Investigating the psychometric properties of the revised child anxiety and depression scale (RCADS) in a non-clinical sample of Irish adolescents

The Dynamic Adaptation of the Journey of Hope: A School-Based Intervention to Support Pandemic and Disaster-Affected Children and Youth

The Journey of Hope (JoH) is an evidence-based behavioral health prevention intervention model designed for disaster-affected children and youth. While the in-person JoH model has been extensively delivered and studied, the virtual implementation of this intervention, specifically tailored for the unique needs of children and youth during the COVID-19 pandemic, has not been previously explored. In this context, authors of this article adapted the JoH to a virtual delivery model, aiming to provide access to behavioral health preventive services for children and youth during the COVID-19 pandemic when in-person services were not feasible. This adaptation, utilizing the dynamic adaptation process (DAP) and community-based participatory research (CBPR) principles, was carefully designed to meet pandemic-related challenges while maintaining the core components of the original intervention. The primary objectives of this article are twofold: (1) to provide an overview of the theoretical and conceptual underpinnings of the JoH-C19, including the framework that guided the adaptation, and (2) to describe the virtually adapted curriculum and initial pilot of the JoH-C19. This adaptation represents a crucial step in ensuring the accessibility of virtual behavioral health interventions for young populations facing various collective traumas and challenges in a rapidly evolving world.

A multi-centre, tolerability study of a cannabidiol-enriched Cannabis Herbal Extract for chronic headaches in adolescents: The CAN-CHA protocol

INTRODUCTION

Cannabis products have been used in the management of headaches in adults and may play a role in pediatric chronic pain. Canadian pediatricians report increasing use of cannabis for the management of chronic headaches, despite no well-controlled studies to inform its dosing, safety, and effectiveness. The aim of our clinical trial is to determine the dosing and safety of a Cannabidiol (CBD)-enriched Cannabis Herbal Extract (CHE) for the treatment of chronic headaches in adolescents.

METHODS AND ANALYSIS

Youth, parents, and an expert steering committee co-designed this tolerability study. Twenty adolescents (aged 14 to 17 years), with a chronic migraine diagnosis for more than 6 months that has not responded to other therapies will be enrolled into an open label, dose escalation study across three Canadian sites. Study participants will receive escalating doses of a CBD-enriched CHE (MPL-001 with a THC:CBD of 1:25), starting at 0.2-0.4 mg/kg of CBD per day and escalating monthly up to 0.8-1.0 mg/kg of CBD per day. The primary objective of this study is to determine the safety and tolerability of CBD-enriched CHE in adolescents with chronic migraine. Secondary objectives of this study will inform the development of subsequent randomized controlled trials and include investigating the relationship between the dose escalation and change in the frequency of headache, impact and intensity of pain, changes in sleep, mood, function, and quality of life. Exploratory outcomes include investigating steady-state trough plasma levels of bioactive cannabinoids and investigating how pharmacogenetic profiles affect cannabinoid metabolism among adolescents receiving CBD-enriched CHE.

DISCUSSION

This protocol was co-designed with youth and describes a tolerability clinical trial of CBD-enriched CHE in adolescents with chronic headaches that have not responded to conventional therapies. This study is the first clinical trial on cannabis products in adolescents with chronic headaches and will inform the development of future comparative effectiveness clinical trials.

TRIAL REGISTRATION

CAN-CHA trial is registered with ClinicalTrials.gov with a number of register NCT05337033.

Macrostructural Brain Morphology as Moderator of the Relationship Between Pandemic-Related Stress and Internalizing Symptomology During COVID-19 in High-Risk Adolescents

BACKGROUND

According to person-by-environment models, individual differences in traits may moderate the association between stressors and the development of psychopathology; however, findings in the literature have been inconsistent and little literature has examined adolescent brain structure as a moderator of the effects of stress on adolescent internalizing symptoms. The COVID-19 pandemic presented a unique opportunity to examine the associations between stress, brain structure, and psychopathology. Given links of cortical morphology with adolescent depression and anxiety, the current study investigated whether cortical morphology moderated the relationship between stress from the COVID-19 pandemic and the development of internalizing symptoms in familial high-risk adolescents.

METHODS

Prior to the COVID-19 pandemic, 72 adolescents (27 male) completed a measure of depressive and anxiety symptoms and underwent magnetic resonance imaging. T1-weighted images were acquired to assess cortical thickness and surface area. Approximately 6 to 8 months after COVID-19 was declared a global pandemic, adolescents reported their depressive and anxiety symptoms and pandemic-related stress.

RESULTS

Adjusting for pre-pandemic depressive and anxiety symptoms and stress, increased pandemic-related stress was associated with increased depressive but not anxiety symptoms. This relationship was moderated by cortical thickness and surface area in the anterior cingulate and cortical thickness in the medial orbitofrontal cortex such that increased stress was only associated with increased depressive and anxiety symptoms among adolescents with lower cortical surface area and higher cortical thickness in these regions.

CONCLUSIONS

Results further our understanding of neural vulnerabilities to the associations between stress and internalizing symptoms in general and during the COVID-19 pandemic in particular.

Parental physical activity, parental mental health, children's physical activity, and children's mental health

Introduction

The benefits of physical activity for mental health and well-being and the associations between parental mental health and children's mental health have been well established. These important issues tend to be examined separately however, and there is limited research on the associations between parent and child physical activity and mental health when all considered together. While family focused practice is recommended to provide support for parents who have mental health problems and their families and includes various components (such as psychoeducation, support for mental health and parenting), promoting physical activity for parents and children is not usually a core component of these interventions.

Methods

The Northern Ireland Youth Wellbeing Survey aimed to provide estimates of the prevalence of mental health problems among children and young people. The survey also included questions about parental physical activity, parental mental health, and children's physical activity (for those aged 11-19 years). The main aim of the analysis reported in this article was to explore possible bivariate associations between parent and child physical activity and mental health and also explore these associations when all considered together. Participants were included in the analysis where there were completed interviews for the young person and one of their parents, and both young person and parent provided responses in relation to questions on weekly physical activity (n = 882).

Results

The findings highlight the positive associations between parental physical activity and parental mental health, and between children's physical activity and children's mental health. They also explore some of the more complex interactions between these four variables, which suggest that gender may also be an important consideration. There were significant associations between father's physical activity and son's mental health, and son's physical activity and father's mental health.

Discussions

These findings suggest that including support for parental physical activity and children's physical activity should be a routine component of family focused mental health interventions. It is important to acknowledge that there may be additional barriers to engaging in physical activity for families where a parent is experiencing mental health problems, and these should also be explored and addressed.

A pilot study of a brief and scalable psychosocial intervention for children and adolescents following disasters

OBJECTIVES

Following disaster exposure, a significant proportion of children/adolescents will develop levels of post-traumatic stress symptoms (PTSS) that do not meet diagnostic threshold for PTSD, but which cause ongoing distress. This paper describes the development and pilot testing of a brief, scalable, psychosocial intervention. SOLAR-Kids/Teens has been designed to be delivered by non-mental health professionals ('coaches') to children/adolescents experiencing moderate levels of PTSS following disasters.

METHODS

An international collaboration of experts developed The Skills fOr Life Adjustment and Resilience (SOLAR) for Kids and Teens programs. The programs were piloted-using a pre-post mixed methods design-with 10 children and adolescents (8-18 years), with the aims of examining the feasibility of the program's delivery model as well as the program's potential usefulness.

RESULTS

The pilot data indicated that after 1 day of training and with ongoing supervision, the SOLAR program was safe and feasible for coaches to deliver to children/adolescents experiencing PTSS. Coaches reported increased knowledge (p = .001), confidence (p = .001) and skills (p = .006). The programs were acceptable to coaches, children/adolescents and parents. Parents and children/adolescents reported reductions in trauma and anxiety symptoms from pre- to post-treatment, with moderate to large effect sizes.

CONCLUSIONS

The preliminary findings demonstrate that the SOLAR-Kids/Teens program is feasible, acceptable and safe to be delivered by trained non-mental health professionals to children and adolescents experiencing PTSS and anxiety following disaster exposure. Randomized controlled trials are required to evaluate the efficacy of the SOLAR-Kids/Teens programs.

Preliminary Effectiveness of a Brief School-Based HERO Intervention: Improving the Wellbeing of Final Year Adolescent Female Students

Young people face multiple challenges, including appearance dissatisfaction, academic stressors, anxiety and depression. These challenges may increase during the final year of high school and may have become further exacerbated by the COVID-19 pandemic. This study examines the preliminary effectiveness of a brief, uncontrolled school-based intervention aimed at enhancing Psychological Capital (PsyCap), consisting of positive resources of hope, self-efficacy, resilience and optimism (HERO), and reducing mental health symptoms among female year 12 students (n = 95, Mage = 16.78, SD = 0.45). Outcomes on measures of HERO and secondary outcomes of flourishing, appearance dissatisfaction, anxiety and depression were measured at pre and post-intervention. In the overall cohort, no significant changes were found on the HERO outcomes or flourishing post-intervention, while symptoms of depression, anxiety and appearance dissatisfaction decreased significantly. For students with higher baseline anxiety, optimism and anxiety symptoms improved significantly at post-intervention. However, students with lower baseline anxiety experienced significant decreases in self-efficacy and optimism, as well as a significant increase in anxiety symptoms post-intervention. Baseline depression levels did not impact intervention outcomes. The findings, although mixed and limited by the lack of control group, suggest that a brief intervention grounded in PsyCap theory may improve student wellbeing under challenging circumstances.

Validation of the eating pathology symptoms inventory (EPSI) in Swedish adolescents

BACKGROUND

Eating disorders (ED) are associated with symptoms across body image, disordered eating, and exercise-related domains, and while predominantly affecting females, ED in males is also a significant concern. However, popular self-report methods insufficiently capture male presentations. This study aimed (1) to validate the first Swedish translation of the Eating Pathology Symptoms Inventory (EPSI), which was designed to overcome limitations in previous measures, and (2) compare genders gender-specific manifestations of eating pathology, depression, and anxiety in Swedish high-school students.

METHODS

Participants were 359 high-school students (47% males) aged 17.0 years (range 15-21).

RESULTS

Confirmatory factor analysis and correlation patterns showed support for the 8-factor structure and convergent validity, but poorer discriminant validity may suggest caution in interpreting single scales as evidence of ED pathology. Gender comparisons were broadly consistent with previous research.

CONLUSIONS

The Swedish EPSI may be used to asses ED symptoms, but caution is suggested in interpreting some scales in isolation as indicative of ED pathology.

Guided self-help treatment for children and young people with threshold and subthreshold eating disorders: A pilot study protocol

BACKGROUND

Prompt access to evidence-based treatment for children and young people with eating disorders is important for outcomes, yet the gap in service provision remains pervasive. Record levels of young people are waiting for eating disorder treatment and access to care is limited. Guided self-help interventions that are brief and require minimal clinician support have the potential to meet the unprecedented demand for treatment quickly and effectively.

OBJECTIVE

To examine the feasibility, acceptability and proof of concept of a novel, CBT guided self-help intervention for children and young people with threshold and subthreshold eating disorders.

METHODS

A single-arm, proof-of-concept pilot study of the CBT guided self-help intervention will be conducted. Children and young people (aged 11-19) with threshold and subthreshold eating disorders will receive a self-help intervention covering the core components of CBT, supported by 8 weekly guidance sessions delivered remotely. Clinical outcomes (eating-related psychopathology and associated impairment, changes in weight, depression, anxiety, and behavioural difficulties) will be assessed at baseline and post-intervention (12 weeks). Feasibility and acceptability of the intervention will be measured using various outcomes, including adherence to, and engagement with the intervention, rates of recruitment and retention, measure completion and treatment satisfaction. Qualitative data will also be collected for future intervention refinement.

DISCUSSION

If the intervention is shown to produce clinical benefits in this pilot study, a fully powered randomised pilot study will be warranted with the ultimate goal of increasing access to psychological treatment for children and young people threshold and subthreshold eating disorders.

ADMINISTRATIVE INFORMATION

This study protocol (S1 File) adheres to the guidelines outlined in the Standard Protocol Items: Recommendations for Interventional Trials (SPIRIT) checklist for trial protocols [1, 2] which can be found in S1 Checklist. The numbers in parentheses in this protocol correspond to the item numbers in the SPIRIT checklist. The order of items has been modified to group similar items.

Developmental trajectories of adolescent internalizing symptoms and parental responses to distress

Parents' responses to their children's negative emotions are a central aspect of emotion socialization that have well-established associations with the development of psychopathology. Yet research is lacking on potential bidirectional associations between parental responses and youth symptoms that may unfold over time. Further, additional research is needed on sociocultural factors that may be related to the trajectories of these constructs. In this study, we examined associations between trajectories of parental responses to negative emotions and adolescent internalizing symptoms and the potential role of youth sex and racial identity. Adolescents and caregivers (N = 256) completed six assessments that spanned adolescent ages 13-18 years. Multivariate growth models revealed that adolescents with higher internalizing symptoms at baseline experienced increasingly non-supportive parental responses over time (punitive and distress responses). By contrast, parental responses did not predict initial levels of or changes in internalizing symptoms. Parents of Black youth reported higher minimization and emotion-focused responses and lower distress responses compared to parents of White youth. We found minimal evidence for sex differences in parental responses. Internalizing symptoms in early adolescence had enduring effects on parental responses to distress, suggesting that adolescents may play an active role in shaping their emotion socialization developmental context.

Building Resilience and Attachment in Vulnerable Adolescents: The Feasibility of a Virtually Delivered Group Intervention for Adolescents with Suicidal Ideation and Their Caregivers

Background

The COVID-19 pandemic required many interventions to be conducted virtually. Building Resilience and Attachment in Vulnerable Adolescents (BRAVA) is a group intervention designed for adolescents and their caregivers to reduce adolescent suicidal ideation (SI).

Objective

We aimed to adapt BRAVA for virtual delivery and evaluate its acceptability and feasibility.

Methods

We conducted an 8-week pre-post trial between October and December 2020. Six adolescents and six primary caregivers were recruited from a pediatric hospital in Ontario, Canada. Families completed a virtual intake and exit assessment together and 6 weekly BRAVA group sessions separately. Satisfaction feedback was collected after each group session and during their exit, and clinical outcomes were collected at intake and exit. Weekly team meetings were conducted to gather clinician feedback.

Results

The study uptake rate was 42.9% of eligible participants. There were no dropouts. Adolescent and caregiver attendance rates for group sessions were high (median = 6). Most youth (83.4%) and caregivers (66.7%) reported that the virtual process worked well. All caregivers (100%) agreed they would participate in a virtual group session again, compared with youth (50%). Providers approved of the virtual adaptation but identified potential improvements (e.g., manual content, safety procedures). Adolescent SI decreased significantly post-treatment (Mpre = 50.7, Mpost = 29.7, p = 0.002).

Conclusions

Virtual delivery of BRAVA is acceptable and feasible and may help reduce SI in adolescents. Uptake, retention, and satisfaction were high for adolescents and caregivers. Feedback collected will improve BRAVA for future evaluations, including a randomized controlled trial.

Prospective Associations Between Fears of Negative Evaluation, Fears of Positive Evaluation, and Social Anxiety Symptoms in Adolescence

Fear of negative evaluation (FNE) and fear of positive evaluation (FPE) are independently associated with social anxiety symptoms in adolescence, though no study has tested these relations longitudinally. The current study examined longitudinal relations between FNE, FPE, and social anxiety symptoms using a multi-informant design, in addition to testing adolescent gender as a moderator. Adolescents (N = 113; Mage = 12.39; Girls = 44.2%) and parents completed measures of FNE, FPE, and two ratings of social anxiety approximately 6 months apart. FNE and FPE demonstrated significant stability over time, but neither predicted change in the other construct. Adolescent and parent-reported FNE, but not FPE, predicted increased social anxiety symptoms. Adolescent report of social anxiety symptoms predicted increased FPE over time, whereas parent report of social anxiety symptoms predicted increased FNE. Contrary to hypothesis, gender did not moderate any of the pathways in the model. Findings provide the first evidence that FNE may function as a risk factor for increased social anxiety in adolescence.

The German version of the Revised Children's Anxiety and Depression Scale-Psychometric properties and normative data for German 8- to 17-year-olds

OBJECTIVES

Anxiety and depression are internalizing mental disorders often commencing in childhood and manifesting in adolescence. The Revised Anxiety and Depression Scale (RCADS) is an internationally widely used standardized diagnostic tool, but the German version has only been validated in a pediatric chronic pain sample; normative data are not available. The aim of this study is to test its reliability (internal consistency) and validity (factorial, convergent, known-groups) in a representative German school sample and to provide norm data.

METHODS

Data were collected from N = 1562 German schoolchildren (Mage  = 12.2; SDage  = 2.33; range 8-17 years; 52.4% girls).

RESULTS

Cronbach's α ranged from 0.73 to 0.96 for the total and the six subscales (five anxiety and one depression). Confirmatory factor analysis showed the 6-factor model had acceptable to good model fit with CFI = 0.93, TLI = 0.93, RMSEA = 0.05, SRMR = 0.05, which was better than 1- and 2-factor models. The (sub)scales correlated moderate to high negatively with health-related quality of life (-0.31 ≤ τ ≤ -0.51; p < 0.001) and positively with functional impairment (0.31 ≤ τ ≤ 0.48; p < 0.001). Mean scores of anxiety and depression scales were significantly higher in girls and partly in adolescents.

CONCLUSION

Findings provide support for the good psychometric properties of the German RCADS in a community sample.

Emotion dysregulation and symptoms of anxiety and depression in early adolescence: Bidirectional longitudinal associations and the antecedent role of parent-child attachment

Difficulties in emotion regulation have been consistently associated with various psychological difficulties, including anxiety and depression; however, less is known about the directionality of this relationship, particularly in adolescents. In addition, early parent-child attachment quality has been closely linked to the development of emotion regulation. Previous studies have proposed an overarching model in attempt to describe the developmental trajectory of anxiety and depression from early attachment, albeit with several limitations that are discussed in this paper. This study adds to this field of research by investigating the longitudinal associations between emotion dysregulation (ED) and symptoms of anxiety and depression among 534 early adolescents in Singapore over three timepoints in a school year, and the antecedent role of attachment quality on individual differences on these variables. Bidirectional influences were found between ED and anxiety and depression symptoms, respectively, between T1 and T2, but not T2 and T3, at the between- and within-individual levels of analysis. Additionally, attachment anxiety and avoidance were both significantly predictive of individual differences in ED and for both psychological symptoms. The current findings provide preliminary evidence of a mutually reinforcing relationship between ED and symptoms of anxiety and depression in early adolescence, where attachment quality serves as a developmental antecedent that sets these longitudinal associations in motion.

Psychometric properties of the revised children's anxiety and depression scale (RCADS) for autistic youth without co-occurring intellectual disability

Autistic youth often present with comorbid anxiety and depression yet there is a dearth of validated assessment tools. The Revised Children's Anxiety and Depression Scale (RCADS) assesses internalizing symptoms but there is little psychometric data in autistic youth. Treatment-seeking autistic youth with anxiety or obsessive-compulsive symptoms (N = 74; age 6-14 years), and caregivers, were administered the RCADS-Parent, RCADS-Child, and assessments of internalizing, externalizing symptoms and social impairment indicative of autism. RCADS-Parent and RCADS-Child total anxiety scores demonstrated excellent internal consistency, and the six subscales demonstrated acceptable-to-good internal consistency. The RCADS-Child and Parent total anxiety scores were weakly correlated, and neither child age nor gender altered the strength of this association. Convergent validity was supported by moderate-to-strong correlations with clinician and parent-reported anxiety symptoms. Support for divergent validity was mixed. Results provide support for the RCADS-Parent and RCADS-Child as reliable, valid measures of internalizing symptoms in autistic youth.

The influence of adverse and positive childhood experiences on young people's mental health and experiences of self-harm and suicidal ideation

BACKGROUND

Few studies have examined the interaction of adverse childhood experiences (ACEs) and positive childhood experiences (PCEs) with mental health outcomes in nationally representative European populations.

OBJECTIVE

The primary objective was to test models of resilience through investigating associations between ACEs and PCEs and young people's risk of common mood and anxiety disorders, self-harm and suicidal ideation.

PARTICIPANTS AND SETTING

Data were from the Northern Ireland Youth Wellbeing Survey (NIYWS), a stratified random probability household survey conducted between June 2019 and March 2020. Analysis is based on data from adolescents aged 11-19 years (n = 1299).

METHOD

Logistic regression was used to test the direct effects of ACEs and PCEs on mental health outcomes and the moderating effect of PCEs at different levels of ACE exposure.

RESULTS

Prevalence rates of mental health outcomes were: common mood and anxiety disorders (16 %); self-harm (10 %); suicidal ideation (12 %). ACEs and PCEs both independently predicted common mood and anxiety disorders, self-harm and suicidal ideation. Every additional ACE increased the likelihood of a common mood and anxiety disorder (81 %), self-harm (88 %) and suicidal ideation (88 %). Every additional PCE reduced common mood and anxiety disorders (14 %), self-harm (13 %) and suicidal ideation (7 %). There was no moderating effect of PCEs on ACEs and mental health outcomes.

CONCLUSION

The findings suggest that PCEs act largely independently of ACEs and that initiatives to increase PCEs can assist in the prevention of mental health problems.

The development of Cognitive Behavioural Therapy (CBT) for chronic loneliness in children and young people: Protocol for a single-case experimental design

Loneliness is a significant problem for young people and is associated with a range of physical and mental health difficulties. Meta-analyses have identified that interventions aimed at young people who report loneliness as their primary problem are lacking within the literature. In adults, the most effective interventions for loneliness are those which target the underlying maladaptive social cognitions. Therefore, we have developed a modular Cognitive Behavioural Therapy (CBT) intervention for children and young people. The aim of this study is to conduct a multiple baseline single-case experimental design (SCED) to assess the efficacy, feasibility and acceptability of this intervention. In total 6-8 11-18-year-olds and their families will be recruited. The design consists of AB+ post-intervention, where A is the baseline phase, B is the intervention phase and then a post-intervention phase. Participants will complete a baseline assessment, before being randomised to one of four different baseline lengths (12 days, 19 days, 26 days or 33 days). Participants will then complete an average of 12 sessions of CBT, with the aim being to reduce their feelings of loneliness. Participants will then complete a 12-day post-intervention phase. Participant loneliness will be repeatedly assessed throughout the three phases of the intervention using the Three-item Loneliness Scale, which will be the primary outcome. Secondary outcomes will be reliable and clinically meaningful change on the UCLA Loneliness Scale, Revised Child Anxiety and Depression Scale (RCADS) and Strengths and Difficulties Questionnaire (SDQ). Feasibility and participant satisfaction will also be assessed and reported. Trial registration: ClinicalTrails.gov trial registration number: NCT05149963 (Date registered: 07.12.2021). https://www.clinicaltrials.gov/ct2/show/NCT05149963?term=cbt&cond=loneliness&draw=2&rank=1.

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

BACKGROUND

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

METHODS

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

RESULTS

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

LIMITATIONS

No clinical sample was included.

CONCLUSIONS

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

Prevalence and risk factors of mood and anxiety disorders in children and young people: Findings from the Northern Ireland Youth Wellbeing Survey

OBJECTIVE

This paper presents the key findings from the Northern Ireland Youth Wellbeing Prevalence Survey (NIYWS), specifically the prevalence of common mental health disorders and their association with personal, familial and socio-economic risk factors.

METHODS

The Northern Ireland Youth Wellbeing Survey (NIYWS) is a large nationally representative household survey of young people aged 2-19 years (N = 3074) and their parents (N = 2816). Data collection was by means of a stratified random probability household survey. Children and young people were eligible to take part if they were aged 2 to 19 and lived in Northern Ireland. Mood and anxiety disorders were measured using the Revised Children's Anxiety and Depression Scale (RCADS: Chorpita et al., 2000).

RESULTS

Based on the cut-off scores for the RCADS 11.5% of the sample met the criteria for any mental health disorder. The most prevalent disorder was panic disorder (6.76%) and the least common was generalised anxiety disorder (2.69%). Poor child health, special educational needs, parental separation, living in a household in receipt of benefits, living in an area of deprivation and living in an urban area were all significant predictors of any mood or anxiety disorder.

CONCLUSIONS

The results indicate somewhat elevated prevalence rates of mood and anxiety disorders in children and young people in Northern Ireland compared to England and other international countries. These findings can be used to help inform mental health policy and practice.

The effective delivery of digital CBT: a service evaluation exploring the outcomes of young people who completed video conferencing therapy in 2020

Despite its impressive evidence base, there is a widening access gap to receiving cognitive behavioural therapy (CBT). Video conferencing therapy (VCT) offers an effective solution for logistical barriers to treatment, which has been salient throughout the Coronavirus pandemic. However, research concerning the delivery of CBT via VCT for children and young people (CYP) is in its infancy, and clinical outcome data are limited. The aim of this service evaluation was to explore the effectiveness of a VCT CBT intervention for CYP referred from Child and Adolescent Mental Health Services (CAMHS) in the UK. A total of 989 records of CYP who had completed CBT via VCT in 2020 with Healios, a digital mental health company commissioned by the National Health Service (NHS), were examined to determine changes in anxiety, depression and progress towards personalised goals. Routine outcome measures (ROMs) were completed at baseline and endpoint, as well as session by session. Feedback was collected from CYP and their families at the end of treatment. There was a significant reduction in symptoms of anxiety and depression and significant progress towards goals, with pre- to post-effect sizes (Cohen’s d) demonstrating medium to large effects (d=.45 to d=−1.39). Reliable improvement ranged from 31 to 80%, clinical improvement ranged from 33 to 50%, and 25% clinically and reliably improved on at least one measure; 92% reported that they would recommend Healios. This service evaluation demonstrates that Healios’ CBT delivered via VCT is effective for CYP receiving it as part of routine mental health care.

Key learning aims

(1)

Psychometric properties of the Revised Child Anxiety and Depression Scale in Greek Adolescents

The psychometric properties of the Revised Child Anxiety and Depression Scale (RCADS-47) are established cross-culturally but lacking for the Greek population. The present study examined RCADS internal consistency and validity (structural and concurrent) in Greek adolescents, and tested measurement invariance across sex and age groups. We recruited 619 secondary school students (n = 321 females), aged 12-18 years (n = 318, 12-14-year-olds). Besides RCADS, all students completed Strengths and Difficulties Questionnaire (SDQ), a subsample (n = 300) completed Screen for Child Anxiety-Related Emotional Disorders (SCARED), whereas a non-overlapping subsample (n = 219) completed Depression Self-Rating Scale (DSRS). Structural validity was examined with Confirmatory Factor Analysis and measurement invariance was assessed with Multiple Indicators Multiple Causes (MIMIC) modeling. Convergent and divergent validity were examined using Spearman correlations between RCADS subscales and DSRS, SCARED, and SDQ validators. The six-factor model fitted the data best, validating the originally proposed RCADS structure. Three items displayed differential item functioning for sex, another three for age group, and one item for both, albeit with trivial effect sizes (d < 0.2). Cronbach's alpha was .94. Convergent and divergent validity were also established. In conclusion, the RCADS is a valid and reliable instrument for assessing anxiety and depression symptoms in Greek adolescents.

Trauma and pain sensitization in youth with chronic pain

Greater posttraumatic stress symptoms were associated with higher experimental pain tolerance. Pain may trigger dissociation in youth with chronic pain and higher posttraumatic stress symptoms.

Introduction:

Chronic pain (pain lasting ≥3 months) co-occurs with internalizing mental health issues, such as posttraumatic stress symptoms (PTSS), at high rates in youth. The mechanisms underlying these relationships remain unclear. Posttraumatic stress symptoms, including re-experiencing (eg, intrusive memories), alterations in cognition and mood, hyperarousal, and avoidance could lead to altered neuronal processing, pain sensitization, and greater reports of pain. However, the relationships between PTSS and pain sensitization in youth with chronic pain are not known.

Methods:

Youth (n = 165) aged 10 to 18 years were recruited from outpatient multidisciplinary chronic pain programs. Symptoms of PTSS were assessed using psychometrically sound questionnaires. Youth also underwent a cold-pressor task, the most commonly used experimental pain induction technique. During this task, they reported on their expected pain, actual pain intensity, and pre- and post-state pain catastrophizing. Their pain threshold was recorded. A multivariate general linear model was used to examine the relationships between PTSS, ratings of pain intensity, state pain catastrophizing, and pain threshold, controlling for age, gender, ethnicity, anxiety, and depressive symptoms.

Results:

Higher PTSS were associated with greater pain thresholds (P = 0.03) and higher pre- and post-state pain catastrophizing (P ≤ 0.05).

Conclusions:

Individuals with higher PTSS may avoid or dissociate from pain-inducing stimuli, thus leading to higher pain thresholds. However, individuals with higher PTSS also tend to catastrophize prior to and following exposure to pain. Avoidant and pain catastrophizing behaviors may serve to perpetuate chronic pain conditions. Future research is needed to determine how PTSS are related to pain sensitization prior to the development of chronic pain in at-risk youth.

Using the 11-item Version of the RCADS to Identify Anxiety and Depressive Disorders in Adolescents

The purpose of this study was to identify items from the Revised Children's Anxiety and Depression Scale - RCADS-C/P that provided a brief, reliable and valid screen for anxiety and/or depressive disorders in adolescents. In addition, we examined whether adding items assessing suicidal ideation (Moods and Feelings Questionnaire - MFQ- C/P) and symptom impact and duration (items adapted from the Strengths and Difficulties Questionnaire - SDQ) improved the identification of adolescents with anxiety and/or depressive disorders. We compared two samples of adolescents and their parents - a community sample, recruited through secondary schools in England (n = 214) and a clinic-referred sample, who met diagnostic criteria for anxiety and/or depressive disorder and were recruited through a university-based research clinic (n = 246). Participants completed the RCADS-C/P with additional symptom impact and duration items, and the MFQ-C/P. Using ROC curve analyses, we identified a set of 11 RCADS-C/P items (6 addressing anxiety and 5 depression symptoms) for adolescent- and parent-report. This set of 11 symptom items achieved sensitivity/specificity values > .75, which were comparable to corresponding values for the RCADS-47-C/P. Combining adolescent and parent-report improved the identification of anxiety/depression in adolescents compared to using adolescent-report alone. Finally, adding two symptom impact items further improved the sensitivity/specificity of the 11 symptom items, whereas adding suicidal ideation items did not. The 11 RCADS items accurately discriminated between the community and clinic-referred sample with anxiety and/or depressive disorders and have the potential to quickly and accurately identify adolescents with these disorders in community settings.

Review: Social networking sites and associations with depressive and anxiety symptoms in children and adolescents - a systematic review

BACKGROUND

Given social networking sites (SNSs) have become a pervasive part of culture; it is critical to understand the ways in which they may be advantageous or detrimental to the mental health of young people. This systematic narrative review examined the relationships between SNS and depressive and anxiety symptoms in the child and adolescent population (5-18 years).

METHODS

Four databases were searched, and all articles between January 2005 and March 2019 were identified.

RESULTS

Increased time spent or frequency of SNS use, and problematic and addictive behaviour on SNS were significantly associated with higher levels of depressive symptoms. Two cross-sectional studies found that increased time spent or frequency of SNS use and higher levels of investment on SNS were significantly associated with higher levels of anxiety symptoms. However, other potential confounding factors could explain the relationship between SNS and depressive and anxiety symptoms, including perceived social support, social comparison and fear of missing out (FoMO).

CONCLUSIONS

While there is evidence that there is a relationship between SNS and anxiety and depressive symptoms, the effect size tends to be small and informed by studies of poor quality. Therefore, results should be interpreted cautiously. Methodological issues in conceptualising SNS complicated the findings. Future studies should explore the various conditions by which SNS may either interfere or enhance the development of emotional regulation in young people. These findings help to inform clinicians and educators in targeting vulnerable young people who are at risk of developing mental health problems.

Attentional Bias for Cues Signaling Punishment and Reward in Adolescents: Cross-Sectional and Prognostic Associations with Symptoms of Anxiety and Behavioral Disorders

Heightened reward sensitivity has been proposed as a risk factor for developing behavioral disorders whereas heightened punishment sensitivity has been related to the development of anxiety disorders in youth. Combining a cross-sectional (n = 696, mean age = 16.14) and prospective (n = 598, mean age = 20.20) approach, this study tested the hypotheses that an attentional bias for punishing cues is involved in the development of anxiety disorders and an attentional bias for rewarding cues in the development of behavioral disorders. A spatial orientation task was used to examine the relation between an attentional bias for punishing cues and an attentional bias for rewarding cues with anxiety and behavioral problems in a subsample of a large prospective population cohort study. Our study indicates that attentional biases to general cues of punishment and reward do not seem to be important risk factors for the development of anxiety or behavioral problems respectively. It might be that attentional biases play a role in the maintenance of psychological problems. This remains open for future research.

Validating the German version of the Revised Children's Anxiety and Depression Scale in a sample of pediatric chronic pain patients

OBJECTIVE

Many children and adolescents with chronic pain report substantial emotional distress, such as symptoms of anxiety and depression, that need to be assessed for successful chronic pain treatment. In the context of pediatric chronic pain, the Revised Children's Anxiety and Depression Scale has been recommended for the assessment of anxiety and depression symptoms. Therefore, the present study aimed to validate the German version of the Revised Children's Anxiety and Depression Scale in a sample of children and adolescents with chronic pain.

METHODS

Data were collected from N = 300 children and adolescents (age 8-17 years) who presented with headache, abdominal pain and/or musculoskeletal pain at a specialized pediatric pain center for interdisciplinary outpatient pain evaluation.

RESULTS

Cronbach's α for the total and subscales of the Revised Children's Anxiety and Depression scale ranged from 0.73 to 0.95. Sound psychometric properties were found in terms of item properties, factor structure and convergent validity with other measures of anxiety and depression (r ranged from 0.40 to 0.94). Girls reported significantly higher levels of anxiety and depression compared with boys. Higher pain severity was associated with more symptoms of anxiety and depression.

CONCLUSION

This study demonstrated that the German version of the Revised Children's Anxiety and Depression Scale is a reliable and valid measure for the assessment of anxiety and depression symptoms in children and adolescents with chronic pain. Further studies in school and clinical samples are needed to establish German norms and cutoff points for this scale.