Teleological Perspectives in Child and Adolescent Development.

The way adults think about children is of enormous consequence. Around the world, adults are "in charge" of children, claiming responsibility for their safety and lives. This may seem natural and intuitive, but adult concepts of youth, including in the sciences of development, can lead to a worldview in which the adult is seen as better, more important, more complex, and more valuable than the child.1.

Developing an appropriate evolutionary baseline model for the study of SARS-CoV-2 patient samples.

Over the past 3 years, Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) has spread through human populations in several waves, resulting in a global health crisis. In response, genomic surveillance efforts have proliferated in the hopes of tracking and anticipating the evolution of this virus, resulting in millions of patient isolates now being available in public databases. Yet, while there is a tremendous focus on identifying newly emerging adaptive viral variants, this quantification is far from trivial. Specifically, multiple co-occurring and interacting evolutionary processes are constantly in operation and must be jointly considered and modeled in order to perform accurate inference. We here outline critical individual components of such an evolutionary baseline model-mutation rates, recombination rates, the distribution of fitness effects, infection dynamics, and compartmentalization-and describe the current state of knowledge pertaining to the related parameters of each in SARS-CoV-2. We close with a series of recommendations for future clinical sampling, model construction, and statistical analysis.

Editors' Best of 2022.

There is, in the content of the Journal, an embarrassment of riches, and picking a "best" seems to demand a certain qualification: is the "best" the most interesting, most surprising, most educational, most important, most provocative, most enjoyable? How to choose? We are hardly unbiased and can admit to a special affection for the ones that we and the authors worked hardest on, hammering version after version into shape. Acknowledging these biases, here are the 2022 articles that we think deserve your attention or at least a second read.

Editors' Note: Second Annual Report Regarding JAACAP's Antiracist Journey.

In 2020, we wrote to you of our dedication and vision for this Journal "to be antiracist at every level," outlining the following 6 initiatives "to reshape the Journal to pursue this vision:" (1) Issuing a Call for Papers on racism and its impacts on child development and children's mental health; (2) updating our Guide for Authors to emphasize that we will evaluate articles submitted to the Journal on whether their study designs are inclusive and their discussions consider and address human diversity and structural determinants of health in the context of their research questions and hypotheses; (3) assembling a special collection of Journal articles on bias, bigotry, discrimination, racism, and mental health inequities; (4) accelerating our efforts to make our Editorial Board inclusive and representative of our community of scientists and practitioners as well as the communities we serve; (5) engaging in continuing education and dialogue as an Editorial Board that will include antiracism training and praxis; and (6) critically examining "our editorial and peer review process to ensure it is antiracist."1 In this Editors' Note, we write to update you on our progress, including a new initiative we started in the past year: (7) a new option for authors to add a statement to their manuscripts regarding the inclusion and diversity initiatives and practices they employed in pursuing their work. With the launch this year of JAACAP Open, the Academy's new open access publication and the newest member of the JAACAP family of journals, we have expanded opportunities to pursue these efforts, and look forward to sharing more about JAACAP Open in future updates.

Editors' Best of 2021.

There is, in the content of the Journal, an embarrassment of riches, and picking a "best" seems to demand a certain qualification: is the "best" the most interesting, most surprising, most educational, most important, most provocative, most enjoyable? How to choose? We are hardly unbiased and can admit to a special affection for the ones that we and the authors worked hardest on, hammering version after version into shape. Acknowledging these biases, here are the 2021 articles that we think deserve your attention or at least a second read.

Editors' Note: First Annual Report Regarding JAACAP's Antiracist Journey.

Last year, we wrote to you of our dedication and vision for this journal "to be antiracist at every level," outlining the following 6 initiatives "to reshape the Journal to pursue this vision:" (1) Issuing a Call for Papers "on racism and its impacts on child development and children's mental health;" (2) updating our Guide for Authors "to emphasize that we will evaluate articles submitted to the Journal on whether their study designs and discussions consider and address human diversity in the context of their research questions and hypotheses; (3) assembling a special collection of "Journal articles on bias, bigotry, racism, and mental health disparities;" (4) accelerating "our efforts to make our editorial board inclusive and representative of our community of scientists and practitioners as well as the communities we all serve;" (5) engaging in "continuing education and dialogue as an Editorial Board that will include antiracism training;" and (6) critically examining "our editorial and peer review process to ensure it is antiracist.1 In this Editors' Note, we write to update you on our progress.

Leveraging natural history biorepositories as a global, decentralized, pathogen surveillance network.

The Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) pandemic reveals a major gap in global biosecurity infrastructure: a lack of publicly available biological samples representative across space, time, and taxonomic diversity. The shortfall, in this case for vertebrates, prevents accurate and rapid identification and monitoring of emerging pathogens and their reservoir host(s) and precludes extended investigation of ecological, evolutionary, and environmental associations that lead to human infection or spillover. Natural history museum biorepositories form the backbone of a critically needed, decentralized, global network for zoonotic pathogen surveillance, yet this infrastructure remains marginally developed, underutilized, underfunded, and disconnected from public health initiatives. Proactive detection and mitigation for emerging infectious diseases (EIDs) requires expanded biodiversity infrastructure and training (particularly in biodiverse and lower income countries) and new communication pipelines that connect biorepositories and biomedical communities. To this end, we highlight a novel adaptation of Project ECHO's virtual community of practice model: Museums and Emerging Pathogens in the Americas (MEPA). MEPA is a virtual network aimed at fostering communication, coordination, and collaborative problem-solving among pathogen researchers, public health officials, and biorepositories in the Americas. MEPA now acts as a model of effective international, interdisciplinary collaboration that can and should be replicated in other biodiversity hotspots. We encourage deposition of wildlife specimens and associated data with public biorepositories, regardless of original collection purpose, and urge biorepositories to embrace new specimen sources, types, and uses to maximize strategic growth and utility for EID research. Taxonomically, geographically, and temporally deep biorepository archives serve as the foundation of a proactive and increasingly predictive approach to zoonotic spillover, risk assessment, and threat mitigation.

Editors' Note and Special Communication: Research Priorities in Child and Adolescent Mental Health Emerging From the COVID-19 Pandemic.

Over the last year, the coronavirus disease 2019 (COVID-19) pandemic has resulted in profound disruptions across the globe, with school closures, social isolation, job loss, illness, and death affecting the lives of children and families in myriad ways. In an Editors' Note in our June 2020 issue,1 our senior editorial team described this Journal's role in advancing knowledge in child and adolescent mental health during the pandemic and outlined areas we identified as important for science and practice in our field. Since then, the Journal has published articles on the impacts of the pandemic on child and adolescent mental health and service systems,2-5 which are available in a special collection accessible through the Journal's website.6 Alongside many opinion papers, the pace of publication of empirical research in this area is rapidly expanding, covering important issues such as increased frequency of mental health symptoms among children and adolescents3,5,7-10 and changes in patterns of clinical service use such as emergency department visits.11-14 As the Senior Editors prepared that Editors' Note, they were acutely aware that the priorities that they identified were broad and generated by only a small group of scientists and clinicians. Although this had the advantage of enabling us to get this information out to readers quickly, we decided that a more systematic approach to developing recommendations for research priorities would be of greater long-term value. We were particularly influenced by the efforts of the partnership between the UK Academy of Medical Scientists and a UK mental health research charity (MQ: Transforming Mental Health) to detail COVID-19-related research priorities for "Mental Health Science" that was published online by Holmes et al. in The Lancet Psychiatry in April 2020.15 Consistent with its focus on mental health research across the lifespan, several recommendations highlighted child development and children's mental health. However, a more detailed assessment of research priorities related to child and adolescent mental health was beyond the scope of that paper. Furthermore, the publication of that position paper preceded the death of George Floyd at the hands of Minneapolis police on May 25, 2020, which re-energized efforts to acknowledge and to address racism and healthcare disparities in the United States and many other countries. To build upon the JAACAP Editors' Note1 and the work of Holmes et al.,15 we conducted an international survey of professionals-practitioners and researchers-working on child and adolescent development and pediatric mental health to identify concerns about the impact of the pandemic on children, adolescents, and their families, as well as what is helping families navigate these impacts, and the specific research topics that are of greatest importance.

Editors' Best of 2020.

There is, in the content of the Journal, an embarrassment of riches, and picking a "best" seems to demand a certain qualification: is the "best" the most interesting, most surprising, most educational, most important, most provocative, most enjoyable? How to choose? We are hardly unbiased and can admit to a special affection for the ones that we and the authors worked hardest on, hammering version after version into shape. Acknowledging these biases, here are the 2020 articles that we think deserve your attention, or at least a second read.

Editorial: Analyzing Treatment and Prescribing in Large Administrative Datasets With a Lens on Equity.

In this issue of the Journal, Bushnell and colleagues1 present findings from their analysis of a commercial insurance administrative dataset, examining the ways that antipsychotics are used in young children (aged 2-7 years) in the United States. From 2009 to 2017, they find that the use of antipsychotics decreased and there was a shift toward use of medications in alignment with evidence-based standards. The most common conditions for use of antipsychotics included pervasive developmental disorders, externalizing disorders, and attention-deficit/hyperactivity disorder. More troubling were the findings that less than half of young children on antipsychotics had a visit with a psychiatrist, and only a third of children had evidence of a minimum dose of psychotherapy. These findings deserve attention and should be a cause for strengthening the use of existing treatment guidelines for preschool and younger children. They should also prompt enhanced advocacy to expand access to evidence-based mental health care for children that includes high-quality psychiatric assessment, treatment, and psychotherapy. The latter includes increasing the number of child and adolescent psychiatrists who focus on preschool-aged and younger children.

Reassortment Between Divergent Strains of Camp Ripley Virus (Hantaviridae) in the Northern Short-Tailed Shrew (Blarina brevicauda).

Genomic reassortment of segmented RNA virus strains is an important evolutionary mechanism that can generate novel viruses with profound effects on human and animal health, such as the H1N1 influenza pandemic in 2009 arising from reassortment of two swine influenza viruses. Reassortment is not restricted to influenza virus and has been shown to occur in members of the order Bunyavirales. The majority of reassortment events occurs between closely related lineages purportedly due to molecular constraints during viral packaging. In the original report of Camp Ripley virus (RPLV), a newfound hantavirus in the northern short-tailed shrew (Blarina brevicauda), phylogenetic incongruence between different genomic segments suggested reassortment. We have expanded sampling to include RPLV sequences amplified from archival tissues of 36 northern short-tailed shrews collected in 12 states (Arkansas, Iowa, Kansas, Maryland, Massachusetts, Michigan, Minnesota, New Hampshire, Ohio, Pennsylvania, Virginia, Wisconsin), and one southern short-tailed shrew (Blarina carolinensis) from Florida, within the United States. Using Bayesian phylogenetic analysis and Graph-incompatibility-based Reassortment Finder, we identified multiple instances of reassortment that spanned the Hantaviridae phylogenetic tree, including three highly divergent, co-circulating lineages of the M segment that have reassorted with a conserved L segment in multiple populations of B. brevicauda. In addition to identifying the first known mobatvirus-like M-segment sequences from a soricid host and only the second from a eulipotyphlan mammal, our results suggest that reassortment may be common between divergent virus strains and provide strong justification for expanded spatial, temporal, and taxonomic analyses of segmented viruses.

Our Vision: An Antiracist Journal.

Our renewed vision for the Journal is to be antiracist at every level. To achieve this, we will go beyond our long-standing charge to advance the knowledge of child development, children's mental health, and prevention and treatment of mental illness to solicit and disseminate research that addresses the systemic presence of racism and its influence on the health and well-being of children of color and their families. We acknowledge that our efforts as a journal to address these inequities have been insufficient and that dismantling the threads of White supremacy requires us to take a more active role. We pledge to do the work to advance research that understands the individual, cultural, and societal factors that contribute to the persistent disparities we have previously noted but failed to correct.

JAACAP's Role in Advancing the Science of Pediatric Mental Health and Promoting the Care of Youth and Families During the COVID-19 Pandemic.

As we pen these words, the COVID-19 pandemic is having profound impacts on human society. Based on decades of research, we know that the accompanying illness,1 death,2 social isolation,3,4 and malnutrition5 will have deep and lasting impacts on our children and adolescents, their families, and the communities in which they develop. The pandemic is exposing, with terrible clarity, the disparities in human society-racism,6 poverty,7,8 domestic violence,9,10 and child maltreatment and neglect11-and tragically will likely amplify the negative impacts that each has on child development and mental health.

A Case of Clinical Scholarship.

A 32-year-old child and adolescent psychiatry resident with a history of presenting an abstract at a local psychiatric conference during residency and fourth authorship on an immunotherapy paper from a summer internship during medical school presents with a new-onset desire to write a case report. She has just come off her consultation liaison rotation, during which she consulted on a 12-year-old boy with attention-deficit/hyperactivity disorder, oppositional defiant disorder, disruptive mood dysregulation disorder, and low depressive state hospitalized for pseudoseizures, a new-onset inability to walk, and aggressive outbursts. He had a negative magnetic resonance imaging scan, negative computed tomography scan, negative laboratory test results, and an unremarkable lumbar puncture. Based on an equivocal electroencephalogram, a neurology resident decided to prescribe a mood stabilizer, obtained it himself from the pharmacy, and administered it to the patient intravenously, only then realizing that it was six times the intended loading dose. Before anybody could stop him, the resident erased all documentation about the medication and fled the city. Nevertheless, that afternoon, before the error and fraud were caught by a pharmacist and before the child and his family were notified, the child's symptoms appeared to resolve and the child walked comfortably for the first time in months. The child and adolescent psychiatry resident is tentatively titling the case report, "Resolution of Conversion Disorder With a Megadose of Unknown Mood Stabilizer."

Editors' Best of 2019.

There is, in the content of the Journal, an embarrassment of riches, and picking a "best" seems to demand a certain qualification: is the "best" the most interesting, most surprising, most educational, most important, most provocative, most enjoyable? How to choose? We are hardly unbiased and can admit to a special affection for the ones that we and the authors worked hardest on, hammering version after version into shape. Acknowledging these biases, here are the 2019 articles that we think deserve your attention or at least a second read.

Complex History of Codiversification and Host Switching of a Newfound Soricid-Borne Orthohantavirus in North America.

Orthohantaviruses are tightly linked to the ecology and evolutionary history of their mammalian hosts. We hypothesized that in regions with dramatic climate shifts throughout the Quaternary, orthohantavirus diversity and evolution are shaped by dynamic host responses to environmental change through processes such as host isolation, host switching, and reassortment. Jemez Springs virus (JMSV), an orthohantavirus harbored by the dusky shrew (Sorex monticola) and five close relatives distributed widely in western North America, was used to test this hypothesis. Total RNAs, extracted from liver or lung tissue from 164 shrews collected from western North America during 1983-2007, were analyzed for orthohantavirus RNA by reverse transcription polymerase chain reaction (RT-PCR). Phylogenies inferred from the L-, M-, and S-segment sequences of 30 JMSV strains were compared with host mitochondrial cytochrome b. Viral clades largely corresponded to host clades, which were primarily structured by geography and were consistent with hypothesized post-glacial expansion. Despite an overall congruence between host and viral gene phylogenies at deeper scales, phylogenetic signals were recovered that also suggested a complex pattern of host switching and at least one reassortment event in the evolutionary history of JMSV. A fundamental understanding of how orthohantaviruses respond to periods of host population expansion, contraction, and secondary host contact is the key to establishing a framework for both more comprehensive understanding of orthohantavirus evolutionary dynamics and broader insights into host-pathogen systems.

What Is "High Risk" and What Are We Actually Supposed to Do About It?

Regulatory agencies are increasingly taking on the important issue of effective risk assessment, risk stratification, and treatment planning for youth with psychiatric illness.1 The Joint Commission mandates a suicide assessment for patients "who exhibit suicidal behavior or who have screened positive for suicidal ideation" followed by risk stratification: after "this assessment, patients should be classified as high, medium or low risk of suicide."2 We anticipate that just as screening for depression and suicidality was initially restricted to emergency departments and inpatient units before being rolled out across all care settings, so risk stratification requirements will roll out to these other settings as well.

Editors' Best of 2018.

There is, in the content of the Journal, an embarrassment of riches, and picking a "best" seems to demand a certain qualification: is the "best" the most interesting, most surprising, most educational, most important, most provocative, most enjoyable? How to choose? We are hardly unbiased and can admit to a special affection for the ones that we and the authors worked hardest on, hammering version after version into shape. Acknowledging these biases, here are the 2018 articles that we think deserve your attention or at least a second read.