Child Psychiatry & Human Development最新文献

Generalized Anxiety Disorder (GAD) typically develops during adolescence and is one of the most prevalent disorders in youths. However, the remission rates associated with treatments indicate substantial room for improvement. An important next step is to more precisely identify modifiable maintenance factors that can be targeted in treatment. Drawing on research in adults, two theoretical models have gained prominence in informing the conceptualization and treatment of adolescent GAD: The Intolerance of Uncertainty model and the Metacognitive model. These models emphasize different knowledge structures as the central maintenance factor of GAD, where the former assigns central importance to intolerance of uncertainty beliefs and the latter to negative metacognitive beliefs about worry. However, empirical studies comparing their contributions to GAD symptoms in adolescents are limited. Hence, the current study aims to assess the relative contribution of intolerance of uncertainty beliefs and negative metacognitive beliefs about worry as statistical predictors of anxiety, depression and chronic worry in a sample of 117 adolescents with analog GAD. Three hierarchical linear regressions were conducted, one for each of the symptom categories. Negative metacognitive beliefs about worry accounted for independent and unique variance across all outcomes, whereas intolerance of uncertainty beliefs only made an additional contribution to anxiety symptoms. These results imply that negative metacognitive beliefs about worry are the most reliable correlate of symptoms and chronic worry in adolescents with analog GAD, and that formulating and modifying them has the potential to improve formulation and intervention strategies.

Interrater agreement on child temperament and personality is often found to be low to moderate. While some interpret this finding as a psychometric problem, others argue that it may instead reflect the distinct contexts and perspectives that shape each informant's perception of the child. To gain a better understanding of this issue, we adapted the parent version of the Integrative Late Childhood Temperament Inventory (ILCTI) for use in children and teachers and examined the agreement between parents, children, and teachers. We collected 280 self- and teacher-ratings of the ILCTI from 9-14-year-old Austrian children and young adolescents. We also obtained parent ratings for 110 children and a second teacher rating for 57 children. Results on psychometric properties supported internal consistency reliability and criterion validity (meaningful associations with internalizing and externalizing problems and school performance) for all three versions. Interrater agreement across all items of the ILCTI (as assessed by dyad-centered agreement), and on the six individual temperament dimensions was highest among teachers, followed by parent-child, parent-teacher, and teacher-child agreement. Interestingly, low parent-teacher agreement was associated with more behavioral and emotional problems in children. Possible explanations for differences in the extent of interrater agreement among rater groups are discussed.

Problematic mobile phone use has risen steadily in recent years, raising concerns about students' mental health and prompting growing scholarly interest in its protective and risk factors. However, certain research gaps have been identified. This study adopted a three-wave design to examine how self-control, perceived parental psychological control, and depression jointly influence the problematic mobile phone use among primary school students. A total of 489 fourth- and fifth-grade children (M_age = 10.560, SD = 0.826) completed questionnaires at three time points during one year. Results showed that a higher level of self-control was associated with a lower level of depression and problematic mobile phone use, whereas a higher level of perceived parental psychological control was associated with a higher level of depression and problematic mobile phone use. Furthermore, depression serves as a mediator both between students' self-control and problematic mobile phone use and between perceived parental psychological control and problematic mobile phone use. These findings indicate that self-control functions as a protective factor, while perceived parental psychological control acts as a risk factor for primary school students' depression and problematic mobile phone use.

Minimal clinically important difference (MCID) is a clinical change metric that can offset setbacks in statistical and effect size approaches. MCIDs may be especially important for characterizing change mechanisms to understand intervention impact. However, MCIDs are rarely examined within the context of mental health-based interventions. The current study employed anchor- and distribution-based methods to derive MCIDs for hopelessness (a change mechanism) within a dataset for publicly accessible, open access interventions. Derived MCIDs were then examined within a randomized controlled trial dataset to understand their relation to prospective depressive symptoms. A cohort of 917 youth aged 11-17 years old (64.4% female, White: 30.3%) participated in brief, digital, self-guided interventions targeting depressive symptoms within the open access dataset. A separate cohort of 1,282 youth aged 13-16 years old (87.9% female, White: 66.7%) engaged with the same interventions in the randomized controlled trial dataset. MCIDs ranged from 0.13 to 0.38 units of change on a 4-point hopelessness scale. After correcting for multiple hypotheses, the MCIDs derived via the publicly accessible, open access interventions dataset did not translate to significant (q < 0.05) differences in three-month post-intervention depressive symptom scores within the randomized controlled trial dataset. Findings from this study led to important considerations for leveraging MCIDs within mental health interventions and outline a potential empirical agenda to further characterize the utility of this change metric.

Child irritability (CI) is a transdiagnostic symptom of multiple psychopathologies, is prospectively associated with negative psychosocial outcomes, and may influence or be influenced by family functioning. The current study assessed bidirectional relations between CI and family conflict (FC) among youth (N = 10,608, M_age = 9.48 years, 47% female, 49.5% White) and one parent (85.3% mothers) across five years in the Adolescent Brain Cognitive Development study. In latent growth curve models with structured residuals, both boys and girls demonstrated curvilinear changes in FC and CI over time, with increasing and subsequently decreasing CI and the reverse trajectory for FC. Significant bidirectional, prospective associations between FC and CI, however, were only present for girls. Early CI was associated with FC one year later, while girls' reports of FC were associated with later CI across all timepoints. Findings highlight biological sex as a critical factor influencing associations between family functioning and children's symptoms.

This systematic review aimed to synthesize evidence on the efficacy of the Supportive Parenting for Anxious Childhood Emotions (SPACE) intervention in reducing child psychological symptomology (e.g. anxiety, OCD) and family accommodations. A systematic review was conducted across PsycINFO, Medline, SCOPUS and Web of Science. Studies were included if they assessed SPACE and provided some measure of symptomology and/or family accommodations. Twelve studies were analysed using narrative synthesis and methodological quality was assessed using the Effective Public Health Practice Project Quality Assessment tool. The majority of studies were rated as low-quality. Most reported reductions in symptomology and family accommodations, although maintenance at follow-up was inconsistent. SPACE was generally comparable to other interventions, although control conditions were limited across studies. Emerging evidence supports the potential of SPACE in reducing both family accommodations and child symptomology. Future directions for research and clinical implications are discussed.

Parental psychological distress is a commonly examined risk factor for the emergence of child problem behaviors, but the factors that contribute to that relationship-such as limited parental resources like greater social support and coping skills-have not been adequately explored, particularly with attention to potential bidirectional relations that incorporate child evocative effects. The current longitudinal study examined maternal and paternal psychological distress in relation to perceived child externalizing behaviors, considering parental resources as mediators within a bidirectional model. The sample included a racially and socioeconomically diverse group of 201 primiparous mothers and 151 fathers. Mothers and fathers reported their current psychological distress, social support satisfaction, and problem-focused coping prenatally, at child age 18 months and at child age 4 years, as well as reporting on child externalizing behaviors in these latter two waves. Results suggest that mothers' psychological distress predicted perceived child externalizing behaviors in both toddlerhood and early childhood. However, for fathers, although their psychological distress did not predict their reports of child externalizing behaviors, perceived child externalizing appeared to predict later paternal psychological distress and social support satisfaction in early childhood, evidencing child evocative effects. No mediation by parental resources was identified for either mothers or fathers. Overall, this study underscores the intricate processes involved in understanding parent-perceived child externalizing behaviors and the importance of examining fathers and the role of children.

Preventing obsessive-compulsive disorder (OCD) before it emerges has long been considered a central, yet elusive, goal for researchers. Achieving this will likely require identifying individuals at elevated risk and intervening during critical developmental periods before the onset of impairing symptoms. This trial evaluated the feasibility of a brief parent-guided online targeted prevention program for children at-risk of developing OCD. We enrolled 35 children aged 5-12 years with a first-degree relative with OCD and/or subclinical obsessive-compulsive symptoms. None met diagnostic criteria for OCD at baseline. The four-week intervention targeted known maintaining factors (compulsions, avoidance and family accommodation) and was delivered online without scheduled therapist contact. The outcomes included feasibility and acceptability measures, along with preliminary efficacy in reducing the targeted maintaining factors. Assessments were conducted at baseline, post-intervention, and at 6-month and 12-month follow-ups. All families initiated the intervention, and 66% completed at least three of the four modules during the study period. Parents reported high credibility and satisfaction with the intervention. At the 12-month follow-up, 33 parents completed the assessment and statistically significant within-group improvements were observed for compulsions (d = 0.66, 95% CI 0.31-1.00), avoidance (d = 0.56, 95% CI 0.12-1.00), and family accommodation (d = 0.75, 95% CI 0.43-1.07). One child met diagnostic criteria for OCD at the 12-month follow-up. This study supports the feasibility and acceptability of a brief prevention program for children at-risk of developing OCD. A randomized controlled trial is now warranted.

In recent years, there has been a noticeable increase in performance-related concerns and a heightened fear of failure among children and adolescents across various settings, such as academics and sports. Despite this trend, research specifically addressing performance anxiety remains limited, with most studies focusing on the broader category of social anxiety. This study addresses this gap by investigating how perceived parental criticism and self-compassion among children/adolescents mediate the relationship between parental overprotection and performance anxiety during childhood and adolescence. The sample comprises 428 dyads of children/adolescents (M = 10y 9 m, SD = 1y 8 m; range = 6-15 years) and their respective educational guardian (85.6% female), recruited from school settings. A sequential mediation model was estimated to analyze the direct and indirect effects of parental overprotection on children's/adolescents' performance anxiety, through their perception of parental criticism and levels of self-compassion. Higher levels of parental overprotection were linked to higher levels of performance anxiety through the children's/adolescents' perception of parental criticism and the sequence of the two mediators under study. This study underscores the need for parental interventions to reduce parental overprotection and criticism and suggests that compassion-based interventions could be particularly effective in helping children/adolescents lower their levels of performance anxiety.

A previous randomized controlled trial comparing problem-focused computer-assisted skills training (ScouT) with supportive resource activation treatment (STARK) in children (6-12 years) with disruptive behavior disorders (DBD) demonstrated significant pre-post changes in both treatment conditions, with ScouT being slightly superior on some outcomes. Based on the same sample (N = 99), the present study examined cross-sectional indirect associations between treatment condition and outcomes via intermediate variables, which conceptually correspond to mediation. We hypothesized that ScouT would lead to stronger reductions in the peer-related aggression-maintaining factor (PAM factor; including dysfunctional social information processing, emotional dysregulation, impulse control problems, deficits in social skills, and dysfunctional social interactions), whereas STARK would lead to greater improvements in self-concept, which in turn would be associated with lower concurrently assessed clinician-, parent- and teacher-rated DBD symptoms and overall externalizing behaviors. Our analysis yielded support for the hypothesized indirect association through the PAM factor, with consistency across all outcome measures. Unexpectedly, compared with STARK, ScouT also led to a more favorable self-concept, which was indirectly associated with less severe clinician-rated DBD symptoms, but not with the other outcomes. This latter indirect association was small and should additionally be interpreted with caution given the low reliability of the clinician-rated scale. These findings may indicate that the treatment of children with DBD may benefit from directly targeting aggression-maintaining factors. Limitations include the concurrent assessment of the intermediate variables (PAM factor, self-concept) and the outcomes, which does not permit causal conclusions. Future research should refine methodologies and explore additional treatment mechanisms.Trial Registration: The study was registered at clinicaltrials.gov on 2014-05-18 (Identifier: NCT02143427).