Internet addiction (IA) is defined as the condition of being addicted to all sorts of activities on the Internet. Individuals with neurodevelopmental disorders, including autism spectrum disorder (ASD), may be susceptible to IA. Early detection and intervention for probable IA are important to prevent severe IA. In this study, we investigated the clinical usefulness of a short version of the Internet Addiction Test (s-IAT) for the screening of IA among autistic adolescents. The subjects were 104 adolescents with a confirmed diagnosis of ASD. They were requested to answer 20 questions from the original Internet Addiction Test (IAT). In the data analysis process, we comparatively calculated the sum of scores to the 12 questions of s-IAT. In total, 14 of the 104 subjects were diagnosed as having IA based on the face-to-face clinical interview that was regarded as the gold standard. Statistical analysis suggested that the optimal cut-off for s-IAT was at 35. When we applied the cut-off of 70 on the IAT, only 2 of 14 subjects (14.3%) with IA were screened positive, whereas 10 (71.4%) of them were screened by using the cut-off point of 35 on s-IAT. The s-IAT might be useful for the screening of IA in adolescents with ASD.

Persistent, interpersonal difficulties are a core feature of borderline personality disorder (BPD). Theories propose that these may result from an insufficient object constancy, for example, the insufficient capacity to maintain feelings of closeness (FC) toward a person when he or she is absent. Based on this assumption, this study examined whether FC toward the mother or the best friend were more dependent on previous contact in adolescents with BPD pathology compared with healthy controls. In addition, the influence of different contact modes was explored. N = 52 female adolescents aged 14 to 18 years (n = 24 with >=5 BPD symptoms [full-threshold BPD], n = 10 with 1-4 BPD symptoms [subthreshold BPD], n = 18 healthy controls) completed up to 12 e-diaries a day on 2 consecutive weekends. Using multilevel mixed-effect regression analyses, we found that the more BPD symptoms a patient fulfilled, the more dependent were FC toward the best friend on actual contact. In contrast, BPD pathology did not influence the dependency of the FC toward the mother on actual contact. Finally, the mode of contact seems to matter: The more BPD symptoms a patient met, the more was the FC toward the best friend dependent on personal compared with written or no contact, whereas phone or written contact was no different from no contact. The present findings partially support the theory of an insufficient object constancy in BPD that seems to become apparent in adolescence mainly in relationships with peers. Replication of the findings, particularly with regard to the impact of mode of contact, in larger samples is required.

Borderline personality disorder (BPD) is among the most severe mental health problems with long-lasting deterioration of functioning. According to a Cochrane review, evidence for methods focused on treatment for adolescent BPD patients is very limited. Aims of the study were to demonstrate the noninferiority of adolescent identity treatment (AIT) compared with dialectical behavior therapy for adolescents (DBT-A), and that intensive early treatment of BPD leads to significant improvement of psychosocial and personality functioning in adolescent patients. In a nonrandomized controlled trial using a noninferiority approach, we compared 37 patients treated with DBT-A with 23 patients treated with AIT. Both treatments included 25 weekly individual psychotherapy sessions and five to eight family sessions. Patients were assessed at four timepoints: baseline, posttreatment, 1- and 2-year follow-up. Primary outcome was psychosocial functioning at 1-year follow-up. We performed both intention-to-treat analyses and per-protocol analyses (completers). Baseline characteristics of both groups were not significantly different except for age and self-injurious behavior. In all, six AIT patients (26%) and 10 DBT-A patients (27%) dropped out of treatment. Both DBT-A and AIT significantly improved adolescents' psychosocial functioning (AIT: d = 1.82; DBT-A: d = 1.73) and personality functioning. BPD criteria and depression were significantly reduced by both treatments. Overall, AIT was found to be not inferior to DBT-A and even more efficient in reducing BPD criteria. Both treatments are highly effective in improving psychosocial functioning and personality functioning in adolescent BPD patients. AIT is a promising approach and not inferior to DBT-A in respect to treatment efficiency.

Objective: The purpose of this article is to characterize the current evidence base related to peer support interventions for adolescents and young adults (AYAs) with inflammatory bowel disease (IBD) and to describe a peer support program to enhance self-management for AYAs with IBD through a case study. There is strong theory and compelling evidence suggesting that AYAs with IBD could benefit from and are interested in receiving peer support to enhance self-management; however, literature on peer support interventions for AYAs with IBD is lacking. Methods: This study (a) presents a topical review describing qualitative factors AYAs with IBD would seek in a peer support program as well as existing peer support programs for this population, (b) presents an innovative one-to-one peer support program targeting self-management through a case study, and (c) discusses clinical implications and directions for future research. Results: Peer support offers a promising approach for AYAs with IBD that is feasible and acceptable to patient populations. However, results from the present topical review identified only two studies that examined peer support interventions for AYAs with IBD. The case study demonstrates how a theoretically driven program uses peer support to promote self-management and adaptive behavioral change. Conclusions: The paucity of literature in this area reveals a critical opportunity for future research and clinical programming to improve existing practices by leveraging peer support. We present the application of an innovative mobile-based peer coaching intervention that has the potential to support AYAs with IBD in their self-management.

Inflammatory processes are associated with mood disorders, but data on pediatric patients are scarce. The aim of this study was to investigate a possible association between elevated neutrophil/lymphocyte ratio (NLR) - a marker of inflammation and mood polarity (manic/depressed) in adolescents, admitted between 2010 and 2015 due to a mood disorder episode and to an adolescent inpatient ward. Electronic medical records of 305 patients (aged 10-19 years, 60.6% males) admitted during the study period due to a mood disorder episode were reviewed. Of these, 63 were diagnosed with manic episodes and 242 with depressive episodes. Multivariate analyses were used to compare NLR between and within the two groups, covarying for age, sex, and antipsychotic use. NLR was significantly higher in the manic episode group compared with the depression one. Moreover, in inpatients with multiple hospitalizations, the NLR was higher during their manic episodes than that during their nonmanic states. These results suggest that, as has been reported in adults with bipolar disorder, inflammatory mechanisms may be involved in adolescents' mood disorders as well, particularly in the manic episodes. Thus, clinicians may consider adding anti-inflammatories as part of the treatment of these patients.

Question Ear piercing is one of the most common forms of body modification seen in children and adolescents presenting to my office. Parents of my younger pediatric patients inquire about potential post-piercing complications and risk factors associated with earlobe infections. What guidance should I give them? Also, are there any specific post-piercing complications to consider for older pediatric patients seeking second piercings in the upper cartilage area?

Answer Piercing the earlobe or auricular cartilage continues to be a popular procedure among children and adolescents. Despite its widespread practice, improper aseptic piercing technique, insufficient training, and trauma to the soft tissue during high-pressure piercing (eg, use of spring-loaded ear-piercing instruments) can increase one’s susceptibility to infections, bleeding, and microfractures. Other post-piercing complications include embedded earrings, keloids, hypertrophic scarring, and cutaneous hypersensitivity. Early recognition and treatment of infections and perichondritis secondary to transcartilaginous piercings can prevent the progression of severe ear deformities requiring reconstructive surgical interventions.

The typical age of a first piercing among young children and adolescents ranges from 6 months to 10 years.1 The ear, including the earlobe and cartilage of the pinna, is the most common location for piercings.2 A cross-sectional survey of 766 college students from 18 universities across the United States and Australia reported that 51% (n=391) of participants had 1 or more body piercings and almost half (45%) reported local infections including pus, blisters, drainage from site, pain, and redness.3 A study of 52 children with ear-piercing complications in Scotland reported 34 (65%) children with local infection, 41 (79%) with embedded earrings, and 1 (2%) with cellulitis.4 Among females aged 18 to 28 years, the prevalence of infection after ear cartilage piercing was significantly more frequent than after earlobe piercing (41.4% vs 29.6%, respectively, P=.0004).5 These more-severe infections (eg, keloids, auricular perichondritis) and associated slow healing are likely owing to limited vascularity of the cartilage.5 Although most infections are local, piercings have also been linked with more-severe complications (less than 3%) such as endocarditis, toxic shock syndrome, and viral hepatitis

Objective: It is well established that adolescents and young adults are increasingly vulnerable to the effects of early opioid exposures, with the emergency department (ED) playing a critical role in such introduction. Our objective was to identify predictors of ED opioid administration (ED-RX) and prescribing at discharge (DC-RX) among adolescent and young adults using a machine learning approach.

Methods: We conducted a secondary analysis of ED visit data from the National Hospital Ambulatory Medical Care Survey from 2014 to 2018. Visits where patients were aged 10 to 24 years were included. Predictors of ED-RX and DC-RX were identified via machine learning methods. Separate weighted logistic regressions were performed to determine the association between each predictor, and ED-RX and DC-RX, respectively.

Results: There were 12,693 ED visits identified within the study time frame, with the majority being female (58.6%) and White (70.7%). Approximately 12.3% of all visits were administered an opioid during the ED visit, and 11.5% were prescribed one at discharge. For ED-RX, the strongest predictors were fracture injury (odds ratio [OR], 5.24; 95% confidence interval [CI], 3.73-7.35) and Southern geographic region (OR, 3.01; 95% CI, 2.14-4.22). The use of nonopioid analgesics significantly reduced the odds of ED-RX (OR, 0.46; 95% CI, 0.37-0.57). Fracture injury was also a strong predictor of DC-RX (OR, 5.91; 95% CI, 4.24-8.25), in addition to tooth pain (OR, 5.47; 95% CI, 3.84-7.69).

Conclusions: Machine learning methodologies were able to identify predictors of ED-RX and DC-RX, which can be used to inform ED prescribing guidelines and risk mitigation efforts among adolescents and young adults.

Non-medical prescription use of opioids (NMPUO) is a public health concern worldwide. Recently, tramadol misuse is increasing, but the systematic research of misuse of this specific opioid is limited. This study set out to assess the relationship between tramadol use and completion of treatment for substance use among adolescents and adults ≤25 years in an outpatient clinical setting. A retrospective cohort study of treatment outcome, expressed as “completion” or “non-completion” of treatment, was conducted in treatment-seeking adolescents with problematic substance use (n=335). Data was extracted from Ung-DOK interviews, a semi-structured assessment instrument designed for adolescents with substance abuse. The study included all treatment-seeking patients at an out-patient facility in 2014-2017. A total of 26% (n=88) were tramadol users (life-time prevalence). Twenty percent (n=66) of all treatments were non-completed. Tramadol users were significantly more likely than non-users to drop out of treatment (35% vs 15%, p<0.001). In multivariate logistic regression, tramadol use and age 18 and above were factors significantly associated with non-completion. Tramadol use was statistically significantly associated with non-completion of treatment. Further research addressing treatment needs and treatment completion among tramadol users is needed.

Abstract
Background
Non-specific low back pain in children and adolescents has increased in recent years. The purpose of this study was to upgrade the evidence of the most effective preventive physiotherapy interventions to improve back care in children and adolescents.

Methods
The study settings were children or adolescents aged 18 years or younger. Data were obtained from the Cochrane Library, MEDLINE, PEDro, Web of Science, LILACS, IBECS, and PsycINFO databases and the specialized journals BMJ and Spine. The included studies were published between May 2012 and May 2020. Controlled trials on children and adolescents who received preventive physiotherapy for back care were considered. Data on all the variables gathered in each individual study were extracted by two authors separately. Two authors assessed risk of bias of included studies using the RoB2 and quality of the body of evidence using the GRADE methodology. Data were described according to PRISMA guidelines. To calculate the effect size, a standardized mean difference “d” was used and a random-effects model was applied for the following outcome variables: behaviour, knowledge, trunk flexion muscle endurance, trunk extension muscle endurance, hamstring flexibility and posture.

Results
Twenty studies were finally included. The most common physiotherapy interventions were exercise, postural hygiene and physical activity. The mean age of the total sample was 11.79 years. When comparing the change from baseline to end of intervention in treatment and control groups, the following overall effect estimates were obtained: behaviour d+ = 1.19 (95% CI: 0.62 and 1.76), knowledge d+ = 1.84 (0.58 and 3.09), trunk flexion endurance d+ = 0.65 (-0.02 and 1.33), trunk extension endurance d+ = 0.71 (0.38 and 1.03), posture d+ = 0.65 (0.24 and 1.07) and hamstrings flexibility d+ = 0.46 (0.36 and 0.56). At follow-up, the measurement of the behaviour variable was between 1 and 12 months, with an effect size of d+ = 1.00 (0.37 and 1.63), whereas the knowledge variable obtained an effect size of d+ = 2.08 (-0.85 and 5.02) at 3 months of follow-up.

Conclusions
Recent studies provide strong support for the use of physiotherapy in the improvement of back care and prevention of non-specific low back pain in children and adolescents. Based on GRADE methodology, we found that the evidence was from very low to moderate quality and interventions involving physical exercise, postural hygiene and physical activity should be preferred.

L’objectif de cette revue de littérature est de synthétiser les résultats de publications nationales et internationales portant sur la transition à la parentalité chez les mères et les pères adolescents, puis de faire un travail de comparaison afin de dégager des différences et similitudes entre les expériences maternelle et paternelle.
À travers une analyse systématique suivant la méthode PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses), trois thèmes principaux ont émergé : 1) la construction de l’identité maternelle ou paternelle adolescentes ; 2) les changements induits par le processus de parentalité ; l’influence et le poids de la famille d’origine, du conjoint, des professionnels de santé et des pairs. Cette synthèse contribue à une meilleure représentation de l’expérience de la parentalité adolescente, des besoins des parents adolescents et des lacunes de la recherche. Elle permet également d’envisager différemment la prise en charge de parents adolescents, notamment dans le contexte francophone où les recherches et programmes de prévention et d’intervention destinés aux parents adolescents demeurent rares.

Haut Potentiel Intellectuel (HPI) en décrochage scolaire . Les adolescents HPI sont nombreux à rencontrer l'échec scolaire, le décrochage ou la phobie scolaire. Par inadéquation, manque de sollicitation ou d'intérêt, ceux-là mêmes qui ne devraient pas rencontrer de difficultés sont parfois décrochés. Pourquoi ? Et surtout, comment y remédier ?. Ce livre s'adresse aux parents d'adolescents ou d'enfants HPI en difficulté au plan scolaire ou qui décrochent, mais également aux enseignants qui souhaitent comprendre les difficultés paradoxales de ces élèves. Il évoque en particulier le risque de décrochage scolaire que rencontrent les adolescents HPI, qui font souvent face à des difficultés d'adaptation scolaire et sociale, et dont les particularités peuvent en effet provoquer un écart à la norme et un décalage, à l'origine d'un désinvestissement pour les apprentissages.. Cet ouvrage ne tient pas ces difficultés pour insurmontables et ne considère pas l'échec comme une fatalité. Il donne au contraire des clés pour l'éviter. Et si le décrochage survient malgré tout, il ne doit pas, surtout dans le cas des élèves HPI, être considéré comme définitif. Le raccrochage scolaire est possible, et les capacités mêmes des HPI peuvent leur permettre de reprendre le chemin des apprentissages. Le goût d'apprendre et de comprendre les a en effet rarement quitté.. Nous proposons dans ce livre les conditions et les modalités de ce raccrochage scolaire : un chemin pour chacun. Fruit de l'expérience professionnelle d'un enseignant spécialisé chargé de la prévention au décrochage scolaire et d'un accompagnement individualisé de nombreux élèves aux profils variés, collégiens et lycéens, cet ouvrage donne des clés pour lutter contre le décrochage, la phobie scolaire ou le désinvestissement. Il se veut aussi un guide vers le raccrochage scolaire. Il existe des moyens pour dépasser le décrochage scolaire et l'échec, pour les contrer, pour revenir vers le savoir, la connaissance puis vers l'école et une réussite scolaire ou académique.

La Maison des adolescents de l’hôpital Cochin à Paris est une structure pluridisciplinaire dotée d’une sensibilité transculturelle z Elle a pour mission d’accueillir les adolescents, mais aussi leurs familles, et de prendre en compte leurs parcours singuliers z De l’accueil de l’adolescent par l’infirmière de consultation à la mise en place de soins spécifiques en groupe transculturel, le parcours de soins nécessite parfois de porter la dyade mère-adolescent pour parvenir à un apaisement des souffrances de chacun.

La douance intellectuelle, qu'est-ce que c'est exactement?? Si un enfant est doué ou semble l'être, est-ce une bonne nouvelle?? Comment l'accompagner afin de lui permettre de développer son potentiel?? Lorsque la douance intellectuelle cohabite avec un autre trouble neurodéveloppemental (trouble du spectre de l'autisme, TDAH, trouble d'apprentissage), on parle de double exceptionnalité (2e). Comment ces profils se présentent-ils?? Dans un contexte où la douance suscite de plus en plus de questions, et ce, tant dans les milieux scolaires que dans le grand public et dans les médias, il est primordial pour tous d'en avoir une compréhension commune, basée sur la littérature scientifique et les données probantes. Dans ce livre, les auteures répondent aux questions les plus fréquemment posées sur le sujet. Elles proposent également des pistes d'intervention permettant d'offrir des opportunités et des outils utiles à la réussite et à l'épanouissement des jeunes doués ou doublement exceptionnels.

Vivre la mort de son père ou de sa mère est une chose terrible. C'est encore plus déchirant lorsqu'il s'agit d'un suicide. Dans cette histoire, Jérémy raconte sa vie quotidienne à l'école et à la maison tout en relatant ses réflexions à la suite de la perte de son père, qui s'est suicidé. Une fenêtre est alors ouverte sur ses peines et ses peurs, mais aussi sur ses accomplissements et ses joies.

L'histoire de Jérémy a été conçue pour aider le jeune qui vit une situation semblable à exprimer ce qu'il ressent et à trouver du réconfort. À la fin du livre sont proposées des réponses à plusieurs questions qu'il pourrait se poser à propos du deuil, de même que des stratégies concrètes pour traverser les moments difficiles. Les parents et les intervenants y trouveront également des informations utiles pour accompagner le jeune endeuillé.

Purpose of review: To examine the spectrum of emergency department presentations associated with cannabis use or misuse that are currently seen in the pediatric population.

Recent findings: There is a growing concern that pediatric emergency department visits related to cannabis are on the rise, especially given rapidly changing legislation on cannabis and its broad availability in certain areas. These concerns are substantiated in the current literature, as the evidence mounts for an array of emergency department presentations of intentional or accidental cannabis use. The range of presentations documented in the recent literature spans gastrointestinal, psychiatric and cardiorespiratory effects, in addition to traumatic injuries and accidental ingestions by younger children. Complications of chronic cannabis use, such as 'cannabis hyperemesis syndrome', depression, psychosis or cognitive impairment, are now recognized outcomes and even more are likely to emerge.

Summary: An array of cannabis-related symptoms is possible from acute use or exposure. Common presentations include acute intoxication, hyperemesis, depression and acute physical injuries from impaired psychomotor function. Uncommon presentations include cardiorespiratory effects, and a range of symptoms in young children that include hyperkinesis and coma. Clinical vigilance is needed to suspect and clinically diagnose cannabis exposure in the emergency department.

Purpose of review: To examine the spectrum of emergency department presentations associated with cannabis use or misuse that are currently seen in the pediatric population.

Recent findings: There is a growing concern that pediatric emergency department visits related to cannabis are on the rise, especially given rapidly changing legislation on cannabis and its broad availability in certain areas. These concerns are substantiated in the current literature, as the evidence mounts for an array of emergency department presentations of intentional or accidental cannabis use. The range of presentations documented in the recent literature spans gastrointestinal, psychiatric and cardiorespiratory effects, in addition to traumatic injuries and accidental ingestions by younger children. Complications of chronic cannabis use, such as 'cannabis hyperemesis syndrome', depression, psychosis or cognitive impairment, are now recognized outcomes and even more are likely to emerge.

Summary: An array of cannabis-related symptoms is possible from acute use or exposure. Common presentations include acute intoxication, hyperemesis, depression and acute physical injuries from impaired psychomotor function. Uncommon presentations include cardiorespiratory effects, and a range of symptoms in young children that include hyperkinesis and coma. Clinical vigilance is needed to suspect and clinically diagnose cannabis exposure in the emergency department.

Background.
Youth with Duchenne muscular dystrophy (DMD) and other neuromuscular disorders are living well into adulthood and often need help engaging in meaningful occupations.

Purpose.
Our purpose was to explore enablers and barriers to engaging in meaningful occupations, from the perspectives of youth, parents, and practitioners.

Method.
This qualitative study involved 26 participants (11 parents, eight youth ages 19 to 28 [mean = 22.3 years], seven practitioners). Data were obtained from semistructured interviews and analyzed using an interpretive descriptive approach.

Findings.
Youth with DMD and neuromuscular disorders engage in meaningful occupations in a variety of ways. Occupational enablers were supports and accommodations and self-care skills and coping strategies, while occupational barriers involved societal expectations of a normative adulthood, discrimination and inaccessible environments, lack of supports and resources, medical challenges, fatigue, lack of motivation, and social isolation and depression.

Implications.
Practitioners should work to uncover what youth consider important and connect them to appropriate resources so they can engage in meaningful occupations.

Purpose of review: Nonadherence is a problem in adolescents and young adults. Risk factors are classified as those of the individual, family, health-care-system, or community. I present the latest reports and how to tackle nonadherence.

Recent findings: Nonadherence risk is independent of one's origin in a high-poverty or low-poverty neighborhood or having private or public insurance in respect to African Americans. Females with male grafts have higher graft-failure risks than do males. Female recipients aged 15-24 with grafts from female donors have higher graft-failure risk than do males. In study of nonadherence risks, such findings must be taken into account. Antibody-mediated rejection is seen in nonadherence. The sirolimus and tacrolimus coefficient of variation is associated with nonadherence, donor-specific antibodies, and rejection. Adolescents had electronically monitored compliance reported by e-mail, text message or visual dose reminders and meetings with coaches. These patients had significantly greater odds of taking medication than did controls. Transition programs have an impact on renal function and rejection episodes.

Summary: Individual risk factors are many, and methods for measuring nonadherence exist. Each transplant center should have a follow-up program to measure nonadherence, especially in adolescence, and a transition program to adult care.