The Revised Child Anxiety and Depression Scale-Short Version: scale reduction via exploratory bifactor modeling of the broad anxiety factor

Test-retest stability, convergent validity, and sensitivity to change for the Goal-Based Outcome tool for adolescents: Analysis of data from a randomized controlled trial

OBJECTIVE(S)

To examine the psychometric properties of the idiographic Goal-Based Outcome (GBO) tool for young people: test-retest stability, convergent validity, and sensitivity to an intervention.

METHODS

This measure validation study used data from a randomized controlled trial of school-based humanistic counseling. We used multilevel analyses to assess test-retest stability, convergent validity of the GBO tool against nomothetic measures of mental wellbeing, and sensitivity to an intervention.

RESULTS

The GBO tool showed acceptable stability over a 6-24 week period; moderate convergent validity with nomothetic measures of mental well-being, self-esteem, and depression; and greater sensitivity to an intervention than a measure of psychological distress.

CONCLUSIONS

The GBO tool shows evidence of having acceptable psychometric properties and is suitable for monitoring change on individual goals. It may also have the capacity to function as a population-level indicator of outcomes in conjunction with the use of other measures of mental health and wellbeing.

Factors Associated With Symptoms of Anxiety and Depression in Children Who Stutter

PURPOSE

Children and adolescents who stutter may be at risk of elevated anxiety and depression symptoms, although studies have indicated variability in reported internalizing symptoms in this population. This study considers the association between anxiety and depression symptoms and stuttering, as well as child, family, and contextual factors that may affect this association.

METHOD

Thirty-five school-age children who stutter completed the Revised Children's Anxiety and Depression Scale-Short Version. We fitted regression models to examine the association between anxiety and depression symptoms with bullying, stuttering severity, family history of adverse mental health, and age in children who stutter.

RESULTS

Family history of adverse mental health was found to significantly predict anxiety and depression scores. Age also predicted depression scores, with older children reporting higher scores.

CONCLUSIONS

Family history of adverse mental health is associated with higher self-reported internalizing symptoms in children who stutter. The interaction between child, family, and contextual factors may change with age, and this requires further exploration in larger, longitudinal studies. The association between bullying and anxiety scores indicates the importance of anti-bullying initiatives in promoting psychosocial development in school-age children who stutter. This study also highlights the contribution of known risk factors for mental health, such as family history, to variability in symptom reporting.

Diagnostic criteria for temporomandibular disorders-INfORM recommendations: Comprehensive and short-form adaptations for children

BACKGROUND

The Diagnostic Criteria for Temporomandibular Disorders (DC/TMD) are used worldwide in adults. Until now, no adaptation for use in children has been proposed.

OBJECTIVE

The aim of this study was to present comprehensive and short-form adaptations of Axis I and Axis II of the DC/TMD for adults that are appropriate for use with children in clinical and research settings.

METHODS

Global Delphi studies with experts in TMDs and in pain psychology identified ways of adapting the DC/TMD for children.

RESULTS

The proposed adaptation is suitable for children aged 6-9 years. Proposed changes in Axis I include (i) adapting the language of the Demographics and the Symptom Questionnaires to be developmentally appropriate for children, (ii) adding a general health questionnaire for children and one for their parents, (iii) replacing the TMD Pain Screener with the 3Q/TMD questionnaire and (iv) modifying the clinical examination protocol. Proposed changes in Axis II include (i) for the Graded Chronic Pain Scale, to be developmentally appropriate for children, (ii) adding anxiety and depression assessments that have been validated in children and (iii) adding three constructs (stress, catastrophising and sleep disorders) to assess psychosocial functioning in children.

CONCLUSION

The recommended DC/TMD, including Axis I and Axis II, for children aged 6-9 years, is appropriate for use in clinical and research settings. This adapted the first version for children includes changes in Axis I and Axis II changes requiring reliability and validity testing in international settings. Official translations to different languages according to INfORM requirements will enable a worldwide dissemination and implementation.

Translation and evaluation of psychometric properties of the Amharic pediatric quality of life inventory 4.0 generic core scale for children with cancer

BACKGROUND

Childhood cancer negatively impacts a child's physical, mental, and behavioural health and significantly affects their health-related quality of life. The Pediatric Quality of Life Inventory 4.0 Generic Core Scale (PedsQL™ 4.0 GCS) is one of the most commonly used measures of the quality of life in children. However, the Amharic version of PedsQL™ 4.0 GCS has not been validated in a paediatric oncology population. This study aimed to translate and evaluate the psychometric properties of the Amharic PedsQL™ 4.0 GCS (PedsQL™ 4.0 GCS (A)) for Ethiopian children with cancer.

METHODS

A descriptive cross-sectional study was conducted among children aged 8-18 years with any type of cancer across the cancer trajectory. Cronbach's alpha and intraclass correlation coefficient were computed to determine the internal consistency and test-retest reliability of the scale. The convergent validity was established by examining the correlation of the PedsQL™ 4.0 GCS (A) with the Amharic version of the Revised Child Anxiety and Depression Scale (RCADS-25(A)). Factorial validity was evaluated by conducting a confirmatory factor analysis.

RESULTS

The study included 142 participants with childhood cancer. PedsQL™ 4.0 GCS (A) had good validity and reliability. It demonstrated high internal consistency with a Cronbach's alpha of 0.96 for the scale and 0.82-0.95 for the subscales. The intraclass correlation coefficient for the scale was 0.9 and that for the subscales was 0.76-0.90. The PedsQL™ 4.0 GCS (A) was highly correlated with RCADS-25 (A) (r = - 0.97, p < 0.001), supporting its convergent validity. The four-factor structure of the model fitted the data satisfactorily (χ²/df = 1.28; CFI = 0.97; TLI = 0.97; RMSEA = 0.05; SRMR = 0.05), supporting the factorial validity of the PedsQL™ 4.0 GCS (A).

CONCLUSION

The PedsQL™ 4.0 GCS (A) demonstrates desirable psychometric properties for assessing quality of life among Ethiopian children with cancer. The scale can be used in clinical settings for assessing and evaluating quality of life in children with cancer. The use of parent-report versions and studies in those with different health conditions and healthy populations are necessary to further establish the psychometric properties of the PedsQL™ 4.0 GCS (A).

Feasibility and Acceptability of a Remote Stepped Care Mental Health Programme for Adolescents during the COVID-19 Pandemic in India

Remote mental health services were rapidly deployed during the COVID-19 pandemic, yet there is relatively little contemporaneous evidence on their feasibility and acceptability. This study assessed the feasibility and acceptability of a stepped care mental health programme delivered remotely by lay counsellors to adolescents in New Delhi, India, during a period of 'lockdown'. The programme consisted of a brief problem-solving intervention ("Step 1") followed by a tailored behavioural module ("Step 2") for non-responders. We enrolled 34 participants (M age = 16.4 years) with a self-identified need for psychological support. Feasibility and acceptability were assessed through quantitative process indicators and qualitative interviews (n = 17 adolescents; n = 5 counsellors). Thirty-one (91%) adolescents started Step 1 and 16 (52%) completed the planned Step 1 protocol. Twelve (75%) of the Step 1 completers were non-responsive. Eight (67%) non-responsive cases started Step 2, all of whom met response criteria when reassessed at 12 weeks post-enrolment. Adolescents favoured voice-only sessions over video-calls due to privacy concerns and difficulties accessing suitable devices. Counsellors noted challenges of completing remote sessions within the allotted time while recognising the importance of supervision for developing competence in new ways of working. Both adolescents and counsellors discussed the importance of working collaboratively and flexibly to fit around individual preferences and circumstances. Disentangling pandemic-specific barriers from more routine challenges to remote delivery should be a focus of future research.

Psychometric Properties and Validation of the General Anxiety Disorder 7-Item Scale Among Adolescents With Persistent Post-Concussive Symptoms

The General Anxiety Disorder 7-Item (GAD-7) scale is commonly used in primary care as a self-report measure of general anxiety symptoms with adult populations. There is little psychometric research on this measure with adolescent populations, particularly those with persistent post-concussive symptoms (PPCS). This study examined the psychometrics properties of the GAD-7 among youth with PPCS. We used baseline data from a randomized controlled trial of collaborative care for treatment of PPCS among 200 sports-injured adolescents 11-18 years of age (M_age = 14.7 years, standard deviation = 1.7). Eligible adolescents had three or more PPCS that lasted for ≥1 month and spoke English. Adolescents reported on their anxious (GAD-7 and Revised Child Anxiety and Depression Scale-Short Version [anxiety subscale]; RCADS) and depressive (Patient Health Questionnaire-9; PHQ-9) symptoms. Parents used the RCADS to report on their adolescents' anxious symptoms. The GAD-7 had good internal validity (Cronbach's alpha = 0.87), and significant (p < 0.001) correlations were detected between the GAD-7 and youth and parent report of anxiety on RCADS (r = 0.73 and r = 0.29) and PHQ-9 (r = 0.77) scores. Confirmatory factor analysis suggested a one-factor solution. These results suggest that the GAD-7 is a valid measure of anxiety with good psychometric properties for youth experiencing PPCS. ClinicalTrials.gov identifier: NCT03034720.

Adolescent Mental Health Priorities During the Covid-19 Pandemic

Increasing evidence has shown that the Covid-19 outbreak has impacted adolescents' mental health. Utilising a mixed-method design, the current study examined a total of 518 adolescent perspectives (60% female), in Scotland, on what has and could help their mental health in the context of Covid-19. A reflexive thematic analysis revealed three themes in relation to what has helped adolescents' mental health since the Covid-19 outbreak. These related to findings about the value of: (1) engaging in recreational activities, (2) engaging with friends, and (3) the disruption to schooling. The remaining four themes related to what could have helped adolescents mental health and wellbeing since the Covid-19 outbreak. These focussed on (1) better support: in relation to mental health; school work; and communication, (2) contact with friends, and (3) more opportunities for recreational activities. Males were more likely to report recreational activities had helped and less likely to report better support could have helped. Adolescents who reached clinical threshold for depression and anxiety and those with elevated PTSD-like symptoms about Covid-19 were more likely to state more support could have helped, and adolescents who reached clinical threshold for depression were less likely to report that friends could have helped their mental health. The findings may inform mental health policy and interventions in the recovery from the Covid-19 pandemic.

Translation and Adaptation of the Revised Children's Anxiety and Depression Scale: A Qualitative Study in Belize

BACKGROUND

Adapting data collection instruments using transcultural translation and adaptation processes is essential to ensure that respondents comprehend the items and the original meaning is retained across languages and contexts. This approach is central to UNICEF's efforts to expand the use of standard data collection tools across settings and close the global data gap on adolescent mental health.

METHODS

We conducted transcultural translation and adaptation processes in Belize using the Revised Children's Anxiety and Depression Scale (RCADS). Items from the original scale were translated into Belizean English and Kriol, reviewed by local mental health experts, and discussed in focus groups. Cognitive interviews were conducted with adolescents and parents. The information collected was analyzed with cultural equivalence domains: comprehensibility, acceptability, relevance, completeness, and technical equivalence. Bilingual discussions of findings informed the final item wordings, and the adapted tool was back-translated.

RESULTS

Adaptation of terms and specific expressions were done to improve comprehensibility and to ensure the appropriate clinical meaning. For example, the expression 'feeling scared' was perceived to imply immaturity or threaten masculinity and was adapted to 'feeling afraid.' Expressions like "shaky" were modified to "trimble" in Kriol. Statements were reworded as questions to enhance acceptability and comprehensibility.

DISCUSSION

A culturally adapted version of the RCADS was developed for use among adolescents in Belize in Belizean English and Kriol. The transcultural translation and adaptation procedure can be applied for other settings or tools to design contextual adaptations of mental health instruments prior to their validation or use in new settings.

Validation of the Kriol and Belizean English Adaptation of the Revised Children's Anxiety and Depression Scale for Use With Adolescents in Belize

PURPOSE

To validate a culturally-adapted Kriol and Belizean English version of the Revised Children's Anxiety and Depression Scale (RCADS) through comparison with clinical diagnoses made using the Kiddie Schedule of Affective Disorders and Schizophrenia.

METHODS

Participants comprised of 256 adolescents aged 10-14 years and 15-19 years, who completed the adapted RCADS (10 depression items, 12 anxiety items) in one-on-one interviews, followed by a diagnostic assessment using Kiddie Schedule of Affective Disorders and Schizophrenia administered by trained clinicians. Sensitivity, specificity, positive predictive value, negative predictive value, diagnostic odds ratios, area under the curve (AUC), and Youden's Index were calculated for RCADS cutoffs and scores on the total scale and anxiety and depression subscales.

RESULTS

For adolescents aged 10-14 years (n = 161), the AUC was 0.72 for the full scale, 0.67 for anxiety subscale, and 0.76 for depression subscale. For adolescents aged 15-19 years (n = 95), the AUCs were 0.82, 0.77, and 0.83. Most depression items performed well in discriminating those with and without diagnoses. Separation anxiety items performed poorly. "Thoughts of death" were common even among adolescents not meeting diagnostic criteria. The RCADS depression subscale presented the strongest psychometric properties with adolescents aged 15-19 years (at cutoff of 13, sensitivity = 0.83, specificity = 0.77, positive predictive value = 0.47, negative predictive value = 0.95, odds ratio = 15.96).

CONCLUSION

The adapted RCADS-22 had acceptable categorization for adolescents aged 10-14 years and excellent categorization for adolescents aged 15-19 years; therefore, the tool is recommended for use among the latter age group. Based on sensitivity and specificity values at different cutoffs, guidance is provided to select different thresholds to suit clinical, public health, or other uses to detect and quantify adolescent depression and anxiety in Belize.

Measurement of Mental Health Among Adolescents at the Population Level: A Multicountry Protocol for Adaptation and Validation of Mental Health Measures

PURPOSE

Mental disorders are among the leading causes of disability among adolescents aged 10-19 years. However, data on prevalence of mental health conditions are extremely sparse across low- and middle-income countries, even though most adolescents live in these settings. This data gap is further exacerbated because few brief instruments for adolescent mental health are validated in these settings, making population-level measurement of adolescent mental health especially cumbersome to carry out. In response, the UNICEF has undertaken the Measurement of Mental Health Among Adolescents at the Population Level (MMAP) initiative, validating open-access brief measures and encouraging data collection in this area.

METHODS

This protocol presents the MMAP mixed-methods approach for cultural adaptation and clinical validation of adolescent mental health data collection tools across settings. Qualitative activities include an initial translation and adaptation, review by mental health experts, focus-group discussions with adolescents, cognitive interviews, synthesis of findings, and back-translation. An enriched sample of adolescents with mental health problems is then interviewed with the adapted tool, followed by gold-standard semistructured diagnostic interviews.

RESULTS

The study protocol is being implemented in Belize, Kenya, Nepal, and South Africa and includes measures for anxiety, depression, functional limitations, suicidality, care-seeking, and connectedness. Analyses, including psychometrics, will be conducted individually by country and combined across settings to assess the MMAP methodological process.

DISCUSSION

This protocol contributes to closing the data gap on adolescent mental health conditions by providing a rigorous process of cross-cultural adaptation and validation of data collection approaches.

Therapist-guided and self-guided internet-delivered behavioural activation for adolescents with depression: a randomised feasibility trial

OBJECTIVE

Access to effective treatments for adolescents with depression needs to improve. Few studies have evaluated behavioural activation (BA) for adolescent depression, and none remotely delivered BA. This study explored the feasibility and acceptability of therapist-guided and self-guided internet-delivered BA (I-BA) in preparation for a future randomised controlled trial (RCT).

DESIGN

A single-blinded randomised controlled feasibility trial.

SETTING

A specialist outpatient clinic in Sweden.

PARTICIPANTS

Thirty-two adolescents with mild-to-moderate major depression, aged 13-17 years.

INTERVENTIONS

Ten weeks of therapist-guided I-BA or self-guided I-BA, or treatment as usual (TAU). Both versions of I-BA included parental support. TAU included referral to usual care within child and youth psychiatry or primary care.

OUTCOMES

Feasibility measures included study take-up, participant retention, acceptability, safety and satisfaction. The primary outcome measure was the blinded assessor-rated Children's Depression Rating Scale, Revised. The primary endpoint was the 3-month follow-up.

RESULTS

154 adolescents were screened and 32 were randomised to therapist-guided I-BA (n=11), self-guided I-BA (n=10) or TAU (n=11). Participant retention was acceptable, with two drop-outs in TAU. Most participants in TAU had been offered interventions by the primary endpoint. The mean number of completed chapters (total of 8) for adolescents was 7.5 in therapist-guided I-BA and 5.4 in self-guided I-BA. No serious adverse events were recorded. Satisfaction was acceptable in both I-BA groups. Following an intent-to-treat approach, the linear mixed-effects model revealed that both therapist-guided and self-guided I-BA (Cohen's d=2.43 and 2.23, respectively), but not TAU (Cohen's d=0.95), showed statistically significant changes on the primary outcome measure with large within-group effect sizes.

CONCLUSIONS

Both therapist-guided and self-guided I-BA are acceptable and potentially efficacious treatments for adolescents with depression. It is feasible to conduct a large-scale RCT to establish the efficacy and cost-effectiveness of I-BA versus TAU.

TRIAL REGISTRATION NUMBER

ClinicalTrials.gov Registry (NCT04117789).

Emotional Adjustment in Children with Vocal Fold Nodules

INTRODUCTION

Vocal fold nodules (VNs) in children are benign, bilateral, callous-like lesions at the junction of the anterior third and posterior two-thirds of the true vocal folds. Chronic, repetitive, and intense vocal behavior is often cited as the primary etiology; however, difficulties with emotional adjustment may predispose some children towards extreme and possibly phonotraumatic vocal activity, thereby contributing secondarily to the development of VNs.

OBJECTIVES

This case-control study examined the association between features of emotional adjustment and VNs in children.

METHODS

Parents of children with VNs (N = 40, Mage = 7.5, SDage = 2.03) and two medical control groups [ie, voice disordered, but not VNs (VDCs; N = 40, Mage= 7.09, SDage = 2.01) and vocally normal controls (VNCs; N = 40, Mage = 7.6, SDage = 1.54)] participated in the study. Features of emotional adjustment were assessed using two inventories: the Parent Rating scale for Reactive and Proactive Aggression and the Revised Child Anxiety and Depression Scale - Parent version.

RESULTS

As compared with the VNCs, children with VNs were significantly more aggressive (P = 0.042, Cohen's d = 0.47) whereas the VDCs were more depressed (P = 0.013, Cohen's d = 0.60). Furthermore, VDCs experienced more separation anxiety than VNs (P = 0.038, Cohen's d = 0.45) and VNCs (P = 0.021, Cohen's d = 0.55). No other significant between-group differences were identified between the VNs and VDCs.

CONCLUSIONS

When present, elevated aggression may represent a risk factor for VNs formation in children, and possibly influence treatment outcomes. Therefore, the current results highlight the importance of understanding the role of emotional adjustment in the evaluation and treatment of dysphonia in children.

Making high-quality measures available in diverse contexts-The psychometric properties of the Revised Child Anxiety and Depression Scale in a Norwegian sample

OBJECTIVES

Recent initiatives have recommended the Revised Child Anxiety and Depression Scale (RCADS) for use in research and as patient-reported outcome in health care globally. We aimed to investigate, for the first time, whether the psychometric properties of the anxiety and depression youth self-report measures, RCADS-47 and RCADS-25, generalize to a Norwegian setting.

METHODS

We examined gender and age differences in symptomatology among 592 children (mean age 10.7 years), and conducted a psychometric investigation of the internal reliability, structural validity, measurement invariance and convergent validity of the RCADS-47 and RCADS-25 youth versions.

RESULTS

Girls reported higher levels of anxious and depressive symptoms than boys, but no age differences were observed. Reliability coefficients for the RCADS-47 and RCADS-25 scales indicated good internal consistency. Structural validity for RCADS-47 and RCADS-25 was supported by confirmatory factor analyses results. For both measures, strong gender-based measurement invariance was present. Convergent validity of the RCADS-47 and RCADS-25 with other well-established self-report measures for anxiety (Multidimensional Anxiety Scale for Children) and depression (The Short Mood and Feelings Questionnaire) was supported.

CONCLUSION

The RCADS-47 and RCADS-25 youth versions are valid and reliable instruments for measuring symptoms of anxiety and depression in a Norwegian setting. The results add to the evidence supporting RCADS's cross-cultural validity.

Mindfulness supports emotional resilience in children during the COVID-19 Pandemic

An important aspect of mental health in children is emotional resilience, the capacity to adapt to, and recover from, stressors and emotional challenges. Variation in trait mindfulness, one’s disposition to attend to experiences with an open and nonjudgmental attitude, may be an important individual difference in children that supports emotional resilience. In this study, we investigated whether trait mindfulness was related to emotional resilience in response to stressful changes in education and home-life during the COVID-19 pandemic in the United States. We conducted a correlational study examining self-report data from July 2020 to February 2021, from 163 eight-to-ten-year-old children living in the US. Higher trait mindfulness scores correlated with less stress, anxiety, depression, and negative affect in children, and lower ratings of COVID-19 impact on their lives. Mindfulness moderated the relationship between COVID-19 child impact and negative affect. Children scoring high on mindfulness showed no correlation between rated COVID-19 impact and negative affect, whereas those who scored low on mindfulness showed a positive correlation between child COVID-19 impact and negative affect. Higher levels of trait mindfulness may have helped children to better cope with a wide range of COVID-19 stressors. Future studies should investigate the mechanisms by which trait mindfulness supports emotional resilience in children.

Time Spent Gaming, Device Type, Addiction Scores, and Well-being of Adolescent English Gamers in the 2021 OxWell Survey: Latent Profile Analysis

BACKGROUND

The shift in the last decades to screen-based and increasingly web-based gaming activity has raised concerns about its impact on the development of children and adolescents. Despite decades of research into gaming and related psychosocial effects, the question remains how best to identify what degree or context of gaming may be a cause for concern.

OBJECTIVE

This study aimed to classify adolescents into gamer profiles based on both gaming behaviors and well-being. Once we distinguished the different gamer profiles, we aimed to explore whether membership to a specific profile could be predicted based on a range of personal characteristics and experiences that could then help identify those at risk.

METHODS

We explored gaming and well-being in an adolescent school population (aged 12-18 years) in England as part of the 2021 OxWell student survey. Self-report measures of time spent playing games on computers or consoles, time spent playing games on mobile phones, the Game Addiction Scale, and the Warwick-Edinburgh Mental Well-being Scale were used to classify adolescent heavy gamers (playing games for at least 3.5 hours a day) using latent profile analysis. We used multinomial logistic regression analysis to predict the profile membership based on a range of personal characteristics and experiences.

RESULTS

In total, 12,725 participants answered the OxWell gaming questions. Almost one-third (3970/12,725, 31.2%) indicated that they play games for at least 3.5 hours a day. The correlation between time spent playing video games overall and well-being was not significant (P=.41). The latent profile analysis distinguished 6 profiles of adolescent heavy gamers: adaptive computer gamers (1747/3970, 44%); casual computer gamers (873/3970, 22%); casual phone gamers (595/3970, 15%); unknown device gamers (476/3970, 12%); maladaptive computer gamers (238/3970, 6%); and maladaptive phone gamers (79/3970, 2%). In comparison with adaptive computer gamers, maladaptive phone gamers were mostly female (odds ratio [OR] 0.08, 95% CI 0.03-0.21) and were more likely to have experienced abuse or neglect (OR 3.18, 95% CI 1.34-7.55). Maladaptive computer gamers, who reported gaming both on their mobile phones and on the computer, were mostly male and more likely to report anxiety (OR 2.25, 95% CI 1.23-4.12), aggressive behavior (OR 2.83, 95% CI 1.65-4.88), and web-based gambling (OR 2.18, 95% CI 1.24-3.81).

CONCLUSIONS

A substantial number of adolescents are spending ≥3.5 hours gaming each day, with almost 1 in 10 (317/3970, 8%) reporting co-occurring gaming and well-being issues. Long hours gaming using mobile phones, particularly common in female gamers, may signal poorer functioning and indicate a need for additional support. Although increased time gaming might be changing how adolescents spend their free time and might thus have public health implications, it does not seem to relate to co-occurring well-being issues or mental ill-health for the majority of adolescent gamers.

Receipt of evidence-based care for children and adolescents with anxiety in Australia

OBJECTIVE

Cognitive-behavioural therapy is recommended as the first-line treatment for children and adolescents with anxiety. Despite its efficacy, a recent United Kingdom study indicated that few children with anxiety disorders receive cognitive-behavioural therapy. The primary aim of this study was to examine the receipt of cognitive-behavioural therapy for children and adolescents with elevated anxiety symptoms in Australia. Second, this study also examined whether there was a difference in the type of treatment received based on socioeconomic status and geographical location.

METHOD

Using self-reported questionnaires, parents of children aged 4-18 years and children aged 12-18 years (N = 784; elevated anxiety symptom sample n = 169) were recruited from four samples: community (n = 164), school (n = 177), clinic (n = 16) and online panel provider (n = 427). Participants reported on the child's anxiety symptoms and the type of treatment (if any) the child received for their anxiety symptoms.

RESULTS

Results indicated that 19.5% of children and adolescents with elevated anxiety symptoms received evidence-based treatment (e.g. cognitive-behavioural therapy). Of those families who did seek help for anxiety in Australia, the majority (66.3%) did not receive cognitive-behavioural therapy. In addition, neither socioeconomic status (which was based on the Australian Index of Community Socio-Educational Advantage [ICSEA]) nor location (metropolitan vs regional/remote) affected whether individuals received evidence-based care or non-evidence-based care.

CONCLUSION

Overall, children and adolescents in this study seeking support for their anxiety symptoms were not receiving adequate evidence-based care, regardless of socioeconomic status and location. These findings indicate there is a need to increase the receipt of cognitive-behavioural therapy for children and adolescents with anxiety symptoms. The findings should tentatively be interpreted, given data were collected during the COVID-19 pandemic.

Effect of stimulant medication on loss of control eating in youth with attention deficit/hyperactivity disorder: a prospective, observational case series study protocol

BACKGROUND

Loss of control eating (LOC-E) in youth predicts the later development of full-syndrome binge-eating disorder (BED), and therefore, could be a relevant target for prevention treatments. To develop these treatments, it is important to understand the underlying disease processes and mechanisms. Based on the putative role of neurocognitive impairments in the pathogenesis of LOC-E, treatments that modulate these neurocognitive factors warrant further exploration. For instance, stimulants are an effective treatment for impulsivity in youth with attention deficit/hyperactivity disorder (ADHD) and have been shown to improve symptoms of BED in adults. Notably, stimulants have not been examined as a treatment for LOC-E in youth. To explore this gap, we aim to measure change in LOC-E episodes and secondary outcomes in youth with comorbid ADHD and LOC-E who are being started on stimulants.

METHODS

We will collect prospective observational data on forty 8-to-13-year-old youth diagnosed with comorbid ADHD and LOC-E who are initiating a stimulant for ADHD. Prior to stimulant initiation, participants will complete baseline measures including LOC-E episode frequency in the last 3 months (primary outcome), and secondary outcomes including disordered eating cognitions, emotions and behaviors, ADHD symptom severity, parental LOC-E, impulsivity and reward sensitivity, and anxiety/mood severity. Outcome measurements will be gathered again at 3-months after initiating the stimulant. Within-patient standardized effect sizes with 95% confidence intervals will be calculated from baseline to 3-month follow-up for all outcomes.

DISCUSSION

Many individuals with LOC-E or binge eating do not fully remit over the course of psychotherapy. Whereas psychotherapy may address psychological and sociocultural domains associated with LOC-E, some individuals with neurocognitive impairments (e.g., ADHD) and neurobiological deficits (e.g., low intrasynaptic dopamine or norepinephrine) may benefit from adjunctive treatment that targets those factors. This will be the first study to provide pilot data for future studies that could examine both the effect of stimulants on LOC-E in youth and underlying mechanisms.

TRIAL REGISTRATION

Trial registration number: NCT05592119.

Brief internet-delivered cognitive-behavioural intervention for children and adolescents with symptoms of anxiety and depression during the COVID-19 pandemic: a randomised controlled trial protocol

BACKGROUND

The COVID-19 pandemic has had major impacts in many different spheres, including mental health. Children and adolescents are especially vulnerable because their central nervous system is still in development and they have fewer coping resources than do adults. Increases in the prevalence of depressive and anxiety symptomatology have been reported worldwide. However, access to mental health care is limited, especially for the paediatric population and in low- and middle-income countries. Therefore, we developed a brief internet-delivered cognitive-behavioural intervention for children and adolescents with symptoms of anxiety and depression. The aim of this proposed study is to test the efficacy of the intervention.

METHODS

We will conduct a two-arm, parallel randomised controlled trial involving children and adolescents (8-11 and 12-17 years of age, respectively) with symptoms of anxiety, depression or both, according to the 25-item Revised Child Anxiety and Depression Scale (t-score > 70). A total of 280 participants will be randomised to the intervention group or the active control group, in a 1:1 ratio. Those in the intervention group will receive five weekly sessions of cognitive-behavioural therapy via teleconference. The sessions will focus on stress responses, family communication, diaphragmatic breathing, emotions, anger management, behavioural activation and cognitive restructuring. Participants in both groups will have access to 15 videos covering the same topics. Participant-guardian pairs will be expected to attend the sessions (intervention group), watch the videos (control group) or both (intervention group only). A blinded assessor will collect data on symptoms of anxiety, depression and irritability, at baseline, at the end of the intervention and 30 days thereafter. Adolescents with access to a smartphone will also be invited to participate in an ecological momentary assessment of emotional problems in the week before and the week after the intervention, as well as in passive data collection from existing smartphone sensors throughout the study.

DISCUSSION

Internet-delivered interventions play a major role in increasing access to mental health care. A brief, manualised, internet-delivered intervention might help children and adolescents with anxiety or depressive symptomatology, even outside the context of the COVID-19 pandemic.

TRIAL REGISTRATION

ClinicalTrials.gov NCT05139433. Registered prospectively in November 2021. Minor amendments made in July 2022.

Urban–Rural Distinction or Economic Segmentation: A Study on Fear and Inferiority in Poor Children’s Peer Relationships

Peer relationships play an important role in the growth of children. This study offers insights about feelings of fear and inferiority in children’s peer relationships. Based on a national survey, the 2018 Construction for Social Policy Support System for Urban and Rural Poor Families in China, initiated by the Ministry of Civil Affairs, and using multiple regression models and a structural equation model, this study discusses whether and how having a rural household registration or being from a poor (dibao) family has an isolation effect on fear and inferiority in children’s peer relationships. The research findings indicate that children with a rural household registration or those from a dibao family are at a disadvantage in peer interactions. Moreover, rural resident identity has an indirect effect on children’s fear of peers and inferiority, mainly through psychological resilience, anxiety and depression, and mobile phone dependence. Being from a dibao family directly influences children’s fear and inferiority in their peer relationships; it also indirectly influences fear of peers and inferiority through psychological resilience. This study suggests that more attention should be paid to fear of peers and inferiority in rural children or children from a dibao family.

Effectiveness of an add-on guided internet-based emotion regulation training (E-TRAIN) in adolescents with depressive and/or anxiety disorders: study protocol for a multicenter randomized controlled trial

BACKGROUND

During adolescence, depressive and anxiety disorders are among the most common mental health disorders. Both disorders tend to persist, are predictive for other mental disorders, and are associated with severe impairment in diverse areas. Although Cognitive Behavioral Therapy (CBT) has proven to be an effective treatment, a considerable number of adolescents do not respond to CBT and residual symptoms often remain. Therefore, it is of great importance to improve treatment outcomes for depressed and/or anxious adolescents. Dysfunctional emotion regulation appears to be a transdiagnostic factor in the development and maintenance of aforementioned disorders. Enhancing emotion regulation skills may therefore reduce symptom severity. In light of this, we developed a guided internet-based emotion regulation training (E-TRAIN) that will be added to CBT. This study aims to evaluate the effectiveness of E-TRAIN + CBT compared to CBT alone on depressive and anxiety outcomes among adolescents with depressive and/or anxiety disorder.

METHODS

In this multicenter two-arm randomized controlled trial with parallel group design, we aim to include 138 adolescents, aged 13-19 years, referred for treatment and diagnosed with depressive and/or anxiety disorder. Participants will be allocated to either CBT or CBT + E-TRAIN. Assessments will take place at baseline, and at 3 (T1), 6 (T2) and 12 (T3) months after baseline. We will conduct multi-informant assessments: the adolescent, a parent/caregiver, and the CBT therapist will be asked to fill in questionnaires. The continuous primary outcome measure is self-reported depressive and anxiety symptoms at six months after baseline, measured with the RCADS25. Secondary outcome measures include anxiety or depression diagnosis based on a semi-structured clinical interview, emotion (dys) regulation, and parent-report measures of anxiety, depression and emotion (dys) regulation.

DISCUSSION

This study is the first randomized controlled trial to examine the additional value of a guided internet-based emotion regulation training to regular CBT in adolescents with depressive and/or anxiety disorders. If this intervention is effective, it can be implemented in mental health care and improve treatment for these young people.

TRIAL REGISTRATION

Registered on June 23, 2021 in The Netherlands Trial Register (NL9564). Retrospectively registered. Recruitment started in May 2021 and is ongoing.

Anxiety and Depression in Northern Plains American Indian Youth: Evidence for Resilience and Risk

Developing research collaborations with Indigenous communities to understand the expression and experience of anxiety and depression in American Indian (AI) youth and identifying protective and risk factors may be an important first step toward addressing AI health inequities. We used a community-based participatory research (CBPR) approach to investigate anxiety and depressive disorder symptoms among AI youth living on a Northern Plains reservation. Moreover, we examined whether symptoms were related to two potential protective and risk factors, anxiety control beliefs and rumination. Our tribal research team collected multi-reporter survey data from 71 AI 3rd-6th graders (8-13-years-old; 62.3% female) attending a tribal school, their caregivers, and teachers. Results pointed toward resilience in this sample with 7.3% and 8.7% of AI youth reporting clinical levels of anxiety and depressive disorder symptoms, respectively, and on average experiencing symptoms "Sometimes." There were moderate correlations between youth- and teacher-reported anxiety and depressive disorder symptoms, but no correlation with caregivers. Anxiety control beliefs were lower in older compared to younger AI youth and negatively related to youth-reported anxiety and depressive disorder symptoms, while rumination was positively related to youth-reported anxiety and depressive disorder symptoms and teacher-reported anxiety disorder symptoms. Age moderated relations between anxiety control beliefs and both youth-reported anxiety and depressive disorder symptoms with only significant relations found for older youth. Our findings are consistent with research showing resilience to internalizing problems in AI youth living on a reservation, but replication of their relations to anxiety control beliefs and rumination in other Indigenous peoples is warranted.

Psychometric properties of the Spanish Child PTSD Symptom Scale for DSM-5-Self-Report in El Salvador

Conducting research in global applied settings necessitates the use of easily administered, brief, and evidentiary measures. One widely used, brief self-report measure of posttraumatic stress disorder (PTSD) symptoms in children and adolescents is the Child PTSD Symptom Scale for DSM-5-Self-Report (CPSS-5-SR). The present study examined the factor structure, measurement invariance, reliability, and convergent validity of the Spanish translation of the CPSS-5-SR in a sample of 1,296 third- through 12th-graders in El Salvador (M_age = 12.73 years, SD = 2.67, 55.2% female, 100.0% Latinx). This sample was collected as part of a government-led initiative to conduct broad school-based psychopathology screening, with the wider goal of introducing trauma-informed services into El Salvador's school system. Consistent with prior research, confirmatory factor analysis indicated that the four-factor DSM-5 model displayed a strong fit with the data. Measurement invariance by gender was also examined, with results showing invariance at the configural, metric, and scalar levels, indicating strong evidence that participants' patterns of response did not differ by gender. The results also indicated strong reliability, Cronbach's α = .91, and convergent validity with measures of commonly comorbid psychopathology, rs = .43-.68. Total scale norms derived from the current sample are provided. These findings highlight the considerable levels of posttraumatic stress experienced by Salvadorian youth and the importance of establishing evidentiary measures of psychopathology that can be used in diverse global populations. In particular, psychometric research represents the first step in augmenting efforts to screen, refer, and treat youth impacted by violence across the globe.

Efficacy of a culturally tailored cognitive-behavioural intervention for Ethiopian children with haematological malignancies: study protocol for randomised controlled trial

BACKGROUND

Paediatric cancer patients often experience anxiety and depression. Evidence suggests that cognitive-behavioural interventions may help reduce anxiety and depression in children undergoing cancer treatment. However, only a few studies evaluated its impact on the psychological well-being and quality of life of paediatric cancer patients globally. In Ethiopia, there has been no published study to date. Thus, this trial aims to evaluate the efficacy of a culturally tailored cognitive-behavioural intervention for Ethiopian children with haematological malignancies receiving chemotherapy.

METHODS

A single-blinded, parallel-group, two-arm, repeated measure randomised controlled trial will be conducted. Eighty children aged 8 - 18 years with haematological malignancy receiving chemotherapy will be recruited and randomly assigned to experimental or control groups. The experimental group will receive five sessions of introducing cognitive-behavioural intervention, identifying and modifying maladaptive thoughts and behaviour, behavioural activation, practising deep breathing exercises, reassessing goals or treatment plans, and encouraging participants to maintain changes. Each session will be conducted face-to-face for 30-35 min a week. The control group will receive usual care. The outcomes will be measured at baseline, post-intervention, and one month after the intervention using the Revised Child Anxiety and Depression Scale and Paediatric Quality of Life Inventory Generic Core Score 4.0.

DISCUSSION

The findings of this study will provide evidence to support the integration of culturally effective cognitive-behavioural intervention strategies into paediatric oncology practice and thus, add new knowledge to the literature and help improve the care of children with haematological malignancies receiving chemotherapy. If the cognitive-behavioural intervention is shown to be effective and culturally acceptable, it will provide evidence to include the intervention as a standard of care in paediatric haematology/oncology.

TRIAL REGISTRATION

ClinicalTrials.gov NCT05270655. Registered on March 8, 2022.

Loneliness and self-harm in adolescents during the first national COVID-19 lockdown: results from a survey of 10,000 secondary school pupils in England

Adolescents' loneliness and self-harm have received considerable attention during the COVID-19 pandemic with concerns that the socioecological changes taking place would contribute to an escalation of both loneliness and self-harm. However, empirical evidence is scant. We estimated the prevalence of loneliness and self-harm in adolescent school pupils and investigated the association of loneliness and change in loneliness during the UK's first lockdown with self-harm during lockdown in a cross-sectional school survey (OxWell) involving 10,460 12-18-year-olds from south England. Loneliness was measured with four items. Self-harm was ascertained through a detailed questionnaire. The prevalence of loneliness and self-harm were estimated applying post-stratification weights to account for differences between the study sample and the target population. The associations between indicators of loneliness and self-harm were examined using mixed effect models. 1,896 of 10,460 adolescents (18.1%) reported feeling lonely 'often' (weighted proportion 16.8%). 3,802/10,460 (36.4%; weighted proportion 35%) felt more lonely since lockdown. Self-harm during lockdown was reported by 787/10,460 adolescents (7.5%; weighted proportion 6.7%). Controlling for confounders, adolescents who reported feeling lonely 'often' [adjusted odds ratio (aOR) 2.8, 95% CI 2.1-3.9, p < 0.0001] or 'sometimes' (aOR 2.2, 95% CI 1.5-3.2, p < 0.0001) were more likely to self-harm during lockdown relative to adolescents who reported 'never' or 'hardly ever' feeling lonely. Exacerbation in loneliness during lockdown was associated with an increase in the odds of self-harm during lockdown. Loneliness, heightened loneliness and self-harm were common during lockdown and closely linked. It is important to support schools in address loneliness and self-harm as part of efforts to improve well-being as the long tail of the pandemic continues to impact on child and adolescent mental health. Understanding how loneliness and self-harm may co-vary could be important for future self-harm reduction strategies in young persons.

Supplementary Information

The online version contains supplementary material available at 10.1007/s12144-022-03651-5.

Acceptance and Commitment Therapy for a Child With Misophonia: A Case Study

Misophonia, a condition involving hypersensitivity, anger, and/or disgust in response to specific noises (e.g., chewing, tapping), is highly underresearched in children. Several case studies point towards the utility of cognitive behavioral therapy and related treatments (e.g., acceptance and commitment therapy [ACT]). ACT presents a particularly promising option, as it focuses on building psychological flexibility in response to difficult internal experiences, rather than trying to remove or change them (e.g., responding effectively to irritation provoked by chewing). The present case study describes “Kelly” (pseudonym), a 12-year-old girl with moderately severe misophonia symptoms, who received a 16-session course of ACT for misophonia. At post-treatment, Kelly reported a decline to the mild range of misophonia, as well as re-engagement in activities that were important to her and clinically significant reductions in depressive symptoms. These results suggest that ACT may be an appropriate treatment for children with misophonia; however, much more research is warranted.

Youth Metacognitive Therapy (YoMeta): protocol for a single-blind randomised feasibility trial of a transdiagnostic intervention versus treatment as usual in 11–16-year-olds with common mental health problems

Background

Mental health disorders in children and young people (CYP) are increasing but the provision of current evidence-based treatment for common mental health problems is limited. Treatment effects vary widely with no clear superiority of a single treatment approach. Further evaluation of contemporary and effective treatments in CYP is needed. Metacognitive therapy (MCT) has shown enhanced efficacy over ‘gold standard’ approaches in adult mental health, but so far has not been evaluated in a randomised trial of CYP. As such, we aim to assess the acceptability and feasibility of group-MCT for CYP with common mental health problems in comparison to usual treatment within Child and Adolescent Mental Health Services (CAMHS).

Method

YoMeta is a multicentre, two-arm, single-blind randomised feasibility trial comparing group-MCT to usual care in CYP with common mental health problems in CAMHS. CYP (target sample n = 100) with a common mental health problem will be recruited across at least three CAMHS services in the UK. Participants in the intervention arm will receive up to eight sessions of group-MCT delivered by a CAMHS mental health practitioner. The control arm will receive usual care in CAMHS which includes individual or group-based therapy. Feasibility will be assessed by the success of recruitment, retention, and data quality. Acceptability of the intervention will be assessed by the number of sessions attended and through qualitative interviews aimed at exploring CYP acceptability and understanding of the intervention. Symptoms of psychological distress will be assessed using the Revised Children Anxiety and Depression Scale (RCADS) at 20 weeks. We will also assess psychological well-being, symptoms of depression, metacognitive beliefs, quality of life, and measures to support economic evaluation (health status and health and social care use). Qualitative interviews will be conducted to understand practitioner’s views on training and delivery of group-MCT.

Discussion

The trial is designed to evaluate the acceptability and feasibility of group-MCT for CYP with common mental health problems. Group-MCT may aid in improving access to treatment, reduce waiting times, and improve outcomes for CYP with common mental health disorders. The study will provide important information and data to evaluate future research potential and confirm sample size estimation for a definitive large-scale RCT to test the effectiveness and cost-effectiveness of group-MCT in CYP.

Trial registration

NCT05260060; ISCTRN18335255

Measuring the Cultural Competence of Latinx Domestic Violence Service Organizations

Domestic violence (DV) represents a significant public health concern in the United States, including among Latinx populations. Despite the negative consequences associated with experiencing DV, research has shown that Latinx DV survivors may be less likely than others to utilize important services. One potential barrier is cultural competence (CC) in the provision of services specific to Latinx survivors among DV organizations. Thus, a beneficial addition to the field of DV service provision for such survivors is a better understanding and measurement of CC for this unique population. The exploratory, cross-sectional study herein presents the development and evaluation of a novel instrument for measuring the CC of DV organizations. Exploratory factor analysis was used on a purposive sample of 76 organizations in North Carolina who completed a comprehensive survey on their characteristics, practices, norms, and values. Psychometric results found best support for a 29-item, 4-factor bifactor model with both a general CC factor as well as three sub-factors. The general scale was named "General Cultural Competence," while the three sub-scales were named "Organizational Values and Procedures," "Latinx Knowledge and Inclusion," and "Latinx DV Knowledge." The final measure also demonstrated convergent validity with key organizational characteristics. Overall, higher CC scores were associated with organizations having more DV services in Spanish, a higher percentage of staff attending CC training, a higher percentage of staff attending Latinx service provision training, and a medium or greater presence in the Latinx community, and a moderate or stronger relationship with the Latinx community. The development of this measure is particularly useful in addressing knowledge gaps regarding the measurement of CC for Latinx DV services. Implications have importance for both the measurement of organizational CC and the scope of the measure's associations with organizational, provider, and client outcomes.

Child, Parent, and Family Adjustment for Patients Followed in a Multidisciplinary Spina Bifida Clinic

Objectives

To characterize child, parent, and family adjustment for patients followed in a multidisciplinary spina bifida (SB) clinic.

Methods

Participants were drawn from clinical cases seen through a multidisciplinary outpatient SB clinic at a children's hospital between 2017 and 2019. Participants included 209 youth under 19 years old who were diagnosed with SB and their parents. Self-reported internalizing symptoms were measured in youth in grade 3 through 12 using the 25-item Revised Children's Anxiety and Depression Scale-25 (RCADS-25). Self- and parent-reported quality of life and family functioning were obtained using the Pediatric Quality of Life Inventory (PedsQL) 4.0 Generic Core Scales and Family Impact Modules.

Results

A total of 45.7% of children and adolescents reported at-risk psychosocial functioning on the PedsQL. In contrast, only 5% of patients reported clinically elevated internalizing symptoms on the RCADS. Parents' quality of life and family functioning in the study were higher than in most studies of parents of children with other chronic health conditions, children with attention deficit-hyperactivity disorder, and healthy control samples.

Conclusion

Our findings indicate that children and adolescents with SB are at risk for poor health-related quality of life (HRQOL); however, poorer HRQOL may not necessarily be associated with more severe psychiatric symptoms in this population. Examining resilience factors that may help to buffer against challenges to HRQOL will be important in informing future interventions.

Speech-Language Pathology Assessment of School-Age Children With Traumatic Brain Injury: A Scoping Review

PURPOSE

The purpose of this study was to describe evidenced-based assessment practices for school-age children with any severity of traumatic brain injury (TBI) that could inform the practice of speech-language pathologists (SLPs).

METHOD

A scoping review of the literature was conducted following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews guidelines. Included studies were assigned thematic labels related to the International Classification of Functioning, Disability and Health framework.

RESULTS

A total of 30 articles met inclusion criteria for this study. Most studies included adolescent or teenage participants with mild TBIs in the acute stages of recovery. Twenty-two different assessments were reported on for children with TBI addressing body structure/function (n = 19 assessments), activities and participation (n = 1 assessment), and contextual factors (n = 3 assessments).

CONCLUSIONS

Current assessments have a clear focus on body structure/function for adolescents after childhood TBI, with little research evidence to address activities and participation or contextual factors. The limited amount of functional assessments directly related to the SLP scope of practice stresses the need for additional research on ecologically valid and comprehensive assessment approaches for school-age children with TBI. The results of this review could be utilized as a resource in providing theoretical, evidence-based, and person-centered evaluation methods for children with TBI.

SUPPLEMENTAL MATERIAL

https://doi.org/10.23641/asha.20422170.

Examining the Process of Implementing a Three-Step Mental Health and Wellbeing System of Care for Children and Adolescents Across Multiple Community Settings

Mental health problems affect large numbers of young people. Integrated systems are required that can be applied in diverse settings to reach youth 'where they are'. We evaluated the process of implementing a three-step youth mental health and wellbeing system in diverse community settings according to three implementation outcomes: feasibility, penetration and acceptability. The study describes 49 applications of the 'Life-Fit-Learning system' designed to assess the mental health and wellbeing of youth (Assess step), provide feedback on assessment results (Reflect step), and connect them to resources and services proportionate to their needs (Connect step). Within a participatory research approach, 3798 administrations were conducted with youth between 9 and 18 years and 90 administrations were conducted with adults. Implementation was based on the four phases of the Quality Implementation Framework and was staged to integrate stakeholder and consumer feedback and experience gained from focus groups and two pilot phases before full implementation. Feasibility ratings of successful implementation ranged from 86.7 to 96.4% across applications and settings. High penetration rates were achieved. The Life-Fit-Learning system successfully reached 91.9% to 96% of youth with the Assess and Reflect steps and low intensity Connect step resources. Of those, 14.7% to 23% were identified at-risk for mental health problems and 93% to 97% of those at-risk youth additionally received Connect step co-delivered group-based programs (moderate intensity care) and/or individual treatment (high intensity care). Youth and parents reported high satisfaction across all steps and delivery modes. With strong collaboration, an integrated model of care can be delivered feasibly, effectively and satisfactorily to reach large numbers of young people across settings.

A multi-group confirmatory factor analysis of the revised children's anxiety and depression scale (RCADS) in Spain, Chile and Sweden

BACKGROUND

There is a need for a measure that can be used across countries and cultures to advance cross-cultural research about internalizing mental health symptoms in children and adolescents. The Revised Children's Anxiety and Depression Scale (RCADS) is a potential candidate, but no study has examined whether its scales are measured similarly in youth populations from different countries.

METHODS

In this study, we use confirmatory factor analysis (CFA) and multi-group CFA to examine the cross-cultural properties of a short and free to use 30-item version of RCADS that assesses social, generalized, panic, and separation anxiety alongside depression and obsessive-compulsive symptoms. We tested the factor structure of RCADS in children and adolescents from Chile, Spain, and Sweden, recruited using different research designs (i.e., school-based studies and an anonymous web survey), and whether the factor structure showed measurement invariance across the three countries.

RESULTS

The proposed factor structure of RCADS showed good model/data fit in all three countries and was superior to a unidimensional model in which correlations among scale items were explained by a single broad internalizing factor. Each RCADS subscale showed adequate to excellent internal consistency in all three countries and multi-group CFA supported scalar invariance across the three countries.

LIMITATIONS

No clinical sample was included.

CONCLUSIONS

This study provides an important first step in supporting the use of RCADS in cross-cultural research on depression, anxiety and obsessive-compulsive symptoms in children and adolescents, but more work on validity aspects of the scale across cultures is needed.

Virtual Reality as Anxiolysis During Laceration Repair in the Pediatric Emergency Department

BACKGROUND

Although procedural pain is effectively treated with analgesics, managing anxiety during laceration repair is more challenging.

OBJECTIVES

We examined the feasibility of using immersive virtual reality (VR) as anxiolysis during laceration repair in the pediatric emergency department (ED).

METHODS

We conducted a non-blinded, observational, pilot study in an urban pediatric ED that enrolled a convenience sample of children aged 5-13 years undergoing sutured repair of non-facial lacerations. Subjects played an immersive VR game while undergoing laceration repair. Parents assessed their child's anxiety on a 100-mm visual analogue scale at enrollment and during laceration repair. The primary outcome measure was the percentage of children whose anxiety score did not increase by ≥ 20 mm from enrollment to the first stitch.

RESULTS

Forty patients completed the study. Mean initial anxiety score was 54 mm (standard deviation 33 mm). Thirty-seven of forty patients (93%; 95% confidence interval [CI] 83-99%) had anxiety scores that did not increase by 20 mm or more from enrollment to the first stitch. Eighty percent (95% CI 64-91%) of patients' anxiety scores decreased between enrollment and first stitch. The mean change in anxiety score at first stitch was -39 mm (95% CI -51 mm to -27 mm; p < 0.001). Similar downward trends in anxiety scores were noted throughout the procedure. All laceration repairs were successfully completed without sedation or restraints. There were no adverse events noted, and the main barriers identified with VR use involved easily correctable technical difficulties with the equipment.

CONCLUSION

Immersive VR is a safe and effective distractive technique to reduce procedural anxiety during laceration repair in the pediatric ED.

Pain and Fear of Cancer Recurrence in Survivors of Childhood Cancer

OBJECTIVES

Theoretical models suggest that anxiety, pain intensity, and pain catastrophizing are implicated in a cycle that leads to heightened fear of cancer recurrence (FCR). However, these relationships have not been empirically examined. The objective of this study was to examine the relationships between anxiety symptoms, pain intensity, pain catastrophizing, and FCR in childhood cancer survivors and their parents and to examine whether pain catastrophizing predicts increased FCR beyond anxiety symptoms and pain intensity.

METHODS

The participants were 54 survivors of various childhood cancers (Mage=13.1 y, range=8.4 to 17.9 y, 50% female) and their parents (94% mothers). Children reported on their pain intensity in the past 7 days. Children and parents separately completed measures of anxiety symptoms, pain catastrophizing, and FCR.

RESULTS

Higher anxiety symptoms were associated with increased pain intensity, pain catastrophizing, and FCR in childhood cancer survivors. Higher anxiety symptoms and pain catastrophizing, but not child pain intensity, were associated with FCR in parents. Hierarchical linear regression models revealed that pain catastrophizing explained unique variance in both parent (ΔR2=0.11, P<0.01) and child (ΔR2=0.07, P<0.05) FCR over and above the effects of their own anxiety symptoms and child pain.

DISCUSSION

The results of this study provides novel data on the association between pain and FCR and suggests that a catastrophic style of thinking about pain is more closely related to heightened FCR than one's anxiety symptoms or the sensory pain experience in both childhood cancer survivors and their parents. Pain catastrophizing may be a novel intervention target for survivors and parents struggling with fears of recurrence.

Trauma-focused cognitive behavioral therapy with Puerto Rican youth in a post-disaster context: Tailoring, implementation, and program evaluation outcomes

PURPOSE

Trauma-Focused Cognitive Behavioral Therapy (TF-CBT) has not yet been systematically evaluated in the Caribbean context, particularly with Hispanic youth exposed to multiple disasters. The objective of this project was twofold: 1) to train mental health providers in Puerto Rico in TF-CBT as part of a clinical implementation project within the largest managed behavioral health organization (MBHO) on the island, and 2) to conduct a program evaluation to determine the feasibility of implementation and the effectiveness of the treatment.

METHOD

Fifteen psychologists were trained in TF-CBT. These psychologists then provided TF-CBT to 56 children and adolescents, ages 5-18, in community-based mental health clinics and one primary care clinic with a co-located psychologist in Puerto Rico. The mean number of traumatic events reported by youth referred for TF-CBT was 4.11.

RESULTS

Thirty-six out of 56 children enrolled in the project (64.3%) successfully completed all components of TF-CBT. Results demonstrated large effect sizes for reduction in youth-reported posttraumatic stress symptoms (PTSS) (Cohen's d = 1.32), depressive symptoms (Cohen's d = 1.32), and anxiety symptoms (Cohen's d = 1.18).

CONCLUSIONS

These results suggest that it was feasible to train providers in TF-CBT, that providers were able to deliver TF-CBT in community-based settings both in person and via telehealth (due to the COVID-19 pandemic), and that TF-CBT was an effective treatment option to address trauma-related concerns for youth in Puerto Rico in a post-disaster context. This project is an important first step in the dissemination and implementation of evidence-based trauma-focused treatment for Hispanic youth and disaster-affected youth in the Caribbean.

Utilization and Acceptability of Formal and Informal Support for Adolescents Following Self-Harm Before and During the First COVID-19 Lockdown: Results From a Large-Scale English Schools Survey

Background

Little is known about the perceived acceptability and usefulness of supports that adolescents have accessed following self-harm, especially since the onset of the COVID-19 pandemic.

Aims

To examine the utilization and acceptability of formal, informal, and online support accessed by adolescents following self-harm before and during the pandemic.

Method

Cross-sectional survey (OxWell) of 10,560 secondary school students aged 12-18 years in the south of England. Information on self-harm, support(s) accessed after self-harm, and satisfaction with support received were obtained via a structured, self-report questionnaire. No tests for significance were conducted.

Results

1,457 (12.5%) students reported having ever self-harmed and 789 (6.7%) reported self-harming during the first national lockdown. Informal sources of support were accessed by the greatest proportion of respondents (friends: 35.9%; parents: 25.0%). Formal sources of support were accessed by considerably fewer respondents (Child and Adolescent Mental Health Services: 12.1%; psychologist/ psychiatrist: 10.2%; general practitioner: 7.4%). Online support was accessed by 8.6% of respondents, and 38.3% reported accessing no support at all. Informal sources of support were rated as most helpful, followed by formal sources, and online support. Of the respondents who sought no support, 11.3% reported this as being helpful.

Conclusions

More than a third of secondary school students in this sample did not seek any help following self-harm. The majority of those not seeking help did not find this to be a helpful way of coping. Further work needs to determine effective ways of overcoming barriers to help-seeking among adolescents who self-harm and improving perceived helpfulness of the supports accessed.

The Roles of Social Media Use and Friendship Quality in Adolescents' Internalizing Problems and Well-being

Adolescents spend increasing amounts of time using social media, but whether social media use has a beneficial or harmful role in internalizing problems and well-being during adolescence remains under debate. The present study explored associations of social media use and friendship quality with adolescents' internalizing problems and well-being both concurrently and longitudinally, including the exploration of interactive effects between social media use and friendship quality and the examination of gender differences. Online questionnaire data collected in Spring 2018 and Spring 2019 from 1,298 Dutch adolescents aged 11-17 years (mean age 13.7 ± 1.1 years, 53.2% girls) were used. Path analyses showed that, cross-sectionally, girls (not boys) who used social media more frequently had more internalizing problems and lower well-being. Boys and girls with higher-quality friendships reported fewer concurrent internalizing problems and higher concurrent and longitudinal well-being; the association with internalizing problems was significantly stronger for girls as for boys. We found no significant interaction between social media use and friendship quality. Thus, the present study indicates that social media use and friendship quality have unique roles in adolescents' internalizing problems and well-being. Furthermore, the findings support the importance of gender-specific approaches to decrease adolescents' internalizing problems and enhance their well-being.

Long-term alterations in somatosensory functioning in survivors of childhood cancer

ABSTRACT

Cancer and its treatment can have lasting consequences on somatosensation, including pain, which is often underrecognized and undertreated. Research characterizing the impact of cancer on pain and sensory processing in survivors of childhood cancer is scarce. This study aimed to quantify generalized differences in pain and sensory processing in survivors of childhood cancer compared with reference data using a standardized thermal and mechanical quantitative sensory testing (QST) protocol. The association between demographic, clinical (eg, leukemia vs other cancers and treatment exposures), and psychosocial (eg, anxiety and pain catastrophizing) variables and sensitivity to pain and sensory stimuli were also evaluated. Participants were 56 survivors of various types of childhood cancer (52% male, Mage = 13.5 years, SD = 3.2, range = 8-17 years). On average, children were 7 years (SD = 4.1, range = 1.2-16.5) post treatment. Almost all participants (86%) had at least 1 abnormal QST parameter compared with age- and sex-matched reference data; however, few participants self-reported the presence of sensory abnormalities. Generally, participants exhibited reduced sensitivity across the QST parameters examined (Ps < 0.05, ds = 0.40-3.45). A significant minority (45%) also exhibited pain sensitization (P <0.001, d = 0.42). Several risk factors for changes in sensory processing were identified, including current age, history of leukemia, certain treatment exposures (eg, vincristine cumulative dose, major surgery, and bone marrow or stem cell transplant), time off treatment, and higher anxiety and pain catastrophizing scores. Overall, this study demonstrated that somatosensory changes are prevalent in survivors of childhood cancer years after the completion of treatment. Future research is needed to understand long-term implications of altered somatosensation in this complex population.

Rates, perceptions and predictors of depression, anxiety and Post Traumatic Stress Disorder (PTSD)-like symptoms about Covid-19 in adolescents

Increasing evidence has shown that the Covid-19 outbreak, and subsequent school closures and exam cancellations that followed, has impacted adolescent mental health. The current cross-sectional study examined rates of depression, anxiety and Post Traumatic Stress Disorder (PTSD)-like symptoms about Covid-19 in adolescents and whether current or past mental health support, additional support in school, keyworker status, poorer household relationships since the outbreak of Covid-19 or reduced physical activity were associated with elevated levels of depression, anxiety or PTSD-like symptoms. Lastly, it examined perceived changes in mental health due to the Covid-19 pandemic, school closures and the cancellation of exams. A total of 899 adolescents (14–18 years) took part in the ’in isolation instead of in school’ (INISS) project. Findings indicated that older adolescents, females, those who currently or previously received mental health support or additional support in school and adolescents who reported poorer relationships at home since Covid-19 were more likely to meet clinical threshold levels for their mental health. Adolescents highlighted worsening of their mental health due to Covid-19 and school closures with mixed positive and negative impact of exam cancellations. Adolescents experiencing clinical threshold levels of depression and anxiety uniquely reported worsening of their mental health since the Covid-19 pandemic, school closures and exam cancellations. Understanding the rates, perceptions and factors associated with increases in depression, anxiety and PTSD-like symptoms in adolescents during the Covid-19 pandemic will inform national policy in supporting adolescent mental health and recovery from the Covid-19 pandemic.

Childhood Disorder: Dysregulated Self-Conscious Emotions? Psychopathological Correlates of Implicit and Explicit Shame and Guilt in Clinical and Non-clinical Children and Adolescents

This study examined psychopathological correlates of implicit and explicit shame and guilt in 30 clinical and 129 non-clinical youths aged 8-17 years. Shame and guilt were measured explicitly via two self-reports and a parent report, and implicitly by means of an Implicit Association Test (IAT), while a wide range of psychopathological symptoms were assessed with questionnaires completed by children, parents, and teachers. The results showed no differences of implicit and explicit shame and guilt between the clinical and non-clinical group, implying that dysregulation of these self-conscious emotions is not per definition associated with psychopathology. Correlational analyses indicated that self-reported explicit shame was positively associated with a broad range of internalizing psychopathology, while self-reported explicit guilt was associated with higher levels of anxiety and to some extent lower levels of externalizing psychopathology. Correlations with parent-rated shame and guilt revealed the same pattern of results but were in general weaker. Furthermore, implicit shame and guilt did not show significant correlations with the various measures of psychopathology. It can be concluded that the link between shame and guilt and psychopathology is complex, and partly dependent on the disorder under study and context-related factors defining the maladaptive nature of these self-conscious emotions.

Adolescent anxiety and depression: burden of disease study in 53,894 secondary school pupils in the Netherlands

BACKGROUND

Prevalence rates of anxiety and depression in adolescence are rising markedly in early adolescence. It is important to quantify the non-fatal disease burden of anxiety and depression, such that early interventions can be well targeted, and resources can be allocated in a just and optimal way. This study aimed to estimate the non-fatal disease burden of anxiety and depression with and without suicidal ideation in girls and boys aged 13, 14, and 15 years.

METHODS

Participants were 53,894 secondary school pupils who completed health questionnaires between September 2018 and July 2019. A design-based approach was used for complex survey data with post-stratification weights and taking clustering at school-level into account. At individual level, disability weights (DWs) were calculated for each disorder. At population level, DWs were multiplied by the point-prevalence per one thousand population of the respective disorders to compute years lived with disability (YLD). DWs and YLD of anxiety and depression were calculated with and without adjustment for comorbid eating disorders, substance use disorders and somatic illnesses.

RESULTS

The unadjusted DW of depression with suicidal ideation (0.30) was greater than without suicidal ideation (0.26), and both were greater than the DW of anxiety (0.24). A similar ranking was obtained after adjusting for comorbidities. At population level, where the prevalence of the disorders come into play, the YLD disease burden was greatest for anxiety, followed by depression with suicidal ideation and depression without suicidal ideation with 17.40, 9.85, and 5.28 YLD per one thousand population, unadjusted for comorbidities. This pattern was the same after adjustment, but then the total YLD of depression with and without suicidal ideation was similar to the YLD of anxiety (12.47 and 12.46, respectively). Girls showed a significantly greater YLD burden of anxiety and depression than boys, but no differences were found between different age groups.

CONCLUSIONS

From an individual clinical perspective, depression, especially when accompanied by suicidal ideation, was identified as a major health concern, especially in girls. From a public health perspective, both anxiety and depression, especially when accompanied by suicidal ideation, were identified as major drivers of disease burden, again most notably in girls.

Protocol for a randomised controlled trial investigating an intervention to boost decentering in response to distressing mental experiences during adolescence: the decentering in adolescence study (DECADES)

INTRODUCTION

Decentering describes the ability to voluntarily adopt an objective self-perspective from which to notice internal, typically distressing, stressors (eg, difficult thoughts, memories and feelings). The reinforcement of this skill may be an active ingredient through which different psychological interventions accrue reductions in anxiety and/or depression. However, it is unclear if decentering can be selectively trained at a young age and if this might reduce psychological distress. The aim of the current trial is to address this research gap.

METHODS AND ANALYSIS

Adolescents, recruited from schools in the UK and Ireland (n=57 per group, age range=16-19 years), will be randomised to complete 5 weeks of decentering training, or an active control group that will take part in a combination of light physical exercise and cognitive training. The coprimary training outcomes include a self-reported decentering inventory (ie, the Experiences Questionnaire) and the momentary use of decentering in response to psychological stressors, using experience sampling. The secondary mental health outcomes will include self-reported inventories of depression and anxiety symptoms, as well as psychological well-being. Initial statistical analysis will use between-group analysis of covariance to estimate the effect of training condition on self-rated inventories, adjusted for baseline scores. Additionally, experience sampling data will be examined using hierarchical linear models.

ETHICS AND DISSEMINATION

This study was approved by the Cambridge Psychology Research Ethics Committee, University of Cambridge (PRE.2019.109). Findings will be disseminated through typical academic routes including poster/paper presentations at (inter)national conferences, academic institutes and through publication in peer-reviewed journals.

TRIAL REGISTRATION NUMBER

ISRCTN14329613.

Identification of a Pain-Specific Gene Expression Profile for Pediatric Recurrent Abdominal Pain

Objectives: Functional Abdominal Pain (FAP) and Irritable Bowel Syndrome (IBS) are common recurrent abdominal pain diagnoses with the hallmark, lack of inflammation. To identify a biological signature for IBS/FAP in the colon, this study used genetic profiling to uncover gene expression changes associated with IBS/FAP and abdominal pain. Methods: Patients (8 to 17 years) newly diagnosed with IBS or FAP were enrolled in the study. At diagnostic colonoscopy, three rectal biopsies were collected, and gene expression analysis was performed using a Qiagen PCR Array. Relative fold difference in gene expression for 84 pain-associated genes was calculated using the 2-ΔΔ Cq method compared with pain-free controls. Factors affecting pain burden (Pain Burden Interview; PBI) were analyzed, including age, sex, rectal inflammation, and gene expression. Data were analyzed using multiple stepwise linear regression and 2-tailed t tests (P ≤ 0.05). Results: Of the 22 total patients in the study, 19 were diagnosed with either IBS-Constipation (frequency of 5.26%), IBS-Diarrhea (47.37%), IBS-Mixed (10.53%), or FAP (36.84%). IBS/FAP patients reported significantly higher pain burden at the time of diagnosis compared to pain-free controls (p < 0.001), as well as significantly higher abdominal pain (p = 0.01). Of the 84 genes, expression of GRIN1 (p = 0.02), MAPK3 (p = 0.04), P2X4 (p = 0.04), and PTGES3 (p = 0.02) were all significantly associated with PBI score. Discussion: Abdominal pain associated with IBS/FAP in pediatric patients may be linked to the expression of GRIN1, MAPK3, P2X4, and PTGES3, pointing to potential novel therapeutic targets for management of recurring abdominal pain.

Efficacy of the integrative Body-Mind-Spirit group intervention for improving quality of life in parent-child dyads adjusting to atopic dermatitis: protocol for a randomised controlled trial

INTRODUCTION

Atopic dermatitis (AD) is the most common childhood inflammatory skin problem affecting 15%-30% of children. Although AD adversely impacts the psychosocial well-being of children and their parent caregivers, parents' psychosocial well-being is seldom mentioned in most non-pharmacological education programmes. A family-based psychosocial intervention, Integrative Body-Mind-Spirit (I-BMS) intervention, is examined. This study compares the efficacy of two versions of the I-BMS intervention (one delivered to both parents and children; one delivered to parents only) with a health education active control (delivered to parents only) in promoting adaptive emotional regulation and quality of life of children with AD and their parent caregivers.

METHODS AND ANALYSIS

This is a three-arm, with equal randomisation, parallel randomised controlled trial. 192 parent-child dyads will be recruited through hospitals and non-governmental organisations in Hong Kong. Each dyad will complete an individual pre-group screening interview. Eligible dyads will be randomised in a ratio of 1:1:1 into one of the three arms. Each arm consists of six weekly sessions. A computer-generated list of random numbers will be used to perform randomisation. The primary outcomes are quality of life and emotional regulation. Assessments are administered at baseline, post-intervention and 6-week follow-up. Mixed factorial Analysis of Covariance (ANCOVAs) based on intention-to-treat principle will be conducted to examine the efficacy of the two I-BMS interventions. Structural equation modelling will be conducted to examine the parent-child interdependent effects of intervention.

ETHICS AND DISSEMINATION

Ethics approval was obtained from the Human Research Ethics Committee of the University of Hong Kong (EA2001001) and the Institutional Review Board of the Hospital Authority of Hong Kong (UW 21-400, KC/KE-20-0360/FR-2, NTEC-2021-0408). Consent will be sought from participating parents and children. Parental consent for child participants will also be obtained. Findings will be presented in peer-reviewed journals and at conferences in medical dermatology, paediatrics and social work.

TRIAL REGISTRATION NUMBER

ClinicalTrials.gov Registry (NCT04617977).

The Bifactor Structure of the Emotion Expression Scale for Children in a Sample of School-Aged Portuguese Children

The Emotion Expression Scale for Children (EESC) is a 16-item self-report questionnaire assessing children's difficulties in emotion expression (i.e., poor emotion awareness and reluctance to express emotions). Considering the inconsistent findings regarding its factorial structure and dimensionality, this study aims to explore the factor structure and psychometric properties of the EESC in a sample of 286 Portuguese children (8-12 years). Three competing models were analyzed through confirmatory factor analysis (correlated two-factor model, one-factor model, and bifactor model). The bifactor model provided a better fit than the competing models, and the results suggested a strong general factor of "difficulties in emotion expression." The validity of the EESC was also indicated by its positive correlations with variables assessing child anxiety, depression, and behavioral avoidance and its negative correlation with mindfulness skills. The EESC is a valid measure of children's difficulties in emotion expression and the use of its total score is recommended.

Psychometric evaluation of a caregiver-report adaptation of the Overall Anxiety Severity and Impairment Scale (OASIS) for use with youth populations

Background Despite progress in youth anxiety assessment, there is need for a measure that is simultaneously (a) free, (b) brief, (c) focused broadly on anxiety and avoidance severity, frequency, and interference, and (d) concerned with the past week. The adult overall anxiety severity and impairment scale (OASIS) was adapted to yield a caregiver-report of past week youth anxiety and interference (OASIS-Y). Methods In a sample of diverse youth seeking anxiety services (N = 132; 67% racial/ethnic minority) and their caregivers, analyses examined the OASIS-Y factor structure, internal consistency, and convergent and divergent validity. Hierarchical linear modeling in a participant subset examined OASIS-Y sensitivity to treatment-related change. Results OASIS-Y internal consistency was high and confirmatory factor analysis supported a single-factor structure similar to that found in adults. OASIS-Y convergent validity was supported by a medium-sized association with an established, commercially available measure of youth anxiety, and divergent validity was supported by the absence of unique associations with measures of youth attention and externalizing problems. In a sample subset, session-by-session OASIS-Y scores significantly declined across treatment, and declined at a steeper rate among treatment "responders" versus "non-responders," providing evidence of OASIS-Y sensitivity to treatment-related change. Limitations This study focused on a clinical sample and cannot speak to OASIS-Y performance in community settings. Shared method-variance may have also influenced findings. Conclusions This study offers the first psychometric evaluation of the OASIS-Y, and underscores the promising clinical utility of the measure for assessing past week youth anxiety and impairment and for supporting routine outcome monitoring.

Becoming Strong: Sociocultural Experiences, Mental Health, & Black Girls' Strong Black Woman Schema Endorsement

This study examines the precedents and consequences of Black girls' Strong Black Woman schema (SBW) endorsement. Hierarchical regression analyses revealed that, among Black girls (N= 308), racial discrimination experiences and racial barrier socialization messages were positively associated with SBW endorsement. However, there was no significant interaction between racial discrimination and racial barrier messages in predicting SBW endorsement. Our analyses also revealed that SBW was not directly associated with internalizing symptoms (e.g., anxiety and depression symptoms). Furthermore, there was no significant interaction between racial discrimination and SBW endorsement in predicting internalizing symptoms. Findings provide evidence of and clarity on how sociocultural experiences shape SBW development and highlight a need to better understand how SBW endorsement functions in the mental health of Black girls.

Risk and protective factors for depressive symptoms among the youth living with HIV in Namibia

BACKGROUND

: Namibia has one of the highest HIV prevalence rates among young people living with HIV and AIDS. The study of mental well-being among this vulnerable population is emerging as an important area of public health research.

METHODS

: This study examined how gender, social support, food insecurity, HIV-related stigma, HIV treatment adherence and HIV transmission knowledge are related to depressive symptoms among young people living with HIV in rural northern Namibia. Data were collected from 188 participants from the Zambezi region.

RESULTS

: The hierarchical regression analysis revealed that being a female infected with HIV, having perceived food insecurity, experiencing more HIV-related stigma and having low levels of social support can exacerbate the severity of depressive symptoms in this sample of Namibian youth.

DISCUSSION

: Our findings point to the need to expand social support interventions, enhance socio-economic programmes and reduce HIV-related stigma among young people living with HIV, especially those residing in rural, HIV endemic, resource-limited communities in developing countries.

Happier during lockdown: a descriptive analysis of self-reported wellbeing in 17,000 UK school students during Covid-19 lockdown

Relatively little research has focused on children and young people (CYP) whose mental health and wellbeing improved during Covid-19 lockdown measures. We aimed to (1) determine the proportion of CYP who self-reported improvement in their mental wellbeing during the first Covid-19 lockdown and (2) describe the characteristics of this group in relation to their peers. We conducted a descriptive analysis of data from the 2020 OxWell Student Survey, a self-report, cross-sectional survey of English CYP. A total of 16,940 CYP primarily aged 8-18 years reported on change in mental wellbeing during lockdown. We characterised these CYP in terms of school, home, relational, and lifestyle factors as well as feelings about returning to school. One-third (33%) of CYP reported improved mental wellbeing during the first UK national lockdown. Compared with peers who reported no change or deterioration, a higher proportion of CYP with improved mental wellbeing reported improved relationships with friends and family, less loneliness and exclusion, reduced bullying, better management of school tasks, and more sleep and exercise during lockdown. In conclusion, a sizeable minority of CYP reported improved mental wellbeing during lockdown. Determining the reasons why these CYP felt they fared better during lockdown and considering how these beneficial experiences can be maintained beyond the pandemic might provide insights into how to promote the future mental health and wellbeing of school-aged CYP. All those working with CYP now have an opportunity to consider whether a systemic shift is needed in order to understand and realise any learnings from experiences during the pandemic.

The Role of Parent Engagement in a Web-Based Preventive Parenting Intervention for Child Mental Health in Predicting Parenting, Parent and Child Outcomes

Although parents’ engagement in parenting programmes has frequently been posited to influence the efficacy and dissemination of these programmes, its relationship with intervention outcomes in parenting programmes is understudied. This study examined the predictive value of parental engagement on preventive parenting outcomes in a tailored online parenting programme aimed at enhancing parental protective factors and reducing risk factors for child depression and anxiety disorders. The present study also explored the associations between parental engagement and other parent, child and family outcomes. Data were collected from a community sample of 177 parents who received a tailored online parenting programme (‘Parenting Resilient Kids’; PaRK) and their children as part of a randomised controlled trial. Participants completed measures on parenting, child anxiety and depressive symptoms, health-related quality of life and family functioning on three occasions. Multiple regressions showed that parental engagement explained additional variance in preventive parenting (most proximal outcomes) at post-intervention and 12-month follow-up. Indicators of higher levels of parental engagement, operationalised by greater proportions of recommended programme modules and intended goals completed, uniquely predicted higher levels of preventing parenting. Higher levels of parental engagement also predicted higher levels of parental acceptance and parental psychosocial health-related quality of life, lower levels of parental psychological control and lower levels of impairments in child health-related quality of life. However, parental engagement did not explain additional variance in parent or child reported anxiety or depressive symptoms. This study provides support for the role of parental engagement in facilitating parenting changes in parenting-focused interventions.