Child and adolescent psychiatry – Jens Högström's research group

Internet-mediated CBT for mixed anxiety disorders

The generic ICBT treatment is aimed at children aged 8-12 years with different anxiety disorders (separation anxiety disorder, social anxiety disorder, generalized anxiety disorder panic disorder and specific phobias). The program has been evaluated in two pilot studies and two randomized controlled trials and the results have shown good effects.

Internet-mediated CBT for social anxiety disorder

An ICBT treatment specifically aimed at young people, 10-17 years, with social anxiety disorder (social phobia). The treatment has been evaluated in a pilot study and a randomized controlled trial with good results, where ICBT proved to be more effective and more cost-effective than an active control treatment.

JAMA Psychiatry podcast about ICBT for social anxiety

Internet-mediated CBT for generalized anxiety disorder or excessive worry

An ICBT treatment developed for adolescents 13-17 years with generalized anxiety disorder/excessive worry. The treatment has previously been evaluated in two smaller studies with promising results and now recently also in a randomized controlled trial.

Internet-delivered CBT for obsessive-compulsive disorder

This ICBT program has been developed for children and adolescents 7-17 years old with obsessive-compulsive disorder (OCD). The treatment has previously been evaluated for adolescents 13-17 years in a pilot study and a randomized controlled trial and for children 7-12 years in a pilot study. The previous studies have shown good results and the program has now been evaluated in a large randomized controlled trial for the entire age group 7-17 years. In the latest study, ICBT was compared with conventional (face-to-face) CBT at the clinic and the results showed that ICBT was no less effective than conventional CBT.

Internet-delivered CBT in regular care

Two of the treatment programs have been evaluated in studies within the frame of regular care; the ICBT treatment for mixed anxiety disorders has been evaluated in Region Jämtland-Härjedalen and the ICBT treatment for obsessive-compulsive disorder has been evaluated at specialist clinics for OCD in Region Stockholm and Region Västra Götaland. The treatments implemented in regular care are planned to be evaluated in a study where all patients offered internet treatment, regardless of condition, are asked to participate in a research project.

Psychopathology of attention, learning and decision-making

The psychopathology of attention, learning and decision-making project consists of several different studies. Eye tracking and psychological experiments are used to study how children and young people with conditions such as social anxiety, autism and depression learn and perceive the world as well as how they make decisions. A central question in the project is whether abnormal decision-making, learning and attention can be affected by CBT. Another important question is whether these abnormalities can predict who will benefit most from treatment. The research may help us understand the mechanisms behind psychiatric conditions and could contribute to improvement of current treatments. 

The project has generated several publications and the results so far suggest that there are parts of the social attention where young people with social anxiety differ from the general/non-psychiatric population. A study is now ongoing where we are following adolescents with depression.

Associate Professor Johan Lundin Kleberg is responsible for the studies.

Gender dysphoria among children and adolescents

Young people with gender dysphoria experience a suffering caused by the incongruence between their assigned sex and their gender identity. Research shows that there is an increased risk of depression, anxiety, self-harm and suicidality within the group. Gender-affirming treatment has been shown in several studies to reduce that risk. For the past ten years, more and more young people have been seeking care for gender dysphoria in Sweden, as well as in many other countries. But we know very little about what the group and the effects of the provided care. More research is also needed about the effect of psychological and medical treatments (e.g., puberty-suppression and gender-affirming hormone therapy) recommended in national and international guidelines. Within the research group we are planning a project where we want to study young people (<18 years) who are referred to a clinic for gender dysphoria within the child and adolescent psychiatry (BUP KID) in Stockholm. We want to document the interventions provided in the gender dysphoria care and investigate the effects of these interventions on the mental health of children and adolescents. The project also intends to look at long-term outcomes for everyone in Sweden who has been diagnosed with gender dysphoria, in national registers..

Responsible for the studies are associate professor Louise Frisén and associate professor Jens Högström.

Compulsory psychiatric care of children and youth: Risk factors, coercive measures and outcome 

Existing research on child and adolescent psychiatric (CAP) inpatient care (i.e. in a 24-hour ward) in Sweden and internationally does not provide enough basis for treatment and efforts to reduce compulsory care (according to the Compulsory Care Act, LPT) and coercive measure use. Differences in legislation, patient flows and documentation between different countries and across Swedish regions also require careful study design and evaluation of results. 

In several new studies, we examine children and youth in compulsory psychiatric care and care characteristics. A national linked registry study addresses all inpatient CAP care in Sweden (children <18 years) during 2010-2021 as well as psychosocial, psychiatric and organizational risk factors for compulsory care and exposure to coercive measures (seclusion, restraint, forced medication and tube feeding). And the outcomes for these patients. We compare CAP inpatients with young adults (18-24 years) in general psychiatric inpatient care and contrast Swedish with Finnish CAP data. We also conduct a systematic review of existing, international research on the use of and risk factors for various coercive measures. 

To reduce coercive measure use in CAP inpatient care, the Swedish LPT Act was tightened specifically for children on July 1, 2020. Using qualitative interviews, we investigate how CAP professionals handled the change and analyse register data on desired and unintentional changes in compulsory inpatient care and coercive measures after compared to before the tightening of the law. In a representative, national cross-sectional survey, children in ongoing CAP inpatient care are invited to, following informed consent, digitally self-report perceived coercion, and we study organizational and individual risk factors for perceived coercion. 

Improved knowledge about risk factors for compulsory inpatient care and exposure to coercive measures would underpin prevention efforts. Also, counterproductive or harmful work processes in CAP inpatient care can be identified and followed by improvements. Knowledge of whether stricter legislation really reduces the use of coercive measures among children is needed to evaluate whether legislative changes result in intended results without negative side effects. Overall, the project is expected to contribute to better psychiatric care for very vulnerable children and youth in inpatient CAP services. 

PI: Niklas Långström, associate professor of child & adolescent psychiatry and medical officer at the National Board of Health and Welfare (Socialstyrelsen). 

The project has so far secured funding from the Swedish Research Council: Medicine for 2022-2024 and is conducted in collaboration with, among others, dr Erik Pettersson, MEB, KI and professor Riittakerttu Kaltiala, University of Tampere, Finland.

Pedagogy research

A digital skills training program for medical students in suicide risk assessment of children and adolescents is currently under development. Feasibility, acceptability and preliminary effects on the competence of medical students will be evaluated in a pilot study.

Responsible for the study are with Dr Anna Lundh and Professor Eva Serlachius.