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We extended this literature by characterizing a child psychiatric outpatient sample in the United States during the middle of the 2020\u20132021 school year. We also used a computational strategy to identify distinct patterns of psychopathology symptom change and examined correlates and predictors of such change. Among potential predictors were cognition and clinical diagnoses, which have not been studied in this context previously.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Participants were 171 youth (aged 10.6\u2009\u00b1\u20093.1) referred for neuropsychiatric evaluation who enrolled in research and whose parents filled out a survey on COVID-19. The questionnaire included eight psychiatric and six psychosocial domains rated retrospectively prior to the pandemic and currently at the time of evaluation. We examined change in severity of individual domains with Wilcoxon signed-rank tests. We used a latent profile analysis (LPA) to identify groups with distinct symptom change profiles. Using multinomial logistic regression, we examined potential predictors and correlates of LPA-derived groups. Models controlled for age, sex, and assessment date and corrected for multiple testing.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Although the majority of individual psychopathology domains were worse on average during the 2020\u20132021 school year, youth showed distincive patterns of symptom change. In addition to a large group (72.2%) with relatively stable symptoms and a small group (6.4%) that improved on most symptoms, there were two groups with different constellations of worsening symptoms. These latter groups both showed increased sadness, anxiety and oppositionality; however, one had increased hyperactivity\/impulsivity and no change in hopelessness while the other showed greater hopelessness and no change in hyperactivity. Symptoms related to the distinguishable domains of these groups predicted group membership, and changes in screen time, conflict with parents and social isolation were correlates of worsening. Cognition and lifetime clinical diagnoses failed to predict group membership.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>In youth outpatients, psychiatric and psychosocial difficulties were worse on average during the school year following the spring 2020 COVID-19 lockdown; yet, some youth experienced greater and distinctive symptom change. A personalized approach to support may be needed as youth emerge from this period.<\/jats:p><\/jats:sec>","DOI":"10.1186\/s13034-022-00441-6","type":"journal-article","created":{"date-parts":[[2022,2,17]],"date-time":"2022-02-17T10:14:59Z","timestamp":1645092899000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Distinct patterns of emotional and behavioral change in child psychiatry outpatients during the COVID-19 pandemic"],"prefix":"10.1186","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8536-2697","authenticated-orcid":false,"given":"Alysa E.","family":"Doyle","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mary K.","family":"Colvin","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Clara S.","family":"Beery","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maya R.","family":"Koven","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pieter J.","family":"Vuijk","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ellen B.","family":"Braaten","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2022,2,17]]},"reference":[{"key":"441_CR1","doi-asserted-by":"crossref","first-page":"547","DOI":"10.1016\/S2215-0366(20)30168-1","volume":"7","author":"EA Holmes","year":"2020","unstructured":"Holmes EA, O\u2019Connor RC, Perry VH, Tracey I, Wessely S, Arseneault L, et al. 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Before data were collected, all parents provided written informed consent, youth ages 7 to 13 provided written assent, and youth 14 to 17 provided and consent (ages 14\u201317) respectively).","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Not applicable.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}},{"value":"The authors report no conflicts of interest. Drs. Vuijk, Colvin, Doyle, and Braaten, and Ms. Beery and Koven have no additional disclosures. Dr. Braaten serves on the board of Magination Press. She receives royalties from books published by Guilford Press\u00a0<i>Bright Kids Who Can\u2019t Keep Up<\/i>\u00a0and\u00a0<i>The Child Clinician\u2019s Report Writing Handbook<\/i>\u00a0and by Sage Publishing\u00a0<i>The Sage Encyclopedia of Intellectual and Developmental Disorders<\/i>. Dr. Colvin receives travel support from Parent Project Muscular Dystrophy (PPMD) and also speaker honoraria from Tourette Syndrome Association, Muscular Dystrophy Association, American Academy of Pediatrics, and American Psychological Association.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Competing interests"}}],"article-number":"12"}}