Management of Autism Spectrum Disorder in Italian Units of Child and Adolescent Mental Health: Diagnostic and Referral Pathways.

Overall, the present pilot study provides detailed information on clinical management for Autism Spectrum Disorder (ASD) referral and diagnosis processes that are mandatory for child and adolescent mental health management. The analysis of ASD management, even if carried out on a selected sample of Child and Adolescent Mental Health (CAMH) units, represents a good approximation of how, in Italian outpatient settings, children and adolescents with ASD are recognised and eventually diagnosed. One of the aims of the study was to verify the adherence of Italian CAMH units to international recommendations for ASD referral and diagnosis and whether these processes can be traced using individual chart reports. Overall, the analysis evidenced that Italian CAMH units adopt an acceptable standard for ASD diagnosis, although the reporting of the ASD managing process in the individual chart is not always accurate. Furthermore, data collected suggest some improvements that CAMH units should implement to fill the gap with international recommendations, namely, establishing a multidisciplinary team for diagnosis, improving the assessment of physical and mental conditions by the use of standardised tools, implementing a specific assessment for challenging behaviours that could allow timely and specific planning of intervention.

Factors associated with the transition of adolescent inpatients from an intensive residential ward to adult mental health services.

Transition of young people from Child and Adolescent Mental Health Services (CAMHS) to Adult Mental Health Services (AMHS) is a complex process. Transition rates are heterogeneously reported, with wide definitions and ranges. Few data are available regarding predictive factors of a successful transition. We explored factors associated with transition in a cohort of former inpatients of a Children and Adolescents Intensive Treatment Ward (CAITW). Socio-demographic and clinical features of patients previously admitted to CAITW were matched to AMHS data for those patients having reached age requirements. We built multiple logistic regression models to identify factors associated with transfer to AMHS (either inpatient or outpatient) and with successful retention in treatment (RIT) at six (short RIT), 12 (intermediate RIT) and 24 months after transfer (long RIT). From a cohort of 322 inpatients, 126 reached the age threshold for transfer to AMHS in the study period. The transfer rate was 50%. Two years after transition-age boundary, CAMHS-AMHS continuity of care was found in 40% and disengagement in 6% of cases. Longer and multiple hospitalizations, atypical antipsychotics prescription and a diagnosis of psychotic disorders were factors associated with short and intermediate RIT. A positive psychiatric family history was negatively associated with successful short and intermediate RIT. Diagnosis of psychosis and learning-supported school attendance were associated with long RIT. Young adults with a history of psychiatric inpatient admission as children or adolescents have a relatively high rate of transition to AMHS. A diagnosis of psychosis seems to be the strongest predictor for transition in these patients. Further research should focus on patients' schooling needs and on children of parents with mental health problems to enhance family and educational system engagement.

Genetic and Non Genetic Hearing Loss and Associated Disabilities: An Epidemiological Survey in Emilia-Romagna Region.

Hearing loss is one of the most common congenital sensory disorders. It can be associated with several comorbidities, in particular developmental disabilities (DD). In Emilia-Romagna (ER), a region in Northern Italy, Child and Adolescent Mental Health Services (CAMHS) provide the diagnostic framework and treatment for these conditions. The aim of the present study is to evaluate the prevalence of hearing loss, both isolated or in association with comorbidities, in the juvenile population. The study draws its data from the ER Childhood and Adolescent Neuropsychiatry Information System (SINPIAER), an Administrative Healthcare Database collecting the clinical data of all those who have attended CAMHS since 2010. The most frequent type of hearing loss was bilateral sensorineural hearing loss, which was present in 69-72% of the cases, while bilateral conductive hearing loss was the second most common type, ranging from 8 to 10%. Among DD, congenital malformations, mental retardation, visual impairment, and cerebral palsy were the most common. In particular, autism spectrum disorders show increasing incidence and prevalence among CAMHS users in ER region. In-depth knowledge of hearing loss epidemiology and related conditions, such as developmental disabilities, in the juvenile population is crucial for disease prevention, health planning, and resource allocation.

Hearing Loss in Children: Clinical-Epidemiological Data from Two Different Provinces of the Same Region.

BACKGROUND: In many countries, neonatal hearing screening programs (NHS) have been available for many years; however, because of the presence of hearing loss at late onset, early hearing detection programs (EHDP) have been implemented. The aim of this study was to evaluate all cases of infantile hearing loss under the care of two different provinces of a regional health service since the introduction of NHS. METHODS: Clinical data (the presence of audiological risk factors, age at which children are placed under the care of health service, entity of hearing loss, treatment, and exposure to bilingualism) were retrospectively collected during the period from 1 January 2012 to 31 December 2018, starting from the IT management system used in all of the regional neuropsychiatric services. RESULTS: In total, 124 children were included-116 cases failed the screening, 1 case had an untraceable result, and 7 cases (5.6%) had hearing screening that passed. Most of the children were placed under the care of a neuropsychiatric infantile and adolescence (NPIA) service within the first year of life. The main differences across the two provinces concerned the percentages of audiological risk factors and the number of unilateral hearing loss cases. CONCLUSION: In order to plan and manage hearing rehabilitation programs for children in the best way, it is very important to know the local clinical-epidemiological features of the population.

Neuroprem: the Neuro-developmental outcome of very low birth weight infants in an Italian region.

INTRODUCTION: The survival of preterm babies has increased worldwide, but the risk of neuro-developmental disabilities remains high, which is of concern to both the public and professionals. The early identification of children at risk of neuro-developmental disabilities may increase access to intervention, potentially influencing the outcome. AIMS: Neuroprem is an area-based prospective cohort study on the neuro-developmental outcome of very low birth weight (VLBW) infants that aims to define severe functional disability at 2 years of age. METHODS: Surviving VLBW infants from an Italian network of 7 neonatal intensive care units (NICUs) were assessed for 24 months through the Griffiths Mental Developmental Scales (GMDS-R) or the Bayley Scales of Infant and Toddler Development (BSDI III) and neuro-functional evaluation according to the International Classification of Disability and Health (ICF-CY). The primary outcome measure was severe functional disability at 2 years of age, defined as cerebral palsy, a BSDI III cognitive composite score < 2 standard deviation (SD) or a GMDS-R global quotients score < 2 SD, bilateral blindness or deafness. RESULTS: Among 211 surviving VLBW infants, 153 completed follow-up at 24 months (72.5%). Thirteen patients (8.5%) developed a severe functional disability, of whom 7 presented with cerebral palsy (overall rate of 4.5%). Patients with cerebral palsy were all classified with ICF-CY scores of 3 or 4. BSDI III composite scores and GMDS-R subscales were significantly correlated with ICF-CY scores (p < 0.01). CONCLUSION: Neuroprem represents an Italian network of NICUs aiming to work together to ensure preterm neuro-developmental assessment. This study updates information on VLBW outcomes in an Italian region, showing a rate of cerebral palsy and major developmental disabilities in line with or even lower than those of similar international studies. Therefore, Neuroprem provides encouraging data on VLBW neurological outcomes and supports the implementation of a preterm follow-up programme from a national network perspective.

The production of direct object clitics in pre-school- and primary school-aged children with specific language impairments.

Third-person direct object (DO) clitic pronoun production is examined through an elicited production method in pre-school- and primary school-aged groups of Italian children with specific language impairment (SLI) to establish whether there is an improvement from age 5 years to age 7 years and whether there are qualitative differences in the two groups' responses. It was found that 5- and 7-year-old Italian children with SLI produce fewer third-person DO clitics than same-age peers. The kind of responses they provide changes: at 5 years, children with SLI tend to omit clitics, while at 7 years, they use a full noun. Production of third-person DO clitics is a persistent challenge for children with SLI and is confirmed to be a good clinical marker both at 5 and 7 years of age.

Continuity of care from child and adolescent to adult mental health services: evidence from a regional survey in Northern Italy.

To examine clinical and demographic factors associated with continuity of care from child-adolescent (CAMHS) to adult mental health services (AMHS), we undertook a record-linkage study to the Adult Mental Health Information System including all those 16 years old and over who were listed between 2010 and 2013 in the Child and Adolescent Neuropsychiatry Information System in Emilia-Romagna, an Italian region of nearly 4.5 million residents. From a cohort of 8239 adolescents attending CAMHS (population at risk about 144,000), 821 (19.4 %) moved to AMHS, excluding cases with specific developmental disorders, whose conditions were not managed by adult psychiatrists, and those with mental retardation who attended usually social services. Young people referred for treatment to AMHS were more likely to receive a discharge diagnosis of schizophrenia and related disorders (Odds Ratio [OR] 3.92; 95 % confidence interval [CI] 2.17-7.08), personality disorders (OR 2.69; 95 % CI 1.89-3.83), and pervasive developmental disorders (OR 2.13; 95 % CI 1.51-2.99). Further factors predicting transfer to AMHS were not living with parents, inpatient psychiatric admission, and being on medication in the previous 24 months. These findings suggest that a relatively small number of adolescents moved to AMHS and are likely to reflect the configuration of local mental health services and alternative care available, mainly for those with less-severe mental disorders.