Journal of Clinical Child and Adolescent Psychology最新文献

Suicide is a leading cause of death worldwide, and is one of the most devastating, complex, and perplexing of all human behaviors. Unfortunately, despite centuries of scientific and scholarly inquiry, suicidal thoughts and behaviors remain exceedingly difficult to understand, predict, and prevent. Fortunately, recent advances in mathematical, computational, and digital methods are providing new opportunities to capture and model the immense complexity of suicidal thoughts and behaviors. In this paper, we first provide a brief review of existing literature and then identify four priorities for future research, including: 1) rigorous conceptual and descriptive research, 2) formal theory development and refinement, 3) measurement in context and over time, and 4) prediction of group- and individual-level suicide risk. Finally, we discuss cross-cutting considerations related to ethical dilemmas, enhancing diversity, and training the next generation of scientists. Together, these future directions offer an actionable agenda to guide the future of suicide research and make meaningful progress toward reducing its global burden.

Objective: This evidence base update investigates the empirical support of psychosocial interventions for self-injurious thoughts and behaviors (SITBs) in youth, focusing on the period since the prior review.

Method: Two major scientific databases (PsycInfo and PubMed) were systematically searched to identify randomized controlled trials (RCTs) published or in press between June 1, 2018 and May 31, 2024.

Results: The search yielded 11 RCTs new to this update and 1 new SITB outcome to an RCT included in the prior review. Since the prior review, Dialectical Behavior Therapy for Adolescents (DBT-A) was reclassified as Level 1: Well-established intervention for reducing adolescent suicide attempts, and Family Therapy was reclassified as Level 2: Probably efficacious for reducing youth suicide ideation (SI). Cognitive behavioral therapy-individual + family was reclassified as Level 4: Experimental for reducing youth suicide attempts. Four new RCTs examining adjunctive skills or boosters for brief interventions were rated as Level 2: Probably Efficacious for reducing SI (adjunctive mindfulness skills + Psychodynamic therapy, adjunctive skills - emotion regulation) or Level 3: Possibly Efficacious for reducing SITBs (adjunctive safety planning interventions).

Conclusions: DBT-A remains the sole well-established intervention for reducing SITBs, with replication by multiple independent research teams. Half the RCTs identified in this review aimed to replicate or extend prior interventions. Several newly identified trials in this review were primarily adjunctive or brief, demonstrating greater efforts to enhance the availability of interventions for SITBs in youth. Further replication of these adjunctive treatments is needed to clarify their effectiveness and potential for widespread implementation.

Objective: Maternal depression is strongly linked to the development of depression in youth; however, most studies have examined this association as a unidirectional pathway over time. Emerging literature suggests that youth psychopathology, such as externalizing behaviors, can also influence parents' mood and symptoms, yet, the impact of youth depressive symptoms on parent depressive symptoms remains poorly understood.

Method: The current study included a sample of mother-child dyads (N = 2322) whose depressive symptoms were assessed across 5 time points, with measurements at 5 time points in early and middle adolescence. In terms of demographics, 47.7% of youth identified as female, 41.3% of participants identified as European American, 24.2% as African American, 12.4% as Latinx, and 12.8% as multiracial.

Results: Results show no significant effect of between-subjects, stable differences across time, but time-specific, within-dyad differences in depressive symptoms indicated bidirectional pathways between maternal and youth depressive symptoms across early and middle adolescence.

Conclusion: The results highlight the critical importance of examining bidirectional pathways of risk, which may implicate family functioning and interventions for youth depression. Interventions for youth depression typically do not reliably incorporate parents; however, as the current findings suggest, both parent and youth depression are mutually reinforcing, such a bidirectional perspective could prove to be beneficial in treatment.

Objective: While daring-impulsive (DI) traits have been deemed an important concept in subtyping youth with conduct disorder (CD) as part of a multispecifier model, no work has examined whether DI traits add to the existing practice of designating youth with CD beyond co-occurring attention-deficit/hyperactivity disorder (ADHD).

Method: This study examined the utility of DI traits (versus ADHD features) in a sample of 322 justice-involved adolescent boys (ages 16-17 years). In addition to a diagnostic interview to determine severity of CD, adolescents completed measures of DI, ADHD, as well as other relevant characteristics.

Results: Findings revealed differential associations between DI and ADHD in relation to indices of CD, externalizing psychopathology (i.e. reactive aggression, proactive aggression, substance use), internalizing psychopathology (i.e. anxiety, depression), and domains of impulsivity (i.e. positive urgency, negative urgency, sensation seeking, premeditation, perseverance). Additionally, over and above ADHD, DI contributed incremental information in explaining CD, externalizing psychopathology, positive urgency, sensation seeking, and lack of premeditation, but not internalizing psychopathology nor negative urgency and lack of perseverance. Of the 286 adolescents with CD, 114 (39.9%) were in the DI group and only 81 (28.3%) were in the ADHD group. Finally, differential correlates emerged between adolescents exhibiting CD alone, high CD and high DI traits, and high CD and high ADHD features.

Conclusions: Findings tentatively suggest DI traits and ADHD features are empirically distinct from each other in relation to CD and relevant characteristics and, therefore, improved clinical care for adolescents with CD will likely require differential consideration of DI and ADHD.

Objective: We examined the longitudinal effects of internet-delivered PCIT (iPCIT) on caregiver and child imitation in young Hispanic/Latine children with developmental delay (DD). We also examined the moderating roles of acculturation and enculturation on such treatment effects.

Method: Three-year-old, Hispanic/Latine children aging out of early intervention services for developmental delay (n = 98) and their primary caregivers were randomized to receive iPCIT or referrals as usual (RAU) in the community. Caregiver and child imitation were observationally coded during a 5-min child-directed play situation, which occurred during home-based evaluations at four timepoints - i.e. Baseline, Post, 6-month follow-up, and 12-month follow-up.

Results: Treatment effects were significantly moderated by caregiver acculturation. Specifically, iPCIT was associated with greater caregiver and child imitation among families reporting higher, but not lower, levels of caregiver acculturation. However, caregiver enculturation did not moderate the effects of iPCIT on either caregiver or child imitation.

Conclusions: Findings suggest parenting intervention effects on levels of imitation were particularly strong for Hispanic/Latine caregivers reporting higher levels of acculturation. This highlights the promotive role acculturative identity can play in boosting parenting intervention effects, particularly those of caregiver and child imitation. Findings also underscore the importance of assessing cultural factors to better inform personalized care and skill acquisition among Hispanic/Latine samples. Future research is needed to identify mechanisms that help explain precisely how cultural identity factors, such as acculturation and enculturation, can boost treatment-related imitation gains for Hispanic/Latine children with DD and their families.

Objective: To determine the proportion and profile of preschoolers on the autism spectrum who do not acquire spoken language despite receiving evidence-supported interventions that target spoken language.

Methods: We examined an aggregate dataset comprising 707 preschoolers on the autism spectrum who had received evidence-supported interventions to determine the proportion and profile of those who experienced limited progress in spoken language. Interventions were delivered through programs affiliated with university research settings and ranged in duration from 6 to 24 months. Spoken language outcomes were determined from parent-report measures, which were validated against direct assessments and natural language samples.

Results: Approximately two-thirds of children who were non-speaking at baseline were using single words or more complex spoken language by intervention exit. Those who remained non-speaking had lower baseline motor imitation scores, derived mainly from parent reports. Approximately half of the children who were minimally speaking (i.e. had single words or no words) at baseline were combining words by intervention exit. Those who did not acquire word combinations had lower baseline scores in cognitive, social, adaptive and motor imitation measures, and shorter intervention duration. Age at intervention start influenced spoken language advancement differently depending on the initial spoken language level. The odds of acquiring spoken language did not differ based on the intervention received.

Conclusions: Approximately one-third of children who had limited or no spoken language at baseline did not advance to spoken language stages following intervention. Development of spoken language was associated with modifiable factors at the child and intervention level.

Objective: While suicidal behaviors among adolescents declined from 1991 to 2017, suicides among Black youth increased. There is limited research on suicidal help-seeking behaviors among Black adolescents, which is essential for effective suicide prevention and intervention. This study examined suicidal help-seeking behaviors and treatment preferences among Black youth and caregivers, using the Psychological Framework of Radical Hope to explore strategies for fostering hope and healing.

Methods: This qualitative study included Black youth (ages 14-19), caregivers, health and mental health providers, and community members (N = 55). Participants were predominantly Black (96%) and female (53%), with ages ranging from 14 to 68 years. Semi-structured interviews, conducted in 60-90-min virtual focus groups, explored experiences with suicidal help-seeking, service needs, and support preferences. Constant comparative methodology was employed to organize and categorize data into themes.

Results: Youth balanced ideas of faith and agency toward help-seeking behaviors. In contrast, caregivers, providers, and community members were less optimistic about the service needs of Black youth being met largely due to historical and current experiences with systemic barriers. Participant groups discussed how collective memory informs their experiences and inspires them to have hope for positive change.

Discussion: Suicide-specific interventions should integrate strategies for fostering hope, faith, and agency individually and collectively with diverse groups to support Black youth suicidal help-seeking behaviors. Clinical strategies are provided to support the design of interventions to effectively address suicidal help-seeking behaviors for Black youth and their caregivers.

Objective: Lesbian, gay, bisexual, transgender, and queer/questioning (LGBTQ+) youth experience known inequities in mental health outcomes, including depression and suicidality. The Promoting Wellbeing & Resilience (PWR) class is an interactive, developmentally tailored group that provides strength-based, practical skills to LGBTQ+ teenagers with depression. It is designed to be implemented by paraprofessionals to increase community-based access to care.

Method: Investigators developed and piloted an eight-session cognitive-behavioral class for LGBTQ+ youth (N = 21) ages 12 to 17 (M = 14.8 years, 81% Caucasian, 57% gender diverse, 100% non-heterosexual) with depression symptoms. The youth received training in mood regulation, communication skills, stress management, and goal setting in a small group format (5-8 youth per group). Outcomes were youth-reported depression (primary), anxiety, and trauma symptoms at pre-treatment and post-treatment. Paired sample (dependent) one-tailed t-tests were used to examine treatment effects. Focus groups were also conducted with participants to assess satisfaction and collect qualitative feedback regarding class content and format.

Result: The resilience class was associated with reductions in depression symptoms post-treatment (t(17) = 3.3, p = .002, d = 0.5) but not anxiety (t(17) = 1.8, p = .049, d = 0.3) or trauma symptoms (t(17) = 1.2, p = .118, d = 0.1). Completion rates for all group sessions were high (95%), and the majority (57%) of participants returned for an optional review session.

Conclusion: Preliminary results suggest a manualized 8-week skills-based cognitive-behavioral group intervention designed to be delivered by paraprofessionals may be effective at reducing depression symptoms in actively depressed LGBTQ+ youth.

Objective: To examine differences in parenting factors among caregivers with children with and without externalizing behavior problems (EBP) in a community homeless shelter sample versus a stable housing sample.

Method: Nine hundred and fourteen children (ages = 2.01-7.49 years, SD = 1.45 years, 40.8% female, 54.3% Black, 46.7% Hispanic) were recruited from a service-driven research project in a shelter setting (n = 638) and a longitudinal/clinical study (n = 276). Primary caregivers (97% mothers) completed a parenting stress questionnaire and an observational measure of parent-child interactions.

Results: Logistic regression indicated that children who were Black and/or of Hispanic background were less likely to be identified as having elevated EBP but only in the homeless shelter sample. Multivariate analyses indicated that the homeless shelter-EBP group reported the highest levels of overall stress compared to the homeless shelter-typically developing (TD), stable housing-EBP and stable housing-TD groups. Mothers from the homeless shelter-EBP group exhibited a higher proportion of negative verbalizations relative to caregivers from all other groups while mothers from the homeless shelter-TD group exhibited a higher proportion of positive verbalizations relative to the caregivers from the homeless shelter-EBP group and the stable housing TD group. Both homeless shelter groups engaged in less total verbalizations relative to both stable housing samples, with the stable housing-EBP group exhibiting the most verbalizations.

Conclusions: High levels of parenting stress and negative parent-child interactions within a homeless shelter sample are exacerbated by having a child with EBP. Embedding universal parenting programs in a homeless shelter setting to reduce parenting stress would be valuable to address health disparities in this vulnerable population.