'I wouldn't want one or the other': Understanding parents' preferences for direct support or parent coaching for young autistic children

LAY ABSTRACT

Professionals often support autistic children by working with them directly (direct support) or by coaching their parents. We know a lot about what parents think about parent coaching, but we do not know as much about what they think about direct support. We also do not know whether parents prefer parent coaching or direct support. The current study involved 22 parents who each received 2 h a week of direct support for their autistic child and up to 1 h a week of parent coaching for 6 months. At the end of 6 months, all these parents indicated in a survey whether they preferred parent coaching or direct support. Eleven of these participating parents also chose to take part in an interview to understand more about these preferences. Our findings suggest that parents generally liked both supports and believed they worked well together; however, they preferred direct support over parent coaching. While parents think that both approaches are beneficial, there are strengths and challenges of each. These findings emphasise the importance of parent choice in the delivery of support. It may also be possible to adapt both approaches to address some of the identified challenges and improve the whole family's experience.

Does Camouflaging Cause Reduced Quality of Life? A Co-Twin Control Study

Camouflaging has been proposed to have a detrimental effect on quality of life, yet previous research has not accounted sufficiently for potential confounding by genetic and shared environmental factors. The current study utilized a co-twin control design providing stringent control for a range of confounders to investigate the hypothesis that camouflaging autistic traits has a negative impact on quality of life. The sample included 140 individual twins from 42 monozygotic (MZ) and 28 dizygotic (DZ) twin-pairs, enriched for participants with neurodevelopmental conditions including 22 autistic participants. All twins provided self-reports of camouflaging and quality of life. Autistic participants and specifically autistic females displayed increased camouflaging behaviors compared to non-autistic participants. Across the sample, higher levels of camouflaging were associated with reduced quality of life, surviving adjustment for confounding effects of autistic traits, ADHD, sex, and age. Within DZ- as well as MZ-pairs, which provide the highest level of control for unmeasured confounders, twins who camouflaged more reported lower quality of life compared to their co-twins, consistent with a causal influence of camouflaging on quality of life. Our results strengthen previous claims purporting camouflaging behaviors as a risk factor for reduced quality of life.

An Investigation of the Longitudinal Bidirectional Associations Between Interactive Versus Passive Social Media Behaviors and Youth Internalizing Difficulties. A Within-Person Approach

Ongoing concerns about the mental health of young people have intensified interest in the role of social media, with research suggesting that the nature of social media behaviors-whether interactive or passive-may differentially impact mental health. However, the bidirectional relationships between specific types of social media use and internalizing difficulties (anxiety and depression) remain underexplored, particularly at the within-person level over time. Data were extracted from the Dutch population-based Longitudinal Internet Studies for the Social Sciences (LISS) panel. Four yearly studies assessing time spent on interactive (communication) and passive use of social media in October (2019-2022) and four annual studies evaluating internalizing difficulties (anxiety and depression) in November (2019-2022) were used. Respondents who were 16- 25 years old in October 2019 (N = 321; M = 20.49; SD = 2.94; 61.7% female). Random Intercept Cross Lagged Path Models were used to analyze the data. There were no significant associations between passive social media use and internalizing difficulties at the within-person level over time. Within-person interactive use was associated with decreases in internalizing difficulties at one time point (2021 to 2022). The results provide marginal evidence that distinct social media behaviors are prospective factors associated with internalizing difficulties in young people.

Parenting-Related Social Networking Site Use and Psychological Distress in Parents of Infants: Cross-sectional Study Exploring the Moderating Effects of Loneliness and Parenting Anxiety

Background

In the digital age, social networking sites (SNSs) have revolutionized the approach to parenting. These platforms, widely used to access parenting information and support, affect parents both positively and negatively, with negative effects potentially increasing for those experiencing loneliness or anxiety.

Objective

This study examined the relationship between SNS use and psychological distress among parents of young children, controlling for the moderating effects of loneliness and parenting anxiety. We hypothesized that higher SNS use correlates to greater psychological distress, particularly among parents with elevated levels of loneliness or parenting anxiety.

Methods

A cross-sectional survey design using a closed web-based questionnaire was employed. Participants included 429 parents (205 mothers and 224 fathers) of children aged 0-3 years recruited through a web-based survey company in Japan. The majority of the participants were couples, with some living with extended family members. The sample also encompassed individuals in cohabiting partnerships and single parents. The survey included measures of psychological distress, loneliness, parenting anxiety, frequency of SNS use for parenting, and covariates. Analytical models to explain psychological distress included interactions between loneliness or parenting anxiety and SNS use, individually for both fathers and mothers.

Results

For mothers, a significant interaction effect was determined only between parenting anxiety and SNS use (b=0.247, SE 0.091; P=.008). Meanwhile, for fathers, significant interaction effects were observed for both loneliness (b=0.324, SE 0.127; P=.012) and parenting anxiety (b=0.144, SE 0.069; P=.038) with SNS use. A simple slope analysis for mothers indicated that SNS use was related to psychological distress only at higher levels of parenting anxiety (b=0.304, SE 0.090, β=.317; P<.001). Among fathers, SNS use was associated with psychological distress at higher levels of either parenting anxiety (b=0.330, SE 0.069, β=.346; P<.001) or loneliness (b=0.390, SE 0.098, β=.409; P<.001).

Conclusions

The study concluded that the relationship between SNS use and psychological distress among parents of young children is moderated by loneliness and parenting anxiety. The findings highlight the need for tailored approaches to help parents manage SNS use, particularly focusing on those with higher levels of loneliness and parenting anxiety. It is imperative that health professionals provide nuanced guidance to parents on SNS use, considering individual psychological factors and potential gender differences in the impact of SNSs on mental well-being.

Development of the Parent-Child Communication Quality Scale from the Perspective of Children's Psychological Needs

Parent-child communication plays a crucial role in children's healthy growth. Nevertheless, there is currently a paucity of instruments designed to measure the quality of parent-child communication from a psychological perspective. Accordingly, based on the self psychology theory, this study has developed the Parent-Child Communication Quality Scale (PCCQS) to assess the quality of parent-child communication in terms of the extent to which children's psychological needs are met. A total of 1095 urban children (50.9% girls, M = 9.92, SD = 1.15) aged 8 to 12 years in eastern China were surveyed in this study. The measurement structure of the PCCQS was examined using an exploratory factor analysis (EFA) and a confirmatory factor analysis (CFA). The results of the CFA supported the second-order, four-factor structure of the PCCQS, with the 15-item PCCQS consisting of four factors (i.e., mirroring, idealization, empathy, and appropriate response). In conclusion, the PCCQS has good construct and criterion validity, as well as high internal consistency and split-half reliability. The scale is therefore a valuable tool for assessing the quality of parent-child communication.

Parental control and adolescent social anxiety: A focus on emotional regulation strategies and socioeconomic influences in China

An individual's social adaptation, which is influenced by both internalizing and externalizing factors, depends on social anxiety. We proposed that the connection between parental psychological control and social anxiety among middle school students was mediated by negative emotion response-focused strategies and moderated by socioeconomic status (SES). We collected data from 1343 Chinese students from 12 to 16 years old (M = 13.3, SD = 0.96) by applying the questionnaire of parental psychological control scale, social anxiety scale and negative emotion response-focused strategies scale. The findings demonstrated that parental psychological control, including father and mother psychological control, was positively associated with social anxiety and that the relationship between parental psychological control and children's social anxiety was mediated by negative emotion response-focused strategies. Meanwhile, SES played a moderating role in the relationship between children's negative emotion response-focused strategies and social anxiety. The findings also suggest that we should pay more attention to the psychological status and social interaction of children with lower SES.

Exploring predictors of interaction among low-birth-weight infants and their caregivers: a machine learning-based random forest approach

BACKGROUND

Quality caregiver-infant interaction is crucial for infant growth, health, and development. Traditional methods for evaluating the quality of caregiver-infant interaction have predominantly relied on rating scales or observational techniques. However, rating scales are prone to inaccuracies, while observational techniques are resource-intensive. The utilization of easily collected medical records in conjunction with machine learning techniques offers a promising and viable strategy for accurate and efficient assessment of caregiver-infant interaction quality.

METHODS

This study was conducted at a follow-up outpatient clinic at two tertiary maternal and infant health centers located in Shanghai, China. 68 caregivers and their 3-15-month-old infants were videotaped for 3-5 min during playing interactions in non-threatening environment. Two trained experts utilized the Infant CARE-Index (ICI) procedure to assess whether the caregivers were sensitive or not in a dyadic context. This served as the gold standard. Predictors were collected through Health Information Systems (HIS) and questionnaires, which included accessible features such as demographic information, parental coping ability, infant neuropsychological development, maternal depression, parent-infant interaction, and infant temperament. Four classification models with fivefold cross-validation and grid search hyperparameter tuning techniques were employed to yield prediction metrics. Interpretable analyses were conducted to explain the results.

RESULTS

The score of sensitive caregiver-infant interaction was 6.34 ± 2.62. The Random Forest model gave the best accuracy (83.85%±6.93%). Convergent findings identified infant age, care skills of infants, mother age, infant temperament-regulatory capacity, birth weight, positive coping, health-care-knowledge-of-infants, type of caregiver, MABIS-bonding issues, ASQ-Fine Motor as the strongest predictors of interaction sensitivity between infants and their caregiver.

CONCLUSIONS

The proposed method presents a promising and efficient approach that synergistically combines rating scales and artificial technology to detect important features of caregiver-infant interactions. This novel approach holds several implications for the development of automatic computational assessment tools in the field of nursing studies.

Factors Associated With Not Receiving Mental Health Services Among Children With A Mental Disorder in Early Childhood in the United States, 2021-2022

Introduction

Many mental disorders begin in early childhood. Without timely treatment, mental disorders experienced by young children can impair their learning ability and relationships with others, causing lifelong complications. However, not all children with a mental disorder in early childhood receive treatment.

Methods

Using data collected from 46,424 children aged 2 to 8 years in the 2 most recent cycles of the National Survey of Children's Health (2021 and 2022), we estimated the prevalence of having a mental disorder and investigated factors associated with young children not receiving mental health care when needed. All analyses were adjusted for survey weights to account for the complex sampling design and nonresponse biases in generating nationally representative estimates.

Results

In 2021 and 2022, 19.0% of US children aged 2 to 8 years had 1 or more mental disorders. Of these children, 9.1% reported not receiving any needed health care in the previous 12 months, and of these, 45.8% reported not receiving mental health services when needed. The primary reasons for not receiving needed health care were problems getting an appointment (72.1%), issues related to cost (39.3%), and services needed not being available in the area (38.5%). Poor experiences with health care providers were consistently associated with not receiving needed mental health services among children with mental disorders.

Conclusion

Our findings suggest a strong link between health care factors and not receiving needed mental health services among US children with a mental disorder in early childhood. In addition to increasing the availability of mental health services and expanding health insurance coverage, future public health efforts should prioritize enhancing patients' experiences with health care providers.

Chronic Physiological Dysregulation and Changes in Depressive Symptoms: Testing Sex and Race as Vulnerability Factors

Depression is a growing public health concern that affects approximately 5% of adults in their lifetime (WHO in Depression, 2021). Understanding the biological correlates of depression is imperative for advancing treatment. Of particular interest is allostatic load, a multisystem indicator of chronic physiological dysregulation (McEwen and Seeman in, Ann N Y Acad Sci, 1999). The current longitudinal study examined the association between allostatic load, depressive symptoms, and the moderating roles of sex and race. Participants consisted of 150 young adults (Mage = 18.81) who reported their demographics and depressive symptoms at T1 and T2, a year and a half later. Allostatic load was computed using indicators of metabolic, cardiovascular, and neuroendocrine functioning. Allostatic load was found to predict changes in depressive symptoms. Moreover, interaction effects models revealed that the associations between allostatic load and depressive symptoms at follow-up were further influenced by sex, such that the relationship was significant for males, with pronounced effects for Black males in particular. Black males may be particularly vulnerable to the mental health consequences of biological dysregulation.

Factors influencing postdeployment reintegration adjustment for U.S. service members and their spouses by spouse gender

Research on spouses' adjustment after military deployment has focused primarily on female spouses of male service members; little is known about how adjustment differs by gender. We used Walsh's family resilience framework to examine communication, belief system, organizational factors, and other stressors, likely associated with postdeployment adjustment. Using Millennium Cohort Family Study data, logistic regressions assessed risk and protective factors on spouses' and service members' time to adjust, exploring whether spouse gender moderated their associations. Findings indicated that the association of (1) spouses' perceptions of their own mental functioning with spouses' and service members' adjustment and (2) spouses' mental readiness for deployment with service members' adjustment both differed by spouse gender, with associations attenuated for male spouses and their service member partners. Other factors associated with family adjustment included the spouse's satisfaction with communication, the extent to which the service member shared deployment experiences, the extent to which the spouse was bothered by deployment experiences, the spouse's participation in postdeployment transition programs, the spouse's informal support during deployment, and length of deployment. Results indicated shared and gender-specific risk and protective factors associated with spouse and service member adjustment, demonstrating the importance of tailored military family support programs addressing the needs of different populations of military spouses.

Clinical study on the intervention effect of digital therapy on children with attention deficit hyperactivity disorder (ADHD)

To evaluate the efficacy and safety of digital therapy for children aged 6 to 12 years with attention deficit hyperactivity disorder (ADHD). From January to March 2023, 52 children aged 6 to 12 years with attention deficit hyperactivity disorder (ADHD) from Wuhan Children's Hospital, Hubei Province, China were selected for intervention using the "MindPro1" attention training software developed by Jiangsu Ruinao Qizhi Medical Technology Co., Ltd. Before the intervention, the children were in a stable treatment state, and no modifications were made to the original treatment plan during the MindPro1 intervention. Subjects with severe mental illness or other conditions that may affect the implementation and evaluation of disease treatment were excluded. Subjects completed the planned 4-week intervention, and changes in attention-related variables were assessed using the Test of Attention Variables (TOVA) and the parent version of the 18-item SNAP-IV scale (Swanson, Nolan, and Pelham, version IV scale) before and after the intervention. After 4 weeks of intervention, the lower limit of the 95% confidence interval of the response rate of the 18-item SNAP-IV-Parent scale, which was ≥ 30% improvement from baseline, was higher than 27.5% (better than similar products on the market); the SNAP-IV parent score improved (P < 0.001), with statistical significance; the TOVA-ACS score improved (P < 0.05), with statistical significance. The acceptance rate of parents of children was 100%, and the average compliance rate was 95%. There were 4 cases (7.69%) of adverse reactions that may be related to the device in this trial, which recovered spontaneously within 2 days of discontinuation, and no serious adverse events occurred. After 4 weeks of treatment with ADHD auxiliary treatment software, the objective attention assessment data and attention function assessment scale were significantly improved. Parents had a high acceptance of the software, the average compliance rate of participants was high, and the incidence of related adverse events was low and mild.

Metabolic profiling of blood plasma in depression in pregnant women during early pregnancy

OBJECTIVE

The study aimed to perform metabolic profiling of serum samples using liquid chromatography with mass spectroscopy (LC-MS) and to explore potential biomarkers of early trimester depression.

METHOD

Using the Edinburgh Postnatal Depression Scale (EPDS), participants were randomly divided into study and control groups. Serum metabolic profiles of the two groups were analysed by using LC-MS. Differential metabolite and pathway analysis were identified by using orthogonal projections to latent structure-discriminant analysis (OPLS-DA) and Kyoto Encyclopedia of Genes and Genomes (KEGG) enrichment analysis. Additionally, least absolute shrinkage and selection operator (LASSO) logistic and receiver operating characteristic (ROC) curve analyses were also conducted to explore potential biomarkers of antenatal depression (AD).

RESULTS

The study included 41 participants, consisting of 16 subjects with AD and 25 controls. A total of 22 different metabolites were identified (p < .005), mainly affecting glycerophospholipid metabolism, linoleic acid metabolism, synthesis and degradation of ketone bodies, phenylalanine metabolism, and butanoate metabolism. The area under the ROC curve (AUC) for the LysoPC (24:0) was 0.858. This suggests that LysoPC (24:0) may be a potentially effective predictor of risk factors for AD.

CONCLUSIONS

The study suggests that LysoPC (24:0) may be an effective and specific lipid biomarker for early trimester depression.

Individual Participant Data Meta-Analysis: Individual Differences in Mediators of Parenting Program Effects on Disruptive Behavior

OBJECTIVE

Although parenting programs are the most widely used approach to reduce children's disruptive behavior, there is a notable lack of understanding of the exact changes in parenting that underlie their effects. Challenges include the frequent use of composite measures of parenting behavior, and insufficient power to detect mediation effects and individual differences in these in individual trials.

METHOD

We pooled individual participant data from 14 European randomized controlled trials of social learning-based parenting programs to examine which specific parenting behaviors best explain program effects. Participants were 3,252 families with children aged 1 to 13 years. As putative mediators, we included parental use of praise, tangible rewards, physical discipline, harsh verbal discipline, and not following through on discipline. Additionally, we explored whether subgroups of families showing different mediational pathways exist.

RESULTS

Changes in parenting partially mediated program effects, with all included parenting behaviors, except parental use of praise, serving as unique mediators. Less harsh verbal discipline and increased following through on discipline were the strongest mediators. We identified three subgroups with distinct responses to parenting programs. Most families benefited, partly through increased following through on discipline; those with the least or most difficulties were more likely to benefit less, or not at all.

CONCLUSION

Our findings offer insight into the specific parenting behavior changes key to reducing disruptive child behavior, while highlighting the need for innovative research methodologies to gain a deeper understanding of individual differences in parenting program benefits and mechanisms.

Training of Awareness in ADHD: Leveraging Metacognition

Attention deficit hyperactivity disorder (ADHD) is a disorder that is prevalent in children and adults, with significant impact on life outcomes. Common treatment strategies include a combination of pharmacological and psychosocial interventions which have recognized limits to their effectiveness. Consequently, there exists interest in additional non-pharmacological interventions. In the current minireview we aim to complement existing surveys by focusing on a complementary approach, namely rooted in metacognition or the training of awareness. We review programs that incorporate metacognitive training of awareness in skill-training, psychosocial interventions, and mindfulness, and discuss existing assessments of metacognitive ability in ADHD. Existing data suggest that metacognitive approaches have potential in supporting symptom management in ADHD, with gains in objective assessments in near and far transfer tasks in educational research and high satisfaction from parents. Further research is warranted in assessment of the relative contribution of metacognitive elements relative to other treatment components, objective assessments of outcomes in psychosocial interventions, and efficacy in adult interventions.

The Effects of Having a Child with Cancer on Parental Psychology: A Cross-Sectional Study

Objective: In childhood cancers, parents are affected psychologically as well as children. We aimed to evaluate the effect of childhood cancer type and stage, as well as elapsed time from diagnosis, on the anxiety and stress indicators among parents. Materials and Methods: Patients aged between 0-18 years and diagnosed with cancer who were receiving chemotherapy (0-1 month, 1-6 month, 6-12 month) and completed treatment were included. Parents of those children (mother or father) who agreed to participate this study were also included. The personal information form and three psychological assessment scales (Beck Hopelessness Scale (PSS), Psychological Resilience Scale (PRS), Uncertainty Intolerance Scale (IUS)) were used for assessment of mental health of the parents. Scores of the scales and clinical features of the children with cancer were compared statistically. Results: The study included 84 parents (57 mothers, 27 fathers) and 84 children. The rate of children with solid tumors was 60% (n:50) and 40% of them were metastatic, which means advanced stage. The rate of the children with leukemia was 40% (n:34) and 23% of them were in high-risk group. According to the type (leukemia vs. solid tumors) and stage (high risk/advanced stage vs. others) of the cancer, there was no statistical difference among parents in the psychological scales (p > 0.05). Additionally, results of the psychological scales showed no significant difference between mothers and fathers (p > 0.05). The hopelessness scores are significantly higher among parents whose child's treatment is terminated compared with those whose active therapy is ongoing, and resilience scores are higher among parents who have less than 1 month since diagnosis of childhood cancer than later periods. Conclusions: The regular assessment of mental health among parents of children with cancer across all the survivorship trajectory: at the time of diagnosis, during active therapy, and after treatment.

The Effectiveness of a Parent Empowerment Intervention for Caregivers of Children with Cystic Fibrosis: A Randomized Controlled Trial

This paper focused on the effectiveness of a parent empowerment intervention based on nursing education (PEINE). This study examined whether the intervention improved the quality of life of children with cystic fibrosis (CF) and improved their caregivers learn about the disease and develop problem-solving and coping skills. This randomized-controlled trial used a pretest-posttest parallel-group research design. The sample consisted of 48 parents (caregivers) of children with CF. Participants were randomly assigned to an intervention (n = 24) and a control group (n = 24). The intervention group received PEINE and standard care and treatment for ten weeks. The control group received standard care and treatment. Data were collected using a Disease Information Survey (DIS), the Ways of Coping Inventory (WCI), the Problem-Solving Inventory (PSI), and the Cystic Fibrosis Questionnaire (CFQ-R). After the intervention, the intervention group DIS scores (d: 1,627 [CI: 0.934,2.305], had more correct answers than the control group. Nursing interventions were effective (p < .001). There was no significant difference in the mean pretest-posttest PSI scores (d: 0.378 [CI: -0.221-0.972], posttest WCI scores (d: 0.239 [CI:-0.356-0.831]) between the intervention and control groups (p>.05). There was a significant difference in the mean posttest CFQ-R scores between the intervention and control groups (d: 1.363 [CI: l.698, 2.015]);(p < .001). PEINE increased the intervention group participants develop disease-management skills. However, the increase in their PSI and WCI scores was statistically insignificant. PEINE also increased the quality of life of children with CF. Parents of children followed in pediatric pulmonary diseases participated in the study. Parents were informed during outpatient clinic visits. After the first meeting, the children and parents who voluntarily agreed to participate in the research were contacted by phone. The outpatient nurse assisted in communicating with children and parents.

The Essentials: Upskilling a National Health Workforce in the Identification and Treatment of Eating Disorders

OBJECTIVE

Health practitioners report limited skills and lack of confidence in managing and treating people with eating disorders. The purpose of this study was to evaluate the national rollout of comprehensive basic training in identification, assessment, treatment, and management of people with eating disorders to clinicians.

METHODS

The Essentials: Training Clinicians in Eating Disorders is a core competency eLearning program. As part of a nation-wide multidisciplinary workforce training strategy, 7500 course places were provided free of charge to public and private health care professionals across all jurisdictions of Australia between January 2020 and March 2022.

RESULTS

A total of 7370 health professionals enrolled during the study period. All learning outcomes showed improvement with large effect (Cohen's d = 1.2-2), with the largest improvements for self-reported knowledge of requirements for working with children and adolescents. Effects did not depend on years of working with eating disorders suggesting that the training was beneficial across levels of experience. Those who started with very low knowledge of eating disorders or higher willingness to treat eating disorders were most likely to complete the course. Most participants reported that the course was relevant to their clinical practice, that they expected their clinical practices to change, and that they would recommend the course to other health professionals.

DISCUSSION

The strategy to provide government-funded core competency training in eating disorder care to healthcare professionals met key objectives by reaching health professionals eligible to provide government-rebated services in public and private settings across all jurisdictions including regional and remote areas.

Estimating adolescent mental health in the general population: current challenges and opportunities

Adolescence is a period of change and increased mental health difficulties, which are important for lifetime outcomes. Adolescent mental health is therefore an active research area, with large samples often drawing on self-report general measures (ie, not disorder-specific or focused on a narrow outcome). We argue that these measures have a key role in our understanding of issues such as prevalence, antecedents, prevention, and intervention, however, measurement has been given little attention and high-quality measures do not tend to be available or used. We offer insights into historical and psychometric challenges that have contributed to current problems and highlight the implications of relying on poor measures, which at their worst can be biased and unethical. We make recommendations for research and practice on selecting measures and improving the evidence base and make a call to action to reject low-quality measurement in this field.

Cognitive Stimulation and Maternal Feeding Styles in Families with Low Incomes: Impacts from a Randomized Clinical Trial

OBJECTIVE

To examine associations between cognitive stimulation in the home at 6 months and maternal feeding styles at 24 months, direct intervention effects of Smart Beginnings (SB) on feeding styles, and potential indirect effects of SB on feeding styles via earlier intervention effects on cognitive stimulation.

METHODS

Single-blind, two-site randomized clinical trial (RCT) of the SB intervention. SB integrates PlayReadVIP, a universal, pediatric primary care-based program, and Family Check-Up (FCU), a targeted secondary home-based parenting intervention. Mother-infant dyads (N = 327) were randomized at birth to standard pediatric care or the SB intervention. Linear regression analyses determined associations between cognitive stimulation at 6 months and maternal feeding styles at 24 months, a secondary data analysis. Direct intervention impacts on feeding styles, a secondary RCT outcome, were also assessed and mediation analyses explored intervention effects on feeding styles via earlier intervention impacts on cognitive stimulation.

RESULTS

Cognitive stimulation was significantly associated with higher responsive and lower indulgent feeding styles. SB mothers were less likely to exhibit pressuring styles compared with controls (Effect Size [ES]=-0.12, P = 0.02). Although no direct intervention effects were found on responsive or indulgent feeding styles, indirect effects of SB were evident on these feeding styles through intervention-induced increases in cognitive stimulation in the SB group.

CONCLUSIONS

This study found positive linkages between cognitive stimulation in the home and later feeding styles. Additionally, the SB intervention was associated with less pressured feeding and indirect pathways mediated by intervention effects on cognitive stimulation. Implications for early childhood parenting interventions are discussed.

Appearance Comparison, Body Appreciation, and Adolescent Depressive Symptoms: Roles of Gender, Age, and Body-Mass Index

Objective

This study aimed to examine the association between appearance comparison and adolescent depressive symptoms, the mediating role of body appreciation, and the moderating roles of gender and body-mass index (BMI) among adolescents in different age groups.

Methods

A cross-sectional sample of 2645 Chinese students aged 12-16 years (44.7% girls) participated. The measurements included depressive symptoms, appearance comparison, body appreciation, weight, and height. Multigroup path analysis was used to examine the moderated mediation model.

Results

Compared with boys, adolescent girls presented greater levels of appearance, which increased with age. Body appreciation mediated the association between appearance comparison and depressive symptoms in girls, whereas appearance comparison directly correlated with depressive symptoms in boys. Body appreciation decreased with increasing BMI in boys but remained relatively stable in girls. Similar patterns were observed among junior and senior high school students.

Conclusion

This study underscores the significant relationship between appearance comparison and adolescent depressive symptoms, suggesting varied mechanisms based on gender and BMI levels.

Cross-Cultural Comparison of the Strengths and Difficulties Self-Report Questionnaire in 12 Asian and European Countries

OBJECTIVE

The self-report Strengths and Difficulties Questionnaire (SDQ) is widely used globally; hence, the validity of the intergroup comparisons is essential. This study examined the structure of the self-report SDQ in a large multinational adolescent sample, tested its measurement invariance across genders and countries, and compared youth mental health in 12 European and Asian countries.

METHOD

This study is part of the Eurasian Child Mental Health Study (EACMHS), a cross-cultural research study of child and adolescent well-being and mental health in 12 Asian and European countries. The sample (N = 26,306) came from a cross-sectional school-based survey of adolescents. Confirmatory factor analysis was used to assess a common measurement model for the self-report SDQ and the measurement invariance of the model across gender and country.

RESULTS

Fit indices in the total sample, in each gender, and in each of the 12 countries separately supported the use of the first-order 3-factor model (without the reverse-coded items) as a common measurement model for the self-report SDQ. Measurement invariance analyses provided good support for configural, metric, and scalar invariance across gender; however, metric invariance across countries was not supported. There were significant gender main effects for all SDQ subscales except for hyperactivity/inattention. Culture had significant main effects and moderated the magnitude of gender differences in all subscales.

CONCLUSION

The present findings support the use of the correlated 3-factor model comprising the positive dimension of prosocial behavior and 2 broad groupings of internalizing and externalizing problems, without the reverse-coded problem items, as a common measurement model for the self-report SDQ internationally.

Investigating cross-sectional and longitudinal relationships between brain structure and distinct dimensions of externalizing psychopathology in the ABCD sample

Externalizing psychopathology in childhood is a predictor of poor outcomes across the lifespan. Children exhibiting elevated externalizing symptoms also commonly show emotion dysregulation and callous-unemotional (CU) traits. Examining cross-sectional and longitudinal neural correlates across dimensions linked to externalizing psychopathology during childhood may clarify shared or distinct neurobiological vulnerability for psychopathological impairment later in life. We used tabulated brain structure and behavioural data from baseline, year 1, and year 2 timepoints of the Adolescent Brain Cognitive Development Study (ABCD; baseline n = 10,534). We fit separate linear mixed effect models to examine whether baseline brain structures in frontolimbic and striatal regions (cortical thickness or subcortical volume) were associated with externalizing symptoms, emotion dysregulation, and/or CU traits at baseline and over a two-year period. The most robust relationships found at the cross-sectional level was between cortical thickness in the right rostral middle frontal gyrus and bilateral pars orbitalis was positively associated with CU traits (β = |0.027-0.033|, pcorrected = 0.009-0.03). Over the two-year follow-up period, higher baseline cortical thickness in the left pars triangularis and rostral middle frontal gyrus predicted greater decreases in externalizing symptoms ((F = 6.33-6.94, pcorrected = 0.014). The results of the current study suggest that unique regions within frontolimbic and striatal networks may be more strongly associated with different dimensions of externalizing psychopathology. The longitudinal findings indicate that brain structure in early childhood may provide insight into structural features that influence behaviour over time.

Adolescents and Social Media: Longitudinal Links Between Motivations for Using Social Media and Subsequent Internalizing Symptoms

Knowledge is lacking on whether adolescents' motivations for social media use predict internalizing symptoms, and few studies have considered the moderating role of extraversion. In 2017 (T1) and 2018 (T2), 197 adolescents (49.70% girls, Mage = 13.15, SD = 0.36) from a large metropolitan area participated in this study. Adolescents reported on their social media use motivations and extraversion (at T1) and depressive and anxiety symptoms (T1 and T2). Latent class analysis revealed four motivation profiles at T1: (1) entertainment and fun (30.97%); (2) avoidance and escapism (14.21%); (3) meeting new people, feel involved (16.75%); (4) boredom (38.07%). Social motivations (profile 3) predicted elevated internalizing symptoms at T2. Avoidance and boredom motivations (profile 2 and 4) predicted internalizing symptoms for adolescents with low extraversion. Social media use motivations and extraversion distinguish adolescents who benefit from social media from those who experience difficulties.

Use of telemediated caregiver coaching to increase access to naturalistic developmental behavioral interventions within a statewide early intervention system

LAY ABSTRACT

Many families seek access to evidence-based therapy to support their child's learning. Naturalistic developmental behavioral intervention is a set of practices that use a child's natural motivation and interest to teach skills in everyday routines. Many families find naturalistic developmental behavioral interventions appealing and they have been proven to be effective. However, families may not be able to enroll in naturalistic developmental behavioral intervention-based programs due to the limited availability of trained service providers. Telehealth is the use of technology to engage with care providers, including doctors and therapists. Telehealth is an effective tool for improving access to services, especially for people in rural and underserved communities. Telehealth offers a way for providers to connect with families but it does not address the low numbers of trained providers. In this article, we share a statewide model developed to increase access to naturalistic developmental behavioral interventions for families while increasing training opportunities for early intervention providers. Through this model, expert consultants worked with caregivers and providers via telehealth for a brief series of visits. During these visits, consultants taught caregivers and providers strategies based in naturalistic developmental behavioral interventions. Feedback from caregivers and providers, along with improvement in child skills, show that this model was effective and acceptable.

A Digital Health Model for School-Based Implementation to Improve Parent and Child Outcomes: Comparison of Active Versus Light-Touch Coaching Effects

Online or app-based parenting interventions have become more widely available in recent years. However, challenges related to poor engagement and high attrition have been noted in the literature, and there are important questions regarding ways to enhance parental engagement and improve treatment outcomes through digital health, including through the addition of therapeutic coaches. The current study evaluated differences in the effects of active versus "light-touch" coaching implementations of an enhanced version of Family Check-Up Online (FCU-O) on parent/family and child-level outcomes from pre-treatment to 2-month follow-up assessments. The enhanced version of the FCU-O was adapted to support families in coping with pandemic-related stressors to prevent youth behavioral and emotional problems during middle school and included app-based modules designed to support effective parenting practices as well as virtual coaching. In the "active-coach" condition, parenting coaches were active in efforts to arrange coaching sessions with parents as they worked through the app-based modules, while in the light-touch intervention, parent-coaches enrolled participants in the context of a one-time support session but did not actively pursue families to schedule additional sessions. Parents in the active-coach condition exhibited greater engagement with both the app and coaching sessions than parents in the light-touch condition. Further, stronger improvements in several aspects of parenting and child functioning were observed in the active-coach versus light-touch conditions. However, parents in the light-touch condition showed reductions in stress and comparable levels of dosage when using the app. Implications for prevention and accessibility of digital health interventions are discussed.

Moderators of the Effects of a Digital Parenting Intervention on Child Conduct and Emotional Problems Implemented During the COVID-19 Pandemic: Results From a Secondary Analysis of Data From the Supporting Parents and Kids Through Lockdown Experiences (SPARKLE) Randomized Controlled Trial

BACKGROUND

A smartphone app, Parent Positive, was developed to help parents manage their children's conduct and emotional problems during the COVID-19 pandemic. A randomized controlled trial, Supporting Parents and Kids Through Lockdown Experiences (SPARKLE), found Parent Positive to be effective in reducing children's emotional problems. However, app effectiveness may be influenced by a range of child, family, socioeconomic, and pandemic-related factors.

OBJECTIVE

This study examined whether baseline factors related to the child, family, and socioeconomic status, as well as pandemic-related disruption circumstances, moderated Parent Positive's effects on child conduct and emotional problems at 1- and 2-month follow-up.

METHODS

This study was a secondary exploratory analysis of SPARKLE data. The data set included 646 children (4-10 years of age) with parents randomized to either Parent Positive (n=320) or follow-up as usual (n=326). Candidate baseline moderators included child age, gender, attention-deficit/hyperactivity disorder symptoms, parental psychological distress, family conflict, household income, employment status, household overcrowding, and pandemic-related disruption risk (ie, homeschooling, lockdown status, and isolation status). Child conduct and emotional problem outcomes measured at 1- (T2) and 2-months (T3) post randomization were analyzed using linear mixed-effects analysis of covariance models adjusting for baseline (T1) measure of outcome and including intervention and intervention by time point interaction terms allowing for different effects at the 2 time points. Moderation of intervention effects by baseline factors was assessed by replacing the intervention by time interaction terms with intervention by time point by baseline moderator interaction terms.

RESULTS

Child gender was a significant moderator of the Parent Positive versus follow-up as usual effect on emotional problems (B=0.72, 95% CI 0.12-1.33; P=.02). Specifically, the effect of Parent Positive was close to significant (T2: B=-0.41, 95% CI -0.82 to 0.0004; P=.05) or significant (T3: B=-0.76, 95% CI -1.22 to -0.30; P<.001) in males only when compared with females, and males experienced a significantly larger reduction in emotional problems than females in the Parent Positive arm at the 2-month post randomization time point. None of the other investigated baseline factors moderated effects on emotional problems, and no factors moderated effects on conduct problems.

CONCLUSIONS

This study highlights Parent Positive's potential for effectively reducing emotional problems in primary school-aged male children across a wide range of families. However, due to limited variability in the demographic background of the families, cautious interpretation is required, and replications are necessary in diverse samples with longer follow-up times.

TRIAL REGISTRATION

ClinicalTrials.gov NCT04786080; https://clinicaltrials.gov/ct2/show/NCT04786080.

Understanding irritability through the lens of self-regulatory control processes in children and adolescents: a systematic review

Among youths, pathological irritability is highly prevalent and severely disabling. As a frequent symptom, it often leads to referrals to child and adolescent mental health services. Self-regulatory control (SRC) processes are a set of socio-psycho-physiological processes that allow individuals to adapt to their ever-changing environments. This conceptual framework may enhance the current understanding of the cognitive, emotional, behavioural and social dysregulations underlying irritability. The present systematic review (PROSPERO registration: #CRD42022370390) aims to synthesize existing studies that examine irritability through the lens of SRC processes among youths (< 18 years of age). We conducted a comprehensive literature search among six bibliographic databases: Embase.com, Medline ALL Ovid, APA PsycInfo Ovid, Web of Science Core Collection, the Cochrane Database of Systematic Reviews Wiley and ProQuest Dissertations & Theses A&I. Additional searches were performed using citation tracing strategies. The retrieved reports totalled 2612, of which we included 82 (i.e., articles) from 74 studies. More than 85% of reports were published during the last 6 years, highlighting the topicality of this work. The studies sampled n = 26,764 participants (n = 12,384 girls and n = 12,905 boys, n = 1475 no information) with an average age of 8.08 years (SD = 5.26). The included reports suggest that irritability has an association with lower effortful control, lower cognitive control and delay intolerance. Further, evidence indicates both cross-sectional and longitudinal associations between irritability and a lack of regulation skills for positive and negative emotions, particularly anger. Physiological regulation seems to moderate the association between irritability and psychopathology. Finally, the mutual influence between a child's irritability and parenting practice has been established in several studies. This review uses the lens of SRC to illustrate the current understanding of irritability in psychopathology, discusses important gaps in the literature, and highlights new avenues for further research.

Understanding Emotional Outbursts: A Cross-Cultural Study in Latin American Children with Autism Spectrum Disorder

OBJECTIVES

One of the behavioral problems strongly associated with emotional dysregulation (ED) in ASD is emotional outbursts (EOs) characterized by a pattern of challenging behavior that varies across individuals and across time. Cultural factors can modulate the expression of EOs. This study aimed to characterize the profile of emotional outbursts (EOs) in children with autism spectrum disorder (ASD) across various countries in Latin America and to identify clinical, emotional, and contextual factors that contribute to the onset and frequency of EOs within this diverse sample.

METHODS

A cross-sectional and cross-cultural study was conducted between 2023 and 2024 comprising samples from five countries in the Latin American Network for Autism-REAL: Argentina, Brazil, Chile, Uruguay, and the Dominican Republic. We studied 689 children with ASD (age x = 8.7 ± 2.6 years) using the Emotional Outburst Questionnaire (EOQ).

RESULTS

We identified different types of EO among children with ASD in our sample. The most frequent was the 'behavioral indicators of emotion' (52.0%) followed by 'increased motor activity' (28.3%), 'non-speech vocalizations', (27.6%), 'mild verbal aggression' (23.8%), and 'avoidance' (21.5%). Children in a bad mood or having a bad day or experiencing irritability were the most significant factors that increased the likelihood of EOs.

CONCLUSIONS

Our results revealed that irritability is an important trigger for EOs and should not be disregarded or underestimated when monitoring the mental health of children with ASD.

Development and Acceptability of Provider Training to Increase Treatment Engagement of Parents in Their Children's Behavioral Health Care Need

BACKGROUND: Disruptive, Impulse-Control, and Conduct disorders (DIC) affect 5 million children in the United States and often require comprehensive and long-term behavioral health care for which sustained parental involvement is essential. Our research team is developing an intervention to improve parental engagement in the behavioral health care of their children with DIC. The intervention, which will be a modification of an evidence-based shared decision-making intervention called DECIDE, will include a parent component and a provider component. AIM: To determine the acceptability of the provider component of the modified DECIDE intervention. METHODS: The provider intervention is an asynchronous self-paced online training program made up of five modules: introduction, shared decision-making, perspective-taking, attributional errors, and being a responsive provider. The training was piloted with 41 providers in two public child and adolescent treatment programs. Following completion of the training, semi-structured interviews were conducted with the providers to assess the acceptability of the training. The interviews were analyzed with conventional content analysis. RESULTS: The provider training was well received by providers, and many had made practice changes based on what they had learned. Several offered recommendations for improvement, most notably the need to tailor the training based on provider role, discipline, and level of expertise. CONCLUSIONS: The feedback given by providers will be used to refine future iterations of the provider training component of the modified DECIDE intervention. Psychiatric nurses and other clinicians may draw from strategies incorporated in the training program to improve parent engagement in the treatment of children with DIC.

Adolescents' offline and online social support: A study on latent groups and their relationship with mental health

INTRODUCTION

The internet has become a common space for adolescents to connect with others and find information. However, it remains unclear whether online encounters can serve as new sources of social support for Chinese adolescents. The present study aimed to identify distinct patterns in Chinese adolescents' social support from both offline and online sources and to examine how these patterns relate to individual and family factors and adolescents' mental health conditions.

METHODS

Data were obtained from a cross-sectional survey of 1031 Chinese adolescents (47.1% female, mean age = 13.67) in Foshan, Guangdong province. Latent profile analysis was performed with Mplus. Associations between the identified classes and auxiliary variables were examined with the "R3STEP" procedure and the DCON command in Mplus.

RESULTS

We identified four groups. Three groups showed consistent patterns in terms of receiving social support from offline and online sources, namely, the high support group (24.8%), moderate support group (43.8%), and low support group (15.3%), respectively. The fourth group received a moderate level of offline but low level of online support (16%), named the moderate offline-low online support group. The groups differed in individual and family characteristics. Higher support was associated with higher life satisfaction, lower depression, and social anxiety, but also higher problematic internet use. Overall, the moderate offline-low online support group showed better mental health than the other groups.

CONCLUSIONS

Our study extends social support research by revealing heterogeneity in adolescents' social support patterns. The findings encourage a balanced use of offline and online support.

Psychometric properties of the Strengths and Difficulties Questionnaire in an Icelandic community sample

PURPOSE

The current paper aimed to evaluate the psychometric properties of the Icelandic translation of the Strengths and Difficulties Questionnaire, for both parent and teacher reports. SDQ is a widely used questionnaire for screening mental problems among youth. However, only a few studies have conducted a factor analysis on the youngest and oldest cohorts using an adequate sample size. This study aims not only to examine the traditional 5-factor model and alternative models suggested in prior research but also to establish norm data for the Icelandic population.

MATERIALS AND METHODS

The total sample consists of 1653 youth aged 5-16 years, thereof 316 parent reports and 271 teacher reports for the 5-year-old sample. We used confirmatory factor analysis to evaluate the factor structure. Special attention was given to the models' performance across different age groups and between genders. This cross-demographic evaluation is vital to ensure that the SDQ's utility is not limited by developmental or gender-specific variations in symptom expression or reporting.

RESULTS

We found an acceptable fit for both the original five-factor model and the more recent three-factor model with higher-order internalizing and externalizing factors. The fit for the factor structures seemed to be quite similar across ages. However, we observed goodness-of-fit below the acceptable range for girls on the parent ratings. We also found evidence for the convergent and divergent validity of both models.

CONCLUSIONS

The current study provides further evidence of the utility of the SDQ as a screening instrument, with an acceptable factor structure across ages.

The association of personal, parental, school and community factors with depressive symptoms among a sample of Colombian students of ages 9 to 12 years

Few studies have examined how the personal characteristics of students, together with factors from their local social environments and communities, affect students living in generally high levels of social disruption. We examined the influence that personal characteristics as well as factors from the local social environments and communities may have on Colombian students' levels of depressive symptoms shortly after the end of the of armed conflict. Data were collected from 710 students attending the fifth grade in a random sample of elementary schools in the province of Sucre in Colombia. Information was gathered on the students' ages and gender as well as characteristics of their parents, school factors, and community factors. A five-level hierarchical regression model was used to determine the extent to which all these variables predicted depression scores, as measured by the Adolescent Depression Rating Scale. While personal, parental, school and community factors were all found to predict depression scores, the category, parental factors had the most impact. That was followed by school factors, community factors and finally personal characteristics. Multiple social and environmental factors were associated with the level of depression experienced by Colombian students.

Obsessive-compulsive disorder with compulsive exercise leading to intensive care treatment in an adolescent male: a case report

Obsessive-compulsive disorder (OCD) and eating disorders (ED) are compulsive disorders with overlapping symptoms. However, weight loss and over-exercise causing secondary medical complications are rarely seen in OCD. We report the case of a 15-year-old male who presented with atypical symptoms of OCD leading to severe medical compromise. Covid-19 related team sport restrictions led to compulsive exercise associated with intrusive thoughts. The onset of stress fractures limited exercise ability, prompting compensatory food restriction. Bradycardia, hypothermia and hypoglycaemia resulted from severe malnourishment and weight loss in the context of OCD. His weight was 85.8% of ideal body weight on admission, reflective of a weight 10-15 kg lower than his premorbid weight. During admission, he developed exercise-induced rhabdomyolysis with significantly elevated creatinine kinase and required intensive care unit treatment. Psychotropic medication included lamotrigine, olanzapine and high dose fluoxetine alongside cognitive-behavioural therapy. Medical stabilisation and weight restoration allowed discharge to an outpatient Child and Adolescent Mental Health Service. This atypical case of OCD highlights the potentially life-threatening risks associated with excessive exercise and malnutrition. This paper highlights the complexities of treatment in a patient who cannot adhere to bed rest and the differential diagnoses of anorexia nervosa, orthorexia nervosa and exercise addiction.

Prediction of adolescent depression from prenatal and childhood data from ALSPAC using machine learning

Depression is a major cause of disability and mortality for young people worldwide and is typically first diagnosed during adolescence. In this work, we present a machine learning framework to predict adolescent depression occurring between ages 12 and 18 years using environmental, biological, and lifestyle features of the child, mother, and partner from the child's prenatal period to age 10 years using data from 8467 participants enrolled in the Avon Longitudinal Study of Parents and Children (ALSPAC). We trained and compared several cross-sectional and longitudinal machine learning techniques and found the resulting models predicted adolescent depression with recall (0.59 ± 0.20), specificity (0.61 ± 0.17), and accuracy (0.64 ± 0.13), using on average 39 out of the 885 total features (4.4%) included in the models. The leading informative features in our predictive models of adolescent depression were female sex, parental depression and anxiety, and exposure to stressful events or environments. This work demonstrates how using a broad array of evidence-driven predictors from early in life can inform the development of preventative decision support tools to assist in the early detection of risk for mental illness.

Individual child factors affecting the diagnosis of attention deficit hyperactivity disorder (ADHD) in children and adolescents: a systematic review

Attention deficit hyperactivity disorder (ADHD) is a prevalent condition characterised by patterns of inattention, hyperactivity, and impulsivity. This systematic literature review aims to identify the child clinical and sociodemographic factors related to the detection and diagnosis of ADHD in children and adolescents, given concerns about delays or failures in identifying ADHD as well as over-diagnosis, hindering appropriate and timely support for children and families. Through electronic and manual searches of peer-reviewed and grey literature, 5852 articles were identified and subjected to two stages of screening by independent reviewers. Due to the heterogeneity in study methods, a narrative approach was used to summarise study findings. Forty-one studies meeting eligibility criteria revealed sixteen child-related factors influencing the ADHD diagnostic process. These factors include ADHD subtype, ADHD symptom severity, comorbid mental disorders, behavior problems, internalizing symptoms, functional impairment, social and cognitive functioning, physical health, gender, age, relative age, race/ethnicity, socio-economic status, insurance coverage, residence urbanicity, and family structure. While the impact of many of these factors on ADHD diagnosis was inconsistent due to the substantial diversity in study designs and context, certain patterns emerged. Meeting the criteria for the inattentive subtype, lower functional impairment, female gender, Black or Latinx ethnicity, and being relatively young for their grade were consistently found to be associated with a delayed or absent ADHD diagnosis. Further research is needed to explore the intricate relationships between these child-level variables and their implications for ADHD recognition, referral, and evaluation, especially outside the USA.

Feeling the distance: The relationship between emotion regulation and spatial ability in childhood

Research has shown experimentally that if children are taught to use language to create distance (socially, physically, and temporarily) when they revisit a potentially traumatic experience they reduce the intensity of their emotions. Building on this, this study was carried out to explore whether children with better spatial skills are better at such downregulation because of their very aptitude in understanding the concept of distance. Using data from a general-population birth cohort in the UK, the study examined the bidirectional association between emotional dysregulation and spatial ability among children aged 5 and 7 years. The findings reveal a significant reciprocal relationship even after adjusting for family, contextual, and individual confounders including verbal ability: spatial skills at age 5 years were inversely related to emotional dysregulation at age 7 years, and conversely, greater emotional dysregulation at age 5 years was associated with poorer spatial ability at age 7 years. The two paths were equally strong and there was no evidence of differences between them on the basis of sex. Our results suggest that enhancing spatial abilities could be a potential avenue for supporting emotion regulation in middle childhood.

Social influence on drug use and sexual behaviors among rural LGBTQ+ individuals

Background: Traveling to meet sexual partners and substance use are associated with increased risk of infectious disease. It is important to understand what factors may increase substances use or increased infection transmission risk (IITR) sexual behaviors among rural LGBTQ+ individuals.Objective: This study investigates substance use and sexual behaviors associated with increased infection transmission risk among rural LGBTQ+ individuals, and how these are associated with relationship type (friends or romantic partners) and travel distance.Methods: Participants (18 years+, identify as LGBTQ+, and provided a $25 gift card) were recruited from Illinois (25 counties), in 2021. Data included demographics, sexual and drug use behaviors, and assessed how these behaviors varied by relationship type and distance traveled (e.g. when meeting friends out-of-state).Results: The 398 participants were 79.1% White and 12.3% Black. By orientation, 29% heterosexual, 36% gay/lesbian, and 35% bisexual/other. By identity, 43% cisgender male, 51% cisgender female, and 6% genderqueer/other. Alcohol use while visiting out-of-state friends was more frequent among transgender (vs cisgender men; OR = 9.686, 95% confidence interval = 2.123-44.19), and individuals traveling > 1/month (all p < .050). Infection-related sexual behaviors while visiting out-of-state romantic partners was more frequent among prescription medication misuse (all p < .050) and traveling > 1/week (vs < 1/month; OR = 3.399, 95% CI = 1.037-11.144).Conclusion: This study of rural LGBTQ+ identified that alcohol use was associated with travel to visit out-of-state romantic partners, and prescription medication misuse increased infection-related sexual behavior during out-of-state travel. Health professionals can develop substance use and increased infection transmission risk sexual behavior interventions on gender minority groups in rural areas and target those who are traveling.

Childhood Traumas and Depressive Symptoms: The Moderating Role of Anxiety Sensitivity

Purpose

Depression is one of the most common public health problems. Considering the frequency of childhood trauma in people with depressive symptoms, determining mediating factors is important in understanding the relationship between them. Our study aimed to evaluate the mediating effect of anxiety sensitivity, one of the cognitive structures that plays a role in the etiology and maintenance of psychopathologies, on depression symptoms of childhood traumas.

Patients and Methods

The study included 110 participants aged between 18 and 65, diagnosed with depression, and applied to the psychiatry outpatient clinic. Of the participants, 35 were male and 75 were female. The majority of participants were in the 18-25 age group (39.1%), followed by a smaller percentage in the 25-35 age group (32.7%). The Beck Depression Inventory (BDI-I), Childhood Trauma Questionnaire (CTQ), and Anxiety Sensitivity Index (ASI-3) were administered to participants between 15 February and 15 April 2024.

Results

When the sample was examined according to the history of depressive symptoms, it was found that the score of the cognitive subscale of ASI-3 and the scores of the physical neglect, emotional neglect, and emotional abuse subscales of the CTQ were significantly higher in the group with depressive symptoms. When the mediating effect of the scores of "Emotional neglect", "Physical neglect", and "Emotional abuse" subscales of CTQ, and the score of "Cognitive" subscale of ASI-3 score was examined with regression models, it was found that the history of emotional neglect and abuse in childhood predicted depressive symptoms through the cognitive sub-group of AS.

Conclusion

In our study, it was shown that childhood trauma, which could cause a person to evaluate stressful life events as more depressogenic and the formation of negative cognitions about themselves and the world, predicted the severity and occurrence of depressive symptoms through fear of cognitive dysfunction.

A systematic review of social camouflaging in autistic adults and youth: Implications and theory

Social camouflaging (SC) is a set of behaviors used by autistic people to assimilate with their social environment. Using SC behaviours may put autistic people at risk for poor mental health outcomes. Following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, the goal of this systematic review was to investigate the development of SC and inform theory in this area by outlining the predictors, phenotype, and consequences of SC. This review fills a gap in existing literature by integrating quantitative and qualitative methodologies, including all gender identities/age groups of autistic individuals, incorporating a large scope of associated factors with SC, and expanding on theory/implications. Papers were sourced using Medline, PsycInfo, and ERIC. Results indicate that self-protection and desire for social connection motivate SC. Camouflaging behaviors include compensation, masking, and assimilation. Female individuals were found to be more likely to SC. Additionally, this review yielded novel insights including contextual factors of SC, interpersonal relational and identity-related consequences of SC, and possible bidirectional associations between SC and mental health, cognition, and age of diagnosis. Autistic youth and adults have similar SC motivations, outward expression of SC behavior, and experience similar consequences post-camouflaging. Further empirical exploration is needed to investigate the directionality between predictors and consequences of SC, and possible mitigating factors such as social stigma and gender identity.

The Feasibility and Acceptability of Using a Digital Conversational Agent (Chatbot) for Delivering Parenting Interventions: Systematic Review

BACKGROUND

Parenting interventions are crucial for promoting family well-being, reducing violence against children, and improving child development outcomes; however, scaling these programs remains a challenge. Prior reviews have characterized the feasibility, acceptability, and effectiveness of other more robust forms of digital parenting interventions (eg, via the web, mobile apps, and videoconferencing). Recently, chatbot technology has emerged as a possible mode for adapting and delivering parenting programs to larger populations (eg, Parenting for Lifelong Health, Incredible Years, and Triple P Parenting).

OBJECTIVE

This study aims to review the evidence of using chatbots to deliver parenting interventions and assess the feasibility of implementation, acceptability of these interventions, and preliminary outcomes.

METHODS

This review conducted a comprehensive search of databases, including Web of Science, MEDLINE, Scopus, ProQuest, and Cochrane Central Register of Controlled Trials. Cochrane Handbook for Systematic Review of Interventions and PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines were used to conduct the search. Eligible studies targeted parents of children aged 0 to 18 years; used chatbots via digital platforms, such as the internet, mobile apps, or SMS text messaging; and targeted improving family well-being through parenting. Implementation measures, acceptability, and any reported preliminary measures of effectiveness were included.

RESULTS

Of the 1766 initial results, 10 studies met the inclusion criteria. The included studies, primarily conducted in high-income countries (8/10, 80%), demonstrated a high mean retention rate (72.8%) and reported high acceptability (10/10, 100%). However, significant heterogeneity in interventions, measurement methods, and study quality necessitate cautious interpretation. Reporting bias, lack of clarity in the operationalization of engagement measures, and platform limitations were identified as limiting factors in interpreting findings.

CONCLUSIONS

This is the first study to review the implementation feasibility and acceptability of chatbots for delivering parenting programs. While preliminary evidence suggests that chatbots can be used to deliver parenting programs, further research, standardization of reporting, and scaling up of effectiveness testing are critical to harness the full benefits of chatbots for promoting family well-being.

Quality of Life and Outcomes Associated with Adverse Effects in Pediatric Patients with Attention-Deficit/Hyperactivity Disorder and Their Parents/Caregivers

Objectives: To assess quality of life and outcomes associated with adverse effects (AEs) in pediatric patients receiving pharmacological treatment for attention-deficit/hyperactivity disorder (ADHD) and their parents/caregivers. Methods: An online survey was conducted (10/13/2023-10/20/2023) among parents/caregivers recruited from Dynata's U.S. panel who lived with a pediatric patient (6-17 years) currently treated for ADHD. Patient and parent/caregiver characteristics and outcomes were descriptively reported. Patients were considered to have AEs if they experienced symptoms/complications in the past 30 days that appeared, worsened, or remained unchanged after initiating their latest ADHD treatment. Regression analyses were used to estimate correlations between the number of AEs and key outcomes, including patients' health-related quality of life (HRQoL; based on the Pediatric Quality of Life Inventory) and parents/caregivers' work and activity impairments (based on Work Productivity and Activity Impairment: Caregiver) and mental health (based on Patient Health Questionnaire-4). Results: A total of 401 parents/caregivers from all U.S. regions completed the survey (caregiver median age: 38 years, 58.9% female; patient median age: 11 years; 37.7% female). In the 30 days prior to data collection, 66.8% of patients had AEs (overall mean: 1.2 AEs), with insomnia/sleep disturbances and decreased appetite/weight loss being the most frequently reported (14.2% and 11.7%, respectively). The number of AEs was significantly correlated with reduced patient's HRQoL (including reduced physical, emotional, and school functioning), increased parent/caregiver's work and activity impairment, and a higher likelihood of parents/caregivers having generalized anxiety disorder or major depressive disorder, respectively (all p < 0.001). Conclusions: AEs are common among pediatric patients receiving pharmacological treatment for ADHD and are associated with poorer quality of life and outcomes in pediatric patients and their parents/caregivers. Therapies with better safety profiles may help improve patient's HRQoL and parent/caregiver outcomes.

Black Mothers of Children With and Without ADHD: Relationships Among Maternal Psychopathology, Parenting Stress, and Parenting Cognitions

INTRODUCTION

Parents of children with attention-deficit/hyperactivity disorder (ADHD) endorse increased parenting stress and lower levels of parenting efficacy and satisfaction as compared to parents of children without ADHD. Additionally, maternal ADHD and depression differentiate children with and without ADHD, with children with ADHD being more likely to have a mother with psychopathology.

METHOD

With a focus on an understudied population, we investigated the extent to which maternal self-reported ADHD and depression were associated with self-reported parenting stress and parenting cognitions in 70 Black mothers of children with (maternal Mage = 35.52, SD = 6.49) and without ADHD (maternal Mage = 35.39, SD = 6.53) recruited from a metropolitan area in the southeastern United States.

RESULTS

Analyses indicated that Black mothers of children with ADHD reported higher levels of parenting stress, lower levels of parenting efficacy, and lower levels of parenting satisfaction. However, there were no significant differences between groups on measures of maternal ADHD or depression. Maternal depression significantly accounted for variability in both parenting satisfaction and parenting stress beyond child ADHD and maternal education. With maternal depression in the models, the association between maternal ADHD and parenting stress and parenting satisfaction lost significance.

DISCUSSION

Given the racial disparities in the treatment of ADHD, future research should focus on investigating the linkages between maternal depression, parenting stress, parenting satisfaction, and parenting behaviors in Black mothers in order to delineate whether there are cultural adaptations that may improve treatment utilization rates for child ADHD within this population.

Gender Differences in Variability in Intimate Relationship Satisfaction: A Secondary Analysis and Meta-Analysis

There is a long-standing interest in gender differences in satisfaction in intimate relationships. Whereas prior research has focused on gender differences in central tendency (i.e., means), we conducted two studies - a secondary analysis of data from a probability sample of Australian married couples and a meta-analysis - to examine gender differences in variability (i.e., variances). We hypothesized that compared to males, females would demonstrate greater variability in intimate relationship satisfaction (i.e., greater female variability hypothesis), particularly at lower levels of relationship satisfaction. Results from a secondary analysis of data from 2,711 married couples in the Household, Income and Labour Dynamics in Australia (HILDA) survey and from a meta-analysis of 20 years of research (k = 171, N = 84,976), including independent samples from 33 countries, indicated that relative to males, females reported greater variability in relationship satisfaction. Obtained effect sizes (female-to-male variance ratios [VRs] of 1.42 for the HILDA sample and 1.19 for the meta-analysis) were larger than proposed cutoffs for meaningful group differences in variability. Analysis of tail ratios (ratios of the relative proportion of females divided by the relative proportion of males in the distributional tail regions) in the HILDA sample indicated that gender differences in variability were greater at lower (versus higher) levels of satisfaction. Findings support the greater female variability hypothesis and suggest that by focusing only on gender differences in means, the existing literature has underestimated gender differences in intimate relationship satisfaction.

Research Review: Pharmacological and non-pharmacological treatments for adolescents with attention deficit/hyperactivity disorder - a systematic review of the literature

BACKGROUND

Attention Deficit/Hyperactivity Disorder (ADHD) demonstrates unique developmental manifestations in adolescence with implications for optimized, age-appropriate treatment. This 10-year update is the third in a series of systematic reviews examining the efficacy and safety of adolescent ADHD treatments. We broadly examined efficacy on ADHD symptoms, impairments, and other reported outcomes. Acute and long-term efficacy, and treatment moderators, were considered.

METHOD

We performed PubMed, EMBASE, and PsycINFO searches for articles published or in press from 2013 to 2024, integrated with hand search and randomized controlled trials (RCTs) identified in this series' earlier reviews. RCTs examining the safety or efficacy of interventions delivered to adolescents (ages 10.0-19.9) with a diagnosis of ADHD were included. Study characteristics were extracted and reviewed, quality of evidence was assessed using GRADE, and effect sizes were calculated for individual studies and illustrated using forest plots.

RESULTS

Sixty-three RCTs were identified. Quality of evidence ranged from high (medication; k = 29) to very low (nutrient supplementation, neurofeedback, occupational therapy; k = 1 each). Medications demonstrated consistent strong impact on ADHD symptoms and inconsistent impact on impairment. Diverse cognitive/behavioral treatments (C/BTs) demonstrated inconsistent impact on ADHD symptoms but strong and consistent impact on impairment and executive function skills, plus moderate benefits on internalizing symptoms. No interventions demonstrated significant safety concerns. Long-term maintenance (up to 3 years post-treatment) was demonstrated for C/BTs, though moderate quality of evidence was noted because participants cannot be fully blinded to receipt of treatment.

CONCLUSIONS

The effects of C/BTs and medication appear complementary, not duplicative. Combining medication and C/BT is advised at treatment outset to maximize engagement, maintenance, and response breadth (i.e. improving both ADHD symptoms/cognitive performance and coping skills/functional impairments). Engagement strategies (e.g. motivational interviewing) may facilitate uptake. Novel treatments do not yet demonstrate effects on ADHD symptoms or impairments in adolescents but remain a promising area for research.

Family Check-Up Online effects on parenting and parent wellbeing in families of toddler to preschool-age children

Online parenting interventions hold promise for increasing access to behavioral support for families with low income and who reside in rural areas. The current study evaluates the efficacy of a mobile app-based parenting support program, the Family Check-Up Online (FCU-O) with telehealth coaching support, for parents of children 1.5-5 years old at risk of experiencing parenting challenges. We tested effects of the FCU-O on parent wellbeing (parenting self-efficacy and symptoms of depression and anxiety) and parent-reported parenting skills (support for positive behavior, limit-setting, and proactive parenting) at the 3-month follow-up in a randomized controlled trial (FCU-O versus control). We also tested relationships between parents' baseline characteristics and their engagement with the app and telehealth coaching. Eligibility criteria included endorsing depressive symptoms or current or past substance misuse. Participants (N = 356) were predominantly White (72%) and low-income, with 43% of families residing in a rural area. Approximately one third of participants reported clinically significant symptoms of anxiety or depression and one third endorsed a lifetime history of opioid misuse. Intent to treat analyses tested effects of the FCU-O on parent wellbeing and parenting skills. The FCU-O was associated with improvements to parents' support for positive behavior, limit-setting, and proactive parenting skills, as well as parenting self-efficacy and depressive symptoms. Parents' initial symptoms of depression and anxiety significantly predicted greater telehealth coach engagement; low levels of initial self-reported skills positive behavior support and limit-setting significantly predicted greater app engagement. Results provide support for the FCU-O as a preventive parenting intervention for parents experiencing mental health challenges, with implications for reducing barriers to accessing parenting support for underserved families.

Anxiety in children and adolescents with autism spectrum disorder: behavioural phenotypes and environmental factors

BACKGROUND

Anxiety is the most prevalent comorbidity among children and adolescents with autism spectrum disorder (ASD), yet little is known about the associated risk factors.

METHODS

In a heterogenous cohort of children aged 5-18 years old (n = 262, 42% ASD), participants and their parents completed standardized questionnaires to assess anxiety, ASD symptom severity, inattention/hyperactivity, emotional problems, depressive symptoms, parental styles and stress, and demographic factors.

RESULTS

An artificial neural network analysis using a self-organizing map, a statistical technique used to cluster large datasets, revealed 3 distinct anxiety profiles: low (n = 114, 5% ASD), moderate (n = 70, 64% ASD) and high (n = 78, 96% ASD) anxiety. A recursive feature elimination analysis revealed that depression and peer problems contributed the most to differences between the anxiety profiles. Difficulties with peers in individuals with ASD who experience anxiety may be related to challenges with social competence and this may heighten depressive symptoms.

CONCLUSION

Findings highlight the importance of assessing depressive symptoms in children and adolescents with ASD who experience anxiety. Identifying anxiety profiles among children and adolescents with ASD may prove beneficial in clinical practice by facilitating the development of tailored interventions that aid in managing anxiety and depressive symptoms. Furthermore, strengthening social communication skills may improve peer relationships and could aid in managing depressive symptoms among children and adolescents with ASD who experience anxiety.

Resilience after adversity: an umbrella review of adversity protective factors and resilience-promoting interventions

Introduction

Resilience is the dynamic adaptive process of maintaining or recovering mental health from stressors, such as trauma, challenging life circumstances, critical transitions, or physical illnesses. Resilience after adversity can be fostered through protective factors and the implementation of interventions that promote resilience. Hence, it is essential to investigate both protective and vulnerable factors to reduce the negative effects of unfavorable life events and increase resilience through positive risk-response interventions.

Objective

To assess the effect of previous adversity, protecting factors, and resilience-promoting interventions to possess resilience after adversity in a global context.

Methods

The study included English language articles sourced from PubMed, Embase, Scopus, Web of Sciences, the Cochrane Database of Systematic Reviews, Scopus, and Google Scholar published before 15 April 2024. These articles reported the effect of adversity, protecting factors, and/or resilience-promoting interventions to possess resilience after adversity in a global context without a population age limitation. The quality of the included studies was assessed using the Assessment of Multiple Systematic Reviews. A weighted inverse-variance random-effects model was applied to find the pooled estimates. The subgroup analysis, heterogeneity, publication bias, and sensitivity analysis were also assessed.

Results

A total of 44 articles (n = 556,920 participants) were included in this umbrella review. From the random-effects model analysis, the pooled effect of adversity on the development of resilience was 0.25 (p < 0.001). The pooled effects of adversity-protective factors and resilience-promoting interventions after adversity were 0.31 (p < 0.001) and 0.42 (p < 0.001), respectively. The pooled effects of specific adversity protective factors were 0.26, 0.09, 0.05, 0.34, 0.23, and 0.43 for the availability of support, cognitive ability, community cohesion, positive self-perception, religious involvement, and self-regulation, respectively. The pooled effects of specific resilience-promoting interventions were 0.30, 0.21, 0.51, and 0.52 for cognitive behavior therapy (CBT) interventions, mindfulness-based interventions, mixed interventions, and resilience-promoting interventions, respectively.

Conclusion

The findings of this umbrella review revealed that people who experienced early adversity can develop resilience later in life. The study highlights the need to consider adversity protective factors, such as availability of support (family, friends, and school), cognitive ability, community cohesion, positive self-perception, religious involvement, and self-regulation, and resilience-promoting interventions, including CBT interventions, mindfulness-based interventions, and mixed interventions, to enhance resilience promotion programs.

Parenting stress and child behavior problems: Developmental psychopathology perspectives

The growing base of research on parenting stress and its relation to child behavior problems has largely paralleled the emergence of developmental psychopathology as a field of inquiry. Specifically, the focus on mechanism rather than main effects has begun to elevate explanatory models in the connection between parenting stress and a variety of adverse child and parent conditions. Still, work on parenting stress is limited by conceptual confusion, the absence of attention to developmental differentiation, a focus on child-specific rather than system influences. Recent research on these parenting stress issues is briefly reviewed, highlighting studies that have illustrated developmental psychopathology perspectives. A conceptual model is offered to illustrate the complex recursive nature of connections between parenting stress, parenting behavior, parent well-being, and children's adjustment, and I make a case for the adoption of a more systemic perspective to influence the next generation of developmental psychopathology research on parenting stress.

A longitudinal path model examining the transactional nature of parenting and child externalizing behaviors in a large, sociodemographically diverse sample

Children's externalizing behaviors are associated with impairments across the lifespan. Developmental psychopathology theories propose transactional (bidirectional) associations between child externalizing behaviors and parenting during childhood and adolescence. Yet, these foundational relations in early childhood are not well-studied. Utilizing a large, mixed-sex sample, we examined the reciprocal nature of parenting and child externalizing behaviors across early childhood using robust repeated-measures models. Repeated measures data were drawn from a socioeconomically diverse, longitudinal pregnancy cohort of 1287 (64% Black, 31% White) mother-child dyads at four time points (ages one to six). Three variables were included in cross-lagged panel models: observed parenting quality, child externalizing symptoms, and a maternal risk composite. In covariate-adjusted models, higher parenting quality at Wave 1 predicted lower child externalizing symptoms at Wave 2. Higher externalizing symptoms at Wave 1 and Wave 2 predicted lower parenting quality at Wave 2 and Wave 3, respectively. Maternal risk and parenting quality were not significantly associated. Findings showed both parent-driven and child-driven effects across early childhood that did not vary by child sex. The transactional nature of the parent-child relationship begins in infancy, underscoring the importance of early screening and provision of supports for families to minimize and prevent the development of serious psychopathology.

Factors associated with caregiver strain among mothers and fathers of children with advanced cancer

OBJECTIVES

To characterize caregiver experiences in the context of advanced pediatric cancer by identifying individual (i.e., demographic factors, stress) and family context factors (i.e., family roles, social support) associated with caregiver strain.

METHODS

Families of children (ages 5-25) with advanced cancer (i.e., physician-estimated prognosis < 60%, relapsed/refractory disease) were recruited from a large children's hospital. Mothers (n = 55; 87% White) and fathers (n = 30; 83% White) reported on their caregiver strain, cancer-specific stress, general stress, social support, division of 7 family roles (e.g., medical care of ill child, household chores), and their satisfaction with each role.

RESULTS

Parents reported moderate caregiver strain, cancer-specific stress, and general stress, and high social support and satisfaction with family roles. Fathers reported family roles were shared equally, whereas mothers reported either sharing roles or completing them independently. When accounting for income and partnership status, greater caregiver strain for mothers was associated with greater general stress, greater satisfaction with family roles, and lower social support. For fathers, greater caregiver strain was associated only with greater cancer-specific stress.

SIGNIFICANCE OF RESULTS

In the context of advanced pediatric cancer, fathers may experience caregiver strain as cancer-specific stress increases, whereas mothers' strain may depend on broader family and social factors. Psychosocial providers should address general and cancer-specific stress within families, and provide resources for enhancing mothers' social support. Additional research is needed with larger, more diverse samples to inform future intervention approaches.