Child Psychiatry & Human Development最新文献

While research has explored parental perspectives on help-seeking and treatment engagement for child anxiety, less is known about how parents make sense of their everyday caregiving role. Understanding this lived experience is crucial for developing meaningful supports. This qualitative study explored how parents experience supporting a 7- to 12-year-old child with anxiety in daily life. Eight parents participated in in-depth, semi-structured online interviews, analysed using Interpretative Phenomenological Analysis to develop a detailed understanding of their meaning-making. This paper presents the group experiential theme "Exhausting uncertainty: Parenting as a constant battle" and its four subthemes depicting the challenges of parenting a child with anxiety: (1) "Understanding the unknown", (2) "Anticipating the next move", (3) "Responding to escalations", and (4) "Regrouping for the next battle". Parents described a continual trial-and-error process of interpreting and managing anxiety, characterised by parent-child communication gaps and a lack of clear guidance. While they found small ways to recover amidst daily struggles, they often felt isolated, on edge, and unequipped to respond to escalations. These findings highlight the emotional and practical complexities of parenting a child with anxiety. Supports that are grounded in parents' everyday experiences and acknowledge uncertainty, emotional strain, and diverse family contexts may more effectively meet the needs of both parents and children.

A prolific amount of data regarding maternal sensitivity and child development outcomes comes from high income, industrialised western contexts. Sparse attention has been paid to characterising patterns or unique expressions of sensitivity as an independent topic of study globally with a glaring dearth of comparative data from LMICs including sub-Saharan Africa. We aimed to detail maternal sensitivity within the dyadic interaction between mother and her 42-month-old child (n = 130) in a peri-urban low socioeconomic context as part of the Drakenstein Child Health Study. Ten-minute videoed interactions were coded using the Emotional Availability Scale. We found no report of psychometric properties and applicability of the EA in our context, therefore confirmatory followed by exploratory factor analysis on the four maternal subscales was conducted. EFA using scree plot and parallel analysis extracted a 3 factor model that better fit our data than the original four. Factor 1-Sensitive Engagement, Factor 2-Non-Hostile Supportive Engagement and Factor 3-Non-Intrusive Engagement aligned theoretically with the original maternal subscales. The new Sensitive Engagement subscale accounted for 25% cohort variance and mothers showed varied distribution over five categories ranging from Highly Sensitive to Highly Insensitive. Cumulatively, 59% of total variance is explained by 3 factors - Factor 2-22% and Factor 3-12%. Significantly, our cohort shows remarkably resilient sensitivity patterns and behaviours considering the extremely harsh and challenging environments in which they must raise children.

The silent behaviour of children with selective mutism (SM) is often assumed to reflect an acute stress-related response to social-communicative anxiety, yet objective evidence remains limited, especially in young children. To explore the potential stress-related mechanisms underlying silence in socially challenging situations, we assessed both acute and chronic stress. Eighty-three children aged 4-8 years (37 with SM, 46 controls) completed two socially demanding interaction tasks - one verbal and one nonverbal - each with three phases: anticipation, performance, and recovery. Heart rate (HR) was measured at rest and continuously throughout all task phases. Chronic stress was indexed via hair cortisol concentration (HCC). Compared to controls, children with SM showed elevated resting HR and higher arousal during both verbal and nonverbal social tasks. During the verbal task, the SM group (80% remained silent) exhibited blunted HR reactivity from anticipation to performance, suggesting a silence related coping effect. No group differences emerged in arousal patterns over time during the nonverbal task. HCC levels were significantly higher in the SM group, indicating increased chronic stress, however HCC was not correlated with SM severity. These findings support the view that mutism serves as an emotion regulation mechanism to reduce arousal in anticipation of verbal demands. The results underscore the importance of stress-reducing interventions for young children experiencing high stress in daily life and support the need for exposure-based interventions for children with SM, enabling them to learn that anticipated threats often do not occur, leading to decreased arousal and improved regulation.

Adolescence is a critical period for developing obsessive-compulsive disorder (OCD) symptoms, highlighting the need for preventive strategies. GGOC-AD is a newly adapted module for adolescents within the OCD.app mobile platform, aimed at addressing maladaptive beliefs. This pilot study evaluated the feasibility, acceptability, usability, and preliminary efficacy of GGOC-AD in the adolescent general population. A parallel two-arm pilot trial was conducted with 36 students (55.6% male; M_age = 16.25, SD = 0.5), of which 18 were assigned to the experimental group (using the GGOC-AD app, 14 days) and 18 to the control group (using the neutral GGN-AD app, 14 days). Participants from the experimental group were assessed after using the app for study feasibility, acceptability, and usability through self-reports and an ad-hoc interview. Furthermore, all participants were evaluated at baseline and post-intervention for OCD-related maladaptive beliefs, OC and emotional symptoms, and self-esteem. Quantitative and qualitative data were analyzed.The study concluded that the protocol used was feasible. Participants who used the GGOC-AD app rated it as both acceptable and usable. The preliminary efficacy results of GGOC-AD did not reveal a significant intervention effect on OC symptoms, maladaptive beliefs, emotional symptoms, or self-esteem. These findings provide valuable data for optimizing the study protocol and designing a future randomized controlled trial. This pilot study is an essential step given the critical role of usability and acceptability in driving engagement with mHealth interventions.

Phasic and tonic irritability are highly correlated clinical constructs yet differentially associated with developmental trajectories and treatment response. However, limited research has identified their shared and unique underlying behavioral mechanisms. In a sample of youths enriched for irritability (N = 141, age range 7-18, age M[SD] = 12.60[2.54], 48.23% female), we investigated whether inhibitory control is differentially associated with phasic versus tonic irritability. Replicating prior work, tonic and phasic irritability were estimated via independent confirmatory factor analyses (CFAs) using items and/or subscales from multi-informant questionnaires. A latent factor of inhibitory control was extracted from four behavioral tasks. Initial multiple linear regression analysis found that phasic, not tonic, irritability was significantly associated with impaired inhibitory control. However, results were no longer significant after accounting for shared associations with age. In addition, when adding commonly co-occurring symptoms such as attention-deficit/hyperactivity disorder (ADHD) symptoms and oppositionality, age and ADHD were significant predictors of inhibitory control, but phasic irritability was not. Results suggest that inhibitory control alone may not be a salient mechanism for disambiguating phasic and tonic irritability. Future work leveraging longitudinal methods and consideration of other potential contextual factors is needed.

Despite ample evidence linking self-stigma of mental illness with many negative outcomes, little is known how self-stigma may manifest during psychotherapy, especially among adolescents. In this investigation, seventy-one adolescents (ages 12-17), predominately female and White, who recently began treatment at an outpatient psychology clinic, completed surveys assessing self-stigma and symptom severity at five time points over a sixteen-week period. Multilevel modeling was utilized to assess outcomes in self-stigma. Results indicated that self-stigma did not decline over time, nor was there evidence of variable rate-of-change in our sample. Higher average psychological symptomatology was strongly associated with higher self-stigma. Additionally, when participants reported higher-than-usual symptoms, their self-stigma was also greater. Initial psychological symptomatology did not moderate rate of change in self-stigma. Findings of this study provide a novel understanding of adolescent mental illness self-stigma following the initiation of psychotherapy and highlight the need for clinicians to further consider self-stigma in treatment.

Pollution exposure is often present in high levels in disadvantaged neighborhoods and may independently confer risk for antisocial behavior (AB) and exacerbate relations between maternal depression and AB. The present study used multinomial logistic regression to test whether pollution exposure in early childhood (ages 0-2) and middle childhood (ages 5-12) was associated with trajectories of mother-reported AB (ages 5-11) in a sample of low-income boys (N = 218), controlling for established contextual risk factors. We also tested whether pollution moderated the association between maternal depression and AB. Pollution exposure was not directly associated with AB but did exacerbate the effects of maternal depression on AB. Results indicate pollution may impact behavioral outcomes for boys from low-income families in the context of maternal depression and suggest that more precise measures of pollution exposure are critical to use in future studies.

Children of parents with eating disorders (EDs) are at greater risk of developing an ED, likely due to an interplay of genetic and environmental factors. The familial high-risk (FHR) study design offers a valuable framework for studying development of EDs in individuals at increased risk over time. The study aimed to (1) to explore mothers' with EDs perspectives on the intergenerational transmission of EDs and (2) to explore mothers' with EDs perspective on FHR research related to EDs. Three focus group interviews were conducted in October and November 2023 with a total of eight mothers with a current ED, comprising groups of two, three, and three participants, respectively. All participants had a child of at least five years. Data were analyzed using thematic framework analysis. The first theme focused on navigating motherhood with an ED including experiences and reflections on how having an ED can impact children and had the subtheme: Communicating with children about EDs. The second theme was advancing prevention and early detection of EDs incorporating the promising impact of research on early detection of EDs and targeted preventive interventions and had two subthemes: Protecting children's emotional well-being and willingness to participate in research. Overall, mothers with EDs were deeply concerned about intergenerational transmission and the implications of disclosing their ED to their children, yet they remained highly motivated to participate in prevention research, offering valuable insights into how to engage families more effectively in ED research.

Racial disparities in ADHD diagnoses may be attributable to parent-teacher discrepancies in symptom ratings, as teachers rate Black children as more symptomatic than non-Black children. Implicit racial biases may be a contributor to these parent-teacher differences. This study examined specific forms of racial biases among White teachers and Black parents, and their association with ratings of Black and White children's ADHD behaviors. Participants watched short videoclips and rated children's ADHD symptoms, and completed measures of implicit and explicit racial attitudes and ADHD stereotypes. Results showed that White teachers demonstrated more implicit biases than did Black parents. Implicit racial attitudes toward Black boys were associated with biased ratings of Black boys' ADHD symptoms, and explicit racial attitudes were associated with biased ratings of Black girls' ADHD symptoms. These findings demonstrate a potential role of teachers' implicit racial biases in ratings of Black children's externalizing behaviors, including ADHD.

We examined the factor structure and psychometric properties of the Parent-Child Sleep Interactions Scale (PSIS) in families with children adopted from foster care. Data were collected from adoptive parents of 240 preschool-aged children, ages 3-6 years, (M = 4.24 years, SD = 1.06; 41.67% female) from across the U.S. Parents completed questionnaires assessing demographics, child sleep problems, and child depressive and anxiety symptoms. We randomly split the sample and conducted an exploratory factor analysis (EFA) in sample one, followed by a confirmatory factor analysis (CFA) in sample two. Internal consistency reliability and convergent validity of the final PSIS from the CFA were assessed. The EFA revealed the same three factors identified in the original 12-item measure: Sleep Reinforcement, Sleep Conflict, and Sleep Dependence. However, two items' factor loadings did not meet retention criteria. After removing these items, the three-factor solution was maintained, with good model fit. Internal consistency reliability for all PSIS subscales was good and all subscales were negatively correlated with sleep quality and positively correlated with total child sleep problems and symptoms of separation anxiety. Findings provide evidence for the reliability and validity of the revised PSIS for assessing sleep-related parent-child interactions among preschoolers with a history of placement in foster care.