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Abstract Objective To critically analyze the factors influencing prevalence estimates of Autism Spectrum Disorder (ASD), considering methodological, clinical, etiological, and sociocultural determinants that shape epidemiological data and diagnostic practices. Data synthesis In recent decades, a substantial increase in ASD prevalence has been observed globally. This phenomenon is shaped by a combination of factors, including changes in diagnostic criteria, improved detection methods, expanded access to health services, and greater public awareness. However, it also raises concerns about possible overdiagnosis, particularly in complex clinical contexts. The interpretation of prevalence data is influenced by methodological designs, population characteristics, and sociocultural dynamics. Summary of the findings The absence of biological markers, the high rate of psychiatric comorbidities, and disparities in access to qualified professionals further complicate the diagnostic process. These elements highlight the need for caution when comparing data across studies, time periods, or geographic regions. Conclusion The ASD prevalence reflects a multifaceted process that demands careful and comprehensive interpretation. A deeper understanding of this scenario requires critical reflection on how diagnoses are established, interpreted, and applied. Strengthening diagnostic practices and epidemiological approaches is essential for ensure more accurate data and support informed decision-making in health policies.

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Abstract Objective To review the associations between various neurodevelopmental disorders and the most prevalent sleep disorders in children and adolescents, focusing on clinical characteristics and diagnostic approaches. Data sources A literature review was conducted using the PubMed database, employing the search terms “neurodevelopmental disorders” and “sleep disorders,” including “insomnia,” “sleep-related breathing disorders,” “circadian rhythm sleep-wake disorders,” “sleep-related movement disorders,” “parasomnias,” and “central disorders of hypersomnolence.” Specific diagnostic terms related to neurodevelopmental and sleep disorders were also utilized. Additionally, the reference lists of selected manuscripts were manually reviewed to identify further relevant publications. Data synthesis Sleep disorders are frequently associated with neurodevelopmental disorders such as autism spectrum disorder, attention-deficit/hyperactivity disorder, and intellectual disability, as well as genetic syndromes known to predispose individuals to sleep disturbances, including Down syndrome, Smith-Magenis syndrome, Prader-Willi syndrome, and mucopolysaccharidosis type II. These associations are mediated by anatomical, biological, and behavioral mechanisms. Diagnostic evaluation should be guided by clinical suspicion and typically involves a comprehensive clinical history, sleep diaries, standardized questionnaires, and, when indicated, additional diagnostic procedures. Conclusions Sleep disorders are more prevalent in children and adolescents with neurodevelopmental disorders. A thorough understanding of the most commonly associated sleep disturbances and the implementation of targeted diagnostic strategies are essential for appropriate clinical management and for improving long-term outcomes in this population.

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Abstract Objective To discuss the importance of balancing quality versus quantity in behavioral interventions for individuals with Autism Spectrum Disorder (ASD), highlighting evidence-based approaches and the role of therapist training. Data sources Narrative review of the literature examining evidence-based behavioral approaches for ASD, the tension between intervention intensity and quality, factors influencing individualized treatment planning, and the importance of professional qualification. Summary of findings Evidence indicates that more hours of therapy do not necessarily result in better outcomes, with studies showing no consistent dose-response relationship. Individual learning rates, comorbid conditions, and quality of implementation significantly influence results. High-quality, individualized planning, consistent execution, family engagement, and well-trained professionals are essential. Lack of regulation and standardized training, particularly in contexts without professional certification systems, poses challenges to delivering effective, evidence-based care. Conclusion Behavioral interventions for ASD must prioritize quality over quantity, ensuring evidence-based, individualized, and well-supervised treatment plans delivered by qualified professionals to achieve meaningful outcomes.

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Abstract Objective To critically examine the effectiveness of complementary and alternative therapies (CATs) in the treatment of neurodevelopmental disorders, distinguishing myths from evidence-based practices and supporting informed therapeutic decision-making for healthcare professionals, educators, and families. Data sources Evidence was collected from PubMed, Scopus, and Web of Science up to August 2025. Systematic reviews, meta-analyses, and international consensus statements addressing attention-deficit/hyperactivity disorder (ADHD), autism spectrum disorder (ASD), specific learning disorders, communication and language disorders, intellectual disability, and developmental coordination disorder were included. Summary of findings Interest in interventions such as neurofeedback, transcranial direct current stimulation, music therapy, equine-assisted therapy, virtual reality, and gamification has grown substantially. However, most of these approaches lack methodological standardization and robust evidence to justify their use as primary treatments. Some demonstrate modest benefits as adjunctive strategies, especially when integrated into structured programs and supervised by multidisciplinary teams. Conversely, therapies including acupuncture, ozone therapy, and hyperbaric oxygen therapy present insufficient scientific support and should not be considered substitutes for validated methods. Conclusion Complementary and alternative therapies remain a topic of significant debate in the management of neurodevelopmental disorders. While certain approaches may offer limited adjunctive benefits, their clinical use should be carefully evaluated within evidence-based frameworks. The development of rigorous evaluations, standardized protocols, and the safe integration of innovative technologies is essential to optimize therapeutic outcomes without compromising access to scientifically validated interventions.

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Abstract Objective Irritability is one of the most frequent concerns in pediatric mental health and a predictor of long-term psychopathology and burden. This article aims to provide a comprehensive review of non-episodic irritability along with evidence-based clinical recommendations for pediatric care professionals. Sources A narrative review was conducted based on the literature from the last 10 years and additional key studies. Observational studies, randomized controlled trials, systematic reviews, and meta-analyses were considered. Summary of the findings Non-episodic irritability is a transdiagnostic construct associated with several mental disorders. Research on etiological pathways suggests that irritability may involve distinct mechanisms, moderate heritability, and genetic associations with attention-deficit/hyperactivity disorder (ADHD), and depression. Clinical manifestations vary across different developmental stages, and distinguishing pathological from normative irritability may be challenging. Although there is no gold-standard measure, validated instruments are available. Despite recent advances, evidence-based treatment remains limited. Evidence supports psychosocial interventions that integrate parent- and child-focused components, as well as the use of stimulants for patients with comorbid ADHD. Antipsychotics are effective in reducing irritability in children with autism spectrum disorder. However, its use requires caution in non-autistic youth with irritability without a diagnosable disorder or with oppositional defiant disorder due to inconclusive efficacy and potential adverse effects. Conclusions Although publications on non-episodic irritability have increased, the evidence remains relatively nascent. Further research is needed to advance the knowledge on underlying mechanisms, enhance clinical recognition, identify effective interventions, and support the development of new treatments, ensuring that irritability is adequately addressed in clinical practice.

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Abstract Objectives To review the state of the art in autism spectrum disorder (ASD), including its etiologic puzzle, clinical features, pathophysiologic mechanisms, differential diagnosis, and therapeutic management. Data sources A search for papers published over the past 10 years in the databases PubMed-MEDLINE, Cochrane Library, and SCIELO was performed using the following terms: “autism” and “clinical features”, “differential diagnosis”, “pathophysiology”, or “management”. The search yielded 3240, 590, 6904, and 5023 papers, respectively. A total of 120 most relevant papers were selected based on their title and abstract content. Data synthesis The current prevalence of ASD is 1 in every 31 eight-year-old children. A genetic defect is found in 10-20% of individuals with ASD. Environmental risk factors that increase the likelihood of ASD include advanced parental age and maternal health conditions. Epigenetic mechanisms may play a crucial role in the interplay between genetic and environmental factors in the pathogenesis of ASD. In addition to language delay, pediatricians should monitor and screen for several early signs of ASD. Differential diagnosis is complex because several neurodevelopmental conditions show clinical features that overlap with ASD. Medications may be used to treat comorbid conditions. Conclusions Management is based on a multidisciplinary team, and pediatricians are in a unique position to coordinate this team, given the trustworthy relationship they have with patients and their families.

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Abstract Objective To review the epidemiology, diagnostic criteria, and therapeutic options for the most prevalent anxiety and depressive disorders in childhood and adolescence. Sources of data A non-systematic review was conducted in the PubMed, SciELO, and Google Scholar databases. Diagnostic criteria were defined according to the Diagnostic and Statistical Manual of Mental Disorders (DSM-5-TR) and updated textbooks on child and adolescent psychiatry. Summary of the data Diagnosis requires a comprehensive clinical assessment, considering age-specific manifestations and differentiating expected developmental emotional responses from pathological conditions. Conclusions Management relies on psychoeducation and psychotherapeutic interventions—particularly cognitive-behavioral therapy—and, in moderate to severe cases, pharmacotherapy with selective serotonin reuptake inhibitors, preferably combined with psychotherapy. Early identification, especially at the pediatric care level, is essential to reduce morbidity, prevent recurrence, and promote healthy development.

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Abstract Objective This review article describes the main clinical, emotional, educational, and social aspects involved in the transition to adolescence for individuals with these conditions. It also addresses implications for healthcare, the continuity of educational support, and the importance of individualized transition strategies, highlighting the need for a multidisciplinary approach centered on the individual and on continuity of care. Data sources Review of the latest literature on neurodevelopmental disorders in adolescents. Data summary Adolescence represents a vital period of biopsychosocial transformation, particularly challenging for individuals with neurodevelopmental disorders (NDDs), such as autism spectrum disorder (ASD), attention-deficit/hyperactivity disorder (ADHD), and intellectual disability. Conclusions Integrated, person-centered, continuous, and collaborative health care is essential to promote the well-being and inclusion of these adolescents.

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Abstract Objective To review current evidence on the pathophysiology, clinical features, differential diagnosis, and therapeutic management of Attention-Deficit/Hyperactivity Disorder (ADHD), emphasizing the pediatrician’s role in diagnostic recognition and coordination of multidisciplinary care. Data sources Narrative synthesis of the contemporary literature addressing genetic and neurobiological underpinnings, diagnostic criteria, comorbidities, and treatment strategies relevant to pediatric practice. Summary of findings ADHD is a multifactorial neurodevelopmental disorder involving genetic predisposition and neurobiological alterations, particularly in cortico-subcortical circuits related to dopaminergic and noradrenergic modulation. Clinical presentation varies with age and context and may be accompanied by comorbidities such as learning disorders, anxiety, and depression. Diagnosis is clinical, based on standardized criteria and assessment across multiple settings, and requires exclusion of conditions that mimic ADHD. Management is multimodal, encompassing psychosocial interventions, school-based support, and, when indicated, pharmacological therapy. Pediatricians serve as the first point of contact and play a central role in early identification, family guidance, and integration of healthcare and educational teams. Conclusion Proactive pediatrician involvement is essential for early diagnosis and effective management of ADHD, supporting better prognosis and the child’s overall development.

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Abstract Objective To analyze the current scientific literature on the main dietary and nutritional interventions proposed for children and adolescents with neuropsychiatric disorders and describe their efficacy and safety, differentiating evidence-based practices from common myths. Data source The search was conducted using PubMed, SciELO, Cochrane, and Web of Science databases (2019-2025). The specific terms used in the search were formulated to encompass dietary interventions in children and adolescents with neuropsychiatric disorders and their outcomes. Data synthesis Gluten-free and casein-free (GFCF) diets did not reduce ASD symptoms and should be reserved for confirmed allergy or intolerance. Probiotics have shown inconsistent results for core ASD/ADHD symptoms, although they may alleviate gastrointestinal complaints in subgroups. Omega-3 s have shown modest and heterogeneous effects; In ADHD, high-dose EPA may improve attention when baseline levels are low, without consistent benefit in other domains. N-acetylcysteine reduced irritability in some trials, with no consistent effect on core symptoms. Folinic acid showed benefits in subgroups defined by biomarkers (folate receptor autoantibodies) and in ASD with language impairment, but this needs to be confirmed in larger studies. For vitamin D, high rates of insufficiency and possible modest gains in sub-outcomes were observed, with methodological heterogeneity. Conclusions This literature review showed that there is no scientific support for generalized dietary interventions, such as restrictive diets or nutritional supplementation, in the treatment of childhood neuropsychiatric disorders. Current evidence suggests the need for individualization and continuous monitoring. Specific interventions are justified only in the case of documented nutritional deficiencies.

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Abstract Objective The present study aims to present and discuss the role of neuropsychological assessment (NA) in the investigation of neurodevelopmental disorders (NDDs), with an emphasis on early diagnosis, on the steps that make up the evaluation process, and on the resources that complement clinical evaluation. Furthermore, the discussion is expanded to specific conditions, such as Attention Deficit/Hyperactivity Disorder (ADHD), Autism Spectrum Disorder (ASD), and Specific Learning Disorders (SLD), considering that they represent frequent assessment demands. Data sources A critical review of the national and international literature on neuropsychological assessment in NDDs was carried out, highlighting standardized instruments for the Brazilian context, complementary clinical tasks, and main cognitive and behavioral domains. References to essential books and manuals were included, with analysis enriched by the authors' clinical and teaching experience. Data synthesis NA constitutes a central tool for the early identification of alterations in neurodevelopment, with contributions to diagnosis and to the definition of intervention strategies. The process involves systematic steps, such as detailed anamnesis, application of standardized tests, and behavior analysis, covering different domains. The feedback, the final stage of the process, is essential for the understanding of the results and for adhering to the suggested procedures, and it should guide parents on practical implications, therapeutic and educational recommendations, and necessary referrals. Conclusions NA represents an essential resource in pediatric practice, both for diagnostic support and for directing interventions and monitoring the progress of children with NDDs. Its early use can modify the prognosis and promote better functional, academic, and socioemotional outcomes.

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Abstract Objective To synthesize the most consistent warning signs (“red flags”) for NDDs: autism spectrum disorder, cerebral palsy, intellectual disability, language development disorder, coordination developmental disorder, attention deficit hyperactivity disorder, and global developmental delay. Data source Review in PubMed/Medline, Cochrane Library, SciELO, CAPES, and BVS, 2003-2025. Methodological quality was assessed with NOS, CASP, and AMSTAR. Data summary 54 studies were included. The most consistent early signs were grouped by NPMD domains: Motor: delay to sit ≥ 9 m, absence of independent walking 18 m, absence of pincer grasp 10 m, and asymmetrical motor patterns 12 m; Language: absence of babbling at 9-12 m, lack of words until 15-18 m, and absence of two-word combination 24 m; Social: absence of social smile, poor eye contact, deficits in shared attention and communicative gestures; Cognitive and behavioral: regression of skills, repetitive behaviors, absence of symbolic play, and irritability or inattention; Others: atypical sensory responses, sleep disturbances, and feeding difficulties. Instruments such as M-CHAT-R/F, ASQ, Bayley, and HINE increased the accuracy of screening and reduced referral delays. Conclusion Early recognition of warning signs for NPMD disorder associated with complementary examinations and formal assessment should be integrated into routine pediatric care.

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Abstract Objective This text proposes a discussion and analysis of the effects of exposure to real-world and virtual violence in childhood and adolescence, and its repercussions on development. Data sources literature review on the topic of children's and adolescents' exposure to real-world and virtual violence, and observations from case studies of children and adolescents who were victims of serious and very serious violence, assisted by the DEDICA Program - Defense of the Rights of Children and Adolescents in Curitiba in the first semester of 2025. Summary of findings It is observed that a significant number of children and adolescents, regardless of their origins, ethnicities, beliefs, cultures, and the sociocultural condition of their guardians, are being exposed to various forms of violence, whether intrafamilial, domestic, institutional, or from their surroundings, through what they observe, witness, and experience in the real or virtual world. Conclusions It is concluded that exposure to situations of violence through direct aggression, witnessing, cohabitation, and/or participation can promote desensitization and the normalization of causing harm to others. Without protection or contestation of violent acts, whatever their source, those who are learning their own value and the value of others, and how to fight for life, come to accept them as an inevitable part of life, either suffering them or perpetrating them. The need for pediatric consultations to include guidance for caregivers and patients on preventing exposure to any form of violence, as well as the adoption of protective measures, including legal ones, against the harm to which they may be subjected, is evident.