Journal of Clinical Child and Adolescent Psychology最新文献

Objective: Depression disparities between heterosexual youth and lesbian, gay, bisexual, queer, and other non-heterosexual (LGBQ+) youth are robust and linked to discrimination in schools. Advocacy by school-based Gender-Sexuality Alliances (GSAs) to raise awareness of LGBQ+ issues and to counteract discrimination may reduce these disparities within schools, yet has not been investigated schoolwide. We considered whether GSA advocacy over the school year moderated sexual orientation differences in depressive symptoms at the school year's end for students in the general school population (i.e., students who were not members of the GSA).

Method: Participants were 1,362 students (M_age = 15.68; 89% heterosexual; 52.6% female; 72.2% White) in 23 Massachusetts secondary schools with GSAs. Participants reported depressive symptoms at the beginning and end of the school year. Separately, GSA members and advisors reported their GSA's advocacy activities during the school year and other GSA characteristics.

Results: LGBQ+ youth reported higher depressive symptoms than heterosexual youth at the school year's beginning. However, after adjusting for initial depressive symptoms and multiple covariates, sexual orientation was a weaker predictor of depressive symptoms at the school year's end for youth in schools whose GSAs engaged in more advocacy. Depression disparities were significant in schools whose GSAs reported lower advocacy, but were statistically non-significant in schools whose GSAs reported higher advocacy.

Conclusion: Advocacy could be a means by which GSAs achieve school-wide impacts, benefiting LGBQ+ youth who are not GSA members. GSAs may therefore be a key resource for addressing the mental health needs of LGBQ+ youth.

Objective: Internalizing problems are common in adolescence and increased substantially during the COVID-19 pandemic. Although rates of anxiety and depression have since improved, the general increase in the prevalence of mental health problems and disruptions to mental health services during the COVID-19 pandemic has resulted in huge gaps in care. Although research has primarily focused on proximal correlates of internalizing problems, a growing literature suggests that factors outside youths' immediate microsystems are equally crucial for their mental well-being. Thus, it is important to investigate multisystemic correlates of internalizing problems to inform individual and community-based interventions to address the current mental health burden.

Method: Leveraging secondary data from a nationally diverse U.S. sample of 2,954 adolescents (ages 13-16), we examined the associations between factors at multiple levels of youths' ecologies - spanning indicators of threat and deprivation - and their depression and anxiety symptoms during the COVID-19 pandemic. Furthermore, in follow-up exploratory analyses, we examined if these associations differed by adolescents' racial/ethnic groups.

Results: Consistent with socioecological models, we found that indicators of threat and deprivation in the adolescents' immediate home and more distal neighborhood environments were associated with depression and anxiety symptoms. The patterns of associations were similar across racial/ethnic groups in multigroup structural equation models. Additionally, we found that mean levels of internalizing symptoms and socioecological predictors significantly differed across racial/ethnic groups.

Conclusion: These findings have important implications for understanding multi-level contributors to adolescent mental health, which may inform research, practice, and policy.

Objective: Ample evidence demonstrates that structural stigma - defined as societal-level conditions, cultural norms, and institutional policies and practices that constrain opportunities, resources, and well-being of stigmatized populations - is associated with psychopathology in adults from marginalized groups. Yet there is limited research on whether structural stigma is similarly associated with internalizing and externalizing symptoms among youth.

Method: Structural stigma related to sex, sexual orientation, race, and Latinx ethnicity was measured using indicators of state-level policy and aggregated attitudes. Using data from the Adolescent Brain Cognitive Development (ABCD) Study (N = 10,414; M age = 12 years, SD = 0.66; 48% female, 6.8% lesbian, gay, and bisexual (LGB), 13.4% Black, 20% Latinx), we examined associations of structural stigma with internalizing and externalizing symptoms among female, LGB, Black, and Latinx youth.

Results: LGB youth living in higher (vs. lower) structural stigma states had elevated levels of internalizing and externalizing symptoms. In lower structural stigma states, there were no differences in externalizing symptoms between LGB and heterosexual youth. Similarly, Latinx youth and females living in higher (vs. lower) structural stigma states had elevated levels of externalizing symptoms. In lower structural stigma states, there were no differences in externalizing symptoms between Latinx youth and non-Latinx White youth. Structural stigma related to race was unrelated to internalizing or externalizing symptoms for Black youth.

Conclusions: This study provides novel evidence that macro-level social environments, in the form of structural stigma, contribute to adverse mental health outcomes for marginalized youth and partly explain disparities in externalizing symptoms.

Objective: Cognitive disengagement syndrome (CDS) includes excessive daydreaming, mental confusion, and hypoactive behaviors that are distinct from attention-deficit/hyperactivity disorder inattentive (ADHD-IN) symptoms. A growing number of studies indicate that CDS symptoms may be associated with ratings of social withdrawal. However, it is important to examine this association in children specifically recruited for the presence or absence of CDS, and to incorporate multiple methods including direct observations of peer interactions. The current study builds on previous research by recruiting children with and without clinically elevated CDS symptoms and using a multi-method, multi-informant design including recess observations and parent, teacher, and child rating scales.

Method: Participants were 207 children in grades 2-5 (63.3% male), including 103 with CDS and 104 without CDS, closely matched on grade and sex.

Results: Controlling for family income, medication status, internalizing symptoms, and ADHD-IN severity, children with CDS were observed during recess to spend more time alone or engaging in parallel play, as well as less time involved in direct social interactions, than children without CDS. Children with CDS were also rated by teachers as being more asocial, shy, and socially disinterested than children without CDS. Although children with and without CDS did not differ on parent- or self-report ratings of shyness or social disinterest, children with CDS rated themselves as lonelier than children without CDS.

Conclusions: Findings indicate that children with CDS have a distinct profile of peer functioning and point to the potential importance of targeting withdrawal in interventions for youth with elevated CDS symptoms.

Objective: Sleep is crucial to overall health, playing a complex role in a wide range of mental health concerns in children and adults. Nevertheless, clinicians may not routinely assess sleep problems due to lack of awareness or limitations such as cost or time. Scoring sleep-related items embedded on broader scales may help clinicians get more out of tools they are already using. The current study explores evidence of reliability, validity, and clinical utility of sleep-related items embedded on two caregiver-report tools: the Child Behavior Checklist (CBCL) and Parent General Behavior Inventory (P-GBI).

Method: Youth aged 5-18 years and their parents were recruited from both an academic medical center (N = 759) and an urban community health center (N = 618). Caregivers completed the CBCL and P-GBI as part of a more comprehensive outpatient evaluation. Exploratory factor analyses, multi-group confirmatory factor analyses, and graded response models evaluated dimensionality, reliability, and invariance across samples. Correlations and receiver operating characteristic curve analyses probed associations with diagnostic and demographic variables.

Results: Two subscales emerged for each itemset. Across both samples, P-GBI sleep subscales were more reliable and consistent than CBCL sleep subscales, showed greater coverage of sleepiness and insomnia constructs, were better at discriminating individuals within a wider range of sleep complaints, and showed significant correlation with mood disorder diagnoses.

Conclusions: The P-GBI sleep items provide a brief, reliable measure for assessing distinct dimensions of sleep complaints and detecting mood symptoms or diagnoses related to the youth's sleep functioning, making them a useful addition to clinical practice.

Objective: The identification of a common set of symptoms for assessing cognitive disengagement syndrome (CDS, formerly sluggish cognitive tempo) for early childhood (ages 5-8), middle childhood (ages 9-12), and adolescence (ages 13-16) is needed to advance research on the developmental psychopathology of CDS (i.e. a common symptom set with comparable internal and external validity for each age group).

Method: Parents of a nationally representative sample of 5,525 Spanish children and adolescents (ages 5 to 16, 56.1% boys) completed measures of CDS, attention-deficit/hyperactivity disorder-inattention (ADHD-IN), and other measures.

Results: First, the 15 CDS symptoms showed convergent and discriminant validity relative to the ADHD-IN symptoms within each age group. Second, CDS showed stronger first-order and unique associations than ADHD-IN with anxiety, depression, somatization, daytime sleep-related impairment, and nighttime sleep disturbance, whereas ADHD-IN showed stronger first-order and unique associations than CDS with ADHD-hyperactivity/impulsivity, oppositional defiant disorder, and academic impairment. Third, CDS showed stronger first-order and unique associations than ADHD-IN with a history of having an anxiety, depression, or bipolar disorder diagnosis, whereas ADHD-IN showed stronger first-order and unique associations with having an ADHD diagnosis.

Conclusions: The identification of a common set of CDS symptoms spanning early childhood to adolescence allows for the advancement of research on CDS, with a particular need now for longitudinal studies and examination of CDS with other functional outcomes and across other cultural contexts.

Objective: Although the significance of the general factor of psychopathology (p) is being increasingly recognized, it remains unclear how to best operationalize and measure p. To test variations in the operationalizations of p and make practical recommendations for its assessment, we compared p-factor scores derived from four models.

Methods: We compared p scores derived from principal axis (Model 1), hierarchical factor (Model 2), and bifactor (Model 3) analyses, plus a Total Problem score (sum of unit-weighted ratings of all problem items; Model 4) for parent- and self-rated youth psychopathology from 24 societies. Separately for each sample, we fitted the models to parent-ratings on the Child Behavior Checklist for Ages 6-18 (CBCL/6-18) and self-ratings on the Youth Self-Report (YSR) for 25,643 11-18-year-olds. Separately for each sample, we computed correlations between p-scores obtained for each pair of models, cross-informant correlations between p-scores for each model, and Q-correlations between mean item x p-score correlations for each pair of models.

Results: Results were similar for all models, as indicated by correlations of .973-.994 between p-scores for Models 1-4, plus similar cross-informant correlations between CBCL/6-18 and YSR Model 1-4 p-scores. Item x p correlations had similar rank orders between Models 1-4, as indicated by Q correlations of .957-.993.

Conclusions: The similar results obtained for Models 1-4 argue for using the simplest model - the unit-weighted Total Problem score - to measure p for clinical and research assessment of youth psychopathology. Practical methods for measuring p may advance the field toward transdiagnostic patterns of problems.

Objective: This mixed-methods study examined teachers' perceptions of student anxiety in urban elementary schools serving predominantly low-income and ethnically/racially minoritized youth.

Method: Most participating teachers were female (87.7%) and from minoritized backgrounds themselves (89.2%), teaching in schools serving predominantly Black/African American (40%) or Hispanic (60%) students, and in which > 70% of students are eligible for free meals. Teachers were asked in surveys (N = 82) and interviews (n = 12) about the nature of student anxiety, and cultural/contextual considerations that influence anxiety.

Results: Overall, teachers reported prevalence and signs of student anxiety that were consistent with the literature, but they reported higher levels of impairment than in previous community samples. Regressions revealed that greater levels of student exposure to community violence and higher proportions of Black students were associated with higher teacher-perceived prevalence and concern about student anxiety, respectively. Moreover, greater emotional exhaustion in teachers was associated with higher reports of anxiety-related impairment in students. Thematic coding of interviews emphasized how teachers perceived 1) most student anxieties to be proportional responses to realistic threats and stress in students' lives (e.g. resource insecurity), 2) systems-level problems (e.g. pressure to perform on standardized tests) contribute to student anxiety, and 3) school-based anxiety sources often interact with traumas and stressors students experience outside of school (e.g. immigration experiences).

Conclusions: Relative to the predominant literature that has focused on biological, cognitive, and other intraindividual factors as sources of anxiety, the present work underscores the importance of considering how broader economic and systems-level influences exacerbate anxiety in marginalized youth.

Objective: Regularly administering outcome measures, measurement-based care (MBC), informs clinical decision-making and improves youth mental health. Understanding predictors of high-fidelity MBC delivery helps ensure all youth can benefit from this evidence-based practice. Research on client and clinician predictors of MBC fidelity has mixed findings.

Method: Participants included 53 clinicians and 115 adolescents from a randomized controlled effectiveness trial with MBC only and MBC + Unified Protocol for the Transdiagnostic Treatment of Emotional Disorders in Adolescents (UPA) conditions. Clients and clinicians reported demographic information. Clinicians completed broad- and narrow-band attitude measures. MBC fidelity was operationalized using the implementation index, combining rates of administering and viewing questionnaires, using objective MBC data.

Results and discussion: The average MBC fidelity was 56.75% (SD = 30.36) and was significantly higher in the MBC only condition (M = 67.46%, SD = 27.63%) than in MBC + UPA condition (M = 46.58%, SD = 29.52%; p = .012). Clients identifying as White received significantly higher MBC fidelity than youth not identifying as White. Youth ethnicity, family income, age, severity, and number of sessions did not significantly predict MBC fidelity. Clinicians with less experience at their agency, less confidence, and who found manualized treatments less appealing, had significantly higher MBC fidelity than other clinicians. These results can inform future efforts to increase fidelity and equity in MBC delivery.