Electronic Diaries: A Feasible Method of Assessing Emotional Experiences in Youth?

Children's emotional reactivity and negative affect predict future ADHD symptom severity beyond initial ADHD symptom severity

Children with Attention-Deficit/Hyperactivity Disorder (ADHD) often experience significant emotion dysregulation. However, there is limited longitudinal data on associations between multiple aspects of emotion dysregulation and ADHD symptoms. Additionally, given substantial evidence that increased levels and variability of negative affect (NA) are identified in children with ADHD, it is important to examine the role of NA in this relationship. The present study used momentary and longitudinal data to examine the relation between two aspects of emotion dysregulation (emotional lability and emotional reactivity), the two ADHD symptom clusters separately (inattentive and hyperactive/impulsive), total ADHD symptom severity, and NA variability over a period of six months. Participants (N = 68) were parents of children aged 7-12 years old (M = 9.80, SD = 1.34) who completed baseline and 6-month follow-up reports of children's ADHD symptoms and emotion dysregulation as well as ecological momentary assessments (EMA) of their children's NA for one week. Results were threefold: (1) children's emotional reactivity predicted inattentive, hyperactive/impulsive, and total ADHD symptom severity above and beyond initial ADHD symptom severity, but emotional lability did not significantly predict severity of any ADHD symptom cluster; (2) NA variability predicted hyperactive/impulsive and total ADHD symptom severity, but not inattentive severity; and (3) initial ADHD symptom severity did not predict emotion dysregulation at follow-up. The current study provides novel insight regarding the longitudinal influence of specific aspects of emotion dysregulation and NA on ADHD symptom severity in children and suggests that targeting emotional reactivity could minimize ADHD symptom severity.

Positive Emotion Is Associated with Attentional Focus on Physical Activity and Eating in Adolescents: A Daily Diary Study

BACKGROUND

There are emerging data linking positive emotion to health behaviors, yet the self-regulatory processes underlying this link are understudied. The purpose of the current study was to examine the associations between daily positive emotion and daily attentional focus on physical activity and overeating as well as the moderating role of trait positive emotion arousal recovery.

METHOD

Adolescents (N = 47) aged 11 to 17 completed a baseline measure of their perceived positive emotion arousal regulation and a 7-day diary about their positive emotion and attentional focus.

RESULTS

Both within-person increases in and greater average daily approach-oriented positive emotion were associated with greater daily attentional focus on physical activity and overeating. Quicker perceived trait approach-oriented positive emotion arousal recovery dampened the association between within-person increases in daily approach-motivated positive emotion and daily attentional focus on overeating but not physical activity.

CONCLUSION

Positive emotion can elicit a narrowing of attentional focus towards emotionally salient health behavior. Future studies should examine the full mechanistic pathway linking positive emotion to health behavior via attentional focus and arousal recovery.

Feasibility, Acceptability, and Usability of Physiology and Emotion Monitoring in Adults and Children Using the Novel Time2Feel Smartphone Application

The present study tests the feasibility, acceptability, and utility of the novel smartphone application-Time2Feel-to monitor family members' emotional experiences, at the experiential and physiological level, and their context. To our knowledge, Time2Feel is the first of its kind, having the capability to monitor multiple members' emotional experiences simultaneously and survey users' emotional experiences when experiencing an increase in physiological arousal. In this study, a total of 44 parents and children used Time2Feel along with the Empatica E4 wrist-wearable device for 10 days. Engagement rates were within the acceptable range and consistent with previous work using experience sampling methods. Perceived ease of use and satisfaction fell mostly in the moderate range, with users reporting challenges with connectivity. We further discuss how addressing connectivity would increase acceptability. Finally, Time2Feel was successful at identifying physiological deviations in electrodermal activity for parents and children alike, and even though responses to those deviation-generated surveys were largely consistent with random survey responses, some differences were noted for mothers and fathers. We discuss the implications of using Time2Feel for understanding families' emotional and stressful experiences day-to-day.

Building an ecological momentary assessment smartphone app for 4- to 10-year-old children: A pilot study

OBJECTIVE

Ecological momentary assessment (EMA) minimizes recall burden and maximizes ecological validity and has emerged as a valuable tool to characterize individual differences, assess contextual associations, and document temporal associations. However, EMA has yet to be reliably utilized in young children, in part due to concerns about responder reliability and limited compliance. The present study addressed these concerns by building a developmentally appropriate EMA smartphone app and testing the app for feasibility and usability with young children ages 4-10 (N = 20; m age = 7.7, SD = 2.0).

METHODS

To pilot test the app, children completed an 11-item survey about their mood and behavior twice a day for 14 days. Parents also completed brief surveys twice a day to allow for parent-child comparisons of responses. Finally, at the end of the two weeks, parents provided user feedback on the smartphone app.

RESULTS

Results indicated a high response rate (nearly 90%) across child surveys and high agreement between parents and children ranging from 0.89-0.97.

CONCLUSIONS

Overall, findings suggest that this developmentally appropriate EMA smartphone app is a reliable and valid tool for collecting in-the-moment data from young children outside of a laboratory setting.

The relationship between basic psychological need satisfaction and intrinsic motivation: The role of individual differences and special educational needs

A within-person perspective with several measurement points per individual allows to analyse relations between variables within individuals. Such an approach is still scarce in research from a self-determination theory perspective. Therefore, this study measured basic psychological need satisfaction and intrinsic motivation in real-time and at several lessons with the experience sampling method. In this way, the relationship between need satisfaction and intrinsic motivation was investigated from both a group level and within-person perspective. The sample consisted of 146 students in pre-vocational secondary education, who completed 4128 diary questionnaires. At the group level, positive relationships between satisfaction of the needs and motivation were found. However, individual differences in the strength and direction of these relationships exist. This marks the importance of taking a within-person perspective, and studying both concepts at several lessons and individually. Students’ special educational needs play a role in the strength of the relationship: compared to typically developing students, satisfaction of autonomy is less important, while satisfaction of competence and relatedness with the teacher are more important for the intrinsic motivation of students with special educational needs. However, students’ special educational needs do not explain all differences between individual students. Future research may investigate other student characteristics to explore where individual differences in the importance of the basic psychological needs come from.

Emotion regulation and angry mood among adolescents with externalizing problems and intellectual disabilities

BACKGROUND AND AIMS

Cognitive behavior therapy targeting emotion regulation is found to be effective in decreasing externalizing problems, but little is known about the emotion regulation capacities of adolescents with externalizing problems and Mild Intellectual Disabilities or Borderline Intellectual Functioning (MID-BIF). Therefore, the aim of this study was to compare emotion (i.e., anger) regulation capacities, angry mood level and angry mood variability between two groups: adolescents with externalizing problems and MID-BIF and adolescents with externalizing problems and average intelligence (AIQ).

METHODS AND PROCEDURES

Participants in the MID-BIF (n = 42, M_age = 15.52, SD = 1.43) and AIQ (n = 39, M_age = 13.67, SD = 1.06) group completed questionnaires about emotion regulation difficulties, emotion regulation strategies, and angry mood.

OUTCOMES AND RESULTS

Adolescents in the MID-BIF group reported fewer emotion regulation difficulties, fewer maladaptive regulation strategies, and lower levels of angry mood than adolescents in the AIQ group. No between-group differences in angry mood variability were found. Lastly, adolescents in the MID-BIF group reported to use more behavioral than cognitive regulation strategies.

CONCLUSIONS AND IMPLICATIONS

These findings provide a starting point in understanding emotion regulation and angry mood of adolescents with externalizing problems and MID-BIF and show that it is important to consider differences between cognitive and behavioral regulation processes.

Ecological Momentary Assessment of Non-Menstrual Pelvic Pain: Potential Pathways of Central Sensitization in Adolescents and Young Adults with and without Primary Dysmenorrhea

Purpose

Primary dysmenorrhea (PD; menstrual pain without an identified organic cause) has been proposed as a possible risk factor for the development of chronic pelvic pain, but the mechanism through which this process occurs is unknown. One possible mechanism is central sensitization – alterations in the central nervous system that increase responsiveness to pain leading to hypersensitivity. Repeated episodes of pain, such as those experienced over time with PD, may alter how the brain processes pain. Ecological momentary assessment (EMA; collection of data in real time in participants’ natural environments) is a novel data collection method that may help elucidate pain occurring during non-menstrual cycle phases.

Patients and Methods

The current observational study assessed the feasibility and acceptability of using EMA via text messages to collect pelvic pain data during menstrual and non-menstrual cycle phases in a community sample of adolescents and young adults (AYA) aged 16–24 years with and without PD and explored occurrence rates and intensity of non-menstrual pelvic pain (NMPP) in each of these groups.

Results

Thirty-nine AYA with PD and 53 healthy controls reported pelvic pain level via nightly text message. Global response rate was 98.5%, and all participants reported that the EMA protocol was acceptable. AYA with PD reported higher intensity (2.0 vs 1.6 on 0–10 numeric rating scale; p=0.003) and frequency (8.7% vs 3.1% of days; p=0.004) of NMPP compared to healthy controls.

Conclusion

The EMA protocol was feasible and acceptable. Though both the intensity and frequency of NMPP were low and at levels that would not typically warrant clinical assessment or intervention, these repeated nociceptive events may represent a potential mechanism contributing to the transition from cyclical to chronic pelvic pain in some individuals.

Stress and Eating Behavior: A Daily Diary Study in Youngsters

Background: Overweight and obesity are growing problems, with more attention recently, to the role of stress in the starting and maintaining process of these clinical problems. However, the mechanisms are not yet known and well-understood; and ecological momentary analyses like the daily variations between stress and eating are far less studied. Emotional eating is highly prevalent and is assumed to be an important mechanism, as a maladaptive emotion regulation (ER) strategy, in starting and maintaining the vicious cycle of (pediatric) obesity. Objectives: The present study aims to investigate in youngsters (10 - 17 years) the daily relationship between stress and the trajectories of self-reported eating behavior (desire to eat motives; hunger eating motives and snacking) throughout 1 week; as well as the moderating role of emotion regulation and emotional eating in an average weight population. Methods: Participants were 109 average weighted youngsters between the age of 10 and 17 years (M _age = 13.49; SD = 1.64). The youngsters filled in a trait-questionnaire on emotion regulation and emotional eating at home before starting the study, and answered an online diary after school time, during seven consecutive days. Desire to eat motives, hunger eating motives and snacking were assessed daily for seven consecutive days. Results: Using multilevel analyses results revealed that daily stress is significantly associated with trajectories of desire to eat motives and hunger eating motives. No evidence was found for the moderating role of maladaptive ER in these relationships; marginally significant evidence was found for the moderating role of emotional eating in the trajectories of desire to eat and snacking. Discussion: These results stress the importance of looking into the daily relationship between stress and eating behavior parameters, as both are related with change over and within days. More research is needed to draw firm conclusion on the moderating role of ER strategies and emotional eating.

Functional Impairment Variability in Children With ADHD Due to Emotional Impulsivity

OBJECTIVE

The present study utilized ecological momentary assessment (EMA) to examine the effects of emotional impulsivity on overall functional impairment and functional impairment variability (FIV) of children with and without ADHD.

METHOD

Parents of 74 children, 8- to 12-year-olds (42 with ADHD, 32 without ADHD), completed EMA assessment protocol ratings of their child's mood (3 times daily) and functional impairment (1 time daily) over the course of 28 days.

RESULTS

Hierarchical regression analyses supported the interaction of ADHD diagnostic status and greater EMA-derived emotional impulsivity in the estimation of total functional impairment (Total FI) and FIV. Thus, greater emotional impulsivity was found to be related to greater Total FI and FIV among children with ADHD but not among children without ADHD.

CONCLUSION

This study suggests that children with ADHD and greater emotional impulsivity demonstrate greater overall levels of functional impairment, with the severity of their impairment varying significantly over time.

Compliance With Mobile Ecological Momentary Assessment Protocols in Children and Adolescents: A Systematic Review and Meta-Analysis

BACKGROUND

Mobile device-based ecological momentary assessment (mobile-EMA) is increasingly used to collect participants' data in real-time and in context. Although EMA offers methodological advantages, these advantages can be diminished by participant noncompliance. However, evidence on how well participants comply with mobile-EMA protocols and how study design factors associated with participant compliance is limited, especially in the youth literature.

OBJECTIVE

To systematically and meta-analytically examine youth's compliance to mobile-EMA protocols and moderators of participant compliance in clinical and nonclinical settings.

METHODS

Studies using mobile devices to collect EMA data among youth (age ≤18 years old) were identified. A systematic review was conducted to describe the characteristics of mobile-EMA protocols and author-reported factors associated with compliance. Random effects meta-analyses were conducted to estimate the overall compliance across studies and to explore factors associated with differences in youths' compliance.

RESULTS

This review included 42 unique studies that assessed behaviors, subjective experiences, and contextual information. Mobile phones were used as the primary mode of EMA data collection in 48% (20/42) of the reviewed studies. In total, 12% (5/42) of the studies used wearable devices in addition to the EMA data collection platforms. About half of the studies (62%, 24/42) recruited youth from nonclinical settings. Most (98%, 41/42) studies used a time-based sampling protocol. Among these studies, most (95%, 39/41) prompted youth 2-9 times daily, for a study length ranging from 2-42 days. Sampling frequency and study length did not differ between studies with participants from clinical versus nonclinical settings. Most (88%, 36/41) studies with a time-based sampling protocol defined compliance as the proportion of prompts to which participants responded. In these studies, the weighted average compliance rate was 78.3%. The average compliance rates were not different between studies with clinical (76.9%) and nonclinical (79.2%; P=.29) and studies that used only a mobile-EMA platform (77.4%) and mobile platform plus additional wearable devices (73.0%, P=.36). Among clinical studies, the mean compliance rate was significantly lower in studies that prompted participants 2-3 times (73.5%) or 4-5 times (66.9%) compared with studies with a higher sampling frequency (6+ times: 89.3%). Among nonclinical studies, a higher average compliance rate was observed in studies that prompted participants 2-3 times daily (91.7%) compared with those that prompted participants more frequently (4-5 times: 77.4%; 6+ times: 75.0%). The reported compliance rates did not differ by duration of EMA period among studies from either clinical or nonclinical settings.

CONCLUSIONS

The compliance rate among mobile-EMA studies in youth is moderate but suboptimal. Study design may affect protocol compliance differently between clinical and nonclinical participants; including additional wearable devices did not affect participant compliance. A more consistent compliance-related result reporting practices can facilitate understanding and improvement of participant compliance with EMA data collection among youth.

Disadvantaged youth report less negative emotion to minor stressors when with peers

Previous Experience Sampling Method (ESM) studies demonstrate that adolescents’ daily emotional states are heavily influenced by their immediate social context. However, despite adolescence being a risk period for exposure to daily stressors, research has yet to examine the influence of peers on adolescents’ emotional responses to stressors encountered in their daily life. Adolescents ( N = 108) from a low-SES school completed ESM reports of their social context, minor stressors and emotions, 5 times a day for 7 days. Based on previous findings that the peer context is experienced as positive and rewarding, we expected being with peers would be associated with lower post-stress negative emotions and higher happiness, compared to being with family or alone. As expected, being with peers after a stressor was associated with lower sadness, worry and jealousy compared to being alone, and lower sadness compared to being with family. Gender differences emerged for the influence of peers on sadness, worry, jealousy and happiness. These findings highlight the salient influence of peers on adolescents’ emotional reactivity to stressors as they occur in their natural environment. Findings are discussed in reference to peers as important emotion socialization agents during adolescence and in terms of theories of coping and emotion regulation.

Emotional Impulsivity and Emotional and Behavioral Difficulties Among Children With ADHD: An Ecological Momentary Assessment Study

OBJECTIVE

Children with ADHD often demonstrate impulsive shifts in emotion, characterized by sudden and intense shifts in affect. This study examined the effects of emotional impulsivity over time on the emotional and behavioral functioning of children with ADHD using ecological momentary assessment (EMA).

METHOD

Twenty-seven 8- to 12-year-old children with ADHD, and their parents, completed baseline measures of the children's emotional and behavioral functioning. Parents and children then completed an EMA protocol, whereby they each rated the child's affect three times daily for 28 days.

RESULTS

Hierarchical regression analyses strongly supported the relation of greater EMA-derived emotional impulsivity to children's increased emotional and behavioral difficulties. These effects were evident across reporters and were maintained after controlling for baseline emotion dysregulation.

CONCLUSION

Overall, this study demonstrated the utility of EMA-based assessments and suggested that emotional impulsivity may play an important role in the emotional and behavioral functioning of children with ADHD.

Focusing on the positive: a review of the role of child positive affect in developmental psychopathology

This review proposes a transactional model of child positive affect (PA) to reflect the ways that PA, in various contexts, may confer both risk and protection for psychosocial adjustment. Though research has largely explored the ways that low PA relates to maladjustment in youth, much less research has focused on the ways that PA can facilitate adjustment, particularly under conditions of risk. Yet, theory suggests that a greater emphasis on PA as a protective factor is an important endeavor in developmental psychopathology research; such conceptual issues are explored in this review. This review also seeks to spur a more nuanced approach to the study of child PA through the use of increased multi-method, longitudinal assessments as well as the consideration of contextual factors. Building upon this research base is important for aiding in the development of intervention and prevention efforts that attempt to promote positive psychosocial development and mitigate the course of psychopathology in youth at risk for PA difficulties.

Maternal positive affect mediates the link between family risk and preschoolers' positive affect

The present study sought to further specify conceptual models of youth positive affect (PA) by examining mothers' observed PA as a mediator of the relation between family risk (based on maternal reports of demographic factors) and children's PA in a sample of 82 mothers (M = 31.25 years, SD = 6.16) and their preschool-aged children (M = 3.51 years, SD = .49, 63.00% boys). Results yielded a significant, negative correlation between family risk and child PA. Mediation analyses indicated that family risk was related to child PA through its effects on maternal PA, even after controlling for maternal depression symptoms. Findings suggest that family risk and maternal PA are important factors to consider in understanding preschoolers' PA development. Identifying children at risk for developing PA difficulties can aid in the implementation of prevention and intervention strategies for promoting young children's PA specifically, and their psychosocial functioning more broadly.

Relations between emotional and social functioning in children with anxiety disorders

The current study investigated concurrent relations between emotional and social functioning in youth with anxiety disorders using a multi-reporter (i.e., children, parents, teachers) assessment strategy. Ninety youth (M age = 8.98 years, SD = 1.68) with a primary diagnosis of generalized anxiety disorder, social phobia, and/or separation anxiety disorder, and a parent participated. Regression analyses indicated that positive affect and emotion regulation coping were related to adaptive measures of social functioning, whereas positive affect, negative affect, reluctance to share emotional experiences with peers, and lability/negativity were related to maladaptive measures of social functioning in the expected directions. For youth high in lability/negativity and low in emotion regulation coping, the relationship between diagnostic severity and social problems was exacerbated. This research contributes to our understanding of the interplay of social and emotional variables and suggests that efforts to facilitate child emotional functioning may improve social functioning for anxious youth, or vice versa.

Developmental Trends in Emotion Regulation: A Systematic Review with Implications for Community Mental Health

The ability to regulate how emotions are experienced is central to psychological well-being. Developmental changes in emotion regulation (ER) strategies are unclear in the literature. Thus, a systematic review of the research literature was conducted in order to (a) describe normative ER development across childhood, adolescence, and emerging adulthood, (b) describe the patterns and processes of specific ER strategies, and (c) identify and describe the influence of specific individual factors on ER. Fifty-five studies were identified that examined key ER strategies across development. The findings highlight the importance of facilitating adaptive ER strategies among children and youth.

Feasibility and validity of ecological momentary assessment in adolescents with high-functioning autism and Asperger's disorder

Ecological Momentary Assessment (EMA) may increase accuracy of data compared with retrospective questionnaires by assessing behaviours as they occur, hence decreasing recall biases and increasing ecological validity. This study examined the feasibility and concurrent validity of an EMA tool for adolescents with High-Functioning Autism Spectrum Disorders (HFASD). Thirty-one adolescents with HFASD completed a mobile phone EMA application that assessed stressors and coping for two weeks. Parents and adolescents also completed retrospective measures of the adolescent's coping/stressors. Moderate compliance with the EMA tool was achieved and some concurrent validity was established with the retrospective measure of coping. Concordance was found between the types of stressors reported by parents and adolescents but not the quantity. The results suggest adolescents with HFASD are capable of reporting on their stressors and coping via EMA. EMA has the potential to be a valuable research tool in this population.

I know it when I quantify it: ecological momentary assessment and recurrence quantification analysis of emotion dysregulation in children with ADHD

Two studies examined the feasibility, utility, and validity of Ecological Momentary Assessment (EMA) and Recurrence Quantification Analysis (RQA) in assessing emotion dysregulation in children with Attention-Deficit/Hyperactivity Disorder (ADHD). In Study 1, 11 parents of children with ADHD ages 8-11 completed EMA-based ratings of their children's mood three times daily for 28 days (84 ratings total) and questionnaires regarding their children's emotion dysregulation. RQA was used to quantify the temporal patterning of dysregulation of the children's mood. In Study 2, five children ages 8-11 completed EMA-based ratings of their mood three times daily for 28 days. Results supported the feasibility and validity of the parent report EMA protocol, with greater intensity, variability, and persistent patterning of variability associated with greater emotion dysregulation. Results did not support the validity of the child report protocol, as children were less likely to complete ratings when emotionally distressed and demonstrated substantial response bias.

Emotion regulation predicts pain and functioning in children with juvenile idiopathic arthritis: an electronic diary study

OBJECTIVES

This study utilized e-diaries to evaluate whether components of emotion regulation predict daily pain and function in children with juvenile idiopathic arthritis (JIA).

METHODS

43 children ages 8-17 years and their caregivers provided baseline reports of child emotion regulation. Children then completed thrice daily e-diary assessments of emotion, pain, and activity involvement for 28 days. E-diary ratings of negative and positive emotions were used to calculate emotion variability and to infer adaptive emotion modulation following periods of high or low emotion intensity. Hierarchical linear models were used to evaluate how emotion regulation related to pain and function.

RESULTS

The attenuation of negative emotion following a period of high negative emotion predicted reduced pain; greater variability of negative emotion predicted higher pain and increased activity limitation. Indices of positive emotion regulation also significantly predicted pain.

CONCLUSIONS

Components of emotion regulation as captured by e-diaries predict important health outcomes in children with JIA.