Research on Child and Adolescent Psychopathology最新文献

Weight-centric health practices are based on the principle that excess weight predicts chronic disease, informing a growing sociopolitical movement to address an "obesity epidemic." This hyper-focus on preventing obesity may contribute to weight stigma (i.e., the devaluation and discrimination of individuals based on body size) and other iatrogenic outcomes for youth, including the development and maintenance of eating disorders (EDs). Current evidence-based treatments for EDs include language and practices that may reinforce fears of fatness, body shame, and unhealthy dietary restriction without guidance on addressing weight stigma. Here, we present case examples from three adolescent patients across ED presentations and body sizes to (1) elucidate the role of weight stigma in ED development, (2) highlight the ubiquity and harms of weight stigma within ED treatments, and (3) outline thoughtful protocol adaptations to avoid further harm and facilitate recovery. We conclude with a call for immediate action to advance research characterizing the harms of weight-centric approaches in existing ED interventions to reduce the risk of iatrogenic effects on youth with EDs and advance weight-inclusive approaches to ED treatment.

The potential harms related to interventions for adults with suicide-related risk, particularly hospitalization, have been well documented. Much less work has focused on the potential harms related to interventions with youth struggling with suicidal thoughts and behaviors. Young people are most likely to receive mental health services in schools, which are recognized as meaningful sites for effective suicide prevention work. However, no overviews have conceptualized the potential harms to youth when schools engage in ineffective suicide prevention efforts. In this article, we discuss three prominent overlapping areas of potential harms: (1) privacy-related, (2) relationship-related, and (3) mental health-related. We then discuss key factors thought to influence the development and maintenance of these potential harms. We conclude by noting ways in which school-based mental health providers may attempt to reduce unintentional harms in this area, with an overarching goal of helping support school mental health providers and the youth they serve.

Childhood callous-unemotional (CU) traits are associated with a neurocognitive response style of high reward and low punishment sensitivity, which may make these children particularly vulnerable to substance misuse. However, the mechanisms explaining the link between CU traits and substance use are poorly understood. This study investigated the mediating influences of reward and punishment sensitivity on the association between childhood CU traits and adolescent substance use. Using data from the UK Millennium Cohort Study, mediation analyses were conducted to investigate the potential indirect effects of age 14 reward and punishment sensitivity in risk-taking on the relationships between age 11 CU traits and alcohol, cannabis, and other illicit drug use at age 17. No direct effects of CU traits on substance use were found when accounting for gender, baseline alcohol use, poverty, emotional symptoms, conduct problems, hyperactivity, and verbal ability at age 11. Indirect effects of increased reward sensitivity on the relationship between CU traits and increased use were seen for alcohol, cannabis, and other drugs. There was a significant indirect effect of reduced punishment sensitivity on the relationship between CU traits and increased alcohol use, but not cannabis or other substance use. Findings suggest that reward and punishment sensitivity may have independent effects on decision-making processes contributing to adolescent substance use. Prevention and early intervention for substance use should consider modifying intervention strategies to fit the needs of adolescents with a callous interpersonal style and a neurocognitive profile characterized by a high drive for rewards and low risk aversion.

Untreated anger and aggression in youth confer heightened risk for subsequent psychosocial problems. However, engaging youth in treatment for anger can be difficult given barriers to accessing care and high rates of attrition. This study examined whether learning relaxation skills and practicing them using a videogame, whose operation was contingent upon keeping heart rate close to baseline levels, could help children learn to manage anger and aggression. Youth ages 7-17 with elevated levels of anger (N = 39) were randomized to receive the active video game condition or a control game that displayed heart rate but did not stop the game if heart rate became elevated. Youth underwent baseline screening, 6 treatment sessions, and follow-up assessments at 2-weeks and 3-months. Compared to the control condition, children in the active condition demonstrated significantly greater improvements in clinician-rated aggression severity (d = 1.48) and youth-rated emotion dysregulation (d = 3.46) at 2-weeks post-treatment. The active group maintained these improvements at 3-month follow-up, but no longer significantly differed from the control group. Intervention effects were nonsignificant for parent-reported emotion dysregulation and aggression. In addition, the intervention group youth, but not control group, experienced increased time with heart rate below baseline over the course of the 6 sessions. Findings suggest a promising brief intervention for reducing aggression and emotion dysregulation in children while they are waiting for longer-term outpatient therapy. Clinical Trial Registration Number: NCT03270813.

Temperament is thought to influence the development of early maladaptive schemas (EMSs). However, whether temperament is longitudinally related to EMSs beyond attachment, the best known predictor of EMSs, has been underexplored. Hence, this study investigated (1) Whether middle childhood temperament is longitudinally related to late adolescent EMSs, (2) To what extent temperament explains EMSs beyond middle childhood attachment, and (3) Whether attachment moderates this temperament-EMSs link. In total, 157 children (M_age = 10.91 in middle childhood, M_age = 16.71 in late adolescence) participated in this study. Adolescent EMSs were assessed along with middle childhood temperamental negative affect, affiliation, surgency, and effortful control, and attachment at both explicit and implicit levels. Results indicated that all temperamental features were longitudinally related to later EMSs; the majority of the temperament-EMSs links did not survive after controlling for attachment, except for some limited correlations between EMSs and negative affect and effortful control; and an inconsistent moderating effect for attachment on the temperament-EMSs link. This study provides further insight into the role of child factors (middle childhood temperament and late adolescent attachment) in understanding EMSs variability in late adolescence. It suggests that EMSs are informed more by past relational experiences (attachment) than children's inborn tendencies (temperament).

Pediatric obsessive-compulsive disorder (OCD) can be debilitating and chronic unless treated early with efficacious intervention. The past several decades of intervention research have identified cognitive-behavioral therapy (CBT) with exposure and response/ritual prevention (ERP) as the first-line, evidence-based psychological intervention for pediatric OCD. Yet, many youths with OCD unfortunately remain inadequately treated. In well-meaning but misguided efforts to treat this complex disorder, clinicians holding misconceptions about ERP may fail to apply evidence-based treatments, misapply generic CBT techniques and ERP principles, or turn to non-evidence-based interventions. Potentially harmful treatments may worsen symptoms, while ineffective treatments can waste resources, impede patient access to efficacious treatment, and weaken public confidence in psychotherapy. The overarching goals of this review paper are to describe potentially harmful and ineffective practices in the treatment of pediatric OCD and to offer recommendations aligned with evidence-based practice. First, we dispel common misconceptions about ERP that may underlie its underuse among clinicians. We then describe potentially harmful and ineffective interventions for pediatric OCD, starting with misapplication of generic CBT techniques and ERP principles. We also identify non-evidence-based treatments for pediatric OCD that have limited conceptual or empirical foundations. Finally, we conclude with recommendations for clinicians who treat pediatric OCD, intervention researchers, training programs across mental health-related disciplines, and policymakers.

Limited studies have investigated differential treatment responses to family-based treatment programs and subgroup trajectories in youth in a high-risk context. This study pioneered an examination of Multisystemic Therapy for Child Abuse and Neglect (MST-CAN) and built on prior research that identified subgroups with different psychopathologies. Participants included 208 parent-child dyads enrolled in the MST-CAN evaluation in Switzerland. Parents reported their children's (M_age = 10.27 years, SD_age = 3.5, 44.2% girls, 55.8% boys, 98.6% White) emotional and behavioral problems. Longitudinal data were examined to analyze the differential changes within the pre- and post-treatment (T1 and T2) subgroups. The T1 cluster and T2 cluster were cross-tabulated to examine changes in the symptom class over time. Overall, the treatment proved to be highly beneficial. Subgroup analyses revealed that four out of the five subgroups (80%) showed positive changes in at least two outcome measures. The treatment was most successful for children with externalizing symptoms. Children with multiple symptoms also showed improvements across different symptoms. Regarding specific symptoms, children with anxious-avoidant symptoms benefited from the treatment. Additionally, the treatment was beneficial for children with normative emotions and behavior. Meanwhile, the treatment did not have any significant effects for children with internalizing symptoms. Notably, child neglect was reduced in three (60%) subgroups. The symptom class remained stable across time for children with externalizing and multiple symptoms. Ultimately, MST-CAN reduced emotional and behavioral problems and child neglect in most families. Understanding children's differential treatment responses to complex treatment programs is essential to adequately address different needs.

Individuals with ADHD are at risk for substance use initiation in adolescence and escalation to problematic use in adulthood. Little is known about the impact of psychosocial ADHD treatment on substance use. Based on existing theory, both therapeutic (i.e., through reducing symptoms and impairments) and iatrogenic effects (i.e., through improved social functioning) of psychosocial treatment for ADHD on adolescent substance use initiation are plausible. A primarily ethnic/racial minority sample (~ 95% Latinx or Black) of rising ninth grade students with ADHD (n = 106) were randomly assigned to receive high intensity (i.e., Summer Treatment Program-Adolescent, parent training, and school consultation) or lower intensity (parent training, organization skills training, and school consultation) intervention the summer before entering high school. Participants were followed four-years post-baseline and substance use was documented. Analyses tested treatment effects on substance use initiation (alcohol and/or marijuana) and mediators of main effects. After controlling for covariates, participants assigned to HI (37.5%) were significantly more likely than LI (18.6%) to initiate substance use by end of high school, indicating an iatrogenic effect of HI treatment. No significant mediators were detected. Post-hoc exploration of moderators suggested that youth with elevated Posttraumatic Stress Disorder (PTSD) symptoms may have experienced a benefit of HI treatment on substance use whereas youth without elevated PTSD symptoms experienced iatrogenic effects. Large, well-powered, samples should examine moderated mediational models to better understand who is most risk for iatrogenic effects of ADHD psychosocial treatment and why. Clinicians delivering psychosocial treatment to adolescents with ADHD should monitor for potential iatrogenic effects.

Beyond achievement, educational settings offer informal supports that may be critical for child and youth mental health. However, children's educational environments have experienced significant disruption with the coronavirus pandemic. School settings offer unique opportunities to support children's mental health, but research must identify powerful points of intervention. This study examined school factors (aspirations, perceived competence, sense of belonging, and emotional engagement) as predictors of children's mental health, and the potential consequences of increasing screen time in and outside of school. Participants (N = 707) were parents and their children (6-18 years) from community and clinical settings who completed prospective surveys about children's school experiences and mental health symptoms (November 2020-May 2022). Standardized measures of depression, anxiety, irritability, inattention, and hyperactivity were collected. Structural equation modelling tested longitudinal associations between screen time, school factors, and mental health outcomes. Positive associations between each of the school factors (B = 0.14 [SE = 0.04] to B = 0.43 [SE = 0.04]) suggested they may reinforce one another. Longitudinally, sense of belonging and emotional engagement at school predicted lower severity for symptoms of depression, anxiety, irritability, and inattention (B=-0.14 [SE = 0.07] to B =-0.33 [SE = 0.10]). Greater screen time was associated with lower aspirations and perceived competence (B = - 0.08 [SE = 0.04] to B = - 0.13 [SE = 0.06]). Results suggest that school factors beyond achievement may be key correlates of child and youth mental health. While curriculum expectations emphasize academic achievement, an investment in supporting positive attitudes and aspirations at school is also warranted.

Little is known about the relationship between violence exposure and mental health in preschoolers living in low- and middle-income countries (LMICs). Multiple regression analyses investigated associations between violence exposure and mental health in the Drakenstein Child Health Study (N = 978), a South African birth cohort. Lifetime violence exposure was assessed at age 4.5 years using the parent-report Child Exposure to Community Violence Checklist (CECV). Mental health was assessed at age 5 years using the Child Behaviour Checklist (CBCL 1.5-5). Eighty-three percent of the children were exposed to some form of violence. Internalising and externalising behaviours were positively associated with overall violence exposure (β per one unit change in the overall score = 0.55 [0.16, 0.94] and β = 0.53 [0.23, 0.84], respectively), domestic victimisation (β per one unit change in the subscore = 1.28 [0.28, 2.27]; β = 1.14 [0.37, 1.90]) and witnessing community violence (β = 0.77 [0.15, 1.39]; β = 0.68 [0.19, 1.18]). There was a positive association between polyvictimisation and externalising (β = 1.02 [0.30, 1.73]) but not internalising (β = 0.87 [-0.06, 1.80]) behaviour problems. Evidence for an association of witnessing domestic violence with internalising (β = 0.63 [-0.97, 2.24]) or externalising (β = 1.23 [-0.04, 2.50]) behaviours was less robust. There was no association between community victimisation and internalising or externalising behaviours (β = 0.72 [-1.52, 2.97; β = 0.68 [ -1.06, 2.41]). Observations highlight the risk for mental health problems among preschoolers living in high-violence contexts and emphasize the need for early interventions.