Background and Objectives: Sleep disorders are common in children with Autism Spectrum Disorder (ASD). The aims of this study were to describe the incidence and characteristics of sleep disorders using a questionnaire completed by the caregiver in a sample of preschool-aged children with ASD and to identify possible differences in a control group of peers. Materials and Methods: Sleep disorders were investigated with the Sleep Disturbance Scale for Children (SDSC) in a population of pre-school-aged (3–5 years) ASD children and in a control group. The Autism Diagnostic Observation Schedule—second ed. (ADOS-2) was further used to assess autism symptom severity. A total of 84 children (69 males; mean age 3.9 ± 0.8 years) with a diagnosis of ASD and 84 healthy controls (65 males; mean age of 3.7 ± 0.8 years) that were matched for age and sex were enrolled. Results: ASD children reported significantly higher (pathological) scores than the control group on the SDSC total scores and in some of the factor scores, such as Difficulty in Initiating and Maintaining Sleep (DIMS), disorders of excessive somnolence (DOES), and sleep hyperhidrosis. A total of 18% of ASD children had a pathological SDSC total T-score, and 46% had an abnormal score on at least one sleep factor; DIMS, parasomnias, and DOES showed the highest rates among the sleep factors. Younger children (3 years) reported higher scores in DIMS and sleep hyperhidrosis than older ones (4 and 5 years). No specific correlation was found between ADOS-2 and SDSC scores. Conclusions: Pre-school children with ASD showed a high incidence of sleep disorders with different distributions of specific sleep factors according to their age. We suggest a screening assessment of sleep disorders using the SDSC in these children with a more in-depth evaluation for those reporting pathological scores on the questionnaire.

Access to the emergency department (ED) for acute psychiatric problems, especially for suicide attempts (SA), has increased in the last decade. This increase has exceptionally accelerated after the COVID-19 pandemic. The aim of this project was to study the increase in acute psychiatric care demand of children and adolescents in the short and medium term after the pandemic, in relation to public health measures and in comparison with a pre pandemic reference period. We retrospectively studied 5445 child psychiatric (CP) consultations requested for any reason and for suicide attempt (SA), suicidal ideation (SI) and non-suicidal self-injury (NSSI) in a pediatric ED during three different pandemic periods in Italy (from March 2020 to May 2022) and compared them to a pre-pandemic reference period (from January 2018 to February 2020). Monthly CP consultations for any reason increased significantly by 2.2 times from 70.9 in 2018 to 157 in 2022 (p < 0.001). During the pandemic, monthly CP consultations for any reason increased significantly from 75/month in the first lockdown to 153/month in the second lockdown, remaining stable in the following year. CP consultations for SA increased significantly from 5/month in the first lockdown to 16/month in the second. Consultations for SI increased gradually but significantly from the pre-pandemic period to the end of the pandemic. Juveniles evaluated for SA during the pandemic vs. pre-pandemic more frequently attempted suicide by self-poisoning and less frequently by precipitation, and they were more likely to be diagnosed with a major depressive disorder. CP consultations for any reason and for suicide attempts significantly increased in the decade before the pandemic and peaked in the second lockdown period in Italy.

Background: Sex differences in psychiatric symptoms among children and adolescents with a major depressive episode (MDE) are less studied than among adults. Previous non-recent studies reported a greater severity in adolescent girls and small differences between sexes in specific symptoms. We aim to explore the differences between male and female patients in the diagnoses, comorbidities, and psychiatric symptoms in a large cohort of pediatric patients referred to a tertiary center for child and adolescent psychiatry.Methods: We collected cross-sectional data on 382 consecutively referred patients (age 6–18 years; 73.8% female patients) with current MDEs (unipolar or bipolar) thoroughly evaluated with clinician (Children’s Depression Rating Scale-Revised; K-SADS Mania Rating Scale; Columbia Suicide Severity Rating Scale) and self and parent report (Children’s Depression Inventory-2; Multidimensional Anxiety Scale for Children-2; Child Behavior Checklist) standardized measures. Bivariate analyses were followed by a logistic regression model to assess significant predictors of the MDE phenotype of female (vs. male) patients.Results: Female patients were more likely to show severe MDEs (41.5% vs. 26.0%; p = 0.006), suicidal ideation (63.9% vs. 47.0%; p < 0.001) and behaviors (29.4% vs. 13.0%; p = 0.001), and non-suicidal self-injury (58.5% vs. 27.0%; p < 0.001). Male patients were more frequently diagnosed with bipolar disorder (21% vs. 11%; p = 0.012) and/or comorbid ADHD/behavior disorders (20% vs. 8.9%; p = 0.003). Male patients also had more frequently significant mixed hypo/manic symptoms (17% vs. 7.7%; p = 0.01) and were younger at the onset of the first psychiatric symptom (6.32 vs. 7.75 years; p = 0.003), onset of mood disorder (11.3 vs. 12.5 years; p = 0.005), and evaluation (14.0 vs. 15.2 years; p = 0.001). Several symptoms were significantly and independently associated with female patients diagnosed with a current MDE, including a) excessive weeping (OR 1.53; p < 0.001), b) mood lability (OR 1.50; p = 0.014), c) excessive fatigue (OR 1.38; p = 0.002), d) appetite disturbance (OR 1.28; p = 0.041), and e) attention problems (OR 1.07; p = 0.001). Distractibility (OR 0.55; p = 0.009) and conduct problems (OR 0.93; p = 0.001) were in turn correlated with MDE among male patients.Discussion: The study confirms that female patients with MDEs exhibit more severe affective symptoms, while male patients present with more externalizing behaviors and comorbidities. We further report more mixed symptoms and bipolar disorder diagnoses in male patients, who also have an earlier onset of psychiatric symptoms. These findings are discussed also considering implications for the diagnosis of pediatric bipolar disorder. A high clinical sensitivity is needed for highlighting subtle mixed and/or atypical features in severe MDEs among girls.

Introduction: Few studies on adolescents have investigated intelligence quotient (IQ) in mood disorders. Evidence on Disruptive Mood Dysregulation Disorder (DMDD), a controversial entity among depressive disorders, is more limited.Materials and methods: We performed an exploratory study on adolescent inpatients with unipolar mood disorders to test specific impairment in cognitive and adaptive profile. We also considered common psychopathological comorbidities. We retrospectively collected data on inpatients with a diagnosis of major depressive disorder (MDD), DMDD or Depressive Disorder – Not Otherwise Specified (DD-NOS) evaluated with Wechsler Scales of Intelligence, Adaptive Behavior Assessment System (ABAS-II), and Children’s Global Assessment Scale (C-GAS).Results: Out of 198 inpatients (85.9% females), 33.3% had MDD, 60.1% DD-NOS and 6.6% DMDD. DMDD patients had higher rates of ADHD (15.4%) and learning disorders (LD, 23.1%), a lower mean IQ (87.8 ± 10.7; p = 0.001) and ABAS-II scores (general composite 68.8 ± 16.8; p = 0.002) than other groups. In linear regression analysis, DMDD retained a significant correlation with lower IQ and adaptive abilities when controlling for sex, and comorbidities. Among comorbidities, LD correlated with lower perceptual reasoning and IQ, and ADHD with lower conceptual adaptive abilities. In all diagnosis groups, working memory and processing speed were lower than verbal comprehension and perceptual reasoning.Discussion: While impairment in working memory and processing speed is a non-specific correlate of active mood disorder, DMDD is burdened by lower general intelligence and adaptive abilities and higher rate of neurodevelopmental comorbidities. Lower IQ in the normal range is a correlate of DMDD among variables examined, not explained by the effect of neurodevelopmental comorbidities. These findings are discussed with regards to possible implications for the consideration of DMDD as a bridge condition between neurodevelopmental disorders and mood disorders.