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

Background: The long-term negative consequences of mental health problems during adolescence highlight the need for effective treatments. Compassion-focused therapy (CFT) aims to help individuals to enhance their ability to support and care for themselves and to alleviate shame and self-stigmatization.

Objective: This non-randomized controlled trial examined the effectiveness of group-based CFT on perceived stress and the extent of self-compassion in a clinical sample of adolescents receiving psychiatric care for complex mental health difficulties and their parents.

Method: The participants were 43 adolescents (ages 14-17; 83.7 % female) under treatment at a child and adolescent psychiatric outpatient clinic in Sweden and their parents (n = 77; 61 % female). The adolescents volunteered for group-based CFT (n = 19); if they did not want to participate, they were asked to join the control group receiving treatment as usual (TAU, n = 24). The CFT parents were given the same treatment as their children in parallel parent groups. The participants completed questionnaires measuring self-compassion and perceived stress before and after treatment. Paired samples t-tests and independent samples t-tests assessed the within-group and between-group differences via change scores.

Results: The fathers scored highest on self-compassion and had less perceived stress at both times than the adolescents or mothers. There were no significant differences between the CFT and TAU groups in self-compassion or perceived stress at either time, and the effect sizes were small (g ≤ 0.25). The TAU mother group was the only group with a significantly changed mean self-compassion score post-treatment.

Conclusions: Some patients seem to benefit from group-based CFT in ways similar to the benefits of specialized therapeutic approaches. Further research into the utility of CFT for adolescents with MH problems and their parents, as well as the long-term clinical effects of CFT for this group is needed.

Background and objective: Cyberbullying is increasingly turning into a significant problem for children and adolescents due to its adverse psychological and academic outcomes. In the present study, the protective and risk factors for cyberbullying has been investigated. One of the aims of the study was to examine the relationship between peer relations, negative emotion regulation strategies, and cyberbullying. The successful identity development process is thought to influence both cyberbullying behaviors as well as adolescents' peer relations and emotion regulation. Also, cyber victimization is seen as a risk factor for cyberbullying. The second aim of the study is to investigate the causal relationship between cyber victimization and cyberbullying.

Method: The study is a descriptive research in which both cross-sectional and longitudinal data were used. In the cross-sectional part of the study, 1,151 adolescents have participated, and the data of the second wave was obtained from 322 of them four months later. Data were analyzed through structural equation modeling (SEM) and hierarchical regression analyses.

Results and conclusion: According to the results of SEM, good peer relations predicted less cyberbullying. The expressive repression explained the cyberbullying through peer relationships. For identity development, contrary to expectations, commitment dimension of identity seemed to be positively related to more cyberbullying and so did higher reconsideration of commitment. Cross-lagged panel analyses revealed that Time 1 cyber victimization predicted Time 2 cyberbullying. Given the pattern of cross-lagged relationships, it was tentatively inferred that cyber victimization was the temporal precursor to cyberbullying. The results of the study have implications for the prevention of cyberbullying.

Background: Mothers' and fathers' internalizing symptoms may influence children's anxiety symptoms differently.

Objective: To explore the relationship between parental internalizing symptoms and children's anxiety symptoms in a clinical sample of children with anxiety disorders.

Method: The sample was recruited through community mental health clinics for a randomized controlled anxiety treatment trial. At pre-intervention, children (n = 182), mothers (n = 165), and fathers (n = 72) reported children's anxiety symptoms. Mothers and fathers also reported their own internalizing symptoms. The children were aged 8 to 15 years (M _age = 11.5 years, SD = 2.1, 52.2% girls) and all had a diagnosis of separation anxiety, social phobia, and/or generalized anxiety disorder. We examined parental internalizing symptoms as predictors of child anxiety symptoms in multiple regression models.

Results: Both mother and father rated internalizing symptoms predicted children's self-rated anxiety levels (adj. R ² = 22.0%). Mother-rated internalizing symptoms predicted mother-rated anxiety symptoms in children (adj. R ² = 7.0%). Father-rated internalizing symptoms did not predict father-rated anxiety in children.

Conclusions: Clinicians should incorporate parental level of internalizing symptoms in their case conceptualizations.

Background: Sleep affects psychiatric health and perceived stress during adolescence.

Objective: The first aim of this study was to investigate the prevalence of poor sleep in a sample of Swedish adolescents aged 15 to 19 years. The second aim was to investigate correlations between: a) sleep and psychiatric symptoms and; b) sleep and perceived stress. The third aim was to examine possible sex differences in sleep.

Method: In 2011, a total of 185 Swedish adolescents (aged 15 to 19 years) from two upper secondary schools participated in this cross-sectional study. We used three different psychometric scales: Pittsburgh Sleep Quality Index (PSQI), Symptoms Checklist (SCL-90), and Perceived Stress Scale (PSS) to measure sleep, general psychiatric health and perceived stress.

Results: In total, 76% of the female students and 71% of the male students had poor overall sleep quality. A large majority, 93%, reported daytime dysfunction and 60% reported problems staying awake during daily activities. The correlation between sleep and general psychiatric health was 0.44 and the correlation between sleep quality and perceived stress was 0.48. Female students reported significantly more sleep disturbances than male students do.

Conclusions: Three out of four of the upper secondary school students presented with poor overall sleep that associated with psychiatric symptoms and perceived stress. These findings add to results from earlier studies and imply that interventions to improve sleep in adolescents, individually as well as on a societal level, should be considered as one way of trying to impact the observed rising numbers of psychiatric complaints. Such interventions may improve mental and somatic health in adolescents and prevent the development of psychiatric and stress-related symptoms. Further studies of possible methods, and their implementation, for improving sleep in adolescents should be of high priority.

Attention Deficit Hyperactivity Disorder (ADHD) is not a singular concept. For the purposes of this study, understandings of ADHD are assumed also to spread along a conceptual dimension that includes some combination of biomedical and psychosocial knowledge. Biomedically, ADHD may be considered a somatic affliction causing inattention and hyperactivity, amenable to pharmaceutical treatment. Psychosocially, ADHD ranks among adverse behaviour patterns that are amenable to psychosocial and pedagogical intervention. Considering both biomedical and psychosocial factors are associated with the ADHD construct, it seems self-evident that young people should be offered information that gives equal consideration to both ways of addressing ADHD, but the question is just how balanced the information available to young people is. This study investigated nine information books on ADHD available in the Netherlands in Dutch, aimed at children and young people up to age 17. Thirteen perspective-dependent text elements were identified in qualitative content analysis. Eight attributes associate with a biomedical view: ADHD as cause, biological factors, clinical diagnosis, brain abnormality, medication, neurofeedback, heritability and persistence. Five text elements associate with a psychosocial view: ADHD as perceived behaviour, environmental factors, descriptive diagnosis, behavioural intervention and normalisation. The most frequent text passages encountered describe ADHD as a brain abnormality, along with medical and behavioural treatment. Providing the main focus for information in eight out of nine books, biomedical information about ADHD predominates in the available youth information books, while psychosocial information about ADHD is far less well covered.

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: 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: 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: 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: 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.