The development and psychometric properties of a measure of social and adaptive functioning for children and adolescents

A systematic review of social functioning and peer relationships in adolescents with chronic pain

OBJECTIVE

There is a need for a systematic review on social functioning and peer relationships among adolescents with chronic pain (ACP) given the high prevalence of chronic pain in adolescence and integral role of peer relationships in adolescent development. This review aims to examine the methods used to evaluate social functioning, the types and extent of peer relationship difficulties, and pain characteristics and sociodemographic factors related to social functioning in ACP.

METHODS

A systematic literature search of PubMed, PsycINFO, CINAHL, Web of Science, and Cochrane databases was performed. Included studies were written in English, presented original, quantitative, peer-reviewed research, had a primary focus on social functioning or peer relationships in ACP, and included study participants between the ages of 10 and 18 years. The review was registered in PROSPERO (No. CRD42022364870).

RESULTS

Twenty-eight articles were included in the review. All studies used self-, parent-, or peer-report questionnaires to evaluate social functioning. Most (89%) of the studies were cross-sectional. Findings suggest that ACP experience social difficulties frequently characterized by loneliness, social anxiety, withdrawal, and peer victimization. Studies examining the associations between social functioning and sociodemographic variables, pain location, and pain-related characteristics yielded mixed findings. Study quality was mixed, with 57.14% rated as "good."

CONCLUSIONS

Findings from this review emphasize the increased risk of reduced social connectedness and the complexity of underlying mechanisms associated with poorer social functioning among ACP. Additional research utilizing longitudinal methodologies is needed to understand potential moderators and directionality of associations between chronic pain and social functioning.

Initial validation of the Multidimensional Adolescent Functioning Scale (MAFS) in Spanish-speaking students from Chilean secondary schools

INTRODUCTION

Psychosocial functioning is closely associated with psychopathology and wellbeing in different populations, particularly adolescents. Despite its relevance, measures assessing psychosocial functioning in healthy adolescents are scant as most focus on adults or clinical populations. We evaluated the psychometric properties of the Multidimensional Adolescent Functioning Scale (MAFS), a self-report questionnaire created to assess three dimensions of psychosocial functioning ('general functioning', 'family-related functioning', and 'peer-related functioning') in adolescents from the general population.

METHODS

After translation and cultural adaptation, we administered the Spanish MAFS to 619 adolescents aged 14 to 19. We assessed the factor structure, internal consistency, and associations with depressive symptoms, suicidal ideation, cognitive-behavioral skills, cognitive reappraisal (CR), and expressive suppression (ES). We additionally tested for measurement invariance based on biological sex.

RESULTS

The original three-factor structure showed the best fit. Internal consistency was good for the total scale (ω = 0.874; α = 0.869; GLB = 0.939, r_M=0.216) and for all subscales (ω = 0.806-0.839; α = 0.769 to 0.812; GLB = 0.861-0.873). Correlations between all three MAFS subscales were significant, ranging between 0.291 and 0.554. All MAFS subscales correlated positively and significantly with cognitive-behavioral skills and adaptive regulatory strategies and negatively with depressive symptoms and suicidal ideation.

CONCLUSION

The Spanish MAFS translation is a valid and reliable self-report measure to assess three domains of psychosocial functioning in adolescents aged 14-19 from the general population.

Early Adolescent Social Media-Related Body Dissatisfaction: Associations with Depressive Symptoms, Social Anxiety, Peers, and Celebrities

OBJECTIVE

It is critical to examine the powerful socializing effects of networked media on early adolescents when social media use, body self-consciousness, and social comparisons are at their peak.

METHOD

Using 2 subsamples (N = 374 and N = 396) of those aged 11 to 14 years from a larger survey sample of 700 middle school participants in the Northeast United States, we conducted a cross-sectional pilot survey using brief, descriptive body dissatisfaction measures directly related to social media use.

RESULTS

Within our body dissatisfaction subsample, 19% reported dissatisfaction to body image issues. Participants' most common concerns around body image included not being thin enough, not attractive enough, and feeling dissatisfaction with body shape, hair, and face. The results from analysis of covariance analyses showed that those reporting social media-related body dissatisfaction checked their social media more frequently. When compared with those who did not feel negatively about their body image because of social media, those who did had higher rates of depressive symptoms, had online social anxiety, had found it harder to make new friends, and were more socially isolated. Those who followed celebrities checked social media more frequently and were more likely to have depressive symptoms and online social anxiety.

CONCLUSION

There may be negative socioemotional health consequences of early adolescent social media users with exposure to particular sources of social media content, such as photographs of celebrities.

Practitioner Review: Anxiety disorders in children and young people - assessment and treatment

Despite significant advancements in our knowledge of anxiety disorders in children and adolescents, they continue to be underrecognised and undertreated. It is critical that these disorders are taken seriously in children and young people as they are highly prevalent, have a negative impact on educational, social and health functioning, create a risk of ongoing anxiety and other mental health disorders across the life span and are associated with substantial economic burden. Yet very few children with anxiety disorders access evidence-based treatments, and there is an urgent need for widespread implementation of effective interventions. This review aimed to provide an overview of recent research developments that will be relevant to clinicians and policymakers, particularly focusing on the development and maintenance of child anxiety disorders and considerations for assessment and treatment. Given the critical need to increase access to effective support, we hope this review will contribute to driving forward a step change in treatment delivery for children and young people with anxiety disorders and their families.

Higher Depressive Symptoms Predict Lower Social Adaptive Functioning in Children and Adolescents with ASD

Objective: Despite the frequent occurrence of depressive symptoms in children and adolescents with autism spectrum disorder (ASD), few studies have investigated the relationship between depressive symptoms and adaptive functioning. The present study explored the impact of depressive symptoms on different domains of adaptive functioning in children and adolescents with ASD.Methods: Depressive symptoms and adaptive functioning were analyzed in 62 children and adolescents with ASD (20 females) and 36 children and adolescents (15 females) with typical development between 5 and 18 years of age.Results: After controlling for IQ, age and sex, higher depressive symptoms predicted lower functioning in the social domain among children and adolescents with ASD. Depressive symptoms did not significantly predict communication or daily living skills.Conclusions: These findings highlight the relevance of depression in social adaptive function in ASD and emphasize the importance of assessing depressive symptomatology when evaluating social skills and planning treatment for children and adolescents with ASD.

The Mediator Role of Academic Resilience in the Relationship of Anxiety Sensitivity, Social and Adaptive Functioning, and School Refusal With School Attachment in High School Students

School has an important function in providing the environment for young people to acquire many skills and knowledge required by contemporary life, but the problems of attachment to school and problematic attendance all over the world reveal an increasing statistic. It is thought that some negative processes such as anxiety sensitivity, social and adaptive functioning, and school refusal can affect this problem. On the other hand, it is considered that the academic resilience of young people has an important protective function in terms of these risk factors. For this purpose, the mediator role of academic resilience between anxiety sensitivity, social and adaptive functioning, and school refusal and school attachment were examined in a Turkish sample of 452 high school students. In the process of data collection, the school refusal assessment scale, social and adaptive functioning scale, and academic resilience scale were adapted and used in the Turkish culture. In the data analysis, the structural equation model was used to determine the direct and indirect predictive effects between the variables. The results of the study showed that academic resilience fully mediated the relationship between anxiety sensitivity and school attachment, whereas it partially mediated the relationship between social and adaptive functioning and school refusal and school attachment. Based on the results of the study, it was evaluated that high academic resilience has a strong protective function against the problems of negative school attachment and problematic school absenteeism among young people, and this finding was discussed within the context of literature.

Child and Adolescent Social Adaptive Functioning Scale: Factorial Invariance, Latent Mean Differences, and Its Impact on School Refusal Behavior in Spanish Children

This study aims to examine the factorial invariance and latent mean differences across gender of the Spanish version of the Child and Adolescent Social Adaptive Functioning Scale (Study 1) and to value the function of social functioning as a protective ability of school refusal behavior (Study 2). Participants were Spanish students aged 8–12 years carefully chosen by simple random cluster, 345 for the first study (M = 9.17; SD = 1.03) and 1,032 students for the second study (M = 10.02; SD = 1.77). The measures used were the Child and Adolescent Social Adaptive Functioning Scale (CASAFS) and the School Refusal Assessment Scale-Revised (SRAS-R). Results about the validation of the scale supported the model proposed in this study for the CASAFS, with 15 items and a four-factor structure (school performance, peer relationships, family relationships, and home duties/self-care). Findings revealed invariance across gender for this model and good internal consistency levels were exhibited in each of the four dimensions of the CASAFS (0.76, 0.72, 0.74, and 0.71). Latent mean differences did not report differences between boys and girls. Regarding the second study, the social functioning acted as a protective factor of school refusal behavior by negatively and significantly predicting high scores in school refusal behavior due to anxiety symptoms or feelings of negative affect linked to the obligation to attend school. Opposite results were found for those students who justify their refusal to attend school in pursuing tangible reinforcements outside the school setting. These findings strengthen the reliability and validity of the CASAFS and the idea of social functioning as a person’s ability which could prevent school refusal behavior is discussed.

The Social Functioning Scale for Alzheimer's Disease: A Short Informant-based Measure of Functional Status in Patients with Alzheimer's Disease in Taiwan

OBJECTIVE

Evaluating social-functioning impairments in patients with Alzheimer's disease (AD) objectively is essential for clinical service. However, the existing instruments lack representative content, consensus on purposes of use, and adequate scoring systems and samples. This study was thus to develop a social functioning scale for patients: the Social Functioning Scale for Alzheimer's Disease (SFSAD).

METHOD

Questionnaires were analyzed from 142 AD patients, 30 patients with amnestic mild cognitive impairment (aMCI), and 50 normal controls.

RESULTS

Based on the literature review and experts' opinions, the final scale includes 20 items in four subscales. The SFSAD showed high internal consistency coefficients (Cronbach's α = .97) and test-retest reliability (r = .99) coefficients. The content validity was desirable, and the criterion-related validity was demonstrated by a significant association with the MMSE, the IADL, and the Barthel ADL. The discriminant validity of the scale was also demonstrated as the level of social-functioning impairment was significantly related to the degree of dementia, and for construct validity, our findings supported the structure of the four-factor hypothesized model.

CONCLUSIONS

The SFSAD is thus a practical, psychometrically sound, and easy-to-administer measure to evaluate social functioning of AD and aMCI in brisk clinical settings.

Positive and negative affect as predictors of social functioning in Spanish children

The aim of this study was to analyze the relationship between affect in its two commonly used theoretical categories, positive affect (PA) and negative affect (NA), and social functioning dimensions (school performance, family relationships, peer relationships and home duties/self-care). The sample comprised 390 students of primary education aged 8–11 years (M = 9.39; SD = 1.15). The short-form of the Positive and Negative Affect Schedule for children (PANAS-C-SF) and the Child and Adolescent Social Adaptive Functioning Scale (CASAFS) were used. Student’s t tests indicated that those reporting high levels on all the social functioning dimensions also reported significantly higher levels of PA than peers who reported low levels; by contrast, students reporting high levels of social functioning reported significantly lower levels of NA than peers who reported low levels. Similarly, logistic regression analyses showed that an increase in PA increased probability of high levels of social functioning, and that an increase in NA decreased the probability of presenting high levels of social functioning dimensions, with the exception of school performance. These results expand the PA and NA relationship with social functioning reported in adults to Spanish children, which is potentially of interest in the fields of Education and Psychology.

Social adjustment experiences of adolescents with Tourette syndrome

AIMS AND OBJECTIVES

To explore and describe the experience of social adjustment of adolescents with Tourette syndrome in Taiwan.

BACKGROUND

Although Tourette syndrome is a non-life-threatening disease, the inherent difficulties in controlling tics and comorbidities can cause long-term physical and psychological issues, as well as social maladjustment among adolescents. Good social adjustment can promote mental health among adolescents. Currently, it is not clear how adolescents with Tourette syndrome can self-adjust and maintain harmonious social interaction with others.

DESIGN

Descriptive phenomenological approach was used in this study. Four criteria were applied to establish the trustworthiness or methodological rigour.

METHODS

Sixteen adolescents with Tourette syndrome were recruited by purposive sampling from a medical centre in Northern Taiwan. Semistructured one-on-one interviews were performed from March 2014-April 2015 for data collection. Every participant was interviewed once or twice, and each interview lasted for duration of around 60-90 min. Data were analysed with Giorgi's phenomenological method for data analysis.

RESULTS

Three themes were identified from the adolescent' interviews. The themes were included visible and invisible destitution, moulding a socially acceptable self and coexisting friends and foes.

CONCLUSIONS

Adolescents with Tourette syndrome experienced that tics are often not understood nor accepted during social interactions with others. However, with age and autonomy of adolescents, they were able to adjust and develop a socially acceptable body image and maintain amicable social interactions with others. Accompanied by positive thinking, support from friends and families, the adolescents could achieve good social adjustments for living with Tourette syndrome.

RELEVANCE TO CLINICAL PRACTICE

The experiences and feelings highlighted in this study can bring awareness to nurses and healthcare professionals for developing interventions that promote healthy social adjustment and mental health for adolescents with Tourette syndrome.

Cognitive behavioural therapy (CBT), third-wave CBT and interpersonal therapy (IPT) based interventions for preventing depression in children and adolescents

BACKGROUND

Depression is common in young people. It has a marked negative impact and is associated with self-harm and suicide. Preventing its onset would be an important advance in public health. This is an update of a Cochrane review that was last updated in 2011.

OBJECTIVES

To determine whether evidence-based psychological interventions (including cognitive behavioural therapy (CBT), interpersonal therapy (IPT) and third wave CBT)) are effective in preventing the onset of depressive disorder in children and adolescents.

SEARCH METHODS

We searched the specialised register of the Cochrane Common Mental Disorders Group (CCMDCTR to 11 September 2015), which includes relevant randomised controlled trials from the following bibliographic databases: The Cochrane Library (all years), EMBASE (1974 to date), MEDLINE (1950 to date) and PsycINFO (1967 to date). We searched conference abstracts and reference lists of included trials and reviews, and contacted experts in the field.

SELECTION CRITERIA

We included randomised controlled trials of an evidence-based psychological prevention programme compared with any comparison control for young people aged 5 to 19 years, who did not currently meet diagnostic criteria for depression.

DATA COLLECTION AND ANALYSIS

Two authors independently assessed trials for inclusion and rated their risk of bias. We adjusted sample sizes to take account of cluster designs and multiple comparisons. We contacted trial authors for additional information where needed. We assessed the quality of evidence for the primary outcomes using GRADE.

MAIN RESULTS

We included 83 trials in this review. The majority of trials (67) were carried out in school settings with eight in colleges or universities, four in clinical settings, three in the community and four in mixed settings. Twenty-nine trials were carried out in unselected populations and 53 in targeted populations.For the primary outcome of depression diagnosis at medium-term follow-up (up to 12 months), there were 32 trials with 5965 participants and the risk of having a diagnosis of depression was reduced for participants receiving an intervention compared to those receiving no intervention (risk difference (RD) -0.03, 95% confidence interval (CI) -0.05 to -0.01; P value = 0.01). We rated this evidence as moderate quality according to the GRADE criteria. There were 70 trials (73 trial arms) with 13,829 participants that contributed to the analysis for the primary outcome of depression symptoms (self-rated) at the post-intervention time point, with results showing a small but statistically significant effect (standardised mean difference (SMD) -0.21, 95% CI -0.27 to -0.15; P value < 0.0001). This effect persisted to the short-term assessment point (up to three months) (SMD -0.31, 95% CI -0.45 to -0.17; P value < 0.0001; 16 studies; 1558 participants) and medium-term (4 to 12 months) assessment point (SMD -0.12, 95% CI -0.18 to -0.05; P value = 0.0002; 53 studies; 11,913 participants); however, the effect was no longer evident at the long-term follow-up. We rated this evidence as low to moderate quality according to the GRADE criteria.The evidence from this review is unclear with regard to whether the type of population modified the overall effects; there was statistically significant moderation of the overall effect for depression symptoms (P value = 0.0002), but not for depressive disorder (P value = 0.08). For trials implemented in universal populations there was no effect for depression diagnosis (RD -0.01, 95% CI -0.03 to 0.01) and a small effect for depression symptoms (SMD -0.11, 95% CI -0.17 to -0.05). For trials implemented in targeted populations there was a statistically significantly beneficial effect of intervention (depression diagnosis RD -0.04, 95% CI -0.07 to -0.01; depression symptoms SMD -0.32, 95% CI -0.42 to -0.23). Of note were the lack of attention placebo-controlled trials in targeted populations (none for depression diagnosis and four for depression symptoms). Among trials implemented in universal populations a number used an attention placebo comparison in which the intervention consistently showed no effect.

AUTHORS' CONCLUSIONS

Overall the results show small positive benefits of depression prevention, for both the primary outcomes of self-rated depressive symptoms post-intervention and depression diagnosis up to 12 months (but not beyond). Estimates of numbers needed to treat to benefit (NNTB = 11) compare well with other public health interventions. However, the evidence was of moderate to low quality using the GRADE framework and the results were heterogeneous. Prevention programmes delivered to universal populations showed a sobering lack of effect when compared with an attention placebo control. Interventions delivered to targeted populations, particularly those selected on the basis of depression symptoms, had larger effect sizes, but these seldom used an attention placebo comparison and there are practical difficulties inherent in the implementation of targeted programmes. We conclude that there is still not enough evidence to support the implementation of depression prevention programmes.Future research should focus on current gaps in our knowledge. Given the relative lack of evidence for universal interventions compared with attention placebo controls and the poor results from well-conducted effectiveness trials of universal interventions, in our opinion any future such trials should test a depression prevention programme in an indicated targeted population using a credible attention placebo comparison group. Depressive disorder as the primary outcome should be measured over the longer term, as well as clinician-rated depression. Such a trial should consider scalability as well as the potential for the intervention to do harm.

The epidemiological characteristics of depressive symptoms in the left-behind children and adolescents of Chongqing in China

OBJECTIVE

To assess the prevalence rate of depressive symptoms in left-behind participants aged 7-17 years and to explore the associated socio-demographic and communication factors.

METHODS

Participants were 4857 left-behind children and adolescents in Chongqing. They were screened for depressive symptoms using a 27-item Children׳s Depression Inventory (CDI) and social-demographic variables were evaluated with a structured scale. Uncorrected Pearson chi-square test and logistic regression were applied to analyzing the data.

RESULTS

The total prevalence rate of depressive symptoms was 24.8%. Significant difference was found in the prevalence rate of depressive symptoms among groups of different income, grade, age, left-behind subtypes, and different frequency, ways and topics of parent-child communication. We found that the risk factors for depression were absence of parents, low frequency of parent-child communication, and communication by letter or about sensitive topics. The grade group 2-3 and age group 16-17 were at a higher risk of depression than all other grade and age subgroups. The protective factors for depression were high-income, high frequency of parent-child communication, communication by telephone or about such topic as learning experience, school life, and feelings.

LIMITATIONS

Self-report bias and cross-sectional nature of the sampling are major limitations of this study.

CONCLUSIONS

The prevalence rate of depressive symptoms among left-behind children and adolescents in Chongqing is much higher than previously reported prevalence in other regions of China. The risk and protective factors for depression among left-behind children and adolescents are worthy of public attention.

Exploring risk and protective factors with a community sample of American Indian adolescents who attempted suicide

American Indian adolescents are at disproportionate risk for suicide, and community-based studies of this population, which allow a deeper understanding of risks and resilience to inform interventions, are rare. This is a cross-sectional study of N = 71 Apache adolescents. Strengths include the role of the community and American Indian paraprofessionals in the design, implementation, and interpretation of findings. Participants were M = 16.0 years old, 65% female, and 69% multiple attempters. Risks included suicidal behavior among peers and family (68%), caregivers with substance problems (62%), and participant substance use history, namely alcohol (91%) and marijuana (88%). Areas of resiliency included lower depression scores (M = 23.1) and cultural activity participation. A multi-tiered intervention at individual, family, and community levels is needed.

A naturalistic study of suicidal adolescents treated with an SSRI: suicidal ideation and behavior during 3-month post-hospitalization period

OBJECTIVE

Describe suicidal ideation and suicide related/other emergencies (SRE), among depressed and acutely suicidal adolescents during a 3-month period following psychiatric hospitalization.

METHODS

One hundred twenty adolescents, who were both depressed and suicidal, were receiving an SSRI either alone or in combination with other medications, remained on a consistent medication regimen between baseline and at 3-months and their 3-month outcome data were available. The participants were divided into four medication groups: SSRI antidepressant only (n=71); SSRI plus mood stabilizer (n=17); SSRI plus antipsychotic (n=20); and SSRI plus antipsychotic and mood stabilizer (n=12). Standardized instruments were used.

RESULTS

Mean age=15.5±1.3, Caucasian=80.8%, female=74.2%, mean CDRS-R=61.7±12.1, suicide attempt during month prior to hospitalization=58.6%. During the 3-month post-hospitalization period: (1) there were no suicides, six participants (5%) attempted suicide and 21 (17.5%) experienced an SRE; (2) decline in suicidal ideation and depression severity was noted; (3) SSRI plus an antipsychotic group reported the highest number of SREs; (4) higher baseline hopelessness and aggression scores were associated with greater reduction in suicidal ideation at 3-months.

CONCLUSION

Declines in suicidal ideation, depression severity, and suicide attempts were noted, irrespective of psychotropic-combination received. A higher rate of SREs was associated with receiving an antipsychotic agent in combination with an SSRI. Given naturalistic design of study, cause-effect conclusions cannot be drawn. The lack of an objective measure to identify medication adherence is a study limitation.

Subthreshold depression in children and adolescents - a systematic review

BACKGROUND

Depressive disorders are disabling conditions striking at all ages. In adults, subthreshold depression (SD) is viewed as being on a continuum with major depressive disorder (MDD). Whether this holds for children and adolescents, is still unclear. We performed the first systematic review of SD in subjects below 18 years, in order to explore if childhood SD and MDD share causal pathways, phenomenology and outcomes, supporting a dimensional view.

METHODS

A critical systematic review in accordance with preferred reporting items for systematic reviews and meta-analyses (PRISMA) statement. A review protocol was developed a priori, and all reports were assessed by two reviewers.

RESULTS

The literature search generated 941 eligible references and 24 studies were included. Although diagnostic criteria for SD showed great variability, similarities for SD and MDD were striking. Both were common conditions with similar risk factor patterns. Clinical characteristics in both groups were depressed mood, suicidal ideation and high comorbidity. Outcomes were almost equally poor, with increased psychiatric morbidity and health service use. SD intervention studies showed promising results.

LIMITATIONS

Reports with data on SD not reported in keywords or abstract may have been missed by the search strategy.

CONCLUSION

A dimensional view of depressive disorders is also supported in children and adolescents, suggesting SD to be a precursor to MDD. Although SD is a somewhat milder condition than MDD, it has severe outcomes with psychopathology and impairment. There is a need of identifying cost-efficient and longlasting interventions in order to prevent development of early SD into MDD.

Zur Lebenszeitprävalenz Affektiver Störungen im Jugendalter

Schon vor einigen Jahren konnte die Bremer Jugendstudie zeigen, dass Affektive Störungen im Jugendalter ein häufiges psychisches Störungsbild darstellen ( Essau, Karpinski, Petermann & Conradt, 1998 ). Aktuell fehlen Studien, die den kategorialen Ansatz zur Messung psychischer Störungen heranziehen und aktuelle Daten für die Verbreitung Affektiver Störungen bei Jugendlichen liefern. Die vorliegende Studie führte mit 333 Jugendlichen zwischen 12 und 17 Jahren vollstandardisierte, klinische Interviews zur Messung von Lebenszeitprävalenzen psychischer Störungen in der Stadt Bremen durch und erhob darüber hinaus mithilfe eines Fragebogenkatalogs umfassende Angaben zum psychischen Funktionsniveau der Jugendlichen. Die ersten Ergebnisse zeigen, dass insgesamt 14.4 % der Jugendlichen von Affektiven Störungen betroffen waren (7.5 % Major Depression, 5.4 % Dysthyme Störung, 1.5 % Bipolare und Hypomane Störungen). Diese Ergebnisse entsprechen Prävalenzschätzungen früherer Studien und betonen die Notwendigkeit einer frühzeitigen Prävention und Behandlung.

Are children with "pure" generalized anxiety disorder impaired? A comparison with comorbid and healthy children

Despite the approach of the Diagnostic and Statistical Manual of Mental Disorders (5th ed.), generalized anxiety disorder (GAD) of childhood continues to face questions as to whether it should be considered a distinct clinical disorder. A potentially critical issue embedded in this debate involves the role of functional impairment which has yet to be demonstrated in children with "pure" GAD. Participants included 41 children between the ages of 6 and 11 years who met diagnostic criteria for primary GAD. Children with pure GAD (n = 17) were compared to children with comorbid GAD (n = 24) as well as a healthy control group (n = 20) in terms of clinician-rated severity and impairment and child-reported adaptive functioning across four domains. On average, children with pure GAD were more likely to be male and younger than children with comorbid GAD. Based on traditional significance testing, global impairment was greater in the comorbid compared to pure GAD group, although functioning in both groups was in the "variable" range. Both clinical groups reported less adaptive family relationships than controls, whereas only the comorbid group reported lower levels of home-based functioning. Equivalence testing nonetheless indicated a lack of comparability (i.e., nonequivalence) across the three groups for each of the domains examined. Findings indicate children with pure GAD to be functionally impaired compared to their healthy peers, though not to the same extent as children with secondary psychiatric diagnoses. Child functioning within the family domain specifically may be among the most vulnerable when GAD is present. Results support consideration of childhood GAD as a distinct clinical disorder.

Prevention of anxiety symptoms in children: results from a universal school-based trial

The present study evaluated the effectiveness of a universal school-based cognitive behavior prevention program (the FRIENDS program) for childhood anxiety. Participants were 638 children, ages 9 to 12 years, from 14 schools in North Rhine-Westphalia, Germany. All the children completed standardized measures of anxiety and depression, social and adaptive functioning, coping strategies, social skills, and perfectionism before and after the 10-week FRIENDS program and at two follow-up assessments (6 and 12 months) or wait period. Children who participated in the FRIENDS program exhibited significantly fewer anxiety and depressive symptoms, and lower perfectionism scores than children in the control group at 12-month follow-up. Younger children (9-10-year-olds) displayed treatment gains immediately after the intervention, whereas older children (11-12-year-olds) showed anxiety reduction only at 6- and 12-month follow-up. Perfectionism and avoidant coping acted as mediators of pre- to postintervention changes in anxiety scores. This study provides empirical evidence for the utility of the FRIENDS program in reducing anxiety and depressive symptoms among German children.

School functioning and chronic pain: a review of methods and measures

OBJECTIVE

School functioning is among the most important life domains impacted by chronic pain. This review provides a summary of the measures currently used by researchers to assess school functioning in children with chronic pain.

METHODS

We conducted a systematic review of the literature on school absenteeism and school functioning in children and adolescents with pain. Searches were restricted to a time frame including January 1985 to December 2010.

RESULTS

Fifty-three articles are reviewed: all include some form of assessment of school absenteeism or school functioning as part of the study outcome measures. Of the 53 articles, 26 assessed school absenteeism and 27 assessed an aspect of school functioning; 14 of these 27 articles assessed both.

CONCLUSIONS

Understanding the comprehensive impact of pain on school functioning will require improvements in our current assessment methods.

Social function assessment tools for children and adolescents: a systematic review from 1988 to 2010

Advances in neuroscience have added to the understanding of social functioning which has become an increasing area of focus in the psychology and neuropsychology literature. Given importance of appropriate social functioning to everyday interactions, as well as psychological well-being, accurately identifying and documenting such functions constitute a critical undertaking for both researchers and clinicians in psychology and related health professions. This review aimed to identify available social function assessment tools for children and adolescents using a comprehensive search method. Eighty-six measures were identified. Information on the assessment tools including the theoretical model they are based on, age range, sample used in development, and psychometric information are described. Results will aid researchers, psychologists and other health professionals in the selection of an appropriate tool to assess social function.

Toward a taxonomy of adolescents with chronic pain: exploratory cluster and discriminant analyses of the bath adolescent pain questionnaire

Emerging evidence has indicated that adolescent chronic pain is a significant healthcare issue, the impact of which is determined by a complex interplay of biological, emotional, social, and familial factors. Recently, progress has been made in assessment of pain and functioning in adolescents with chronic pain. A next step is to evaluate whether discrete subgroups of patients exist and whether assessment measures can be used to determine subgroup membership for individual pain sufferers. The present study sought to address these two issues. A battery of questionnaires, including the bath adolescent pain questionnaire, was completed by 209 adolescents with chronic pain presenting for an assessment appointment. Results from cluster analyses indicated the presence of four distinct subgroups. Three clusters differed from one another along a single continuum of severity and the fourth was characterized by good family cohesion, moderate emotional difficulties, and significant difficulties with physical functioning. Follow-up analyses indicated significant differences among the clusters across eight of nine measures of functioning including pain intensity, healthcare utilization, school attendance, amount of weekly exercise, depression, disability, social functioning, and catastrophic thinking. A discriminant analysis was able to correctly classify over 95% of participants into the correct cluster. These results provide strong support for the derived four cluster solution, which may be useful in both clinical and research settings, as it allows for individual adolescent pain sufferers to be classified into groupings according to the severity and type of difficulties being experienced.

Assessing child and youth well-being: implications for child welfare practice

The measurement of child well-being has become increasingly important in child welfare practice in the past ten years with the federal emphasis on measuring positive outcomes for children and families. Practical and methodological barriers to evaluating well-being exist alongside positive developments in the field. This article reviews the research literature related to child and youth well-being, providing a context for the discussion of measurement issues in child welfare settings. Based on a structured review of the literature, the article discusses instruments that appear to be most appropriate for use in a child welfare setting. Instruments are presented within stages of development, including (1) Infancy and Early Childhood, (2) Middle Childhood, and (3) Adolescence. Implications for the design and use of child well-being instruments in child welfare practice are discussed.

Development and preliminary psychometric evaluation of the parent report version of the Bath Adolescent Pain Questionnaire (BAPQ-P): A multidimensional parent report instrument to assess the impact of chronic pain on adolescents

Assessing the experience and impact of pain in adolescents with chronic pain is necessary to guide both individual treatment and to inform treatment development. Ideally, to obtain a comprehensive understanding of the impact of pain, assessment should be multidimensional, should be sensitive to contextual variables, and should allow for multiple informants (in particular, parents). The purpose of this study was to develop a standardized parent-report measure of chronic pain in adolescents, the Bath Adolescent Pain Questionnaire - Parent report (BAPQ-P). Participants included 222 adolescents with chronic pain and their parents recruited from two specialty clinics in the UK. The adolescents completed a battery of self-report inventories related to their pain and daily functioning whilst parents completed the BAPQ-P and additional measures of adolescent functioning. Scales of the BAPQ-P emerged to be internally consistent and temporally stable over a 17-day period. Validity was examined in relation to existing validated child report measures of anxiety, depression, catastrophizing, disability, family, and social functioning and parent report measures of disability and family functioning. Psychometric evaluation suggests that the BAPQ-P is a reliable and valid parental report tool for assessing the multidimensional impact of adolescent chronic pain. It can be used in conjunction with the previously established adolescent self-report measure, the BAPQ, alone where adolescent self report is not possible, in studies where parent report is the focus, or in studies where concordance between parent and adolescent reports is of interest.

Callous-unemotional traits in a community sample of adolescents

This study examined the structure, distribution, and correlates of a new measure of self-reported callous-unemotional (CU) traits in 1,443 adolescents (774 boys, 669 girls) between the ages of 13 to 18 years. The Inventory of Callous-Unemotional Traits was subjected to exploratory factor analysis and confirmatory factor analysis. Exploratory factor analysis produced three factors: callousness, uncaring, and unemotional. Fit indexes suggested that the three-factor model, with a single higher-order factor, represented a satisfactory solution for the data. This factor structure fits well for both boys and girls. CU traits correlated significantly with measures of conduct problems and psychosocial impairment. Furthermore, the traits showed predicted associations with sensation seeking and the Big Five personality dimensions, supporting the construct validity of the measure of CU traits.

Disability in adolescents with chronic pain: Patterns and predictors across different domains of functioning

Many children and adolescents experience recurrent pain, but only a few become disabled by it. Research has established that higher pain intensity and worse depression seem to predict poorer functioning in this population. Parent and family variables have been minimally researched. This study investigated functional disability, social/adaptive functioning and school attendance in a population of highly disabled adolescents and their parents seeking help for chronic pain. Adolescents (N=110) were assessed using the Bath Adolescent Pain Questionnaire [BAPQ; Eccleston C, Jordan A, McCracken LM, Sleed M, Connell H, Clinch J. The Bath Adolescent Pain Questionnaire (BAPQ): Development and preliminary psychometric evaluation of an instrument to assess the impact of chronic pain on adolescents. Pain 2005;118:263-70], a multidimensional instrument designed for a pain population. Pain intensity and depression predicted functional disability. However, social/adaptive functioning was associated with different variables, including parent factors, and school attendance showed no association with pain intensity or anxiety. The results emphasise the need to measure multiple domains of functioning, and show that the connections between pain, physical disability and adaptive functioning are looser than might be predicted.

Evaluation of universal, indicated, and combined cognitive-behavioral approaches to the prevention of depression among adolescents

A cluster, stratified randomized design was used to evaluate the impact of universal, indicated, and combined universal plus indicated cognitive- behavioral approaches to the prevention of depression among 13- to 15-year-olds initially reporting elevated symptoms of depression. None of the intervention approaches differed significantly from a no-intervention condition or from each other on changes in depressive symptoms, anxiety, externalizing problems, coping skills, and social adjustment. All high-symptom students, irrespective of condition, showed a significant decline in depressive symptoms and improvement in emotional well-being over time although they still demonstrated elevated levels of psychopathology compared with the general population of peers at 12-month follow-up. There were also no significant intervention effects for the universal intervention in comparison with no intervention for the total sample of students in those conditions.

The Bath Adolescent Pain Questionnaire (BAPQ): Development and preliminary psychometric evaluation of an instrument to assess the impact of chronic pain on adolescents

Chronic pain causes significant problems in the lives of many adolescents, considerably affecting their physical, psychological and social functioning. The assessment of the multidimensional impact of chronic pain is an essential clinical task. This study reports on the development and psychometric evaluation of the Bath Adolescent Pain Questionnaire (BAPQ); an assessment tool designed specifically for use with adolescents who experience chronic pain. A sample of 222 adolescents (11-18 years) experiencing chronic pain completed the 109-item draft inventory. Participants were recruited from two different UK clinics. All participants responded to items using a 5-point frequency scale. Psychometric evaluation of the data resulted in a reduced inventory length of 61 items. Internal consistency of all seven questionnaire subscales was established using Cronbach's alpha. Comparative validity was undertaken by comparison of all individual subscales with existing validated measures (SCAS, CDI-S, FDI, Brief FAM. PCS and CASAFS). The temporal reliability of each inventory subscale was established using a sub-sample of 30 adolescent participants over a 17-day period. Psychometric evaluation of the data suggests the inventory yields both a reliable and valid assessment of the impact of chronic pain on the lives of adolescents. The BAPQ may offer a comprehensive way to assess the widespread deleterious impact of adolescent chronic pain in both a research and clinical setting. Further investigation is needed on the predictive validity of the subscales. Additional data from samples of patients with diagnoses that are not musculoskeletal in origin would be of great assistance.

Evaluation and treatment of anxiety disorders in the general pediatric population: a clinician's guide

This article provides an overview of research on the recognition, assessment, and treatment of children and adolescents who have anxiety disorders and emphasizes practical issues facing clinicians. Discussion includes an overview of the prevalence and consequences of anxiety and reviews assessment tools, maintenance factors, and evidence-based approaches to treatment. Topics also include developmental considerations, approaches to informant discrepancy, predictors of treatment outcome, and recent innovative approaches to treatment that may potentially improve dissemination to the general pediatric population.

Long-term outcome of a school-based, universal approach to prevention of depression in adolescents

In this study, the authors examined the 2-, 3-, and 4-year outcomes of a school-based, universal approach to the prevention of adolescent depression. Despite initial short-term positive effects, these benefits were not maintained over time. Adolescents who completed the teacher-administered cognitive-behavioral intervention did not differ significantly from adolescents in the monitoring-control condition in terms of changes in depressive symptoms, problem solving, attributional style, or other indicators of psychopathology from preintervention to 4-year follow-up. Results were equivalent irrespective of initial level of depressive symptoms.

Preventing adolescent depression: an evaluation of the problem solving for life program

This study evaluated the effectiveness of the Problem Solving For Life program as a universal approach to the prevention of adolescent depression. Short-term results indicated that participants with initially elevated depressions scores (high risk) who received the intervention showed a significantly greater decrease in depressive symptoms and increase in life problem-solving scores from pre- to postintervention compared with a high-risk control group. Low-risk participants who received the intervention reported a small but significant decrease in depression scores over the intervention period, whereas the low-risk controls reported an increase in depression scores. The low-risk group reported a significantly greater increase in problem-solving scores over the intervention period compared with low-risk controls. These results were not maintained, however, at 12-month follow-up.