Research on Child and Adolescent Psychopathology最新文献

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.

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.

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.

Parental practices and stress are associated with both CU and autistic traits, with parents of children with these traits facing challenges that other parents do not encounter. However, the majority of available studies focused mainly on the unique effects of CU and autistic traits with parental stress and practices without exploring their interaction. The current study examines the distinct associations and interactions between CU and autistic traits with parental practices (parental involvement, poor monitoring, inconsistent discipline, and corporal punishment), care, and distress after considering the effect of conduct problems (CPs), age and sex in a Greek-Cypriot sample (N = 146, Mage = 7.30, SD = 1.43). Hierarchical multiple regression analysis revealed that children with CU traits were more likely to experience negative parenting, while parents showed heightened levels of distress. Notably, the study found no association between CU traits and positive parental practices. Further analysis indicated no significant relation between autistic traits and interactions with the target variables, signifying that these traits are not associated with difficulties in parenting and distress. No sex differences were found in all analyses. Age was negatively significant only in relation to parental distress These findings provide valuable insights into the impact of CU traits and underscore the need for additional studies investigating the impact of autistic traits, possibly within clinical samples.

The present study investigated the relations between maternal depressive symptoms and internalizing problems in offspring during late childhood and early adolescence, examining sex differences using symptom network analysis. A total of 885 Chinese youths in late childhood (n = 497, 38.6% girls; age = 9.58 years, SD = 0.24) and early adolescence (n = 388, 48.5% girls; age = 11.30 years, SD = 0.24) and their mothers (M_age = 37.34 years, SD = 5.42) were recruited. Cross-lagged panel network (CLPN) analysis was used to explore bridge symptoms (i.e., symptoms connecting two or more mental disorders) and identify transmission pathways between maternal depressive symptoms and offspring's internalizing problems at these two developmental stages. The CLPN results revealed that in late childhood, the bridge connections in the network model were boys feeling worried to mothers feeling distractible, and girls feeling worried to mothers feeling powerless. In early adolescence, the bridge connections were boys experiencing depressed mood to mothers feeling powerless, and mothers feeling bad to girls experiencing depressed mood. These findings highlight the network-level relations between maternal depressive symptoms and offspring internalizing problems. They provide insights into the developmental differences and similarities in symptoms during these periods and suggest ways to break the vicious cycle of psychopathology between mothers and their children.

Adolescence is a developmental period in which social interactions are critical for mental health. While the onset of COVID-19 significantly disrupted adolescents' social environments and mental health, it remains unclear how adolescents have adapted to later stages of the pandemic. We harnessed a machine learning architecture of Long Short-Term Memory recurrent networks (LSTM) with gradient-based feature importance, to model the association among daily social interactions and depressive symptoms during three stages of the pandemic. A year before COVID-19, 148 adolescents reported social interactions and depressive symptoms, every day for 21 days. One hundred sixteen of these youths completed a 28-day diary after schools closed due to COVID-19. Seventy-nine of these youths and additional 116 new participants completed a 28-day diary approximately a year into the pandemic. Our results show that LSTM successfully predicted depressive symptoms from at least a week of social interactions for all three waves (r² > .70). Our study shows the utility of using an analytic approach that can identify temporal and nonlinear pathways through which social interactions may confer risk for depression. Our unique analysis of the importance of input features enabled us to interpret the association between social interactions and depressive symptoms. Collectively, we observed a return to pre-pandemic patterns a year into the pandemic, with reduced gender and age differences during the pandemic closures. This pattern suggests that the system of social influences in adolescence was affected by COVID-19, and that this effect was attenuated in more chronic stages of the pandemic.

Social anxiety is common in childhood and potentially transitions into clinical disorders including depression. The present study aimed to examine the effectiveness of an indicated prevention program for children screened in routine care. Data came from the PROMPt project, a prospective implementation study (10/2018-09/2022) that explored a novel care chain, starting with screening with the Strengths and Difficulties Questionnaire (SDQ) as part of regular health check-ups, followed by indicated assignment and participation in a prevention program. Questionnaires assessing anxiety and depression symptoms were administered shortly after screening or before program participation (T0), six months after screening or after program participation (T1) and at a follow-up, six months after T1 (T2). Children who participated in a group cognitive-behavioral social skills program (TT; n = 145) were compared using mixed model analyses with non-participating children who were either screened as normal (NOR; n = 894) or refused program participation despite indication (NoTT; n = 67). TT scores improved from T0 to T1 compared to NOR and NoTT (anxiety β = -0.71 and β = -0.71, social anxiety β = -0.46 and β = -0.52, depression β = -0.52 and β = -0.73). Improvement was maintained at T2. Moderation analyses showed a trend toward greater benefit for participants with higher baseline scores. Indicated prevention can improve anxiety and depression symptoms in children identified by screening in routine care. Systematic screening and targeted prevention may positively affect mental health of children on a population level.

Research on the link between peer victimization and callous-unemotional (CU) traits has primarily relied on cross-sectional designs and yielded equivocal findings. In light of the poor outcomes related to peer victimization and CU traits, it is important to determine whether this link is reciprocal in nature and to identify factors that may influence its strength. Accordingly, the current study investigated the bidirectional association between peer victimization and CU traits over a 6-month period, accounting for the moderating effects of parents (i.e., support and hostility) and teachers (i.e., support and conflict). Participants included 284 third- through fifth-grade students (ages 7-12; 51.8% boys; 51.1% Hispanic) and their homeroom teachers. Children provided ratings of peer victimization, parental hostility, and parent and teacher support. Teachers provided ratings of CU traits and student-teacher conflict. A series of cross-lagged panel models were estimated. Results revealed that, at higher levels of parental hostility, peer victimization predicted increases in CU traits over time; in contrast, peer victimization predicted decreases in CU traits at lower levels of parental hostility. Surprisingly, at higher levels of teacher conflict, peer victimization predicted decreases in CU traits over time. CU traits did not interact with parent or teacher variables to predict subsequent peer victimization. Moreover, parental hostility was positively associated with subsequent peer victimization, whereas teacher support predicted decreases in victimization over time. These findings build on previous research examining environmental influences on the expression of CU traits by highlighting peer victimization and parental hostility as potential risk factors.

Although pre-treatment assessments of the capacity for the psychotherapy process can aid in identifying patients experiencing great difficulties in therapy and in tailoring therapies for individual patients, limited information exists for adolescents. To address this gap, this study followed the World Health Organization's age standards for adolescents (younger adolescents aged 10-14 years; older adolescents aged 15-19 years), examined the psychometric properties of the Capacity for Psychotherapy Process Scale (CFPPS; mainly used for adult patients) in these two groups of adolescents, and compared their capacities for the psychotherapy process. The participants were 434 younger adolescent (mean age = 13.00 ± 1.08 years; 70.0% female) and 883 older adolescent outpatients (mean age = 16.68 ± 1.29 years; 62.3% female) at the department of psychiatry of the hospital in Guangzhou, China. The results of exploratory and confirmatory factor analyses validated the 5-factor model (motivation, belief, self-revelation, persistence, and insight) in both groups. The scale also demonstrated good internal consistency. Furthermore, the CFPPS exhibited small or no associations with pre-treatment sleep problems, depression symptoms, or anxiety symptoms but was a significant predictor of working alliance and psychological benefit in therapy. The capacity for the psychotherapy process among younger adolescents was lower than that among older adolescents. The CFPPS appears to be a reliable and validated instrument for measuring the capacity for the psychotherapy process among adolescent outpatients in China. Therapists should provide therapy tailored to the Chinese adolescents' capacity. Future studies are needed to examine the predictive utility of the CFPPS for the whole sessions of the psychotherapy.