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Rapee RM, Kuhnert R, Spence SH, Bowsher I, Burns J, Coen J, Dixon J, Kotselas P, Lourey C, McLellan LF, Mihalopoulos C, Peters L, Prendergast T, Roos T, Thomas D, Wuthrich V. The Brief Evaluation of Adolescents and Children Online (BEACON): Psychometric development of a mental health screening measure for school students. J Clin Psychol 2024; 80:1420-1447. [PMID: 38425210 DOI: 10.1002/jclp.23673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Revised: 01/22/2024] [Accepted: 02/14/2024] [Indexed: 03/02/2024]
Abstract
This paper describes the development and psychometric evaluation of a brief self-report measure (BEACON) to inform universal mental health screening in schools. Items assess symptoms and impairment associated with anxiety and attention/hyperactivity problems (grades 4-11) as well as depression and eating difficulties (grades 6-11), with optional items for suicidality and self-harm (grades 7-11). Initial item examination based on Item Response Theory (IRT) and classical test theory involved 3844 students in grades 4 through 11 (Study 1) and identified 18 items for grades 4-5 and 31 items for grades 6-11 that fulfilled pre-set criteria. Study 2 extended testing with 10,479 students in grades 4-11 and added an additional four items assessing impairment associated with eating difficulties for older students (grades 6-11) creating a total of 35 items for grades 6-11. All items, for both grade-level versions, met the pre-set criteria for IRT and classical test theory analysis supporting their strength in the measurement of the dimensions of concern. The measure showed good reliability (subscale alphas .87 to .95). Validity was also demonstrated against standard symptom measures, school grades, school absenteeism, and help-seeking. The BEACON appears to be a psychometrically sound measure to use in the first stage of school-based screening for mental health problems.
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Affiliation(s)
- Ronald M Rapee
- Centre for Emotional Health, School of Psychological Science, Macquarie University, Sydney, New South Wales, Australia
| | - Rebecca Kuhnert
- Centre for Emotional Health, School of Psychological Science, Macquarie University, Sydney, New South Wales, Australia
| | - Susan H Spence
- Australian Institute of Suicide Research and Prevention and School of Applied Psychology, Griffith University, Mount Gravatt, Queensland, Australia
| | - Ian Bowsher
- Sydney Secondary College, Glebe, New South Wales, Australia
| | - John Burns
- Centre for Emotional Health, School of Psychological Science, Macquarie University, Sydney, New South Wales, Australia
| | - Jennifer Coen
- Wellbeing and CVE, Catholic Schools NSW, Sydney, New South Wales, Australia
| | - Julie Dixon
- The Mental Health Commission of NSW, Gladesville, New South Wales, Australia
| | - Pauline Kotselas
- Psychology and Wellbeing Services, NSW Department of Education, Sydney, New South Wales, Australia
| | - Catherine Lourey
- The Mental Health Commission of NSW, Gladesville, New South Wales, Australia
| | - Lauren F McLellan
- Centre for Emotional Health, School of Psychological Science, Macquarie University, Sydney, New South Wales, Australia
| | - Cathrine Mihalopoulos
- Monash University Health Economics Group, School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
| | - Lorna Peters
- Centre for Emotional Health, School of Psychological Science, Macquarie University, Sydney, New South Wales, Australia
| | - Traci Prendergast
- Psychology and Wellbeing Services, NSW Department of Education, Sydney, New South Wales, Australia
| | - Tiffany Roos
- The Association of Independent Schools of NSW, Sydney, New South Wales, Australia
| | - Danielle Thomas
- Perinatal, Child and Youth, Mental Health Branch, NSW Ministry of Health, St Leonards, New South Wales, Australia
| | - Viviana Wuthrich
- Centre for Emotional Health, School of Psychological Science, Macquarie University, Sydney, New South Wales, Australia
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Rapee RM, McLellan LF, Carl T, Trompeter N, Hudson JL, Jones MP, Wuthrich VM. Comparison of Transdiagnostic Treatment and Specialized Social Anxiety Treatment for Children and Adolescents With Social Anxiety Disorder: A Randomized Controlled Trial. J Am Acad Child Adolesc Psychiatry 2022; 62:646-655. [PMID: 35987298 DOI: 10.1016/j.jaac.2022.08.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Revised: 08/03/2022] [Accepted: 08/10/2022] [Indexed: 11/15/2022]
Abstract
OBJECTIVE Pediatric social anxiety disorder consistently shows the poorest treatment response of all anxiety disorders. The current study compared a generic cognitive-behavioral therapy (CBT) treatment for pediatric anxiety against a modified (social anxiety) treatment that incorporated specific components to target theoretically important maintaining processes. METHOD A total of 200 children and adolescents (mean age = 9.5 years, SD = 2.2 years; 47% boys) diagnosed with social anxiety disorder as either their principal or additional disorder were randomly allocated to either the generic or the modified treatment. Both treatments were based on a manualized, empirically validated program (Cool Kids) and comprised 10 sessions over 12 weeks. Assessments comprised structured diagnostic interview and parent and youth reports, and covered diagnoses, symptoms, life impairment, and assessment of maintaining processes at post-treatment and 6-month follow-up. RESULTS The treatments did not differ significantly on the primary outcome (remission of social anxiety disorder) at either post-treatment (remission in generic = 41%; modified = 44%) or follow-up (remission in generic = 51%; modified = 69%), although the latter approached significance (p = .08). They also did not differ at either time point on most secondary measures of outcome. The only maintaining process that changed more under modified treatment was attention to the current task. CONCLUSION Despite some positive hints in the data, there was little evidence that the modified intervention significantly improved treatment of pediatric social anxiety disorder, despite incorporating strategies to address putative maintaining mechanisms. The similar improvement between treatments on most maintaining processes suggests that new and innovative strategies may be needed to better target these processes. CLINICAL TRIAL REGISTRATION INFORMATION Efficacy of Cognitive Behavioural Treatment for Socially Anxious Youth; https://www.anzctr.org.au/; 12616001065482.
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Affiliation(s)
- Ronald M Rapee
- Centre for Emotional Health, School of Psychological Sciences, Macquarie University, Sydney, Australia.
| | - Lauren F McLellan
- Centre for Emotional Health, School of Psychological Sciences, Macquarie University, Sydney, Australia
| | - Talia Carl
- Centre for Emotional Health, School of Psychological Sciences, Macquarie University, Sydney, Australia
| | - Nora Trompeter
- Centre for Emotional Health, School of Psychological Sciences, Macquarie University, Sydney, Australia
| | - Jennifer L Hudson
- Centre for Emotional Health, School of Psychological Sciences, Macquarie University, Sydney, Australia; Black Dog Institute, University of New South Wales, Sydney, Australia
| | - Michael P Jones
- Centre for Emotional Health, School of Psychological Sciences, Macquarie University, Sydney, Australia
| | - Viviana M Wuthrich
- Centre for Emotional Health, School of Psychological Sciences, Macquarie University, Sydney, Australia
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Xiong H, Berkovsky S, Romano M, Sharan RV, Liu S, Coiera E, McLellan LF. Prediction of anxiety disorders using a feature ensemble based bayesian neural network. J Biomed Inform 2021; 123:103921. [PMID: 34628061 DOI: 10.1016/j.jbi.2021.103921] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Revised: 09/16/2021] [Accepted: 09/29/2021] [Indexed: 11/25/2022]
Abstract
Anxiety disorders are common among youth, posing risks to physical and mental health development. Early screening can help identify such disorders and pave the way for preventative treatment. To this end, the Youth Online Diagnostic Assessment (YODA) tool was developed and deployed to predict youth disorders using online screening questionnaires filled by parents. YODA facilitated collection of several novel unique datasets of self-reported anxiety disorder symptoms. Since the data is self-reported and often noisy, feature selection needs to be performed on the raw data to improve accuracy. However, a single set of selected features may not be informative enough. Consequently, in this work we propose and evaluate a novel feature ensemble based Bayesian Neural Network (FE-BNN) that exploits an ensemble of features for improving the accuracy of disorder predictions. We evaluate the performance of FE-BNN on three disorder-specific datasets collected by YODA. Our method achieved the AUC of 0.8683, 0.8769, 0.9091 for the predictions of Separation Anxiety Disorder, Generalized Anxiety Disorder and Social Anxiety Disorder, respectively. These results provide initial evidence that our method outperforms the original diagnostic scoring function of YODA and several other baseline methods for three anxiety disorders, which can practically help prioritizing diagnostic interviews. Our promising results call for investigation of interpretable methods maintaining high predictive accuracy.
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Affiliation(s)
- Hao Xiong
- Centre for Health Informatics, Australian Institute of Health Innovation, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, Australia.
| | - Shlomo Berkovsky
- Centre for Health Informatics, Australian Institute of Health Innovation, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, Australia
| | - Mia Romano
- Centre for Emotional Health, Department of Psychology, Macquarie University, Sydney, Australia
| | - Roneel V Sharan
- Centre for Health Informatics, Australian Institute of Health Innovation, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, Australia
| | - Sidong Liu
- Centre for Health Informatics, Australian Institute of Health Innovation, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, Australia
| | - Enrico Coiera
- Centre for Health Informatics, Australian Institute of Health Innovation, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, Australia
| | - Lauren F McLellan
- Centre for Emotional Health, Department of Psychology, Macquarie University, Sydney, Australia
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Low intensity treatment for clinically anxious youth: a randomised controlled comparison against face-to-face intervention. Eur Child Adolesc Psychiatry 2021; 30:1071-1079. [PMID: 32632763 DOI: 10.1007/s00787-020-01596-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Accepted: 07/01/2020] [Indexed: 10/23/2022]
Abstract
Methods to deliver empirically validated treatments for anxious youth that require fewer therapist resources (low intensity) are beginning to emerge. However, the relative efficacy of low-intensity treatment for youth anxiety against standard face-to-face delivery has not been comprehensively evaluated. Young people aged 6-16 years with a primary anxiety disorder (N = 281) were randomly allocated to treatment delivered either face-to-face or in a low-intensity format. Face-to-face treatment comprised ten, 60-min sessions delivered by a qualified therapist. Low intensity comprised information delivered in either printed (to parents of children under 13) or electronic (to adolescents aged 13 +) format and was supported by up to four telephone sessions with a minimally qualified therapist. Youth receiving face-to-face treatment were significantly more likely to remit from all anxiety disorders (66%) than youth receiving low intensity (49%). This difference was reflected in parents' (but not child) reports of child's anxiety symptoms and life interference. No significant moderators were identified. Low intensity delivery utilised significantly less total therapist time (175 min) than face-to-face delivery (897 min) and this was reflected in a large mean difference in therapy costs ($A735). Standard, face-to-face treatment for anxious youth is associated with significantly better outcomes than delivery of similar content using low-intensity methods. However, the size of this difference was relatively small. In contrast, low-intensity delivery requires markedly less time from therapists and subsequently lower treatment cost. Data provide valuable information for youth anxiety services.Clinical trial registration information: A randomised controlled trial of standard care versus stepped care for children and adolescents with anxiety disorders; https://anzctr.org.au/ ; ACTRN12612000351819.
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Etkin RG, Lebowitz ER, Silverman WK. Using Evaluative Criteria to Review Youth Anxiety Measures, Part II: Parent-Report. JOURNAL OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY 2021; 50:155-176. [PMID: 33739908 DOI: 10.1080/15374416.2021.1878898] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
This Evidence Base Update of parent-report measures of youth anxiety symptoms is a companion piece to our update on youth self-report anxiety symptom measures (Etkin et al., 2021). We rate the psychometric properties of the parent-report measures as Adequate, Good, or Excellent using criteria developed by Hunsley and Mash (2008) and Youngstrom et al. (2017). Our review reveals that the evidence base for parent-report measures is considerably less developed compared with the evidence base for youth self-report measures. Nevertheless, several measures, the parent-report Screen for Child Anxiety-Related Emotional Disorders, Multidimensional Anxiety Scale for Children, and Spence Children's Anxiety Scale, were found to have Good to Excellent psychometric properties. We conclude our review with suggestions about which parent-report youth anxiety measures are best suited to perform different assessment functions and directions for additional research to expand and strengthen the evidence base.
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