COVID-19 pandemic is prompting multiple stressors -including control strategies such as lockdown- which may impact child and adolescent mental health. 1,529 caregivers answered an online questionnaire about emotional and behavioral symptoms of youths (4-18 years old) using the Pediatric Symptom Checklist (PSC). Percentage of above-the-risk-threshold PSC scores (PSC+) were compared with a baseline measure. Associations between lockdown PSC scores and selected variables were evaluated using a linear regression analysis. PSC+ significatively increased from 13% to 34.7%, baseline to lockdown, mostly driven by depression and anxiety symptoms and with greater risk at younger ages. Youths’ and parents’ positive mental health history additionally increased this risk. In children, caregivers’ stress and depression was the stronger predictor of lockdown PSC scores; in adolescents it was the coping style. These findings suggest a significant mental health impact on children and adolescents associated with COVID-19 pandemic response. Younger ages should be closely monitored.

Sluggish cognitive tempo (SCT) symptoms have largely emerged from investigations of attention-deficit/hyperactivity disorder (ADHD). Recent research has demonstrated the relevance of SCT symptoms in the field of clinical child and adolescent psychiatry. The goal of this research was to study the symptoms of SCT in a clinical child and adolescent sample and to define its features and comorbid conditions. We reviewed 834 clinical records of patients referred to Child and Adolescent Mental Health Services and examined SCT symptoms and their relation with sociodemographic data, clinical diagnosis, comorbid conditions, Child Behavior Checklist dimensions, and intelligence quotient. Of the 515 patients (age range, 4 to 17 y, 62.5% male) for whom a fully completed Child Behavior Checklist for Children and Adolescents was available, 20.8% showed high levels of SCT symptoms. SCT symptoms were strongly associated with age, internalizing symptoms, learning disabilities, and ADHD inattentive subtype (ADHD-I). No significant correlations with intelligence quotient were found. We concluded that SCT symptoms are highly prevalent in a clinical sample, and that these symptoms might be related to the difficulties that some individuals have in responding to demands in their environments, such as academic or social demands, as they increase over time.

Background: Bipolar Disorder (BD) is a recurrent illness associated with high morbidity and mortality. The frequency of mood episode recurrence in BD is highly heterogeneous and significantly impacts the person's psychosocial functioning and well-being. Understanding the factors associated with mood recurrences could inform the prognosis and treatment. The objective of this review is to summarize the literature on factors, present during childhood, that influence recurrence. Methodology:A systematic review of PubMed (1946PubMed ( -2017 and PsycINFO (1884-2017) databases was conducted to identify candidate studies. Search terms included bipolar disorder, episodes, predictors, recurrences, and course. Study characteristics, risk for bias, and factors associated with recurrence were coded by two raters according to predetermined criteria. Results:Twenty child studies and 28 adult studies that retrospectively evaluated childhood variables associated with mood recurrences were included. Early age of onset, low socioeconomic status, comorbid disorders, inter-episode subsyndromal mood symptoms, BD-I/II subtypes, presence of stressors, and family history of BD were associated with higher number of recurrences. Limitations: Risk factors and mood recurrences were assessed and defined in different ways, limiting generalizability. Conclusion: Multiple factors are associated with increased risk of mood episode recurrence in BD. Interventions targeting modifiable factors could reduce the impact of BD. For example, treatment of comorbid disorders and subsyndromal mood symptoms, coupled with appropriate cognitive behavioral and family-focused therapies could ameliorate risk related to many clinical factors. When coupled with social services to address environmental factors, the number of episodes could be reduced and the course of BD significantly improved. K E Y W O R D S bipolar disorder, recurrence, review, risk factors studies only), and race; (i) sample clinical characteristics (number of participants diagnosed with BD, BD I %, illness duration, type of course (eg, predominant polarity, rapid cycling), polarity of the first episode, number of manic, hypomanic, mixed, depressive and total episodes, subsyndromal mood symptoms, comorbid disorders, suicide attempts, and psychotic symptoms); (j) environmental characteristics (living with both natural parents and stressors); (k) family history of BD; (l) assessment tools (eg, how were diagnosis, mood recurrence, and factors measured); (m) outcome or recurrence (definition of recurrence, S U PP O RTI N G I N FO R M ATI O N Additional supporting information may be found online in the Supporting Information section at the end of the article. How to cite this article: Estrada-Prat X, Van Meter AR, Camprodon-Rosanas E, Batlle-Vila S, Goldstein BI, Birmaher B.Childhood factors associated with increased risk for mood episode recurrences in bipolar disorder-A systematic review.

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