OBJECTIVE:This study examined whether Fostering Healthy Futures for Preteens (FHF-P), a 9-month community-based mentoring and skills training program for children in out-of-home care, reduced risk factors for substance use. METHOD:A randomized controlled trial enrolled 270 participants aged 9-11 years who were placed in out-of-home care over the prior year. Participants were 47.4% female, 48.9% Hispanic, 47.8% White, 36.7% American Indian, and 24.8% Black. Interviews, which contained questions about positive and negative appraisals of substance use as well as affiliations with deviant and positive friends, were conducted at baseline (T1), 6-months post intervention (T2), and 1.5 years post intervention (T3). An exploratory analysis examined substance use and related problems among a subset of participants (n = 47) interviewed in young adulthood (T4); the rate of substance use was too low to examine these outcomes at earlier timepoints. RESULTS:FHF-P participants, relative to controls, had greater prosocial friend affiliation at T2; at T3, they had less deviant friend affiliation and 65% lower odds of friends using substances. When examined within sex, significant intervention effects were only observed in the female subgroup. Although there were no group differences in substance use or related problems at T4, a significant interaction between baseline substance use and intervention status suggested that early substance use predicted later substance use and related problems only for the control group. CONCLUSIONS:FHF-P had positive impacts on salient risk and protective factors for substance use and buffered the impact of early risk on young adult problematic substance use in a high-risk population.
OBJECTIVE:This study examines whether school functioning (academic performance and motivation) and social/behavioral functioning (suspensions and peer affiliations) in high school mediate the association between childhood Attention-Deficit/Hyperactivity Disorder (ADHD) and adult educational attainment. METHOD:Participants were 3,762 twins (1,881 same-sex pairs; 52% female; 96% non-Hispanic White) from the population-based Minnesota Twin Family Study. Childhood ADHD symptoms were assessed via structured diagnostic interviews at intake (age 11 or 17, depending on cohort), mediators were assessed via teacher and self reports at age 17, and educational attainment was assessed in adulthood (mean age = 34.7 years). Mediation path models tested each indirect pathway, and co-twin comparisons were used to better isolate potential causal effects by controlling for familial confounding. RESULTS:At the individual level, all tested indirect paths linking ADHD to educational attainment were significant. However, co-twin control analyses indicated that most associations attenuated when accounting for familial confounding. Only the indirect path through academic motivation persisted after co-twin control, such that twins with greater academic motivation relative to their co-twin also had greater educational attainment, consistent with a potential causal effect. Academic performance and social/behavioral mediators did not show significant mediation after accounting for shared genetic and environmental factors. CONCLUSIONS:Academic motivation emerges as the most robust mediator linking childhood ADHD to reduced educational attainment. Interventions targeting student engagement, self-efficacy, and connection to school may improve long-term educational outcomes in youth with ADHD.
OBJECTIVE:Irritability is a common and impairing reason for childhood mental health referral, yet transactional processes between parenting and irritability remain understudied in early childhood, particularly using multi-method approaches. This study examined bidirectional associations between parenting and interview-based child irritability from ages 3 to 6 while accounting for parental psychopathology and child sex. METHOD:Participants were 609 children (54.5% male; 79.5% White, non-Hispanic) recruited at age 3 and followed to age 6. Child irritability was assessed using the Preschool Age Psychiatric Assessment. Parenting was measured using observational coding of parent - child Teaching Tasks (supportive presence, hostility, relationship quality) and mother- and father-reported Parenting Styles and Dimensions Questionnaire (authoritative, authoritarian, permissive). Cross-lagged panel models estimated stability and reciprocal associations between parenting and irritability across time. RESULTS:All constructs demonstrated significant stability from ages 3 to 6. Higher irritability at age 3 predicted lower observed parental support, higher observed hostility, poorer parent - child relationship quality, and higher mother-reported authoritarian parenting at age 6. Parent-to-child effects were more limited: lower observed relationship quality and higher father-reported permissive parenting at age 3 predicted higher irritability at age 6. Findings remained after adjusting for parental lifetime mood, anxiety, and substance use disorders and child sex. CONCLUSIONS:Findings support asymmetrical and caregiver-specific transactional pathways between parenting and irritability during early childhood. Early irritability may shape caregiving behavior over time, whereas dyadic relationship quality and fathers' permissive parenting represent potential targets for early intervention.
OBJECTIVE:Treatment manuals are critical to research and practice. Although existing studies have reviewed treatment manuals available through research, no research has been conducted to understand the body of commercially available youth-focused treatment manuals. METHOD:A scoping review of commercially available psychotherapy treatment manuals focused on youth was conducted. Traditional and programmatic-based search methods were used to query WorldCat, PsycINFO, and Google Books in July 2022, January 2025, and May 2025. A total of 85,264 results were screened during the preliminary screening, 3,166 results were screened during the secondary screening, and 462 treatment manuals were included and coded. RESULTS:Treatment manuals have proliferated over time, with a majority of treatment manuals having been published since 2000 (84.4%). Most treatment manuals offered integrative (n = 123; 26.6%), second-wave cognitive behavioral (n = 111; 24.0%), or behavioral interventions (n = 87; 18.8%). Behavior problems (21.9%), traumatic sequelae (14.3%), emotional issues (9.3%), autism spectrum disorder (8.9%), and posttraumatic stress disorder (8.9%) were most commonly targeted. A small proportion of commercially available manuals (5.8%) presented ≥ 20% of content adapted for specific populations, primarily for gender identity or disability. Only 16% of reviewed treatment manuals were recognized in evidence-based practice guidelines. CONCLUSION:Commercially available manuals for youth continue to grow, with differences in the proliferation by treatment and clinical target. A fraction of reviewed treatment manuals focused on providing adapted content for specific populations. Future efforts focused on creating more accessible, high-quality, and effective training resources for evidence-based practice are needed.
OBJECTIVE:Evidence-Based Parenting Supports (EBPS) have demonstrated efficacy in addressing child behavioral and emotional problems. However, despite their proven benefits, EBPS still reach a minority of families. Online parenting interventions offer a promising solution to this gap, enhancing accessibility and demonstrating effectiveness in various contexts. This study evaluates the effectiveness of three online parenting programs: Triple P Online (TPOL), Fear-less Triple P Online (FLTPOL), and Triple P Online for Baby (TPOLB) which were disseminated nationally through the Australian Government's Parenting and Education Support Program. METHOD:Using a practice-as-usual approach, the study followed a non-randomized, open trial design with pre-, post-, and follow-up assessments. Data were collected from 2,254 participants who completed the baseline evaluation and at least one additional data collection time point. RESULTS:Results indicated that participation in an online intervention was associated with significant improvements in parenting practices, parent self-efficacy, child behavioral and emotional adjustment, and parental mental health. Key moderators of program effectiveness included baseline parenting difficulties, parent age, education, relationship to the child, number of children and family cultural background. However, none of the demographic factors were consistently found to moderate outcomes across programs. CONCLUSIONS:Findings underscore the potential of scalable, digital parenting interventions in public health contexts, offering a robust, inclusive approach to promoting positive parenting. The study calls for ongoing evaluation to optimize engagement and address barriers, thereby strengthening the long-term impact of digital parenting supports.
OBJECTIVE:To examine associations between comorbidity profiles and academic/social correlates in children with ADHD, and to describe whether these associations vary across sex and developmental stage. METHOD:Using data from the 2024 National Survey of Children's Health (N = 6,029 youth ages 6-17 with current, provider-diagnosed ADHD; 63.2% male; 58.2% Non-Hispanic White, 13.2% Non-Hispanic Black, 18.4% Hispanic, 1.9% Asian, 8.2% Other/Multiracial), we categorized participants into five mutually exclusive comorbidity profiles: ADHD-Only (23.5%), ADHD+Internalizing (12.6%), ADHD+Externalizing (9.3%), ADHD+Neurodevelopmental (13.7%), and ADHD+Complex (40.8%). Weighted logistic regression models, adjusted for demographics and ADHD severity, examined associations with grade repetition, school disciplinary contact, academic performance, bullying victimization and perpetration, friendship difficulties, and sports participation. RESULTS:Comorbidity profiles demonstrated differential patterns of parent-reported functioning that persisted after adjustment for ADHD severity. ADHD+Externalizing was associated with bullying perpetration and disciplinary contact but not victimization. ADHD+Internalizing was associated with bullying victimization but not perpetration. ADHD+Neurodevelopmental showed highest grade repetition and lowest sports participation. The ADHD+Complex profile, comprising 40.8% of the sample, exhibited impairment across all correlates, including friendship difficulties, even after severity adjustment. Profile associations remained robust within ADHD severity strata, consistent with the interpretation that comorbidity constellations are associated with functional correlates beyond parent-rated ADHD severity. CONCLUSIONS:These findings suggest that comorbidity profiles, beyond symptom severity alone, are associated with differential patterns of functioning in pediatric ADHD. The ADHD+Complex profile emerges as a potentially high-risk group warranting further study. Future research should examine whether profile-based assessment holds promise for improving clinical risk stratification and guiding transdiagnostic intervention development.
OBJECTIVE:The primary aim of this study was to compare early trajectories of cognitive/motor development and adaptive functioning between school-aged children with attention-deficit/hyperactivity disorder (ADHD) and typically developing (TD) children. A secondary, more exploratory, aim was to determine whether groups differed in their eligibility for early intervention services at individual timepoints. METHOD:This study leveraged data from three prospective longitudinal studies of infants with and without a family history of autism. Our sample was majority male, White, and non-Hispanic. At 6, 12, 18, 24, and 36 months, cognitive/motor development was measured via direct assessment using the Mullen Scales of Early Learning, and adaptive functioning was measured via parent report using two editions of the Vineland Adaptive Behavior Scales (Vineland ABS, Vineland-II). At school age (~6-16 years), children were assigned outcomes of ADHD (n = 62) and TD (n = 123). Linear mixed-effects models were used to estimate subscale-level trajectories, while chi-squared or Fisher's exact tests were used to test for group differences in rates of service eligibility. RESULTS:Trajectories often varied by group. Children with ADHD had lower estimated raw scores on all subscales of the Mullen Scales of Early Learning and nearly all subscales of the Vineland-II than TD children. Further, the ADHD group had higher rates of service eligibility in several domains, particularly communication and socialization. CONCLUSIONS:These findings suggest that children with ADHD differ in early trajectories of cognitive/motor development and adaptive functioning, and that children at elevated likelihood for ADHD may benefit from increased screening and supports for delays.
OBJECTIVE:Reactive aggression (RA) is a transdiagnostic symptom associated with more severe illness and worse clinical course. Despite the clinical importance of RA, few validated screening measures or outcome assessments exist for use with children under 12. The 16-item Reactive Aggression Assessment (RAGA-16) is a novel parent-report instrument with promising evidence of psychometric reliability. The current work presents clinical validation evidence for RAGA-16. METHODS:A retrospective chart review examined the records of children seeking inpatient and outpatient services. Parents completed the RAGA-16 and additional questionnaires assessing depression, hypomania, ADHD symptoms, and aggression at intake. The chart review also included clinical diagnoses, demographic information, and treatment details. Graded response models (GRMs) evaluated the RAGA-16 factor structure and associations with criterion variables evaluated the scores' validity as a screening measure assessing RA. RESULTS:Confirmatory models showed good fit to the hypothesized two-factor structure with high marginal reliability (ωt = .98). RAGA-16 scores showed large significant positive associations with measures of aggression, impulsivity, and oppositionality (rs > .70, ps < .001), lower associations with hypomanic symptoms (r = .40, p < .01), and no significant association with depression (p > .05). RAGA-16 scores statistically discriminated diagnoses associated with severely externalizing symptoms from other diagnoses. Endorsement of RA in more contexts (home, school, or elsewhere) was associated with higher aggression symptoms. CONCLUSIONS:Overall, RAGA-16 scores showed a pattern of criterion associations consistent with the construct of interest along with high score reliability. The addition of inpatient and outpatient clinical score characteristics to the existing epidemiological norms makes RAGA-16 a promising new tool for assessing youth RA.
OBJECTIVE:Despite its widespread use for diagnosing and assessing the severity of posttraumatic stress disorder (PTSD) among youth, psychometric evaluation of the Clinician-Administered PTSD Scale for Children and Adolescents - DSM-5 (CAPS-CA-5) is limited to Portuguese- and Japanese-translated versions. Accordingly, the present study examined the reliability, validity, and diagnostic utility of the CAPS-CA-5 in an English-speaking, U.S. sample of trauma-exposed youth enrolled in the Texas Childhood Trauma Research Network (TX-CTRN). METHOD:A total of 3,134 trauma-exposed youth and young adults aged 8-20 completed an assessment battery in English comprising semi-structured diagnostic interviews and measures of acute stress symptoms, externalizing symptoms, depressive symptoms, resilience, and suicidality. The CAPS-CA-5 was administered at baseline and one-month follow-up. RESULTS:Consistent with the original CAPS-CA, internal consistency was adequate-to-strong for the total score and all subscales except Avoidance, and test-retest reliability was strong. The CAPS-CA-5 evidenced convergent validity with a positive PTSD screen on the MINI International Neuropsychiatric Interview for Children and Adolescents and with acute stress symptoms. Externalizing symptoms, depressive symptoms, resilience, and suicidality all evidenced discriminant validity with the CAPS-CA-5. Cutoff scores were evaluated using Receiver Operating Curves and diagnostic utility was supported through the ability of the CAPS-CA-5 to differentiate categories of functional impairment, which varied by age and sex. CONCLUSIONS:This study, the first to provide psychometric support for the English version of the CAPS-CA-5 in a U.S. sample, contributes to a growing body of literature supporting the CAPS-CA-5 as a psychometrically valid PTSD interview across a range of nationalities and languages.
OBJECTIVE:Maternal depression has been consistently linked to child ADHD symptoms, though much of this research is cross-sectional, single informant, and focused on prenatal or early postnatal depression. Consequently, the direction and temporality of this association is poorly understood. We used Random-Intercepts, Cross-Lagged Panel models (RI-CLPM) to examine bidirectional and transactional associations between maternal depression and child ADHD across pre-adolescence. METHOD:Mothers and children (n = 1,806; 52% male, 77% White) participated across four waves during the COVID-19 pandemic (ages 10-13). At each timepoint, mothers self-reported depressive symptoms and children self-reported hyperactivity and inattention symptoms. Mothers also reported children's symptoms at the latter three waves. Parallel RI-CLPMs were estimated separately by informant and symptom dimension. RESULTS:Across both informants, maternal depression was associated with child hyperactivity and inattention at the between-dyad level (correlations ranging from .27 to .39). The clearest evidence of within-dyad association emerged for child-reported hyperactivity: higher child-reported hyperactivity at age 10 predicted higher maternal depressive symptoms at age 11, which in turn predicted higher child hyperactivity at age 12. Indirect effect analyses supported this transactional pathway. Maternal-reported models provided more limited but broadly convergent evidence for within-dyad effects on hyperactivity. Within-dyad effects were not observed for maternal- or child-reported inattention. Sociodemographic factors did not moderate cross-lagged parameters. CONCLUSIONS:Findings support transactional models of child development, with reciprocal associations between maternal depressive symptoms and child ADHD symptoms appearing most evident for hyperactivity. However, substantial overlap across ADHD symptom dimensions warrants caution in drawing strong conclusions about symptom-specific differences.
OBJECTIVE:Behavioral parent training is a first-line psychosocial intervention for young children with Attention-Deficit/Hyperactivity Disorder. Traditional face-to-face delivery is limited by access to therapists, feasibility, and/or affordability, which may be addressed by online Behavioral parent training. This study (a) evaluated outcomes for face-to-face vs. asynchronous online Behavioral parent training relative to a wait-list control condition in a large sample of young children with Attention-Deficit/Hyperactivity Disorder and (b) extended outcome measurement beyond parent ratings to masked assessment of child behavior self-regulation and home observation of parent-child interactions. METHOD:Participants were 196 young children with Attention-Deficit/Hyperactivity Disorder (65% male, Mage = 50.08 months; SD = 8.55) and primary caregivers randomly assigned to face-to-face Behavioral parent training (n = 66), online Behavioral parent training (n = 65), or WLC (n = 65). BPT comprised 10 sessions of behavior management and optimism training (cognitive-behavioral intervention to reduce pessimistic parenting attributions) that were equivalent across Behavioral parent training delivery modes. RESULTS:Intent-to-treat analyses found no significant differences in session attendance, outcomes, or treatment acceptability for face-to-face and online Behavioral parent training with both conditions yielding significant medium magnitude reductions (ds range from 0.41 to 0.74) in child Attention-Deficit/Hyperactivity Disorder and defiant/aggressive behavior and parent pessimism, along with increases in observed positive parenting behavior relative to wait-list control. No significant differences were found for child self-regulation skills or observed parent or child negative behaviors. CONCLUSIONS:Asynchronous online Behavioral parent training may be a viable option for families who have limited access to clinic-based treatment due to feasibility or affordability challenges.
OBJECTIVE:There has been tremendous growth in Latinx families seeking asylum at the U.S./Mexico border and a health disparity associated with posttraumatic stress disorder (PTSD) is a growing concern. The aim of this study was to examine how attachment to mothers, fathers, and peers relates to PTSD symptoms among Latinx asylum seeking children to provide first data on putative protective interpersonal factors in this high-risk group. METHOD:We interviewed N = 57 (Mage = 9, female = 46%) young Latinx children and their caregivers who had been released from Customs and Border Patrol custody within the last 24 hours. Attachment was measured utilizing the Inventory for Peer and Parent Attachment and PTSD symptoms were assessed using the UCLA PTSD Reaction Index total score via both parent and child report. Questionnaires were completed in Spanish, via one-on-one interview. RESULTS:Linear regression models in which attachment variables (i.e. trust, communication, and alienation) served as independent variables and PTSD symptoms served as the dependent variable, controlling for child sex and age, indicated that maternal communication was significantly, negatively related to PTSD symptoms (t = -2.08, p = .037) and peer alienation was significantly, positively related to PTSD symptoms (t = 3.189, p = .001). CONCLUSIONS:Results indicate the unique and important roles that interpersonal relationships play in PTSD symptomatology in asylum seeking Latinx children and inform targets for intervention development. While findings are preliminary, they are timely given changes in immigration policy and research funding rendering asylum-seeking families more vulnerable.
OBJECTIVES:The COVID-19 pandemic disparately affected Hispanic/Latino families and influenced child mental health. To understand risk in cultural context, we examined whether parental fatalistic beliefs, i.e. to what degree the future is predetermined or controllable, interacted with family pandemic stress to influence child internalizing problems. METHODS:Mexican-heritage parents (N = 301; nmothers = 228, nfathers = 72, nother = 1; 61% US born) with a target child between ages 5-17 (Mage = 11.45, SDage = 3.69) were recruited via Qualtrics Panels. Participants completed an online survey on family pandemic experiences, parent fatalistic beliefs, and child internalizing problems. Linear regression models tested unique (i.e. main) and joint (i.e. interactive) effects of pandemic stress and fatalism on child internalizing. RESULTS:Parents' fatalistic beliefs and pandemic stress jointly influenced parents' ratings of child internalizing (b = 2.31, 95% CI = [0.98, 3.64]). The harmful effect of pandemic stress on children's internalizing was amplified at higher endorsement of fatalistic beliefs. We also explored five fatalism subscales (luck, helplessness, divine control, internality, and core fatalism), and found significant interactions with pandemic stress for luck (b = 2.51, 95% CI = [1.08, 3.64]), helplessness (b = 2.42, 95% CI = [0.93, 3.91]), and core fatalism (b = 1.75, 95% CI = [0.39, 3.10]). These interactions operated similarly to the fatalism composite model. Parents' divine control and internality beliefs (more control and self-efficacy) were not individually or jointly associated with child internalizing symptoms. CONCLUSIONS:Parents' fatalistic beliefs may amplify the noxious effects of stress on children's internalizing. Enhancing parent self-control and self-efficacy beliefs may reduce the effects of stress on children's internalizing, though targeting social inequities should also be a priority.
OBJECTIVES:Anxiety disorders are among the most prevalent and impairing youth mental health problems, underscoring the need for effective treatments. This review synthesized 290 trials of psychosocial interventions for youth with anxiety or avoidance problems. Published between 1966 and mid-2024, these trials encompassed 697 study groups across 66 treatment families. METHOD:Studies were drawn from the PracticeWise Evidence-Based Services database and evaluated using a five-level strength-of-evidence framework. We identified efficacious treatments, examined contexts of effectiveness, and assessed impact and durability on symptoms and functioning. We also analyzed practice element profiles to compare the procedures most often used in CBT, Exposure, and other approaches. RESULTS:Of the 66 treatment families, 43 reached Level 4 support or better: 8 at Level 1 (Best), 26 at Level 2 (Good), 5 at Level 3 (Moderate), and 4 at Level 4 (Minimal). The remaining 23 families were at Level 5 (No Support). CBT and Exposure continued to have the strongest support. Notably, 30 (69.8%) effective families did not involve CBT, reflecting a theoretical diversity of approaches. Additional findings highlight persistent gaps related to generalizability, limited assessment of functioning, and practice element distinctions across treatment types. CONCLUSIONS:Disseminating CBT- and Exposure-based treatments is indicated, and continued investigation of a diversity of approaches is needed to support innovation, access, and contextual fit. Beyond cataloging treatments, this review raises critical questions about methodologies best suited to the ongoing stewardship of decades of research and its equitable translation into actionable knowledge to guide treatment design, training, practice, and policy.
OBJECTIVE:To evaluate the Brief Digital Intervention Program, developed in response to pandemic-era disruptions in school mental health care and the need for flexible and scalable interventions with integrated measurement for students with mild-to-moderate difficulties. The program comprises four brief, digital interventions that teach transdiagnostic, evidence-based skills (relaxation, cognitive restructuring, problem solving, and practicing the opposite of unhelpful behavior), and includes an embedded progress monitoring tool for routinely measuring students' internalizing and externalizing difficulties and "top problems" session-by-session. Study goals were to: 1) examine the acceptability of the intervention; 2) describe barriers and facilitators to its use; and 3) examine pre-post changes in student-reported difficulties. METHOD:Data were examined from 53 school mental health professionals who implemented the intervention with 213 students (Mage = 13.41 years; 63.3% cisgender girls, 27.1% cisgender boys, 9.5% another gender) presenting for mild to moderate mental health concerns from 2021-2024. RESULTS:Professionals and students reported high satisfaction with the intervention. Commonly reported barriers included difficulties with technical navigation and time for training; facilitators included ease of use/accessibility of the technical features and student engagement. Results indicated significant reductions in internalizing difficulties, β = -0.42, p < .001 [small-to-medium effect], externalizing difficulties, β = -0.15, p = -.04 [small effect], and top problem severity, β = -1.01, p < .001 [large effect], from pre- to post-intervention. CONCLUSIONS:Findings provide preliminary support for the acceptability and potential benefits of the Brief Digital Intervention Program for school mental health care. Next steps include evaluation using a controlled, randomized design and testing sustainability.
OBJECTIVE:Emerging evidence suggests that social skills difficulties in children with ADHD are not due to difficulty learning/acquiring age-expected social skills, but instead to difficulty performing known social skills in the moment. The current study reflects the largest investigation to date to disentangle social knowledge vs. performance difficulties in children with and without ADHD, while also probing the extent to which children with ADHD exhibit strengths in specific social domains. METHOD:A clinically evaluated and carefully phenotyped sample of children ages 8-13 with and without ADHD (N = 277; 42.6% girls; 66.8% White Non-Hispanic) was assessed using the well-validated social behavioral analysis framework to quantify social skills acquisition difficulties, performance difficulties, and strengths across settings (home, school). RESULTS:Acquisition difficulties were rare and idiosyncratic for both groups; parents and teachers perceived fewer than 15% of children with ADHD as missing any specific social skill. In contrast, performance difficulties were predominant in the ADHD group and occurred at significantly higher rates across informants relative to the non-ADHD group in the domains of communication, cooperation, empathy, responsibility, and self-control (all p < .001), but not assertion or engagement (both p > .56). Interestingly, children with ADHD were also perceived across informants as having strengths in specific communication and engagement skills, despite exhibiting significantly fewer social strengths overall vs. the non-ADHD group (p < .001). CONCLUSION:These findings are consistent with updated conceptualizations suggesting social skills difficulties in children with ADHD are not primarily due to a lack of social knowledge but rather from the inconsistent execution of known social skills.
OBJECTIVE:Adolescent suicide is a worsening public health crisis. Amid rising authoritarian policies that disproportionately target minoritized youth, the psychological costs of hyper-surveillance (targeted, punitive monitoring) remain unexamined. This study provides an initial operationalization of perceived hyper-surveillance to examine its relationship with suicide ideation (SI) severity, suicide attempts, and antisocial behavior, beyond the effects of discrimination and violence exposure. METHOD:In a cross-sectional study of 476 adolescents (13-17 years; 63% Black; 55% male-identifying) recruited online and in community settings. Hyper-surveillance was operationalized using items from validated measures that captured experiences across community and school settings. Multivariable regression models tested associations between traumatic-stress symptoms, hyper-surveillance, SI severity, suicide attempts, and antisocial behavior. Thematic analysis explored how adolescents believed hyper-surveillance contributed to suicide risk. RESULTS:Traumatic-stress symptoms and hyper-surveillance were independently associated with increased SI severity and suicide attempts (ps < .001). Hyper-surveillance moderated associations between traumatic-stress symptoms and both SI severity and antisocial behavior. Those with darker skin tones experienced disproportionately more hyper-surveillance independent of antisocial behavior. Over half (58.3%) of adolescents with SI reported that hyper-surveillance contributed to their desire to die; qualitative themes reflected negative affect and beliefs about themselves, others, and the world. CONCLUSION:Amid expanding surveillance infrastructure in schools and communities (with known disparities in how these systems operate), these findings provide initial evidence that perceived hyper-surveillance functions as a modifiable risk factor for youth suicide. Clinical assessment of punitive surveillance experiences should be integrated into suicide risk evaluation for adolescents.
OBJECTIVE:Safety planning interventions (SPIs) may prevent suicidal behavior among adolescents, but many adolescents in need do not receive an SPI. Self-guided digital SPIs could reach many vulnerable youth, but the quality of adolescents' self-produced digital safety plans is unknown. METHOD:In this longitudinal study, we analyzed 180 safety plans created using a novel SPI web-application by adolescents aged 13-18 (53% non-Hispanic white, 61% women) with past-year suicidal thoughts or behaviors. We rated safety plan quality and completeness using a validated scoring system, and participants reported safety plan usage at one-month follow-up. RESULTS:Of all safety plans, 78% were rated as at least "Satisfactory." Adolescents' safety plans were mostly complete, with an average completeness score of 15.32 out of 19 (SD = 2.85). Safety plan quality was moderate, with an average quality score of 10.47 out of 18 (SD = 2.02). Safety plan scores did not differ significantly by participant age. At one-month follow-up, 33% of participants reported having used their safety plan. Adolescents whose safety plans were more complete were more likely to use their plan (OR = 1.26, p < .01), but quality and global impression did not predict use. Of those who used their safety plan, 93% said it was at least "somewhat" helpful. Safety plan scores did not predict adolescent-rated plan helpfulness. CONCLUSIONS:Adolescents can use self-guided SPIs to create satisfactory safety plans without clinician guidance. Larger-scale testing of such tools is warranted, including to better understand associations between safety plan characteristics and suicide-relevant outcomes.
OBJECTIVE:This study examined children's attention biases to angry, sad, and happy displays as antecedents to callous-unemotional (CU) traits and subsequent internalizing and externalizing difficulties. The goal was to identify early risk processes that contribute to the developmental cascade of CU traits during the transition from preschool to early elementary school. METHOD:Participants included 238 mothers and their preschool-aged children (Mage = 4.38 years, 52% female) assessed across three annual measurement occasions. The sample was racially and ethnically diverse (68% White, 18% Black, 14% Multiracial or another race; 16% Latinx). A multi-method, multi-informant design was used, including eye-tracking indices of children's fixation duration to angry, sad, and happy facial expressions, maternal reports of CU traits, and both maternal and paternal reports of children's psychological symptoms. Path analyses tested a prospective cascade from children's attention biases to later CU traits and adjustment difficulties, controlling for autoregressive effects and demographic covariates. RESULTS:Children's greater fixation duration on angry faces at Wave 1 predicted residualized increases in CU traits at Wave 2 (b = .35, p < .05). Wave 2 CU traits, in turn, predicted residualized increases in externalizing (b = .31, p < .001) and internalizing (b = .32, p < .001) symptoms at Wave 3. Sensitivity analyses supported the robustness of these associations. CONCLUSIONS:Findings highlight heightened attention to anger in early childhood as a precursor to CU traits, which later shaped emotional and behavioral maladjustment. Early assessment of affective attention may aid prevention efforts targeting socioemotional risk mechanisms in children.
OBJECTIVES:Recent research highlights increasing and disproportionate rates of mental health challenges for Black children. Early intervention and family-centered interventions have the strongest evidence-base for successful treatment with young children. However, Black families may experience different levels of retention and efficacy. Thus, the current study sought to examine the literature covering interventions and prevention programs with Black families with young children and outline future directions for research and practice. METHOD:PRISMA guidelines were used to examine peer-reviewed journal articles published between 1993 and April 2023, covering prevention, intervention, or treatment programs for Black families with young children. Selected studies included: 1) at least 50% Black/African-American participants, 2) a caregiver component, 3) a mean child age between 2 and 7 years, and 4) at least one mental health or child behavior outcome. 21 articles were included for data extraction. RESULTS:11 intervention and prevention programs were represented, with most studies focused on externalizing behaviors. Studies utilized a variety of adaptations and strategies for engagement and retention. Study samples frequently did not disaggregate data and were concentrated in low-income, urban populations. Few studies focused on culturally adapting treatment exclusively for Black families. CONCLUSIONS:Results stress the need for critical examination of "evidence-based" interventions for Black families with young children. Consideration of adaptations to remove participation and retention barriers should be incorporated into treatment frameworks to address implementation challenges. Recommendations for future directions in research and clinical practice are presented focusing on representation, culturally specific care needs, navigation of racism, and innovation of traditional mental health models.
