institute methodology and reported in line with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews checklist. Medline, Embase, PsycINFO, and gray literature sources were searched for studies published between January 1985 and November 2025. Findings were synthesized narratively and organized by medication class.</p><p><strong>Results: </strong>From 3,626 identified records, 19 were included in the final analysis (15 primary studies and 4 systematic reviews). These consisted of case reports (<i>N</i> = 8), open-label trials (<i>N</i> = 4), retrospective chart reviews (<i>N</i> = 2), and one large-scale electronic health record study. Alpha-2 agonists (guanfacine and clonidine) were associated with the most consistently reported improvements for trauma-related symptoms. Although stimulants and atomoxetine did not show consistent improvement in trauma-related symptoms across available studies, real-world data revealed that stimulant use was associated with reduced hospitalization, emergency department visits, and secondary antipsychotic or mood stabilizer prescribing in comorbid youth. No studies evaluating viloxazine were identified.</p><p><strong>Conclusions: </strong>Stimulants have been shown to benefit wider long-term psychiatric outcomes, although smaller studies demonstrated a more consistent improvement in specific trauma-related symptoms with alpha-2 agonists. Rather than following a rigid medication sequence, clinicians should adopt a trauma-informed approach that prioritizes or combines treatments based on whether ADHD or trauma is the primary driver of functional impairment. However, because the current evidence is predominantly low quality and lacks controlled trials, these findings must be interpreted with caution.</p>","PeriodicalId":15277,"journal":{"name":"Journal of child and adolescent psychopharmacology","volume":" ","pages":"597-606"},"PeriodicalIF":1.8,"publicationDate":"2026-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148578713","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Clozapine for Severe Treatment-Resistant Disruptive Behaviors in Youth with Autism Spectrum Disorder: A Prospective Real-World Interventional Study.","authors":"André Luiz Schuh Teixeira da Rosa, Gabriela Bezerra Sorato, Felipe Manjabosco, Lucas Dellazari, Érica Bonganhi de Bem, Arthur Bezerra Falcão, Lucas de Oliveira Cia, Ana Júlia Limberger Nedel, Marina Ribeiro Barreto da Costa, Olivia Sorato Bezerra, Rogério Boff Borges, Luis Augusto Rohde, Ana Soledade Graeff-Martins","doi":"10.1177/10445463261467155","DOIUrl":"10.1177/10445463261467155","url":null,"abstract":"<p><strong>Objective: </strong>Severe disruptive behaviors in youth with autism spectrum disorder (ASD) frequently persist despite conventional treatments, contributing to functional impairment. Although clozapine has antiaggressive properties, evidence guiding its use in treatment-resistant cases in autistic youth remains predominantly observational and retrospective. This study aimed to evaluate systematically and prospectively the effectiveness and safety of clozapine for treatment-resistant disruptive behaviors (TR-DB) in youth with ASD under routine conditions.</p><p><strong>Methods: </strong>This single-arm, open-label trial enrolled participants aged 10-17 with ASD. Inclusion required TR-DB after ≥2 antipsychotic trials and a Clinical Global Impression-Severity score ≥5. Following flexible titration, clozapine was maintained for 12 weeks. The primary outcome was change on the caregiver-rated Aberrant Behavior Checklist-Irritability (ABC-I). Secondary measures included global improvement, autism symptom severity, adaptive behavior, and caregiver quality of life. Response was defined as ≥30% ABC-I reduction plus a CGI-Improvement (CGI-I) of 1 to 2; remission required ≥80% ABC-I reduction and a CGI-I of 1.</p><p><strong>Results: </strong>Thirty-one participants initiated clozapine treatment (mean age 13.4 years; 90.3% male), and 28 completed the trial. ABC-I scores decreased from 32.0 ± 7.7 to 7.4 ± 5.1 (Cohen's d_z -2.5; <i>p</i> < 0.001). Overall, 83.9% responded, and 38.7% remitted. Global severity improved from 6.1 ± 0.6 to 3.8 ± 1.6 (<i>p</i> < 0.001). Significant improvements were observed in daily living skills, caregiver quality of life, and reduced polypharmacy. Adverse drug reactions were mostly mild-to-moderate; however, metabolic changes comprised significant weight gain and triglyceride elevation (both <i>p</i> < 0.05). Serious events included seizures (<i>n</i> = 4) and pneumonia (<i>n</i> = 1).</p><p><strong>Conclusions: </strong>Clozapine was associated with robust, rapid TR-DB reductions and high retention in autistic youth. However, safety risks mandate rigorous monitoring. Controlled trials are needed to confirm efficacy and refine the benefit-risk profile.</p>","PeriodicalId":15277,"journal":{"name":"Journal of child and adolescent psychopharmacology","volume":" ","pages":"617-630"},"PeriodicalIF":1.8,"publicationDate":"2026-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148578662","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Families' Neighborhood Resources Predict Treatment Response for Regulating Together, a Group Therapy for Emotion Dysregulation in Autistic Youth.","authors":"Walker S McKinney, Lauren M Schmitt, Jennifer R Ruberg, Marika Coffman, Debra Reisinger, Rebecca C Shaffer","doi":"10.1177/10445463261477348","DOIUrl":"10.1177/10445463261477348","url":null,"abstract":"<p><strong>Introduction: </strong>Autistic youth often face difficulties with emotion dysregulation (ED) and associated challenging behaviors. The <i>Regulating Together</i> (RT) group therapy was developed to treat ED in autistic youth ages 8-18 years and has been shown to be feasible, acceptable, and efficacious at reducing ED. Results from other clinical trials suggest the efficacy of behavioral therapies may vary based on family- or neighborhood-level social determinants of health (SDOH: \"the conditions in the environments where people are born, live, learn, work, play, worship, and age that affect a wide range of health, functioning, and quality-of-life outcomes and risks\"; U.S. Department of Health and Human Services). The extent to which these factors modify treatment response for RT is not known. This knowledge may help identify characteristics of treatment responders, inform implementation strategies to maximize real-world effectiveness, and guide decisions around treatment assignment and dosing.</p><p><strong>Methods: </strong>This is an exploratory, secondary analysis of our previously reported in-person (<i>N</i> = 37) and telehealth (<i>N</i> = 26) nonrandomized trials of RT. Participants included 63 autistic youth (79.3% male; mean age = 12.8 years, SD = 2.9, range = 8-18) and caregivers. ED and related constructs (e.g., cognitive inflexibility) were assessed at baseline, post-treatment, and 5- and 10-week follow-up visits. Neighborhood-level SDOH were indexed using the Child Opportunity Index based on participants' home addresses. Linear mixed-effects models tested whether neighborhood opportunity moderated treatment response.</p><p><strong>Results: </strong>Neighborhood opportunity was unrelated to baseline clinical characteristics. However, neighborhood opportunity moderated treatment outcomes: reductions in irritability and emotional reactivity were greatest among families in neighborhoods with fewer opportunities.</p><p><strong>Discussion: </strong>Our finding of an amplified treatment response among families living in neighborhoods with fewer resources aligns with results from clinical trials for disruptive behaviors and internalizing disorders in typically developing youth. Possible explanations for this include families' limited prior access to behavioral health services, secondary reductions in caregiver stress, or high satisfaction with RT. These results challenge assumptions about diminished efficacy in low-resource settings and underscore the importance of considering contextual factors in future trials to enhance real-world impact.</p>","PeriodicalId":15277,"journal":{"name":"Journal of child and adolescent psychopharmacology","volume":" ","pages":"649-660"},"PeriodicalIF":1.8,"publicationDate":"2026-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148808759","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Efficacy and Safety of Trimodal Dexmethylphenidate (CTx-1301) in Children and Adolescents with Attention-Deficit/Hyperactivity Disorder: Results From a Phase 3, Randomized, Double-Blind, Fixed-Dose, Placebo-Controlled Trial.","authors":"Ann Childress, Matthew Brams, Michael J Cattaneo, Raul Silva","doi":"10.1177/10445463261469764","DOIUrl":"10.1177/10445463261469764","url":null,"abstract":"<p><strong>Background: </strong>CTx-1301 is the first trimodal dexmethylphenidate formulation developed for the treatment of attention-deficit/hyperactivity disorder (ADHD).</p><p><strong>Methods: </strong>In this 5-week, phase 3, fixed-dose study, patients with ADHD aged 6-17 years were randomized to once-daily treatment with CTx-1301 (18.75, 25.0, or 37.5 mg) or placebo. CTx-1301 was initiated at 12.5 mg and uptitrated weekly to reach the assigned fixed dose. The primary endpoint was the change from baseline to week 5 in the ADHD Rating Scale, Version 5 (ADHD-RS-5). Secondary efficacy endpoints included Clinical Global Impression-Severity (CGI-S) and -Improvement (CGI-I). Statistical comparisons were evaluated at a Bonferroni-adjusted significance level of 0.017.</p><p><strong>Results: </strong>The mean age (±standard deviation) of the study population (<i>N</i> = 103) was 11.3 ± 3.3 years, and the majority of subjects (60.2%) were male. Treatment with CTx-1301 25.0 or 37.5 mg significantly improved ADHD-RS-5 score from baseline compared with placebo (<i>p ≤</i> 0.011). Exploratory <i>post hoc</i> analyses revealed effect sizes for the comparison of CTx-1301 and placebo ranging from 0.732 (18.75-mg dose) to 1.185 (37.5-mg dose). Improvement in CGI-S was statistically significant for CTx-1301 37.5 mg versus placebo (<i>p</i> < 0.001). More than 60% of subjects who received CTx-1301 were much to very much improved on CGI-I compared with 18% for placebo. All adverse events were mild or moderate in severity, no new safety signals were identified, and the safety profile was consistent with the known effects of dexmethylphenidate.</p><p><strong>Conclusions: </strong>CTx-1301 demonstrated dose-related improvements in signs and symptoms of ADHD, although statistical significance is not consistent across all dose groups. The treatment was well tolerated over 5 weeks in children and adolescents with ADHD. Given the limited sample size and reduced statistical power, these findings should be considered preliminary and require confirmation in larger, adequately powered studies.</p>","PeriodicalId":15277,"journal":{"name":"Journal of child and adolescent psychopharmacology","volume":" ","pages":"607-616"},"PeriodicalIF":1.8,"publicationDate":"2026-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148549145","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Centanafadine and the Expanding Pharmacologic Landscape of ADHD.","authors":"Raman Baweja, Timothy E Wilens","doi":"10.1177/10445463261487758","DOIUrl":"10.1177/10445463261487758","url":null,"abstract":"","PeriodicalId":15277,"journal":{"name":"Journal of child and adolescent psychopharmacology","volume":" ","pages":"593-596"},"PeriodicalIF":1.8,"publicationDate":"2026-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148968885","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"<i>Letter:</i> Elevated Prolactin as a Potential Clinical Clue for Sensitivity to D2 Antagonism in an Adolescent Female Presenting with Recurrent Oculogyric Crises--A Case Study.","authors":"Rahoul Gonsalves, Justin Wu, Hall Wang, Sarah Edwards, Jacqueline Clauss","doi":"10.1177/10445463261477332","DOIUrl":"10.1177/10445463261477332","url":null,"abstract":"","PeriodicalId":15277,"journal":{"name":"Journal of child and adolescent psychopharmacology","volume":" ","pages":"661-663"},"PeriodicalIF":1.8,"publicationDate":"2026-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148684654","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Exploring Barriers and Facilitators to Deprescribing Psychotropics in Child and Adolescent Psychiatry: A Qualitative Study from India.","authors":"Kanika Sethi, Harshini Manohar, John Vijay Sagar Kommu","doi":"10.1177/10445463261469316","DOIUrl":"10.1177/10445463261469316","url":null,"abstract":"<p><strong>Background: </strong>Deprescribing, a structured, planned, and supervised approach to medication discontinuation, is increasingly recognized as an imperative rather than an elective component of rational psychopharmacological practice. Deprescribing is particularly compelling in child and adolescent psychiatry, where, despite accumulating evidence for pharmacotherapy, uncertainties regarding long-term risks and benefits persist. This makes deprescribing an important and often complex clinical consideration. Despite growing international attention, deprescribing remains challenging to implement in routine clinical care and is relatively understudied, especially in low- and middle-income countries. This study examined clinicians' perspectives on perceived barriers and facilitators to deprescribing psychotropics in tertiary Child and Adolescent Mental Health Services in India.</p><p><strong>Methods: </strong>The Reflexive Thematic Analysis framework, proposed by Braun and Clarke, was followed. Fourteen child mental health practitioners were recruited through purposive sampling to ensure diverse representation of clinical experience and practice settings. The sample included six consultants, seven specialty trainees, and one general psychiatry resident. Data were collected through in-depth interviews. Data collection and analysis were conducted iteratively.</p><p><strong>Results: </strong>Five interrelated themes were identified: <i>Evolving clinical philosophy</i>; <i>Illness Trajectory, Clinical Risk, and the Timing of Deprescribing</i>; <i>Shared and Shifting Roles in Deprescribing Decision-Making; Health System Constraints and (lack of) Care Continuity;</i> and <i>Cultural and Socioeconomic Context Shaping Deprescribing processes</i>. Together, these themes showed that deprescribing was viewed as a negotiated process influenced by clinician confidence, illness severity, caregiver readiness, adolescent agency, service limitations, and sociocultural pressures.</p><p><strong>Conclusions: </strong>Deprescribing in child and adolescent psychiatry is an evolving clinical competency influenced by clinician, family, health-system, and cultural factors. Structured training, context-specific guidelines, active involvement of children and families, and improved service coordination can support safe deprescribing practices.</p>","PeriodicalId":15277,"journal":{"name":"Journal of child and adolescent psychopharmacology","volume":" ","pages":"631-641"},"PeriodicalIF":1.8,"publicationDate":"2026-12-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148549091","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Neighborhood Disadvantage as a Moderator of Children's Response to a Dyadic Positive Affect Intervention for Children of Mothers with Depressive Symptoms.","authors":"Jordan Yerger, Emilia F Cárdenas, Maria Granros, Cope Feurer, Krupali R Patel, Georgia Moon, Alexandra Stibor, Autumn Kujawa, Katie L Burkhouse","doi":"10.1177/10445463261459344","DOIUrl":"10.1177/10445463261459344","url":null,"abstract":"<p><strong>Background: </strong>Family promoting positive emotions (FPPE) is a dyadic, positive affect-focused preventive intervention shown to reduce perceived stress and emotional symptoms among children of mothers with elevated depressive symptoms, a population at heightened risk for psychopathology. Emerging evidence suggests that contextual disadvantages (e.g., socioeconomic, neighborhood) may shape vulnerability for major depressive disorder in children. The present study examined whether family- and neighborhood-level disadvantage moderated children's response to FPPE relative to a psychoeducation comparison condition, with the goal of informing precision prevention efforts for high-risk families.</p><p><strong>Methods: </strong>Participants included 74 children (ages 8-12 years; 46.3% female) and their biological mothers with elevated depressive symptoms (i.e., Patient Health Questionnaire scores ≥ 8). Following random assignment, 47 dyads were assigned to FPPE, and 27 dyads were assigned to a written information psychoeducation condition. Neighborhood and family-level disadvantage was assessed using the Child Opportunity Index (COI) scores and family-level income-to-needs ratio (INR), respectively. Parent-reported child perceived stress and emotional distress (depressive, anxiety, and anger symptoms) were assessed pre- and post-intervention using the Perceived Stress Scale and Patient-Reported Outcomes Measurement Information System Emotional Distress Scales.</p><p><strong>Results: </strong>Family-level INR did not moderate intervention effects. Results revealed a significant time × group × COI interaction for child-perceived stress, such that greater neighborhood disadvantage was associated with a larger reduction in child-perceived stress pre-to-post intervention in the FPPE but not the written information group. No other significant effects emerged.</p><p><strong>Conclusions: </strong>FPPE was most effective in reducing perceived stress among children of mothers with elevated depression symptoms exposed to greater neighborhood-level disadvantage, suggesting that a positive valence system (PVS) may be a particularly sensitive and proximal preventive intervention target through which downstream reductions in stress occur. These findings suggest that youth facing both intergenerational and environmental risk may benefit the most from dyadic, positive affect-focused interventions to reduce stress. Research should test downstream effects of FPPE on clinical symptoms emerging over longer periods.</p>","PeriodicalId":15277,"journal":{"name":"Journal of child and adolescent psychopharmacology","volume":" ","pages":"550-557"},"PeriodicalIF":1.8,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148277557","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Validation of the Temper Outbursts/Irritability-2: A Two-Item Screener for Temper Outbursts and Irritability in Youth.","authors":"Daniel A Waschbusch, Dara E Babinski, Erika F H Saunders, James G Waxmonsky, Raman Baweja","doi":"10.1177/10445463261459346","DOIUrl":"10.1177/10445463261459346","url":null,"abstract":"<p><strong>Objective: </strong>Irritability and temper outbursts are common presenting concerns in pediatric mental health settings, but systematic monitoring can be difficult to sustain with broad, repeated assessment batteries. This study evaluated the temper outbursts/irritability-2 (TOI-2), an ultra-brief, two-item screener assessing temper outbursts and frequently irritable mood in youth.</p><p><strong>Methods: </strong>Participants were 1515 youth aged 5-17 years (<i>M</i> = 11.80, SD = 3.60) referred to an outpatient child psychiatry clinic. Female caregivers (90.4% biological mothers) completed the TOI-2 and criterion measures at intake. Convergent and discriminant validity were assessed via correlations with the Affective Reactivity Index (ARI), administered with a current-state timeframe, oppositional defiant disorder (ODD) symptom dimensions, attention-deficit/hyperactivity disorder, conduct disorder (CD), depression, and anxiety. Screening accuracy was evaluated using receiver operating characteristic analysis, with elevated irritability defined as ARI ≥ 4. Clinical utility was examined using screen-positive and screen-negative comparisons and known-group analyses.</p><p><strong>Results: </strong>The TOI-2 showed strong convergence with the ARI and ODD-Irritability symptoms (<i>r</i>s = 0.82). Its association with ODD-Irritability was significantly stronger than with ODD-Behavioral symptoms (<i>r</i> = 0.70; <i>p</i> < 0.001), supporting relative specificity to irritability within the broader disruptive behavior spectrum. ROC analysis indicated excellent classification accuracy, area under the curve = 0.91. Cut scores of ≥2.5 and ≥3.0 both optimized overall performance, Youden's J = 0.66. A threshold of ≥3.0 is recommended for specialty-clinic triage, whereas ≥2.5 may be preferable when maximizing case detection is the priority. Youth who screened positive showed greater symptom severity and poorer adjustment across clinical domains. Known-groups analyses showed the largest TOI-2 elevations among youth meeting symptom-count thresholds for ODD and CD.</p><p><strong>Conclusions: </strong>The TOI-2 is a psychometrically sound, ultra-brief screener for clinically significant irritability in youth. Positive screens should prompt more comprehensive clinical assessment of irritability, impairment, disruptive behavior, mood symptoms, and treatment needs.</p>","PeriodicalId":15277,"journal":{"name":"Journal of child and adolescent psychopharmacology","volume":" ","pages":"569-577"},"PeriodicalIF":1.8,"publicationDate":"2026-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148258097","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}