Rumination is thought to be a key mechanism contributing to onset and persistence of depression. We aimed to evaluate the psychometric properties of a measure of rumination, the Children’s Response Styles Questionnaire (CRSQ), in a sample of UK adolescents (11–16 years; N = 615) who also completed measures of anxiety and depression symptoms. Confirmatory factor analysis supported the two-factor solution: ‘rumination’ and ‘distraction and problem-solving’ (DPS), however the DPS subscale was weaker due to item removal. Full and partial measurement invariance was demonstrated for age and gender respectively. The rumination subscale showed good internal consistency, and it is moderately positively correlated with depression and anxiety symptom measures. Our study suggests that the rumination subscale is both reliable and valid and indicates that the measure could be used in research with UK adolescents, however caution is needed if using the DPS subscale. Future research in clinical populations is warranted.
This study examined how childhood maltreatment, bullying victimization, and weakness in social competition co-occur and are associated with adolescent adjustment through belief in a just world (BJW). Data were collected from 1,302 Chinese adolescents over six months. Latent profile analysis identified three adversity profiles: low-adversity profile (84.2
Parent-report screening measures accurately capturing socio-emotional or behavioral (SEB) symptoms in preschool-aged children are needed to identify children requiring support. This study investigated the assessment stability of SEB symptoms in a preschool community population. Parents (N = 178) of children aged 3–5 years, completed the PSC-17, Preschool Pediatric Symptom Checklist (PPSC) and Child Behavior Checklist at baseline, 3-month and 6-month follow-up. At baseline, clinicians interviewed parents using the Diagnostic Interview Schedule for Children, Adolescents and Parents (DISCAP-V), and Children’s Global Assessment Scale. PPSC and PSC-17 total scores, externalizing and attention subscales had significant measurement stability across time. Both PSC measures had moderate–strong correlations with clinical diagnoses, with the exception of internalizing disorders. Predictive validity of PSC measures with DISCAP-V diagnoses resulted in mixed findings. Findings that parent-report screening measures are associated with clinical diagnoses further justifies their use as a low-cost, first step in early-intervention models for preschool children.
Harsh parental disciplinary approaches can negatively impact children emotionally and behaviorally, and early childhood mental health difficulties can impact later life functioning. We examined parental disciplinary approaches (i.e., inductive and power assertion approaches) during childhood in relation to internalizing, externalizing, and total behavior problems across 14 countries. We hypothesized that discipline practice indicators would explain both within- and between-group variance based on differential values, socialization goals, and acceptance of varying approaches across cultures. Caregivers (N = 865) across 14 countries (M = 61 families per site) reported child (Mage = 26.88 months, SDage = 5.65 months; 52
Child behavioral difficulties benefit from early intervention, yet current research lacks analysis of strength-based factors, particularly within high-risk samples from marginalized communities. Towards this end, this secondary data analysis examined the moderating effect of maternal emotion talk on infant behavior outcomes after completing a home-based adaptation of Parent Child Interaction Therapy (PCIT), coined the Infant Behavior Program (IBP). Participants were fifty-eight mother-infant dyads (53
Rating scales are widely used in autism spectrum disorder (ASD) evaluations to provide information about developmental history and behavior across settings. Despite frequent use, limited research has examined the diagnostic utility of the Autism Spectrum Rating Scale (ASRS) in clinical settings. This study evaluated the ability of the ASRS to predict ASD diagnoses in a clinical sample. We conducted a chart review of 2,200 youth ages 8–18 years (M = 10, SD = 3) who completed comprehensive autism evaluations and either received an ASD diagnosis (n = 1101) or did not (n = 1119). We analyzed parent and teacher ASRS forms using t-tests and receiver operating characteristic analyses. The DSM subscale scores were significantly higher in the ASD group, though effect sizes were small. Teacher ratings performed slightly better than parent ratings, but overall diagnostic accuracy was poor (AUC = 0.62). Findings suggest the ASRS may aid screening but has limited diagnostic utility in high base-rate clinical settings.
This study adopts a person-centered approach to examine how profiles of relationships with parents, teacher recognition, and peer relationships conjoin and influence the academic and psychological wellbeing of Chinese migrant adolescents. Drawing upon two-wave data from a nationally representative survey (N = 820; ages 12 to 16), three distinct profiles were identified: Optimally Connected (strong bonds across parents, teachers, and peers), School Risk (strong family ties but low teacher recognition and poor peer relationships), and Family Neutral (weaker family relationships but better school-based ties than the School Risk group). Profile comparisons indicated that adolescents in the two risk profiles had significantly lower psychological wellbeing and educational outcomes compared to Optimally Connected adolescents. Furthermore, the stability of the School Risk Profile was low (11
Early assessment of social-emotional skills is crucial for identifying children at risk and implementing targeted interventions. To address the scarcity of reliable self-reports for young children, we developed the GraSEF, a digital screening instrument for primary students. GraSEF utilizes a situational judgment format to assess internalizing/externalizing behavior, social withdrawal, problem-solving, alongside self-reports for prosocial behavior and emotion regulation strategies. This study examines the instrument’s psychometric properties in a sample of 474 s-graders in Austria (Mage = 7.66 years, SD = 0.42; 52.1
It is important to improve understanding of how parenting stress and coping strategies may be associated. Various coping strategies have been associated with different psychosocial outcomes, including anxiety and depression. Gender differences in coping between women and men may contribute to women reporting higher levels of psychological distress, depression, and anxiety. However, there is a lack of research on gender differences in stress responses and coping behaviors among parents in response to the stress of parenting adolescents, particularly during the COVID-19 pandemic. The current study aimed to address this gap in the literature by recruiting 396 parents (200 mothers and 196 fathers) of adolescents aged 12 to 16 years during the COVID-19 pandemic (November to December, 2021). Participants completed self-report measures and engaged in a standardized audio vignette paradigm to evaluate emotional responses to stress-inducing scenarios involving their adolescent children. Secondary control coping and affective symptoms were associated with maternal emotional reactions to the standardized audio vignettes, while paternal affective symptoms and secondary control coping were associated with anxious responses to the audio vignettes. These findings provide preliminary evidence that it may be important to promote secondary control coping, and to target parental affective symptoms in order to improve parent affective responses to difficult interactions with offspring.
Research suggests gender differences in parent-reported ADHD symptoms, but it remains unclear whether these differences vary across age group and countries. This study examined cross-national gender differences from early, middle and late childhood. Using a meta-analytic approach based on mean values, standardization data from the Strengths and Difficulties Questionnaire (Subscale Hyperactivity/Inattention) from England, the Netherlands, the USA, and Japan were aggregated. A mixed-effects meta-regression model was used to average gender differences and potential moderation by age group and the Gender Inequality Index (GII) simultaneously. The gender difference was significant overall (standardized mean differences [SMD] ≈ 0.27) and in all age groups (SMD early childhood ≈ 0.27, SMD middle childhood ≈ 0.36, SMD late childhood/adolescence ≈ 0.35). The GII did not explain the observed variability but was limited in variance. Residual heterogeneity suggests the involvement of additional factors. Results indicate that gender differences are existing in all age groups and countries. Limitations include the use of aggregated data, categorical age groups, and a small number of countries.
Executive functions (EF) are neurocognitive processes frequently impaired in children with neurodevelopmental disorders, and that significantly impact on their adaptive functioning. This study investigated the relationship between executive functions and adaptive behaviors in 98 Italian preschoolers diagnosed with Autism Spectrum Disorder (ASD), Attention Deficit Hyperactivity Disorder (ADHD), or co-occurring ASD + ADHD. Utilizing both performance-based tasks and parent-reported questionnaires, the research aimed to: 1) examine associations between EF and adaptive behavior across the sample, 2) delineate distinct EF and adaptive functioning profiles within each diagnostic group, and 3) assess the mediating role of EF in the link between diagnosis and adaptive outcomes. Results indicated significant correlations between parent-reported executive behaviors and adaptive skills, highlighting a strong link between lower executive functioning and poorer adaptive outcomes. Diagnostic group comparisons revealed that children with ADHD and ASD + ADHD exhibited greater impairments in executive behaviors, particularly in inhibition and working memory, compared to those with ASD alone. The ASD + ADHD group consistently demonstrated the most severe difficulties across nearly all adaptive behavior domains compared to either single-diagnosis group. Mediation analyses indicated that global executive behaviors significantly mediated the relationship between diagnostic group and adaptive functioning. Findings highlight the critical role of EF in adaptive skills and support EF-focused interventions, to enhance adaptive skills in young children with these neurodevelopmental disorders.
Sleep problems and non-suicidal self-injury (NSSI) represent critical public health concerns during adolescence. While cross-sectional research suggests an association, prospective longitudinal evidence remains limited. This systematic review and meta-analysis evaluated the prospective relationship between sleep problems and subsequent NSSI risk among adolescents. PubMed, Embase, Web of Science, Cochrane Library, and CINAHL were searched from inception to January 2026. Twenty longitudinal studies comprising 62,467 adolescents were included. Pooled analysis revealed that sleep problems significantly increased NSSI risk (OR = 1.60; 95
Comprehensive Behavioral Intervention for Tics (CBIT) is the first-line treatment for Tourette Syndrome and other persistent tic disorders. Efforts to increase access to CBIT have involved training a wide range of providers across practice settings and expanding delivery methods (e.g., teleCBIT, group-based CBIT). Literature regarding how providers implement CBIT across settings is lacking. The current study analyzed surveys from 101 CBIT providers across the United States and Canada to better understand CBIT practice patterns and beliefs. Results indicated that while respondents across disciplines include the key components of CBIT, they also integrate other components and evaluate outcomes beyond symptom reduction. Respondents generally held positive beliefs about CBIT. Results point to the need for future research to evaluate how these practice patterns and beliefs impact treatment outcomes and treatment quality.
In this article, we present a computational framework for predicting treatment response to neurofeedback (NF) among patients with Attention-Deficit/Hyperactivity Disorder (ADHD). The proposed framework uses functional brain connectivity analysis of electroencephalogram (EEG) signals acquired during an early-to-mid NF treatment window to classify participants as eventual responders or non-responders. The six-stage algorithm was evaluated using an open-access EEG dataset from the Mendeley Data repository comprising 60 children with ADHD aged 6–12 years. The framework includes a preprocessing pipeline designed to reduce EEG artifacts and noise. Next, spectral features, specifically of the alpha and beta frequency bands, were extracted from the noise-reduced signals. In the fourth stage, functional connectivity was estimated by calculating Phase Locking Value (PLV) between all electrode pairs, thereby quantifying inter-channel phase synchronization. The fifth stage, which is an essential stage, was dimensionality reduction to find the most discriminative features. Dimensionality reduction was achieved in a two-process manner; for the first process, statistical screening was performed using Welch’s t-test with FDR correction, followed by GA-based channel selection to identify the most discriminative electrode subset. The GA analysis identified a compact six-channel subset consisting of C3, C4, Cz, Fz, Fp1, and T6 from the original 32-channel montage. In the last classification stage, the reduced feature vectors were input as part of an ensemble of machine learning classifiers to achieve classification. Model performance was evaluated using subject-wise grouped cross-validation, with the best configuration achieving an accuracy of 84.72
Anxiety and eating disorders are dangerous, impairing conditions that are increasingly common in youth. Etiology of anxiety and eating disorders may overlap, as both conditions may develop from avoidance of feared situations and sensations. Awareness of feared sensations is related to interoception, the ability to sense internal signals including feared sensations. Atypical interoception in the gastrointestinal domain may be a shared risk factor for anxiety and eating disorders. Gastric sensations are implicated in both eating disorders and anxiety for some individuals. Fear learning may partially explain the relationships among interoceptive deficits and anxiety and eating disorders, such that individuals begin to fear gastric sensations and associated emotional states or situations. Fear of these experiences may generalize to other experiences or sensations associated with gastric discomfort, which may eventually lead to the development of an anxiety and/or eating disorders. Identification of interoceptive deficits in youth presents opportunities for prevention and early intervention of anxiety and eating disorders before they become impairing. This review characterizes interoceptive sensitivity and its role in the onset and maintenance of anxiety and eating disorders. Atypical interoception is defined, fear learning is discussed as it relates to interoception and psychopathology, and the existing research on interoception in children and relationships among interoceptive deficits and anxiety and eating disorders is reviewed respectively. Current gaps in the existing literature are addressed by identifying a recent series of proposed conceptual models, reviewing the evidence for such models, and proposing future research to test these models in youth.
Grounded in the bioecological model, this study examined depressive symptom profiles and their links with school relational factors (teacher–student relationships, home–school relationships, peer friendships, and bullying victimization) among 3,837 Chinese adolescents (Mage = 14.71 years; SDage = 1.42; 51.7
Obsessive–compulsive disorder (OCD) often emerges in childhood. Many children do not receive support until symptoms have been impairing for years. Targeted preventive approaches may therefore be valuable, particularly for children with early obsessive–compulsive symptoms or a family history of OCD. A brief online program has recently been developed to support parents of children at elevated risk of OCD, but little is known about how parents experience engaging with such a preventive intervention. This qualitative study explored parents’ experiences of participating in the online prevention program. Nine parents of children aged 5–11 years were purposively sampled to represent different risk profiles (subclinical symptoms, familial risk, or both). Individual semi-structured interviews were conducted after program completion and analyzed using reflexive thematic analysis by two researchers. Two overarching themes were identified. “Accessibility and design features facilitating engagement” captured how parents experienced the digital, flexible format as lowering practical barriers and enabling integration of the program into everyday family life. “Changes in understanding and parental responses” described shifts in how parents interpreted early OCD-related behaviors, family accommodation, and their own responses. Parents perceived the online preventive program as accessible, relevant, and supportive of both understanding OCD and changing their behavioral responses. The findings support a refinement of the intervention by extending its duration, incorporating more in-depth content, and clarifying its focus on children with early OCD symptoms. These refinements will strengthen the program’s suitability as an early preventive intervention for families at risk of pediatric OCD.
Families of children with neurodevelopmental disorders often face limited access to evidence-based mental health care and supports, despite a disproportionately high prevalence of co-occurring conditions, such as anxiety, among these children. This study aimed to adapt a digital single-session intervention (SSI) designed to reduce parental accommodation of child anxiety by incorporating direct feedback from parents of neurodiverse children. In December 2024, five online human-centered design workshops were conducted with six parents, who provided input on the intervention’s content (e.g., clarity, relevance) and acceptability (e.g., language, confidence to make a change). Responses were systematically coded and analyzed using content analysis. Across workshops, parents emphasized the need for interventions to be practically relevant, emotionally validating, and reflective of daily caregiving experiences, where “every day can feel like a wrestling match.” Participants also raised concerns about the term “accommodation,” which carries a positive connotation within the disability communities. Based on this feedback, revisions included incorporating neurodiversity-specific examples and parenting strategies and using descriptions of rather than labeling parenting behaviors. Through lived experiences, caregiver feedback revealed important adaptations needed to enhance intervention effectiveness and acceptability. Co-designing SSIs with families has the potential to promote equitable access to evidence-based mental health care, and successful adaptations present a scalable framework for integrating SSIs into child mental health services across settings.
Anxiety disorders are common in children and adolescents, but constrained resources limit access to cognitive-behavioral therapy (CBT). Stepped and stratified care models offer different ways to organize care. Stepped care starts with lower-resource CBT and escalates when needed, whereas stratified care matches CBT format to patient complexity from the outset. Economic evidence comparing these models remains scarce. We conducted a pilot economic evaluation alongside an RCT of 51 youths with anxiety disorders to examine the feasibility of health-economic evaluation and generate preliminary cost-effectiveness estimates. Participants were randomized to stepped care (guided internet-delivered CBT [iCBT] with escalation to in-person CBT if needed, n = 25) or stratified care (baseline allocation to guided iCBT or in-person CBT with escalation to in-person CBT if needed, n = 26). Health outcomes and costs from the healthcare and societal perspectives were collected over 6 months, with the base case analysis estimating the change in utility scores. Incremental cost-effectiveness ratios (ICERs) were estimated using non-parametric bootstrapping. Stratified care yielded greater, though not statistically significant, health gains than stepped care and was dominant from the societal perspective. From the healthcare perspective, the AUC-derived quality-adjusted life years (QALY) sensitivity analysis yielded an ICER of USD 6,878 per QALY gained, although estimates remained uncertain given the small pilot sample. Subgroup analyses by age, sex, and treatment response generally supported these patterns while highlighting heterogeneity. These findings support the feasibility of conducting economic evaluations of care models in routine youth mental health care, but larger trials are needed to provide more precise cost-effectiveness estimates and inform service-delivery policy.
The aim of this study was to gather participant feedback to enhance the Lights Out Online Program, a 4-session, self-directed, web-based parent intervention targeting behavioural sleep problems in preschool-aged children using evidence-based strategies. Specifically, we sought to (1) understand parents' experiences with the program itself, including their level of satisfaction and their implementation of program strategies, and (2) gain feedback from parents regarding possible program improvements, to inform improvements and adjustments to the program. Data were collected using session satisfaction surveys at the end of each session, complemented by videoconference interviews with a subset of participants to understand implementation of program strategies following program completion. Twenty-four parents of children aged 3-6 years with sleep problems participated in the program, six of whom also participated in a semi-structured interview. Deductive organisation of survey responses revealed that the program was practical, and that the strategies were easy to implement; however, parents found sessions most helpful when the content related to their child's specific problem. Using a reflexive thematic analysis, four main themes were captured in the interviews: (1) the cascade of positive changes following program completion, (2) the gradual process required for successful implementation and change, (3) the invitation for all parents to be on the same page, and (4) the need for flexibility in delivery. The areas for improvement suggested by parents were incorporated into the revised online program. This revised version of Lights Out Online has the potential to increase acceptability, engagement, and long-term adoption of the program.
