Pietro Muratori

Background: Pharmacological treatments are frequently prescribed for adolescents with anorexia nervosa (AN), mainly to address psychiatry comorbidities and associated clinical features, although evidence supporting medication-specific effects remains limited. This retrospective study examined 12-month clinical trajectories associated with different pharmacological treatment patterns in a cohort of female adolescents with AN admitted to a tertiary university hospital. Methods: Clinical records of 102 female patients aged 12–18 years with AN were retrospectively reviewed. Participants were first classified according to whether they received any pharmacological treatment and were subsequently divided into six groups: no medication, antidepressants, antipsychotics, mood stabilizers, combination therapy, and medication switching. Body mass index (BMI), Clinical Global Impression—Severity (CGI-S), Children’s Global Assessment Scale (C-GAS), and item 40 of the Structured Interview for Anorexic and Bulimic Syndromes—Expert Form (SIAB-EX) were evaluated at admission (T0, before treatment initiation), at 6-month follow-up (T1), and at 12-month follow-up (T2). Results: BMI improved significantly over time across all treatment groups. Compared with participants who received any form of pharmacological treatment, the non-medicated group exhibited a significantly greater increase in mean CGI-S scores and significantly greater reductions in mean C-GAS and SIAB-EX scores. Baseline comparison among the six treatment groups showed significant differences in CGI-S, C-GAS, and SIAB-EX item 40 scores, indicating that the groups were not fully comparable in terms of initial clinical severity, global functioning, and physical hyperactivity. Patients in the medication-switching group generally showed smaller improvements, whereas findings in the mood-stabilizer group should be interpreted cautiously because of the very small sample size. Conclusions: In this real inpatients cohort, adolescents with AN showed clinical improvement over 12 months across different pharmacological treatment patterns. However, baseline differences between groups and the non-randomized retrospective design preclude causal conclusions regarding medication-specific effectiveness. These findings should be interpreted as descriptive clinical trajectories associated with treatment patterns selected in routine care. Further prospective studies with standardized treatment data and adequately powered subgroups are needed.

Background/Objectives: The aim of this pilot study was to examine the effect of an eight-session mindful parenting intervention on parents’ mindfulness and parenting dimensions. Methods: The intervention was delivered to parents of children with Neurodevelopmental Disorder Diagnosis, followed in a child psychiatry hospital. The sample included 63 adults (40 females; mean age = 44 years). At the beginning and end of the intervention, participants completed questionnaires assessing positive and negative parenting and five mindfulness dimensions. Paired-sample t-tests were conducted to detect significant changes in the relevant measures from pre- to post-intervention. Results: Results revealed improvements in Negative Parenting (t = 2.82, p = 0.008, Hedges g = 0.29), Acting with Awareness (t = −2.14, p = 0.039, Hedges g = 0.26), Non-Judging (t = −2.17, p = 0.037, Hedges g = 0.35), and Non-Reacting (t = −2.68, p = 0.011, Hedges g = 0.52). Conclusions: Despite its preliminary results and single-group pre–post design, this pilot study aligns with evidence supporting mindful parenting interventions and provides initial insights into their impact on parents of children with neurodevelopmental disorders.

Parenting is among the most relevant factors implicated in the development and maintenance of children’s externalizing and internalizing problems. Despite a large body of literature investigating the influence of parenting on children’s outcomes, most studies relied on mothers’ data. Little is known about the role of paternal parenting, but increasing evidence suggested that fathers are as equally important as mothers in children’s development and well-being. The current systematic review aimed to summarize the associations between paternal parenting and externalizing and internalizing problems in children aged 6 to 13, a delicate period during which parenting is crucial to help children adjust to the challenges (e.g., school transition) it poses. Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, we conducted a systematic search on three databases (i.e., Scopus, PubMed, PsycINFO), which led to the selection of 45 articles. Despite some mixed results, studies showed that positive paternal parenting was related to fewer externalizing and internalizing problems in the offspring, while negative parenting practices are associated with greater symptoms. Externalizing problems appeared to be linked to discipline-related paternal behavior, while internalizing problems seemed influenced by the emotional quality of father–child relationships. This underscores the importance of actively involving fathers in clinical research and parenting interventions aimed at addressing children’s behavioral and emotional difficulties.

Background: Although self-compassion has been consistently linked to positive outcomes in adults and adolescents, only a few studies have explored self-compassion in children and early adolescents due to a lack of measures specifically designed for younger populations. Methods: The current study explored the psychometric properties of the Italian translation of the Self-Compassion Scale for Children (SCS-C) in a sample of 230 children (mean age = 10.52, SD = 1.33). Results: The results revealed a two-factor solution for our data, with a positive self-compassion factor and a negative self-compassion factor, which were shown to be internally consistent. The SCS-C scores correlated with the children’s mindfulness, self-esteem, and narcissistic traits in the assumed directions. Conclusions: Overall, our study preliminarily supports the reliability and validity of the Italian version of the SCS-C.

We are pleased to introduce this Special Issue of the Journal of Clinical Medicine, dedicated to “(Recent Advances) Treating Psychiatric Disorders in Children and Adolescents: From Theory to Practice”, which addresses one of the most critical topics in mental health nowadays

Background: Lithium is the gold-standard treatment for Bipolar Disorder (BD) in both adults and adolescents, effectively managing mood episodes and reducing suicide risk. While its efficacy in neurotypical youth is well established, its use in adolescents with Autism Spectrum Disorder (ASD) and comorbid BD remains under-researched. Here, we present the protocol for a study aiming to evaluate the efficacy and tolerability of Extended-Release Lithium Salts in treating adolescents with BD and comorbid ASD compared to neurotypical BD patients. Methods: This longitudinal prospective naturalistic comparative study will enroll lithium-naïve adolescents aged 12–18 with BD, with or without comorbid ASD, from the Department of Child and Adolescent Psychiatry and Psychopharmacology. Participants will be followed for six months while receiving Extended-Release Lithium Salts treatment. Primary outcomes will include mood instability, suicidality, emotional dysregulation, and aggression, assessed through a range of clinical rating scales and diagnostic tools at baseline, three months, and six months. Secondary outcomes will focus on the safety and tolerability of Extended-Release Lithium Salts, with measures including side effect ratings, physical exams, and laboratory tests. Results: We hypothesize that Extended-Release Lithium Salts will demonstrate non-inferiority in treating BD symptoms in adolescents with comorbid ASD compared to those without ASD. Conclusions: This study is poised to fill a significant gap in the literature by providing critical data on the use of lithium for adolescents with BD and ASD. Findings will inform clinical practice and future research, potentially guiding more personalized treatment approaches for this complex and vulnerable population.

Literature on the Inventory of Callous-Unemotional (ICU) traits has suggested different versions of the instrument for assessing these traits during development. However, consensus on the instrument version and the best factorial solution remains a matter of debate, with only a few studies having validated ICU versions from a longitudinal perspective. The current study aims to contribute to the literature by comparing ICU models in a longitudinal sample of early adolescents (N = 739; 70.6% of eligible subjects, 371 females and 368 males, in the 6th grade at baseline assessment and in the 8th grade at the second assessment). We tested the validity of various versions of the ICU scales and their respective dimensions by conducting a series of confirmatory factor analyses to verify the factor structure, alongside assessments of internal consistency. For the best-fitting structure, we then analyzed gender and longitudinal invariance in addition to construct and predictive validity, using internalizing and externalizing criteria as well as prosocial behavior. From the comparative analysis, it emerged that the abbreviated 11-item ICU scale version displayed overall better data fit than the full 24-item version. Moreover, its confirmed gender invariance underscores its applicability across genders within the studied age group. With regard to longitudinal invariance, our findings advise caution when comparing ICU scores across early adolescence. Practical implications are discussed.

Empathy is crucial to the development of socio-emotional skills in youth and empathy development is central to understanding and subtyping youth with externalizing problems. This study explored for the first time the psychometric properties of the Measure of Empathy in Early Childhood (MEEC) in a sample of 652 Italian children aged 6 to 8 years. The gender invariance of MEEC scores and their associations with other measures of empathy and prosocial behavior, and children’s externalizing problems and callous-unemotional (CU) traits were also evaluated. Results indicated that with some modifications, a 5-factor structure of the Italian version of MEEC scores fitted the data and was invariant across gender. Results further supported the reliability and validity of MEEC total and subscale scores. Practical implications of these results are discussed.

Psychopathic traits in community and referred youths are strongly associated with severe externalizing problems and low prosocial behavior. However, less is known about the mechanisms that may link youth psychopathy and these outcomes. Social dominance orientation (SDO), defined as the general individual orientation toward unequal and dominant/subordinate relationships, might represent a valuable construct to explore to better understand the association between psychopathic traits, externalizing problems, and prosocial behavior. Based on this, the current study aimed to investigate the relationship between psychopathic traits, SDO, externalizing problems, and prosocial behavior in a community sample (N = 92, 45.57% females, mean age = 12.53, and SD = 0.60) and in a clinical (N = 29, 9% female, mean age = 12.57, and SD = 0.57) samples of adolescents with Oppositional Defiant Disorder or Conduct Disorder. Results showed that SDO mediated the relationship between psychopathic traits and externalizing problems and between psychopathic traits and prosocial behavior only in the clinical sample. These findings can provide valuable information on psychopathic trait correlates in youths with aggressive behavior disorders; treatment implications are discussed.

Research on the association between callous–unemotional (CU) traits and intelligence yielded contradictory results. Moreover, several previous studies focused on global intelligence scores or verbal vs. nonverbal/performance abilities usually evaluated with short/abbreviated instruments. The current study builds on these previous works and explores the link between CU traits and intelligence using the full version of the Wechsler Intelligence Scale for Children—4th Edition (WISC-IV), which provides four different verbal and nonverbal abilities scores. This guarantees a more detailed evaluation of children’s intelligence and its relation to CU traits. The sample included children (N = 149; age 6–14 years old) with severe behavioral problems. Clinicians administered the WISC-IV, and parents completed questionnaires evaluating the child’s externalizing problems and CU traits. Findings showed that CU traits were associated with lower verbal comprehension scores after also controlling for gender, age, externalizing problems, and the other WISC-IV indexes. In addition, CU traits and externalizing problems did not interact in predicting the WISC-IV indexes, and there were no significant differences in the WISC-IV indexes between children with CU traits and high vs. low externalizing problems. The current study suggests the relevance of assessing and addressing verbal abilities in children with behavioral problems and CU traits.