A French community-based intervention for parents of French-Canadian children with behavior problems: The EQUIPE program

ObjectivesBehavior problems are one of the most common reasons for seeking mental health services in pediatric populations. The objectives are to evaluate the effects of the EQUIPE program (Étude Québécoise d’Intervention pour les Parents d’Enfants avec des problèmes de comportement) and to analyze the impact of the severity of behavior problems and of parental characteristics.MethodsThis program was translated from the Community Parent Education Program. The effects of EQUIPE, as compared to a control group, were evaluated by using Child Behavior Checklist and Parent Stress Index questionnaires before (T0) and after the intervention program (T1), and at 6 (T2) and 12 months (T3) follow-up visits.ResultsIn total, 533 participants were enrolled in intervention (n = 465) (with “severe” or “mild” subgroups according to CBCL-T score) and a control group (n = 68). In the two groups, the results showed a statistically significant decrease in Child Behavior Checklist and Parent Stress Index total scores at T1, T2 and T3, with the exception of Child Behavior Checklist total scores in the control group at T2. In the intervention group Child Behavior Checklist total scores were significantly higher in the “severe”; which was not the case for Parent Stress Index total scores at T2 and T3.DiscussionSocioeconomic characteristics, family details, parental medical history and the age of the children appeared to influence changes in Child Behavior Checklist and Parent Stress Index total scores.ConclusionThe EQUIPE program is an effective intervention for reducing behavior problems and parents’ stress in a French-Canadian population.     

The associations of adolescents' dating violence victimization,well-being and engagement in risk behaviors

This brief report describes dating violence victimization among adolescents in Flanders, Belgium, and focuses on how dating violence is related to adolescents' well-being and engagement in risk behaviors, such as substance use, sexual behaviors, and engagement in vandalism or fighting. A survey was conducted in Flanders, Belgium among 1187 adolescents (61.3% female, n = 728). A total of 466 respondents between 16 and 22 years old (M = 17.82 years, SD = 0.92) were in a relationship (71.0% female, n = 331), and, therefore, formed the subsample of the present study. The results show that adolescents, who consume alcohol at a younger age, have ever used marihuana, or were involved in vandalism have a higher probability to become victim of dating violence than adolescents who are not involved in these behaviors. Dating violence victimization was also linked with symptoms of depression and a lower self-esteem.     

Socio-cognitive variables involved in the relationship between violence exposure at home and child-to-parent violence

IntroductionThe aim of the current cross-sectional study was to examine the role of social-cognitive processing in the relation between violence exposure at home and child-to-parent violence.MethodsThe study included 1,624 adolescents (54.9% girls) aged between 12 and 18 years (M_age = 14.7, SD = 1.7 years) from Jaén and Oviedo (Spain) who completed a set of questionnaires about violence exposure, child-to-parent violence and social-cognitive processing.ResultsThe data revealed that exposure to violence at home is related to dysfunctional components of social-cognitive processing, and that whereas some of these components (anger and aggressive response access) are positively related to child-to-parent violence motivated by reactive reasons, other components (anticipation of positive consequences and justification of violence) are positively related to the instrumental use of the aggression against parents.ConclusionsMore prevention work is needed with children exposed to violence at home to reduce the risk of intergenerational transmission of violence. Moreover, treatment programs should include intervention on the way in which adolescents process the information in their interactions with parents. These interventions must be focused on different components of social-cognitive processing, depending on whether these aggressive behaviors are motivated by reactive or instrumental reasons.     

‘That is why we raise children’: African American fathers' race-related concerns for their adolescents and parenting strategies

IntroductionThe current study highlights the voices and perspectives of African American fathers, with specific emphasis on their race-related concerns for their adolescents as well as how these concerns guide their parenting strategies.MethodTwenty-four African American fathers participated in 1.5–3 h long focus group interviews. All fathers (M = 42.24 years, SD = 6.93) resided in a mid-sized city in the Southeastern United States. All participants were either biological fathers (n = 20) or non-biological (n = 4) fathers. Fathers were residential (76%) and non-residential (24%), with at least one adolescent child (M = 14.32 years, SD = 5.80; Range: 10–16 years). Fifty-eight percent of fathers (n = 14) had both male and female children, 29% had only female children (n = 7) and 13% had only male children (n = 3). After codebook development and refinement, key themes were explored using a theoretical thematic analysis.ResultsIn response to race-related and other social risks for African American adolescents, fathers articulated a number of parenting motivations and intentions: 1) fathers' own racial experiences; 2) negative media images of Black youth and families (e.g. media influences, negative stereotypes, and portrayals of Black fathers); 3) preserving families through community support; 4) developing awareness of discrimination and coping strategies; 5) cultivating positive personal and cultural identities; and 6) achievement as necessity. Also, gender emerged as a critical lens for African American fathers’ concerns and parenting strategies.ConclusionOverall, our investigation highlights African American fathers’ own meaning-making around concerns for their adolescents as well as how they shape parenting processes.     

Contrasting deficits on executive functions in Chinese delinquent adolescents with attention deficit and hyperactivity disorder symptoms and/or reading disability

Many studies reported high prevalence of reading disability (RD) and attention deficit hyperactivity disorder (ADHD) among delinquent adolescents. Very few have examined their cognitive profile. The present study compared the executive functions (EFs) and severity of delinquency in delinquent adolescents with RD and/or ADHD symptoms (AS). Delinquents with AS (n = 29), RD (n = 24), comorbidity AS + RD (n = 35) were recruited from juvenile institutions along with typically developing controls (n = 29) from local schools; all completed EF assessments and self-report questionnaires on delinquency. Results showed that pure AS group exhibited impaired inhibition while the pure RD group was weak in processing speed and visual memory. The comorbidity group showed unique impairments in interference control and significantly higher delinquency severity. The present findings suggest that comorbidity AS + RD may influence delinquency severity. It also provides a more comprehensive picture of the unique EF deficits associated with different groups, allowing for better matching for future identification and intervention programme.     

Brief imaginal exposure exercises for social anxiety disorder: A randomized controlled trial of a self-help momentary intervention app

IntroductionEmerging technological interventions for psychological disorders are being developed continually. Offering imaginal exposure exercises as a self-help intervention presents the opportunity to acquire foundational skills to address social anxiety. The current study evaluates the feasibility and effectiveness of a novel smartphone application for social interaction anxiety.MethodsParticipants (n = 82) were adults meeting criteria for social anxiety disorder. They were randomly assigned to imaginal exposure (IE; n = 39) or self-monitoring (n = 43) delivered multiple times daily via a smartphone application for a one-week trial. It was expected that participants using the IE exercises would demonstrate significantly greater declines in social anxiety in addition to increases in self-efficacy and that compliance would serve as a predictor of outcome. Mixed-effects models were utilized.ResultsParticipants using IE (vs. self-monitoring) evidenced significantly greater reductions in social anxiety from pre- to post-treatment and at 1-month follow-up. Similarly, IE (vs. self-monitoring) led to significantly greater increases in self-efficacy from pre- to post-treatment and 1-month follow-up. Further, more completed IE exercises predicted significantly greater changes in social anxiety and self-efficacy at subsequent timepoints compared with self-monitoring.ConclusionsFindings suggest that a brief IE self-help intervention was effective in targeting social interaction anxiety.     

Visual search attentional bias modification reduced social phobia in adolescents

Background and objectivesAn attentional bias for negative information plays an important role in the development and maintenance of (social) anxiety and depression, which are highly prevalent in adolescence. Attention Bias Modification (ABM) might be an interesting tool in the prevention of emotional disorders. The current study investigated whether visual search ABM might affect attentional bias and emotional functioning in adolescents.MethodsA visual search task was used as a training paradigm; participants (n = 16 adolescents, aged 13–16) had to repeatedly identify the only smiling face in a 4 × 4 matrix of negative emotional faces, while participants in the control condition (n = 16) were randomly allocated to one of three placebo training versions. An assessment version of the task was developed to directly test whether attentional bias changed due to the training. Self-reported anxiety and depressive symptoms and self-esteem were measured pre- and post-training.ResultsAfter two sessions of training, the ABM group showed a significant decrease in attentional bias for negative information and self-reported social phobia, while the control group did not. There were no effects of training on depressive mood or self-esteem.LimitationsNo correlation between attentional bias and social phobia was found, which raises questions about the validity of the attentional bias assessment task. Also, the small sample size precludes strong conclusions.ConclusionsVisual search ABM might be beneficial in changing attentional bias and social phobia in adolescents, but further research with larger sample sizes and longer follow-up is needed.     

Associations between sleep,daytime sleepiness and functional outcomes in adolescents with ADHD

Objective/backgroundAdolescents with attention-deficit/hyperactivity disorder (ADHD) experience greater difficulties in the domains of sleep, daytime sleepiness, and functioning compared to their peers. However, the relationship between these domains has not been fully elucidated. This study aimed to examine the relationship between sleep problems (including daytime sleepiness), ADHD severity, and functional outcomes (irritability, sluggish cognitive tempo, homework difficulties, and substance use) in a sample of adolescents with ADHD.Patients/methodsEighty-two adolescents (13–17 years) and their families participated in the study. Sleep was measured by both adolescent and parent-report. Adolescent irritability and sluggish cognitive tempo were reported by both adolescents and parents, while other variables were reported by a single reporter (homework difficulties – parent; ADHD severity – parent; substance use – adolescent). Analyses controlled for demographic factors and internalising and externalising comorbidities.ResultsA weak relationship was found between adolescent-reported sleep problems and daytime sleepiness, which became non-significant in adjusted analyses (β = −0.19, p = 0.115). In adjusted analyses, there was an association between adolescent-reported sleep problems and adolescent-reported irritability (β = −0.27, p = 0.023) as well as between adolescent-reported daytime sleepiness and parent-reported sluggish cognitive tempo (β = 0.28, p = 0.033). In adjusted analyses, parent-reported adolescent sleep problems were associated with ADHD severity (β = 0.54, p = <0.001), parent-reported sluggish cognitive tempo (β = 0.64, p = <0.001), both reporters of irritability (parent-report: β = 0.32, p = 0.004; adolescent-report: β = 0.29, p = 0.022), and homework problems (β = 0.37, p = 0.003). Parent-reported daytime sleepiness was associated with parent-reported sluggish cognitive tempo (β = 0.34, p = 0.024).ConclusionsThis study demonstrates the importance of a holistic assessment of adolescents with ADHD, not only focusing on symptomatology but also on sleep problems and functional outcomes. The importance of multi-informant assessment of sleep problems is also reinforced.     

Family obligations and individuation among immigrant youth: Do generational status and age at immigration matter?

Immigrant children and adolescents often assume parental roles in their families and may feel guilty about psychologically separating and individuating from the family. However, little is known about this phenomenon and youth' generational status and age at immigration. We investigated various aspects of family obligations (instrumental and emotional roles, language and culture brokering, perceived unfairness) and individuation among 302 immigrants from the former Soviet Union in Israel: first-generation (n = 44) and second-generation immigrant adolescents (n = 56); young adults who had arrived in Israel before the age of nine (n = 72) and from this age onward (n = 130). Immigrants who had arrived at age nine and older reported adopting more family obligations than other groups. Among the second-generation immigrants, family obligations were related to lower individuation compared to the first-generation immigrants. Possible explanations for the relations between family obligations and individuation according to generational status are suggested.     

Is digital cognitive behavioural therapy for insomnia effective in treating sub-threshold insomnia: a pilot RCT

Objective/BackgroundMany patients find cognitive behavioral therapy for insomnia (CBT-I) useful. However, it is currently unknown if those with sub-threshold insomnia also benefit. Here we assessed whether CBT-I is both feasible and acceptable in participants with sub-threshold insomnia. The primary aims were to evaluate participation rates and treatment acceptability, and to establish an effect size for symptom improvement.Patients/MethodsA total of 199 female participants (M_age 20 ± 5 years) took part. Following baseline assessments, participants were randomly allocated to either a six-week digital CBT-I intervention or a six-week control group receiving puzzles. Additional assessments were performed three-weeks, six-weeks, and six-months later.ResultsParticipation rates at each survey assessment wave did not differ between the groups (ps > 0.140), though adherence to completing each weekly task was lower in the CBT-I group, p = 0.02. Treatment acceptability was high (M (SD) = 33.61 (4.82), theoretical range 6–42). The CBT-I group showed greater improvement in insomnia symptoms at the end of the intervention compared to the control group (p = 0.013, d = 0.42), with significant variation in outcome (M = 4.69, SD = 5.41). Sub-threshold participants showed a similar pattern of results, whilst those meeting insomnia criteria showed a smaller between-group difference. CBT-I led to improvements in anxiety, paranoia and perceived stress between baseline and end of intervention. Changes in insomnia symptoms were mediated by cognitions about sleep and somatic pre-sleep arousal.ConclusionsCBT-I provides a benefit even in sub-threshold insomnia. CBT-I may be useful to tackle insomnia symptoms even when they are sub-threshold.     

Suicidal behaviors and their relationship with psychotic-like symptoms in children and adolescents at clinical high risk for psychosis

BackgroundPrevious research has demonstrated elevated rates of suicide attempts and ideation in individuals with psychosis. This study investigated rates and severity of suicidal behavior in youth with and at clinical high risk for psychosis, and examined the positive, negative, and disorganized symptoms associated with suicidal behaviors among the clinical high risk group.MethodsEighty-six youth ages 7–18 (n = 21 non-clinical controls [NCC], n = 40 clinical high risk [CHR], n = 25 diagnosed psychotic disorder [PD]) were recruited. CHR and PD participants were identified using the Structured Interview for Prodromal Symptoms (SIPS) and Schedule for Affective Disorders and Schizophrenia for School-Age Children—Present and Lifetime Version (KSADS-PL). All participants completed the Suicide Behaviors Questionnaire-Revised (SBQ-R).ResultsFindings indicated significantly higher levels of suicidal behavior among CHR and PD relative to NCC participants (F = 7.64, p = 0.001). 17.5% of CHR participants had previously attempted suicide. Dysphoric Mood and Odd Behavior or Appearance were significantly correlated with suicidal behavior severity among CHR youth.ConclusionSuicidal behavior was observed with greater frequency and severity in the CHR and PD groups than in the NCC group. CHR suicidal behavior severity was correlated most strongly with Dysphoric Mood and Odd Behavior or Appearance, a relationship which warrants further investigation.     

Long-term effects of theta/beta neurofeedback on EEG power spectra in children with attention deficit hyperactivity disorder

ObjectiveNeurofeedback has been proposed as an effective alternative for pharmacological treatment in children with attention-deficit/hyperactivity disorder (ADHD), with potentially long-term and delayed benefits. However, the specificity of such long-term behavioral improvements remains inconclusive and therefore additional research into the neurophysiological effects of neurofeedback is needed. We compared long-term effects of theta/beta neurofeedback (NFB) to methylphenidate (MPH) and physical activity (PA, semi-active control intervention) on electroencephalogram (EEG) power spectra. Based on the vigilance stabilization model, we hypothesized further reductions in theta and alpha power in the NFB compared to the control groups.MethodEEG power spectra (theta, alpha and beta) during resting and task conditions were recorded at pre-, post-intervention and 6-months follow-up in 67 children, aged 7–13 (NFB: n = 24, MPH: n = 23, or PA: n = 20).ResultsAnalyses revealed no power spectra differences at follow-up between MPH and NFB (range p = .165–.905) and PA and NFB (range p = .172–.822).ConclusionsNo evidence was found for the specificity of theta/beta NFB at follow-up.SignificanceThis was the first study into long-term neurophysiological effects of theta/beta NFB. Future studies are encouraged to explore both specific and non-specific mechanisms of NFB.Clinical trials registration: Train Your Brain? Exercise and neurofeedback intervention for ADHD, https://clinicaltrials.gov/show/NCT01363544, Ref. No. NCT01363544.     

Psychometric properties and clinical relevance of the Adolescent Sleep Hygiene Scale in Dutch adolescents

ObjectiveThis study investigated reliability, validity, and clinical relevance of the Adolescent Sleep Hygiene Scale (ASHS) in Dutch adolescents.MethodsThe Dutch translation of the ASHS was administered to 186 normal-sleeping adolescents and 112 adolescents with insomnia. Their sleep variables were measured using sleep logs and questionnaires. From the insomnia group, scores were also obtained after six weeks of cognitive behavioral therapy for insomnia (n = 58) or waiting list (n = 22).ResultsThe full scale of the ASHS had acceptable internal consistency. The results showed moderate to strong correlations of the ASHS (domains) with sleep quality, sleep duration and chronic sleep reduction. Furthermore, the Dutch ASHS was able to discriminate between normal sleepers and adolescents with insomnia, and scores of adolescents with insomnia improved after treatment.ConclusionsThese findings confirm the importance of sleep hygiene in adolescent sleep, and contribute to the validity of the ASHS and its applicability in research and clinical practice.     

Brief report: Parent–adolescent child concordance in social norms related to gender equity in marriage – findings from rural India

The purpose of this exploratory study was to assess parent–adolescent child concordance on social norms related to gender equity in marriage in rural Maharashtra, India. Survey data on marital norms related to girl's marital age and choice, contraception, and marital violence (MV) were collected from unmarried adolescents (n = 113 girls, 116 boys) and their parents (n = 227 mothers, 203 fathers). Concordance was assessed using a Cohen's unweighted Kappa statistic, with analyses stratified by sex of parent and child. Analyses revealed fair (K = .25–.27) mother-daughter concordance on girls' right to choose when to marry, contraception use, and acceptability of MV. Father-son concordance was seen on girls' right to choose when (K = .22, slight) and who (K = .20, fair) to marry and MV acceptability (K = .53, moderate). No opposite sex parent-child concordance was revealed. Results indicate same but not opposite sex parent-child concordance on gender equity social norms related to marriage, suggesting same sex transfer of these norms.     

Challenges encountered with a mindfulness app: Lessons learnt from a pilot randomized trial involving caregivers and individuals with autism

BackgroundWe undertook a trial to examine the feasibility of a self-guided mindfulness app, Smiling Mind, for children and adults with Autism Spectrum Disorder (ASD) and their parents. The trial encountered problems in recruitment, enrollment and retention which are described here.Methods: Of 169 eligible participants, only 22 consented and were randomly assigned to Smiling Mind (n = 12) or an attention control condition (n = 10). A further six participants withdrew during the study. Barriers to trial participation were subsequently explored through semi-structured interviews, to form case studies, and a follow-up survey.ResultsInterview and survey data highlighted parents’ competing time commitments as a key barrier to participation. For children and adults with ASD, distraction and boredom were major challenges to engagement.ConclusionsA number of modifiable variables in our recruitment procedures and intervention design ultimately resulted in a sample size that was too small to draw any firm conclusions from. Future ASD research can maximize sampling by broadening recruitment strategies and partnering with community services and schools. Engagement in mindfulness could also be improved by incorporating regular communication to motivate time poor participants.     

Motor imagery for walking: A comparison between cerebral palsy adolescents with hemiplegia and diplegia

The goal of the study was to investigate whether motor imagery (MI) could be observed in cerebral palsy (CP) participants presenting a bilateral affected body side (diplegia) as it has been previously revealed in participants presenting a unilateral body affected sided (hemiplegia). MI capacity for walking was investigated in CP adolescents diagnosed with hemiplegia (n = 10) or diplegia (n = 10) and in adolescents with typical motor development (n = 10). Participants were explicitly asked to imagine walking before and after actually walking toward a target located at 4 m and 8 m. Movement durations for executed and imagined trials were recorded. ANOVA and Pearson's correlation analyses revealed the existence of time invariance between executed and imagined movement durations for the control group and both groups of CP participants. However, results revealed that MI capacity in CP participants was observed for the short distance (4 m) but not for the long distance (8 m). Moreover, even for short distance, CP participants performed worse than typical adolescents. These results are discussed inline of recent researches suggesting that MI in CP participants may not depend on the side of the lesion.     

A randomized controlled evaluation of a spiritually integrated treatment for subclinical anxiety in the Jewish community,delivered via the Internet

ObjectiveThis study evaluated the efficacy of a spiritually integrated treatment (SIT) for subclinical anxiety in the Jewish community.MethodOne hundred and twenty-five self-reported religious Jewish individuals with elevated levels of stress and worry received SIT (n = 36), progressive muscle relaxation (PMR, n = 42), or a waitlist control condition (WLC, n = 47). SIT and PMR participants accessed Internet-based treatment on a daily basis for a period of 2 weeks. All participants completed self-report assessments at pre-treatment (T1), post-treatment (T2), and 6–8-week follow-up (T3).ResultsSIT participants reported large improvements in primary (stress and worry) and secondary (depression and intolerance of uncertainty) outcomes, and moderate improvements in spiritual outcomes (positive/negative religious coping; trust/mistrust in God). SIT participants reported greater belief in treatment credibility, greater expectancies from treatment and greater treatment satisfaction than PMR participants. SIT participants also reported better improvements in both primary outcomes (stress and worry), one of two secondary outcomes (intolerance of uncertainty), and two of four spiritual outcomes (positive religious coping and mistrust in God) compared to the WLC group, whereas PMR and WLC participants did not differ on most outcomes.ConclusionsResults of this investigation offer initial support for the efficacy of SIT for the treatment of subclinical anxiety symptoms among religious Jews. Results further suggest that it is important to incorporate spiritual content into treatment to help facilitate the delivery of psychotherapy to religious individuals.     

Transitioning pediatric patients receiving ketogenic diets for epilepsy into adulthood

PurposeTo examine the process for transitioning adolescents on dietary management for intractable epilepsy to adult neurologic care.MethodsTen patients, ages 6–16 years when the ketogenic or modified Atkins diet was initiated, were identified; age at transition was 18–43 years. All patients were seen at Johns Hopkins Hospital, Baltimore, Maryland.ResultsSeven remain on diets (4 Ketogenic, 3 modified Atkins diet) at this time with mean diet duration of 15.5 years (range 4–32 years). Most patients had excellent but not complete seizure control and several had recurrence or worsening of seizures with attempts to wean dietary therapy, hence the need to continue. Three main transition options were utilized: (1) continue being followed in pediatric clinic (n = 2), (2) establish care with an adult neurologist (n = 2), or 3) receive care from the Adult Epilepsy Diet Center (n = 6). Those patients followed in the Adult Epilepsy Diet Center were slightly more likely to remain on dietary therapy following transition (5/6 vs. 1/4, p = 0.12).ConclusionIt is important for adolescents with epilepsy receiving ketogenic diets to have transition plans in place for when they become adults. Adult epilepsy diet centers are the ideal option when possible.     

A randomised controlled trial of two early intervention programs for young children with autism: Centre-based with parent program and home-based

This study compares outcomes of early intervention programs for young children with autism; an individualised home-based program (HB), a small group centre-based program for children combined with a parent training and support group (CB) and a non-treatment comparison group (WL). Outcome measures of interest include social and communication skill development in children, quality of life and stress for parents. Eligible (diagnosed ASD, preschool age) participants were randomised into 2 groups HB (n = 28) and CB (n = 28). A WL (n = 29) comparison group was also recruited. HB and CB groups had 12-month programs. Pre and post assessments were conducted using formal and informal measures. Children in the CB group improved significantly more than HB and WL groups on some social and communication measures. On parent measures outcomes varied with CB group parents making the most gains in perception of competence and quality of life. The small group centre-based program combined with parent program resulted in the best most cost effective outcomes for children and families however this is not an option for all. The CB program did not suit some children and families. The heterogeneity of the autism population indicates that a range of intervention options is necessary to meet the needs of children with autism and their families.     

Sexual orientation,gender: Where is the problem? Nowhere! Correct self-identification and minority stigma

PurposeSelf-concept, at the core of minority stress, is associated with negative mental health outcomes.MethodsWe aimed to assess the effectiveness of a one-shot third-wave CBT intervention targeting correct self-identification to address suffering related to minority stress. The study population included 172 participants (n = 98 heterosexuals, n = 13 transgenders). The intervention consisted of a 90 minutes conference including overview of LGBT's suffering related to distal and proximal factors, a wisdom understanding of the root of suffering (mistaken self-identification) followed by a Questions & Answers session. Participants completed online self-questionnaires assessing sociodemographic data, acceptance by others (external) and oneself (internal) for sexual orientation and gender variables before the conference, immediately after the conference, and three months later.ResultsThe conference helped to improve external acceptance of transgender for the whole sample, especially among the majority group. Those belonging to the minority (LGBT) had a positive benefit from the conference by reducing their fear of judgment. Adding a Q&A session to the conference failed to show any additional benefits.ConclusionA specific wisdom-based self-identification conference appears to be an effective and low-cost intervention to target minority stigma, and therefore mental health and social integration of LGBT people.