Editorial Statement About JCCAP's 2023 Special Issue on Informant Discrepancies in Youth Mental Health Assessments: Observations, Guidelines, and Future Directions Grounded in 60 Years of Research

Maternal suicide risk predicts preschooler emotional and behavioral problems

Maternal history of suicidal thoughts and behaviors (STBs) has been identified as a robust risk factor for offspring emotional and behavioral problems, including risk for offspring STBs. The impact of maternal history of STBs has been well-documented in adolescent and young adult samples, with emerging research highlighting the need to examine early clinical correlates of risk in young children, prior to the emergence of STBs. In an extension of prior work, the current study examined associations between maternal history of STBs and previously identified emotional and behavioral correlates of STBs (negative affect, internalizing problems, attention problems, aggressive behavior) in young children. These associations were examined in a mother-preschooler sample (n = 158, mean preschooler age=41.52 months) with approximately half of mothers endorsing a history of STBs and 20 % of the sample scoring at the threshold that indicates suicide risk. In multivariate models, maternal history of STBs was significantly associated with preschooler aggressive behavior, assessed via mother- (β=0.19) and teacher-report (β=0.21), as well as mother-reported negative affect (β=0.22). Results document a link between maternal history of STBs and increased risk for heightened negative affect and aggressive behavior at home and school during the sensitive preschool period. Findings are discussed within the context of enhancing models of intergenerational transmission suicide risk.

Results from a Pilot Randomized Controlled Trial of a Single-Session Growth-Mindset Intervention for Internalizing Symptoms in Autistic Youth

Autistic youth experience elevated rates of co-occurring internalizing symptoms. Interventions to treat internalizing symptoms in autistic youth are almost uniformly costly and time-intensive, blunting dissemination of intervention and highlighting the need for scalable solutions. One promising option is a relatively new class of evidence-based treatments, single-session interventions (SSIs), however, no study has examined SSIs for depression symptoms in autistic youth. Participants included 40 autistic adolescents ranging in age from 11 to 16 (Mage = 14.22, Nmale = 32). Eligible youth who agreed to participate were randomized to either the active intervention (Project Personality), or an active control designed to mimic supportive therapy. Participants and their caregiver completed questionnaires immediately before, after, and three months post intervention. All participants completed the intervention independently and largely reported enjoying it. The intervention was delivered with 100% fidelity. Findings demonstrated improvements in perceived primary control, malleability of personality, and social competence relative to the active control group immediately post-intervention. Further, results revealed improvements in self-reported depression symptoms and parent reported emotional regulation at 3-month follow up. This study was the first to assess a GM-SSI designed to treat depression symptoms in autistic adolescents. Results indicated improvements in perceived control immediately post-intervention and downstream improvements in depression. Nonetheless, we did not find improvements in symptoms of anxiety, suggesting that autistic adolescents may require modifications to the intervention to maximize benefit. Findings demonstrate the utility of GM-SSI for internalizing symptoms for autistic youth and hold considerable promise as a low-intensity and scalable intervention.

The interaction of family functioning and disease- and treatment-related factors on quality of life for children after cancer

PURPOSE

Children with cancer experience low quality of life (QOL), yet heterogeneity underscores a need to understand how risk and resilience factors interact. This study evaluated if family functioning relates to QOL differentially depending on diagnosis and treatment intensity.

METHODS

Participants included children (ages 8-14) who completed treatment within six months for either brain tumor (BT; n = 42) or non-central nervous system solid tumor (ST; n = 29). Caregivers and children rated QOL and family functioning. Treatment intensity was categorized as low, moderate, or high. Cross-informant moderation models tested hypothesized interactions.

RESULTS

Child-reported family functioning significantly interacted with diagnosis and treatment intensity in models of caregiver-reported QOL. More maladaptive family functioning was associated with reduced QOL for children with BT and moderately-intense treatments.

CONCLUSIONS

Children with BT and moderate treatment intensities are sensitive to family functioning, highlighting an at-risk group to target for family-level intervention. Future work should evaluate these associations longitudinally.

Using Progress Feedback to Enhance Treatment Outcomes: A Narrative Review

We face increasing demand for greater access to effective routine mental health services, including telehealth. However, treatment outcomes in routine clinical practice are only about half the size of those reported in controlled trials. Progress feedback, defined as the ongoing monitoring of patients' treatment response with standardized measures, is an evidence-based practice that continues to be under-utilized in routine care. The aim of the current review is to provide a summary of the current evidence base for the use of progress feedback, its mechanisms of action and considerations for successful implementation. We reviewed ten available meta-analyses, which report small to medium overall effect sizes. The results suggest that adding feedback to a wide range of psychological and psychiatric interventions (ranging from primary care to hospitalization and crisis care) tends to enhance the effectiveness of these interventions. The strongest evidence is for patients with common mental health problems compared to those with very severe disorders. Effect sizes for not-on-track cases, a subgroup of cases that are not progressing well, are found to be somewhat stronger, especially when clinical support tools are added to the feedback. Systematic reviews and recent studies suggest potential mechanisms of action for progress feedback include focusing the clinician's attention, altering clinician expectations, providing new information, and enhancing patient-centered communication. Promising approaches to strengthen progress feedback interventions include advanced systems with signaling technology, clinical problem-solving tools, and a broader spectrum of outcome and progress measures. An overview of methodological and implementation challenges is provided, as well as suggestions for addressing these issues in future studies. We conclude that while feedback has modest effects, it is a small and affordable intervention that can potentially improve outcomes in psychological interventions. Further research into mechanisms of action and effective implementation strategies is needed.

Examining profiles of convergence and divergence in reports of parental warmth: Links to adolescent developmental problems

Parental warmth during the transition from childhood to adolescence is a key protective factor against a host of adolescent problems, including substance use, maladjustment, and diminished well-being. Moreover, adolescents and parents often disagree in their perceptions of parenting quality, and these discrepancies may confer risk for problem outcomes. The current study applies latent profile analysis to a sample of 687 mother-father-6th grade adolescent triads to identify patterns of adolescent-parent convergence and divergence in perceptions of parental warmth. Five profiles were identified, and associations with adolescent positive well-being, substance use, and maladjustment outcomes in 9th grade were assessed. Patterns of divergence in which adolescents had a pronounced negative perception of parental warmth compared to parents, as well as those wherein pronounced divergence was present in only one adolescent-parent dyad, were associated with diminished positive well-being compared to adolescents who had more positive perceptions of warmth than parents. Having more negative perceptions of warmth compared to parents was also associated with elevated risk for alcohol and marijuana initiation, but only when the divergence was pronounced rather than more moderate. These findings add nuance to findings from previous between-family investigations of informant discrepancies, calling for further family-centered methods for investigating multiple perspectives.

Systematic Integration of Multi-Informant Externalizing Ratings in Clinical Settings

Best practice clinical assessment of externalizing problems often necessitates collection of information from parents, youth themselves, and teachers. The present study tested the predictive validity of a psychometrically-driven scoring procedure to integrate multi-informant, dimensional ratings of externalizing problems. Participants were 2264 clinic-referred youth ages 6-18. Parents, teachers, and youth completed questionnaire ratings of externalizing problems (hyperactivity-inattention, conduct problems, and oppositionality-defiance) prior to an initial clinical appointment. The predictive validity of simple (highest informant rating; and all informant ratings separately) and more complex (latent S-1 bifactor model with specific informant factors; and moderated nonlinear factor analysis accounting for child age and sex) methods of informant integration was tested in predicting impairment, comorbidity, and number of clinical encounters. A simple model, in which all informant ratings were included, showed the best predictive validity across outcomes, performing as well or better than the use of the highest informant ratings or more complex latent variable models. The addition of child age and sex as moderators in the factor model did not improve predictive validity. Each informant (parent, teacher, and youth) contributes important information to the prediction of clinically-relevant outcomes. There is insufficient evidence at present to suggest that complex latent variable models should be favored over simpler models that preserve each informant's ratings.

Future Directions: The Phenomenology of Irritable Mood and Outbursts: Hang Together or Hang Separately1

Recognition of the importance of irritable mood and outbursts has been increasing over the past several decades. This "Future Directions" aims to develop a set of recommendations for future research emphasizing that irritable mood and outbursts "hang together," but have important distinctions and thus also need to "hang separately." Outbursts that are the outcome of irritable mood may be quite different from outbursts that are the trigger or driving force that make youth and his/her environment miserable. What, then, is the relation between irritable mood and outbursts? As the field currently stands, we not only cannot answer this question, but we may also lack the tools to effectively do so. Here, we will propose recommendations for understanding the phenomenology of irritable mood and outbursts so that more directed and clinically useful assessment tools can be designed. We discuss the transdiagnostic and treatment implications that relate to improvements in measurement. We describe the need to do more than repurpose our current assessment tools, specifically interviews and rating scales, which were designed for different purposes. The future directions of the study and treatment of irritable mood and outbursts will require, among others, using universally accepted nomenclature, supporting the development of tools to measure the characteristics of each irritable mood and outbursts, understanding the effects of question order, informant, development and longitudinal course, and studying the ways in which outbursts and irritable mood respond to treatment.

Proposed Specifiers for Conduct Disorder (PSCD) self-report: Factor structure and validation in a community sample of Belgian youth

The current study examined the psychometric properties of the Proposed Specifiers for Conduct Disorder (PSCD) in a sample of school-attending adolescent Belgian youth (N = 599; M age = 16.51 years, SD = 1.27). Given the recent interest in the PSCD-Short Version (PSCD-SV), this study focused on the 13-item variant of the PSCD. Study findings showed that the PSCD-SV had a hierarchical four-factor structure including the components of grandiose-manipulative (GM), callous-unemotional (CU), daring-impulsive (DI), and conduct disorder (CD). These interrelated factors were found to be internally consistent. The study also showed that the PSCD-SV total score was positively and significantly related to an alternate measure of psychopathy. Further, the study revealed the PSCD-SV was meaningfully related to the five-factor personality domains (i.e., extraversion, conscientiousness, agreeableness) as well as peer functioning and prosocial behavior. Bivariate correlations demonstrated that the dimensions differed in their associations with external correlates (e.g., peer functioning). Regression analyses showed that the GM, CU, and CD components of the PSCD-SV were uniquely associated to externalizing difficulties, whereas only the GM and CU components of the PSCD-SV were associated with low prosocial behaviors. These findings shed light on the conceptual and developmental models for the consideration of psychopathy and conduct problems. The use of the broader psychopathy condition as well as its underpinning dimensions may have important implications for assessment, treatment, and diagnostic manuals. The implications of the current study are further discussed.

A Multi-Method Examination of Peer Functioning in Children with and without Cognitive Disengagement Syndrome

OBJECTIVE

Cognitive disengagement syndrome (CDS) includes excessive daydreaming, mental confusion, and hypoactive behaviors that are distinct from attention-deficit/hyperactivity disorder inattentive (ADHD-IN) symptoms. A growing number of studies indicate that CDS symptoms may be associated with ratings of social withdrawal. However, it is important to examine this association in children specifically recruited for the presence or absence of CDS, and to incorporate multiple methods including direct observations of peer interactions. The current study builds on previous research by recruiting children with and without clinically elevated CDS symptoms and using a multi-method, multi-informant design including recess observations and parent, teacher, and child rating scales.

METHOD

Participants were 207 children in grades 2-5 (63.3% male), including 103 with CDS and 104 without CDS, closely matched on grade and sex.

RESULTS

Controlling for family income, medication status, internalizing symptoms, and ADHD-IN severity, children with CDS were observed during recess to spend more time alone or engaging in parallel play, as well as less time involved in direct social interactions, than children without CDS. Children with CDS were also rated by teachers as being more asocial, shy, and socially disinterested than children without CDS. Although children with and without CDS did not differ on parent- or self-report ratings of shyness or social disinterest, children with CDS rated themselves as lonelier than children without CDS.

CONCLUSIONS

Findings indicate that children with CDS have a distinct profile of peer functioning and point to the potential importance of targeting withdrawal in interventions for youth with elevated CDS symptoms.

The Proposed Specifiers for Conduct Disorder (PSCD) in Iranian School-Attending Adolescents: A Multi-Informant Validation Study of the PSCD Parent- and Youth Self-Report Versions

The Proposed Specifier for Conduct Disorder (PSCD) was developed to measure the broad psychopathy construct with grandiose-manipulative, callous-unemotional, daring-impulsive, and conduct disorder subscales. This study tested the psychometric properties of Persian parent-and-child self-report PSCD versions with 974 parents (86% mothers) and children/adolescents (46.5% boys) dyads. Results showed that with some modifications the proposed hierarchical four-factor structure for both PSCDs was confirmed and was found to be invariant across gender. Across versions, all PSCD scores were internally consistent and demonstrated expected correlations with parent-reported externalizing problems, anxiety/depression, and poor school performance, supporting the PSCDs scores' validity. This study also is the first to examine and establish acceptable to excellent parent-child agreement of PSCD scores. Finally, all PSCD child-report scores offered small though significant incremental validity over their corresponding PSCD parent-version scores in predicting parent-reported conduct problems and proactive aggression. Findings indicated that both Persian PSCDs may hold promise for assessing psychopathy components in Iranian school-attending adolescents and generating additional research on this topic.

What is the Best Source of Information for Psychopathic Traits in Youth? A Review and Meta-analysis of Self- and Other-Reported Psychopathic Traits and Their Association with Negative Outcomes

Child psychopathic traits appear to be associated with negative outcomes. Despite the study of youth psychopathy often relying on multiple reporters (e.g., child, caregivers, teachers), there is limited insight into how much information these various sources contribute and moreover, how this information is integrated. The present study sought to address this gap in the literature by examining the magnitude of relationships between self- and other-reported youth psychopathy and negative outcomes (e.g., delinquency, aggression) using a meta-analytic approach. Results revealed a moderate association between psychopathic traits and negative outcomes. Moderator analyses showed a greater relationship for other- than self-reported psychopathy, although not to a substantive extent. Results further indicated the magnitude of the overall psychopathy-negative outcomes association was stronger for externalizing than internalizing outcomes. Study findings can inform improvements in the assessment of youth psychopathy across research and practice, in addition to advancing our understanding of the utility of psychopathic traits in the prediction of clinically relevant outcomes. This review also provides guidance for future multisource raters and source-specific information in the study of psychopathy in youth.