Scandinavian Journal of Child and Adolescent Psychiatry and Psychology最新文献

Background: Several systematic reviews have demonstrated the efficacy of cognitive behavioral therapy (CBT) treating anxiety disorders in children and adolescents (hereafter referred to as youths). Treatment of anxiety disorders conducted by student therapists (ST) has been found to be an effective alternative, to treatment conducted by psychologists.

Objective: The primary aim of the study is to investigate the effects of ST treating youths, using a group-based CBT program. Second, the study aims to compare these results with outcomes achieved by professional-therapists (PT).

Method: The study investigate in an open trial design, the treatment outcome from a manualized CBT program (Cool Kids) in a group of youths (n = 54) treated by ST. Results are benchmarked against the outcomes of a group of youths (n = 56) treated by PT using the same program, derived from a separate randomized controlled trial.

Results: There was a significant reduction of both self-reported and clinician rated measures of youth anxiety over time in the ST group, with small to large effect sizes. No significant differences of improvements in self-report measures were found between the ST and the PT groups. There was no significant difference in remission rates for participants' primary anxiety disorder between the ST (50.0%) and the PT (66.1%) at post-treatment or at three-month follow-up (ST: 74.1%, PT: 76.8%). There was a significant difference regarding number of youths free of all anxiety disorder between the ST (14 [25.9%]) and PT (27 [48.2%]) group at post-treatment. This difference was not significant at three-month follow-up (ST: 25 [46.3%], PT: 33 [58.9%]).

Conclusion: The findings support previous findings, suggesting that student-therapists, receiving training and supervision, can successfully treat youths with anxiety disorders using a manualized CBT program. The outcomes following CBT treatment conducted by ST are comparable to outcomes achieved by PT.

Background: The results of several international studies indicate a high prevalence of language and communication impairments among children who are referred to child psychiatric services. However, these impairments are likely to remain undetected unless language and communication impairments are evaluated during the psychiatric assessment.

Aims: The aim of the present study is to investigate the specific association between general and specific mental health problems, as expressed by the problem scales of Child Behavior Checklist (CBCL) and Teachers Report Form (TRF), and pragmatic skills and pragmatic language impairments (PLI) as defined the Pragmatic Composite of the Child Communication Checklist (CCC-PC).

Methods: Children aged from 8 to 13 years (n = 73) were recruited in sequence following referral to a child and adolescent psychiatry (CAMHS) outpatient clinic within 12 months. Children with possible or established autism or intellectual disability were excluded. Standardized instruments measuring language, communication and mental health symptoms were distributed to parents and teachers, an intelligence test administered for clinical purposes, and demographic information was included.

Results: The parent reports showed PLI among 38% of the children and revealed strong associations with the CBCL scales for emotional problems, thought problems and, especially, social and withdrawal symptoms, which mean more associations to internalized and non-externalized problems. PC-scores were at similar levels and PLI was reported by teachers at similar rates (compared to parent reports) with moderate agreement. Teacher PC-scores showed associations to only one TRF-scale, social problems. The CCC-PC subscale with the strongest associations to mental health symptoms was «Use of Context» («Social Relationships» do not contribute to the CCC-PC scores).

Conclusion: There was a general increase in PC-scores and increased prevalence of PLI in this clinical sample. PC-scores correlated with symptom scores for internalizing and non-externalizing problems scales. The strongest common factors appear to be related to the social aspects of mental health. Pragmatic skills should be considered as a protective factor for mental health rather than investigating pragmatic impairment as a risk or vulnerability factor.

Background: ADHD causes impairment in several life contexts and may increase stress and burden of care amongst family members. There is a lack of studies regarding gender inequalities in burden sharing in families of individuals with ADHD.

Objective: The aim of this study was to investigate gendered burden sharing in families who were in contact with an ADHD telephone helpline in Sweden. A further aim was to identify perceived difficulties that prompted contact with the helpline.

Methods: During a period of 28 months (from January 2013 to April 2015), calls were consecutively registered by psychologists manning the helpline through an anonymous digital form. After exclusion of 60 incomplete forms out of 1,410 (4%), information on 1,350 calls was analysed.

Results: The analysis indicated that mothers (82.7% of all callers) had a more important role as information-coordinators for children or adolescents with ADHD, as compared to fathers (13%) or other callers (4.3%). This pattern was also observed among the calls regarding young adults with ADHD. Helpline calls primarily concerned entitlement to academic support (57.9% of calls concerning children or adolescents) and healthcare services (80.6% of calls concerning young adults and adults).

Conclusion: The study concludes that a perceived lack of accessibility to and/or coordination of the school and health care services may be a major stressor for parents of individuals with ADHD. The burden of care through coordination of services and information-seeking may be especially increased in mothers of children, adolescents, and young adults with ADHD.

Background: Stress is an important variable of consequence, particularly in adolescence, a period of intense physical and psychological change. The measurement of stress in adolescence has been widely discussed, and a number of versions of the Adolescent Stress Questionnaire (ASQ) have been developed and validated. The present study sought to examine the psychometric properties (model fit, invariance, internal consistency, and construct validity) of the ASQ-S, which was recently developed in a Swedish context.

Objective: The study was a secondary analysis of data gathered on the full ASQ. The ASQ-S retained nine of the ten ASQ scales, and a study in Swedish adolescents suggested that the scale was psychometrically valid, gender invariant, and that scores were internally consistent. This is the first study to examine the properties of the ASQ-S in an English-speaking population. Participants were high school children in the UK (N = 610, 61.0% girls) from school year 8 through 12.

Results: Confirmatory factor analysis (CFA) revealed that the nine factor solution fit the data well (χ^2s-b(288) = 751.60, CFI = 0.958, TLI = 0.948, SRMR = 0.040, RMSEA = 0.051 [90% CI = 0.047, 0.056]), and that scores were gender, school type (academic versus comprehensive), and school stage (junior versus middle high school) invariant. The nine scales correlated negatively with academic, social, and emotional self-efficacy scores, and self-esteem scores, to varying degrees. Girls reported higher stress levels than boys in six of the nine scales. A regression analysis, adjusted for gender and year in school, suggested that only the stress of peer pressure (negatively) was significantly related to adolescent alcohol use.

Conclusions: Overall this study suggests that the ASQ-S could be a valid measure of adolescent stress, although concerns remain regarding the convergent validity of scale scores.

Background: Interpersonal trust is an important target for the conceptualization, identification, and treatment of psychiatric disorders marked by interpersonal difficulties. A core feature of adolescent externalising disorders is interpersonal impairment. However, research investigating trust is scarce. A relatively novel approach for studying trust in psychopathology is through examination of social decision making using behavioural economic games.

Objective: To employ a modified trust game in order to determine whether externalising adolescents exhibit perturbed decision making in social and/or nonsocial contexts.

Methods: Externalising inpatient adolescents (n = 141) and non-externalising psychiatric controls (n = 122) completed self-report measures of psychopathology and invested in an iterative trust game played under two conditions: social (trust) and nonsocial (lottery condition), each consisting of five consecutive trials.

Results: Externalising adolescents showed a limited increase in trust investments, compared to a significant increase in lottery investments, across early game trials relative to psychiatric controls. This significant three-way interaction between experimental group, game condition, and trials became most evident at the second trial of games. Between-group differences on trust investments were non-significant. However, externalising adolescents invested significantly less in the trust relative to lottery condition, an effect unobserved in psychiatric controls.

Conclusions: This study tentatively suggests that adolescent externalising disorders may be associated with an insensitivity to normative social exchange which may arise, in part, from a lack of anticipated co-player reciprocity. It is not the level of trust that may distinguish externalising adolescents but perhaps the form of which the trust exchange takes shape. Conclusions are tempered by the fact that the employed trust game did not include feedback in the form of co-player repayments.

Background: The Therapeutic Reactance Scale (TRS) is a classic measure of psychological reactance, yet only two studies have evaluated its factorial structure. Both proposed different multidimensional structures based on exploratory analyses. Not only is the factorial structure of the TRS unclear, but the scale has yet to be validated in adolescents.

Objective: This study aimed to test the factorial structure of the TRS in adolescents.

Methods: The authors conducted exploratory and confirmatory factor analyses, and analyses of reliability and validity, with a sample of 1,344 adolescents.

Results: A four-factor model fits well to the data. Three of the four TRS dimensions (not susceptibility to influence, SI) were correlated with the Hong Psychological Reactance Scale (HPRS). These three dimensions were also correlated with novelty seeking, cooperativeness and persistence components of personality (Cloninger's psychobiological model of personality), while SI showed a different pattern.

Conclusions: Overall, this study demonstrates that the TRS is a suitable and potentially useful tool for measuring reactance in adolescents, but the authors propose that practitioners may wish to consider excluding items pertaining to the SI dimension.

Background: Multiple and complex needs (MCN) in children and youth jeopardize their development and pose significant challenges to the different professionals they meet. However, there is no agreed-upon definition of this vulnerable population.

Objectives: To develop a definition of 'MCN in children and youth' that is meaningful for all professionals involved in care delivery for this population.

Method: A cross-sector, multidisciplinary, and geographically spread panel of 47 experts representing mental health, youth care, juvenile justice, and education in Flanders participated in an online Delphi study. Qualitative analysis of answers in the first round yielded four definition possibilities that participants then ranked in the second round. In the last round, participants rated their agreement with the highest ranked definition. An additional survey asked 25 international experts to rate and comment their agreement with the final definition.

Results: The final definition was: Children and adolescents with profound and interacting needs in the context of issues on several life domains (family context, functioning and integration in society) as well as psychiatric problems. The extent of their needs exceeds the capacity (expertise and resources) of existing services and sequential interventions lead to discontinuous care delivery. As such, existing services do not adequately meet the needs of these youths and their families. Cross-sector, integrated and assertive care delivery is necessary for safeguarding the wellbeing, development and societal integration of these young people. Response rates to the three Delphi rounds were 76.6, 89.1, and 91.3%. The definition was widely endorsed among Flemish (93.2% agreement) and international experts (88% agreement).

Conclusion: A definition of MCN in children and youth was constructed using the Delphi method and further evaluated for international relevance in an additional survey. Such an agreed-upon definition can be valuable for optimizing care delivery and conducting research.

Background: Findings show that deficiencies in the ability to understand mental states are related to many forms of psychopathology. Mentalizing dysfunctions are suggested to be the core pathology underlying borderline personality disorder (BPD). Moreover, research suggests that BPD predicts psychopathology in general and findings display that diminished mentalization is related to a range of psychiatric disorders. As yet, no study has investigated the potential link between borderline personality features, mentalization and internalizing and externalizing psychopathology, and whether internalizing and externalizing psychopathology in BPD might be driven by impaired mentalization.

Objective: In a cross-sectional study, 109 patients referred to a child and adolescent psychiatric clinic were assessed with a battery of self-report instruments to asses borderline personality features, mentalization, and internalizing and externalizing psychopathology.

Method: Simple mediation model was used to examine whether mentalizing abilities mediated the relationship between borderline features and psychopathology in regard to externalizing and internalizing psychopathology in adolescents.

Results: The results indicated that mentalization mediated the relationship between borderline personality features and both externalizing and internalizing psychopathology in adolescents, indicating that mentalization underlie externalizing and internalizing psychopathology in adolescents with borderline personality features.

Conclusion: The current study is the first empirical study to evaluate mentalization as a mediating factor between adolescents who met full or sub-threshold criteria for BPD and psychopathology. Clinical implications are discussed.

Background: There exist only few developmentally sensitive assessment instruments for identifying posttraumatic stress disorder (PTSD) and other potentially comorbid affective and behavioral symptomatology in preschool children. Consequently, young children who exhibit post-trauma symptomatology risk not being identified and not receiving the appropriate treatment. One of the few instruments that exist is the Diagnostic Infant and Preschool Assessment (DIPA).

Objective: To examine internal reliability and convergent validity of the Danish version of the DIPA, a semi-structured interview of caregivers about their child's mental health.

Method: In total, 62 caregivers of trauma-exposed children aged 1-6 years were interviewed with the DIPA and completed the Strengths and Difficulties Questionnaire (SDQ).

Results: The children had experienced between one and eight traumas (Mdn = 3). Based on the DIPA, 48.4% of the children exhibited PTSD. The DIPA showed good to excellent internal consistency for the disorders of major depressive disorder, attention deficit hyperactivity disorder, oppositional defiant disorder, separation anxiety disorder and overall internal consistency of PTSD and reactive attachment disorder. Internal consistency was lower for each symptom cluster of PTSD and the overall consistency of sleep disorder with Cronbach's alpha ranging between 0.54 and 0.69. Correlations between continuous scores of eight disorders of the DIPA and SDQ scales provided support for convergent validity of the DIPA.

Conclusion: The study provides preliminary evidence to support the Danish version of DIPA as a valid measure of symptoms of young children exposed to psychological trauma. As a standardized assessment tool, the DIPA can aid in early and structured assessment of young children exposed to trauma and can help guide treatment for those in need.

Background: Scientific literature suggests that the prevalence of delinquency amongst adolescents has decreased internationally in past decades. However, whether this change is consistent across all socioeconomic groups has not yet been studied. Objective: The aim of this study was to examine changes in delinquency amongst Finnish adolescents according to socioeconomic status between 2000 and 2015. Method: A population-based school survey was conducted biennially amongst 14-16-year-old Finns between 2000 and 2015 (n = 761,278). Distributions for delinquency and socioeconomic adversities (low parental education, not living with both parents and parental unemployment in the past year) were calculated using crosstabs. Associations between delinquency, time, and socioeconomic adversities were studied using binomial logistic regression results shown by odds ratios with 95 % confidence intervals. Results: Delinquency was positively associated with all three socioeconomic adversities studied and cumulative socioeconomic adversity. Although the prevalence of delinquency varied only slightly between 2000 and 2015 in the overall population, it increased significantly amongst adolescents with most socioeconomic adversities. Conclusions: The findings indicate that socioeconomic differences in delinquency have increased amongst Finnish adolescents in past decades. Delinquency prevention and intervention programs should take socioeconomic adversities into account.