Autism is a heterogeneous neurodevelopmental condition characterized by persistent difficulties in social communication and interaction, together with restricted and repetitive patterns of behavior, interests, or activities. Camouflaging-related behaviors and co-occurring psychiatric disorders may make autistic features less visible and contribute to delayed recognition. This study aimed to examine clinical characteristics and camouflaging-related behaviors among children and adolescents with late-diagnosed autism. This retrospective chart review included 46 children and adolescents aged 6–21 years who received an ASD diagnosis after the age of six. Autism diagnoses had been confirmed using a standardized observational assessment. Data were retrospectively extracted using structured case report forms based on clinical records, parental reports, and literature-informed camouflaging-related clinical features. Attention-Deficit/Hyperactivity Disorder was the most common co-occurring psychiatric condition. Masking-related social adaptation behaviors were more common among girls. Giftedness and easy temperament were also observed more frequently in girls and were identified among factors associated with delayed recognition. Boys showed greater behavioral difficulties than girls. Clinician-rated camouflaging scores demonstrated a moderate positive correlation with post-diagnosis Global Assessment Scale scores (r = 0.38). The findings describe a clinically heterogeneous group of late-diagnosed children and adolescents and suggest that camouflaging-related behaviors, co-occurring psychiatric conditions, and contextual factors may reduce the visibility of autistic features. Given the retrospective design, small sample size, and use of a clinician-developed measure of camouflaging-related features, the findings should be interpreted as exploratory.
Parents raising children with Down syndrome (DS) encounter multifaceted adversities that may precipitate trauma responses, yet the intersection of caregiving, systemic barriers, and trauma remains underexplored in low-resourced educational contexts. This study examined the nature, sources, and manifestations of parental trauma among caregivers of children with DS enrolled in Learners with Special Educational Needs (LSEN) schools in Johannesburg, South Africa. Using an interpretative phenomenological design, semi-structured interviews and a focus group were conducted with eight purposively selected parents (seven mothers, one father) whose children attended an LSEN school in Johannesburg. Data were analysed following Interpretative Phenomenological Analysis procedures. Four superordinate themes emerged: (1) traumatic shock at diagnosis and systemic betrayal; (2) cumulative caregiving strain as chronic trauma exposure; (3) secondary trauma from institutional gatekeeping and stigma; and (4) precarious resilience and post-traumatic growth. Parents described diagnostic experiences marked by insensitive communication, fragmented healthcare pathways, and educational exclusion that functioned as compound traumatic events. Chronic hypervigilance, anticipatory grief, and moral injury from inadequate institutional support constituted sustained trauma burdens. Parental trauma in LSEN contexts arises from the convergence of individual psychological responses, systemic failures, and structural violence.
Sarah Parry, Geoff Wong, Steven Ariss, Sadie Rodell, Elaine Craig, Emma Ford, David Graham, Zarah Eve, Joy Duxbury
Children and young people in residential care often face multiple, complex traumas, including the distress of being removed from familiar environments. Trauma-responsive care (TRC) offers a framework for understanding and responding to these experiences, yet there is no standardised TRC intervention specifically designed for children's homes in the UK. This lack of tailored guidance contributes to inconsistent care quality and limited support for staff and service providers. The NEST Study aims to co-produce, pilot, and evaluate a trauma-responsive care intervention for children's homes through co-production and realist methods. NEST seeks to understand how, when, and why TRC interventions work for cared-for children and to develop an implementation toolkit that supports sector-wide improvement. This multi-phase realist co-production study comprises three workstreams: 1. A Rapid Realist Review to develop an initial programme theory of TRC in residential settings. 2. Experience-Based Co-Design (EBCD) with children, staff, and stakeholders to co-create the intervention, in alignment with the programme theory. 3. A Realist Evaluation of the intervention across six children's homes in Northern England, followed by refinement of the implementation toolkit. Up to 150 children and young people, 60 staff, and 30 stakeholders will participate. Mixed methods will include qualitative interviews, creative participatory techniques, and validated and adapted quantitative measures (e.g., SDQ, RCADS, ProQOL). Quantitative data will be analysed using descriptive statistics and regression modelling. All data will be analysed using realist logic to identify, refine and test context-mechanism-outcome configurations. The intervention will be piloted over 12 months. The interpretation of emerging findings will be supported by a Lived Experience Advisory Group and Stakeholder Advisory Board. Anticipated outcomes include a refined realist programme theory of TRC in homes for cared for children and an implementation toolkit for care providers to use. Wellbeing and quality of life measures will provide insights into the impact of the pilot for the children, young people and staff who experience the trauma-responsive care pilot throughout the evaluation process. identifier ISRCTN17921858.
Youth mental health problems are a major and growing global challenge. Although effective interventions exist for many common mental health problems, population-level improvements have been limited. This paradox highlights that intervention effectiveness alone is likely insufficient to generate meaningful public health impact. Interventions must also reach young people, be adopted by services and practitioners, be delivered with quality, and be sustained over time. Drawing on implementation science, we argue that youth mental health research should ask not only “Does this intervention work?” but also “Can this intervention generate population-level impact?”. We illustrate how impact considerations can be embedded throughout the intervention lifecycle. First, we discuss designing for reach and adoption, using single-session interventions as an example of scalable approaches aligned with real-world patterns of service use. Second, we highlight the importance of evaluating effectiveness under routine conditions, drawing on a trial of a modular treatment in outpatient child and adolescent clinics as an example of generating externally valid evidence. Third, we emphasise the need to study implementation and sustainment, using examples from national mental health programmes and implementation research initiatives. To reduce the burden of youth mental health problems, implementation, reach, and sustainment must be treated as core objectives if our work is to have population-level impact.
Paola Linguanti, Irene Troiano, Marika Ricci, Greta Tolomei, Roberta Igliozzi, Antonio Narzisi, Gabriele Masi, Gianluca Sesso, Valentina Viglione
Anxiety in pre-schoolers predicts the persistence of anxiety during school age and mid-adolescence and may also interfere with later social and academic functioning. Currently, while no pharmacological treatments are specifically approved for anxiety disorders in the preschool population, novel nutraceutical compounds with potential anxiolytic effects have received increasing research attention. We conducted an exploratory single-center, longitudinal, interventional study aimed at evaluating the efficacy of a 3-month supplementation with a dietary supplement containing Griffonia and Lactium in 22 preschool children (3–6.11 years; mean age 4.6 ± 0.8 years) diagnosed with an anxiety disorder, either as a primary condition or comorbid with other internalizing and externalizing disorders, particularly emotional dysregulation. A small subpopulation of the sample continued supplementation for a total of 6 months, and efficacy outcomes were compared with those observed in participants who received the supplement for only 3 months. Additionally, maintenance of the effects was assessed at a follow-up evaluation conducted 3 months after discontinuation of the dietary supplement. Efficacy of the dietary supplementation at predefined time points was evaluated using both a parent-reported questionnaire (Preschool Anxiety Scale—Parent Report, PAS) and clinician-rated scales derived from available data, including clinical observation (Children's Global Assessment Scale, CGAS and Clinical Global Impression, CGI). The results of the present study suggest that 3 months of supplementation with a Griffonia- and Lactium-based dietary supplement, in addition to demonstrating a favorable safety profile, may be associated with improvements in anxiety symptoms and overall functioning. These effects appear to be maintained up to three months after treatment discontinuation. Moreover, a longer duration of dietary supplement administration, lasting six months, may appear to be associated with more sustained clinical improvement over time. Although this study provides a relevant contribution to an underexplored area of research in the preschool population, the findings should be considered exploratory and further validation through randomized controlled trials is required.
