Developmental Differences in Child and Adolescent Reasoning about Anxiety Sensations

Assessment and treatment of mental health conditions in children and adolescents: A systematic scoping review of how virtual reality environments have been used

BACKGROUND

There is growing interest in the use of virtual reality environments (VREs) in psychological treatment and assessment. Most research has focused on the application of VREs in adult psychological disorders with fewer studies focusing on its applicability with children and adolescents. A systematic scoping review was undertaken of research assessing how VREs have been used in the treatment and assessment of childhood mental health disorders to provide an overview of the current state of the literature and identify future research directions.

METHOD

Systematic searches of online databases were conducted in PsycInfo, PubMed, Embase, Scopus, and Web of Science.

RESULTS

Eleven studies met eligibility criteria and were included in this review, with the majority focusing on VRE interventions for anxiety-related disorders. There is also emerging support for VRE deep breathing training for anxiety, VRE assisted treatment of internet gaming disorder and anorexia nervosa, and VRE assessment of body image evaluation in anorexia nervosa. Most studies were pilot and feasibility studies with only three randomised-controlled trials (RCT).

CONCLUSIONS

The current literature shows some promise for the use of VRE assessments and interventions of childhood mental health problems, particularly for anxiety-related disorders such as social anxiety and specific phobias. However, high-quality RCTs are now needed to establish effectiveness of VREs in this population, and how it compares to existing evidence-based approaches, given its promise to improve both engagement and outcomes.

Multidomain Predictors of Protracted Recovery following Concussion among 5- to 9-Year-Old Patients: A Preliminary Study

OBJECTIVE

To determine which components from a multidomain assessment best predict protracted recovery in pediatric patients with a concussion.

STUDY DESIGN

A prospective cohort of patients aged 5-9 years who presented within 21 days of concussion to a specialty clinic were categorized into normal (≤30 days) and protracted (>30 days) recovery. Participants provided demographic and medical history information, and completed the Child Sport Concussion Assessment Tool-5 symptom report and balance assessment, the Vestibular/Ocular Motor Screen-Child (VOMS-C), and the Pediatric Immediate Post-concussion Assessment and Cognitive Testing. Univariate logistic regressions (LR) were used to inform a follow-up forward stepwise LR to identify the best predictors of protracted recovery. Receiver operating characteristic analysis of the area under the curve (AUC) was used to identify which predictors retained from the LR model best discriminated recovery.

RESULTS

The final sample included 68 patients (7.52 ± 2.3 years; 56% male), 36 (52.9%) with normal and 32 (47.1%) with protracted recovery. Results of the LR to identify protracted recovery were significant (P < .001) and accounted for 39% of the variance. The model accurately classified 78% of patients, with days to first clinic visit (OR, 1.2; 95% CI, 1.1-1.4; P = .003) and positive VOMS-C findings (OR, 8.32; 95% CI, 2.4-28.8; P < .001) as significant predictors. A receiver operating characteristic analysis of the AUC of this 2-factor model discriminated protracted from normal recovery (AUC, 0.82; 95% CI, 0.71-0.92; P < .001).

CONCLUSIONS

Days to first clinic visit and positive findings on the VOMS-C were the most robust predictors of protracted recovery after concussion in young pediatric patients.

Toward a Developmental Model of Continuity and Change in PTSD Symptoms following Exposure to Traumatic and Adverse Experiences

A developmental understanding of the expression of posttraumatic stress (PTS) symptoms following trauma in childhood requires identifying continuity and change in not just overall symptoms but in the individual symptoms as well. Such models of change also require understanding multiple dimensions of time. That is, longitudinal change-the passage of time-may have different effects on symptom expression depending on when in time an individual entered the study - such as what age they were when first assessed. This paper addresses these ideas with an overview of the developmental differences in the assessment of PTS from the fifth edition of the Diagnostic and Statistical Manual of Mental Disorders, (DSM-5), longitudinal research on posttraumatic stress disorder (PTSD) symptoms, and providing synthesis within a symptom network perspective. We then provide an illustration of how individual PTSD symptoms change over time at different ages (elementary versus middle school) with a secondary analysis of data from a previously reported study (n = 191 youth, aged 8-15, assessed at two time points six months apart). The reanalysis of the data suggests both continuity and change in symptoms over time (i.e., some symptoms were more stable than other symptoms) with differences in symptom rates and their longitudinal change as a function of age (i.e., some symptoms more common or more stable in younger versus older or older versus younger). We close with avenues for future research aimed at better understanding symptom cascades over time and at different ages and potential implications for future iterations of assessment/classification systems.