Scoping review on mental health standards for Black youth: identifying gaps and promoting equity in community, primary care, and educational settings

BACKGROUND

Youth mental health is a growing concern in research, practice, and policy. Practice standards, guidelines, or strategies provide an invisible infrastructure that fosters equity, quality, and safety, potentially addressing inconsistencies and more effectively attending to the mental wellness of Black youth as a particular population of concern. This scoping review aimed to address the following question: What standards exist for the delivery of mental health services to Black youth in community, primary care, and educational settings? Due to a limited initial search yield on publications about standards for the delivery of mental health services for Black youth population, our goal was then to identify and map mental health standards, recommendations, or guidelines for the delivery of mental health services using the same settings to all youth.

METHODS

Searches were conducted in various databases, including PubMed/MEDLINE, PsycINFO, Embase, SocINDEX, CINAHL, Gender Studies Database, Social Services Abstracts, Sociological Abstracts, Scopus, Web of Science, and Google Scholar. Screening was independently conducted by two reviewers, with disagreements resolved by a third. Information extraction was performed by two independent reviewers.

RESULTS

Out of the 2,701 screened publications, 54 were included in this scoping review. Among them, 38.9% were published between 2020 and 2023, with 40.7% originating from the United States of America, 20.4% from the United Kingdom, and 13% from Canada. Concerning the settings, 25.9% of the publications focused on primary care, 24.1% on health care services, 20.4% on educational settings, and 3.7% on the community. Additionally, 25.9% were classified as general because recommendations were applicable to various settings. Attention-deficit/hyperactivity disorder (11.1%) was the most frequently considered specific condition, followed by autism spectrum disorder (9.3%) and depression (9.3%). However, 31.5% of the included references addressed mental health in general. Only three references provided specific recommendations for the Black population.

CONCLUSIONS

Recommendations, guidelines, or standards for Black youth mental health services in community, primary care, or educational settings are scarce and limited to North American countries. This scoping review emphasizes the need to consider ethnicity when developing guidelines or standards to improve racial equity and reduce disparities in access to mental health services.

ESCAP practice guidance for autism: a summary of evidence-based recommendations for diagnosis and treatment

Across Europe, there is increased awareness of the frequency and importance of autism spectrum disorder (ASD), which is now recognised not only as a childhood disorder but as a heterogeneous, neurodevelopmental condition that persists throughout life. Services for individuals with autism and their families vary widely, but in most European countries, provision is limited. In 2018, European Society of Child and Adolescent Psychiatry (ESCAP) identified the need for a Practice Guidance document that would help to improve knowledge and practice, especially for individuals in underserviced areas. The present document, prepared by the ASD Working Party and endorsed by the ESCAP Board on October 3, 2019, summarises current information on autism and focuses on ways of detecting, diagnosing, and treating this condition.

Family and Developmental History of Individuals With Autism Spectrum Disorder: Importance of the Clinical Diagnostic Interview for Diagnosis in Adolescents. An Explorative Study

Background: Diagnosis of autism spectrum disorder (ASD) can be made early in childhood, but also later in adolescence or adulthood. In the latter cases, concerns about an individual's behavior typically lead to consultation of a mental health professional (MHP). As part of the initial clinical examination by the MHP, a clinical diagnostic interview is performed, in order to obtain the patient's history, and may lead to the hypothesis of ASD. We were here interested to study family and developmental history as key parts of the patient's history. The aim of the study was to investigate empirical differences between adolescents with ASD and adolescent control persons in family and developmental history. Method: Clinical diagnostic interview items addressing family and developmental history were adopted from their regular use at several university hospitals and in leading textbooks. Parents of male adolescents with normal intelligence and an ASD diagnosis (n = 67) and parents of male adolescents without psychiatric diagnosis (n = 51) between the age of 12 and 17 years were investigated. Data were operationalized into three categories: 0 = normal behavior, 1 = minor pathological behavior, and 2 = major pathological behavior. Differences were analyzed by multiple t-test of two-way ANOVA. Results: Adolescents with ASD expressed a profile of items significantly differing from control persons. Comparison of significant items with the empirical ASD literature indicated robust accordance. Conclusions: Our findings support the importance and feasibility of the clinical diagnostic interview of family and developmental history for initiation of the diagnostic process of ASD in adolescents.

[From pervasive developmental disorder in ICD-10 to Autism Spectrum Disorder in ICD-11]

From pervasive developmental disorder in ICD-10 to Autism Spectrum Disorder in ICD-11 Abstract. This article presents the new diagnostic classification of Autism Spectrum Disorder according to ICD-11 relative to the previous classification according to ICD-10, and DSM-5. It also provides some practical clinical advice regarding the value of multiaxial diagnostic classification. Because ICD-11 shows a high similarity to DSM-5, one may expect prevalence rates to be consolidated. Especially because the classification "atypical autism" has been dropped, prevalence rates may decrease following the implementation of ICD-11 compared to ICD-10. Sensitivity should remain high, however, and specificity may increase, similar to the changes that occurred going from DSM-IV TR to DSM-5.

Clinical genetic testing and counselling in autism spectrum disorder

Autism spectrum disorders (ASDs) are phenotypically as well as genetically heterogeneous developmental disorders with a strong heritability. Clinical and basic science research has described many replicated genetic risk factors. Many findings can well be translated into clinical human genetic practice. The current article summarizes results of genetic studies in ASD, provides a diagnostic algorithm for the clinical human genetic work-up reflecting the German health care system options and gives information with regard to the obligatory genetic counselling after a clinical genetic assessment.

Empirisch untersuchte entwicklungsorientierte und verhaltenstherapeutisch basierte Therapieprogramme zur Verbesserung der Kernsymptome und der Sprachentwicklung bei Klein- und Vorschulkindern mit Autismus-Spektrum-Störungen

Zusammenfassung. Der vorliegende systematische Überblicksartikel basiert auf Vorarbeiten im Rahmen der Erstellung der AWMF-S3-Leitlinien zur Therapie von Autismus-Spektrum-Störungen (ASS). Das Ziel ist, den aktuellen Stand evidenzbasierter Interventionen zur Behandlung der Kernsymptomatik sowie sprachlichen Förderung im Kleinkind- und Vorschulalter für Kinder mit ASS darzustellen. Einschlusskriterien: entwicklungsorientierte oder verhaltenstherapeutisch basierte, manualisierte Intervention für Kinder mit ASS nach DSM-III (R), DSM-IV (TR), DSM-5 oder ICD-10, Alter < 7 Jahre, Publikationsdatum 1.1.2011 bis 31.8.2018. Iterativ-hierarchischer Prozess für den Studieneinschluss: systematisches Review > randomisiert kontrollierte > kontrollierte klinische Studie. Zielgrößen der eingeschlossenen Studien: zentrale autismusspezifische Symptomatik oder entwicklungspsychologisch belegte Vorläuferfertigkeiten oder Verbesserung der sprachlichen Fertigkeiten. Die Interventionen wurden (1) anhand ihrer wöchentlichen Frequenz sowie (2) anhand der therapeutischen Inhalte sortiert. Spezifische Therapieinhalte, wie die Förderung elterlicher Synchronizität sowie kindlicher gemeinsamer Aufmerksamkeit, Symbolspiel und Imitation einerseits oder die umfassende Förderung verschiedener Entwicklungsbereiche andererseits, wurden in den entsprechenden Studien untersucht. Die soziale Interaktion und Kommunikation verbesserte sich langfristig durch das frühe Training elterlicher Synchronizität und kindlicher Reziprozität sowie durch niedrigfrequente, umfassende, entwicklungsorientierte Therapieprogramme, denen das natürliche Lernformat zugrunde liegt. Hochfrequente, am diskreten Lernformat orientierte Programme zeigten diesbezüglich keine Effekte. Sprachliche Fertigkeiten verbesserten sich ebenfalls durch umfassende Förderung. Der Artikel summiert abschließend die Empfehlungen zu der in diesem Artikel untersuchten Fragestellung.

[Transition in autism spectrum disorders]

Transition in autism spectrum disorders Abstract. Children and adolescents with autism spectrum disorder (ASD) are regularly seen by child and adolescent psychiatrists. Many diagnostic and therapeutic interventions are available for this age group. However, ASD is a rather unknown disorder in adult services, including psychiatry - despite the chronic course and the individual need for diagnosis, intervention, and support also in adulthood. Transition from childhood into adulthood is a rather complex topic that includes the challenge of mastering education and employment. This article presents these transition-related aspects and recommendations to improve healthcare in Germany.

Sensitivity and Specificity of the ADOS-2 Algorithm in a Large German Sample

The aim of the present study was to establish diagnostic validity of the new algorithm of the Autism Diagnostic Observation Scale, the ADOS-2, to differentiate between ASD and other clinically relevant psychiatric and developmental disorders in a large German sample. Validity of ADOS and ADOS-2 diagnostic algorithms was established in 826 individuals (n = 455 autism, n = 216 autism spectrum, n = 155 non-ASD patients) by receiver operating curves. Confidence intervals overlapped largely for ADOS and ADOS-2 algorithms, confirming diagnostic validity of both algorithms. Adding information of the Social Communication Questionnaire and the Social Responsiveness Scale resulted in slightly improved classification rates for autism in Module 4. We thus replicated previous findings of the diagnostic validity of the ADOS-2 algorithms.