Objectives:This study aimed to compare cognitive ability, physical (motor proficiency and fitness), and psychosocial (depressive symptoms and quality of life) outcomes between adolescents participating in extracurricular sports (ES) and non-sports (NS) and to examine predictors of problematic Internet use (PIU). Methods:A cross-sectional study was conducted with 433 Indonesian adolescents (ES=239, 49.0% males; NS=194, 52.1% males). Standardized measures included the Problematic and Risky Internet Use Screening Scale for PIU, Raven's Standard Progressive Matrices for cognitive ability, Bruininks-Oseretsky Test-2 for motor proficiency, the Indonesian Student Physical Fitness Test, the Youth Quality of Life-Short Form for quality of life, and the Patient Health Questionnaire-Adolescent Version for depression. Group differences were analyzed using the Mann-Whitney test. Spearman's correlations were used to assess associations between variables, and linear regression was used to identify predictors of PIU. Results:ES adolescents showed significantly higher cognitive ability, motor proficiency, physical fitness, and quality of life and lower PIU and depressive symptoms than the NS groups (all p<0.001). PIU positively correlated with depression and negatively correlated with motor proficiency, physical fitness, cognitive ability, and quality of life. The regression analyses identified depression as a strong positive predictor of PIU, whereas cognitive ability, motor proficiency, physical fitness, and quality of life were significant negative predictors, explaining the substantial variance in PIU. Conclusion:Adolescents participating in ES demonstrated higher cognitive, physical (motor proficiency and fitness), and psychosocial outcomes (depressive symptoms and quality of life) than NS participants. Depression was positively associated with PIU, whereas motor proficiency, fitness, cognitive ability, and quality of life were inversely associated with PIU.
Objectives:Behavioral interventions for Tourette syndrome (TS) involve tic suppression and attention to premonitory urges. However, some patients believe that focusing on tic symptoms or urges may worsen symptoms, and that suppressing tics may exacerbate urges. Using a single experimental dataset with real-time urge monitoring, this study addressed two analytical aims. Aim 1 examined whether tic suppression worsens the intensity, frequency, and persistence of premonitory urges. Aim 2 examined whether sustained attention to urges increases tic frequency or worsens subjective urges. Methods:Ten adult men with TS and frequent tic symptoms (mean age=28.3 years, standard deviation=9.1 years) completed four 5-min conditions twice: rest, suppression, urge-reporting, and suppression+urge-reporting. In the urge-reporting conditions, participants used a handheld monitor to continuously report urges. The sessions were video-recorded, and tic frequency was coded. For Aim 1, the mean urge intensity, frequency of threshold-crossing urge episodes, and post-threshold persistence patterns were compared between the urge-reporting and suppression+urge-reporting conditions. For Aim 2, tic frequency and subjective states were compared between the conditions with and without urge-reporting. Results:At the group level, tic suppression was not associated with consistent worsening of mean urge intensity, frequency of threshold-crossing urge episodes, or post-threshold persistence patterns. This overall pattern did not clearly differ by obsessive-compulsive symptoms, although participants with these symptoms showed larger and more persistent urge responses in the descriptive plots. Sustained urge-reporting was not associated with a consistent group-level increase in tic frequency; instead, marked individual variability was observed. Subjective urge intensity and fatigue were higher after suppression+urge-reporting condition than after suppression condition. Conclusion:Under short-term laboratory conditions, tic suppression was not associated with a consistent group-level worsening pattern in premonitory urge indices, and real-time urge reporting was not associated with a consistent group-level increase in tic frequency. However, individual variability was substantial; this variability may be partly related to obsessive-compulsive symptoms.
Tic disorders are neurodevelopmental conditions characterized by involuntary movements and vocalizations. Recent technological advancements and deeper clinical insights have driven progress in both the neurobiology and treatment paradigms of these disorders. This narrative review provides a comprehensive synthesis of contemporary perspectives, bridging upstream pathophysiological mechanisms with downstream therapeutic modalities. From a pathophysiological perspective, the classic model of cortico-striato-thalamo-cortical circuit dysfunction has significantly expanded into a system-level network. Emerging evidence highlights the critical involvement of cerebellar pathways in tic generation, abnormal insular and somatosensory processing underlying premonitory urges, and intricate neuroendocrine cascades that modulate stress and prepubertal symptom exacerbation. By mirroring these complex biological mechanisms, contemporary treatment strategies are moving toward tailored, mechanism-based interventions. Evidence-based behavioral therapies, led by comprehensive behavioral interventions for tics, remain the first-line options. Pharmacotherapies are reserved for patients with significant functional impairment, whereas novel targeted agents, such as ecopipam, and innovative neuromodulation modalities, including adaptive deep brain stimulation, offer promising avenues for circuit-specific modulation. Thus, integrating advanced neurobiological frameworks with expanding therapeutic alternatives underscores the definitive shift toward precision medicine in tic management.
Tourette syndrome presents with diverse motor and vocal tics, yet involvement of Eustachian tube dynamics has not been previously described. We report the case of a 31-year-old woman who developed an unusual symptom she described as an "ear-popping tic," characterized by a strong premonitory urge to release air from the ears and clicking sounds. Her long clinical history included childhood-onset tics, emotional instability, psychiatric hospitalizations, and fluctuating tic severity. At age 31, she reported repetitive ear-popping sensations accompanied by voluntary suppression to some extent. Ear, nose, and throat examination revealed normal tympanic membranes and hearing thresholds. Acoustic Eustachian tube function testing objectively demonstrated repetitive Eustachian tube opening independent of swallowing, a finding not previously documented in tic disorders. The patient described a strong urge to engage in ear-popping and partial suppressibility, although the temporal relationship between the auditory sensation and the urge was unclear. Differential diagnoses included voluntary ear-popping behavior, palatal myoclonus, middle ear myoclonus, and tensor tympani syndrome. The repetitive non-swallow-related tube opening was considered most consistent with tic-like contractions of the tensor veli palatini and levator veli palatini muscles, although voluntary components could not be fully excluded. One month later, she adopted lifestyle practices inspired by traditional East Asian medicine, leading to gradual psychological stabilization. The ear-popping tic became less intrusive, and all medications were eventually discontinued. This case highlights the importance of objective assessment in distinguishing tic-like phenomena from other causes of Eustachian tube opening.
Objectives:Obsessive-compulsive disorder (OCD) is a neuropsychiatric disorder characterized by obsessions and compulsions, with a prevalence of 1%-3%. Tight junction (TJ) proteins contribute to maintaining the epithelial barrier. This study investigated the association of serum TJ-associated MARVEL protein family and inflammatory markers with OCD severity in children and adolescents. Methods:A total of 43 drug-naive children with "pure" OCD and 37 age-matched healthy controls were included in the study. Serum levels of occludin, tricellulin, MarvelD3, which belong to the TJ-associated MARVEL protein family, along with inflammatory markers (C-reactive protein, tumor necrosis factor-alpha [TNF-α], interleukin-6) were assessed. The severity of OCD was ascertained using the Maudsley Obsessive-Compulsive Inventory (MOCI). Biochemical data of patients and control groups were compared against clinical features such as OCD severity and time since symptom onset. Results:Both groups showed similar sociodemographic factors, except that psychiatric disorders and family histories of OCD were significantly higher in the OCD group. Although serum TJ levels were not significantly different between groups, serum tricellulin (r= 0.427, p=0.004), MarvelD3 (r=0.489, p<0.001), and TNF-α (r=0.495, p<0.001) levels had a positive correlation with the severity of OCD based on MOCI. Conclusion:The findings suggest that tricellulin, MarvelD3, and TNF-α may be associated with OCD severity. Further comprehensive research is required to determine the role of TJ proteins belonging to the MARVEL protein family in the pathophysiology of OCD.
Objectives: This study investigated the trajectories of subjective happiness among children aged 8-13, assessed the impact of the CO-VID-19 pandemic, and identified child-and family-level predictors of variations in happiness. Methods: Drawing on 5855 person-years of data from the nationally representative Panel Study on Korean Children, we employed longitudinal multilevel modeling to examine trends, including those during the pandemic period, and to estimate the influence of child-and family-level predictors. Sex differences were analyzed using interaction terms and stratified analyses. Results: The study revealed a significant negative temporal trend in children's subjective happiness from ages 8 to 13 years, with a sharp decline associated with the onset of the pandemic in 2020 (b=-1.524, p<0.001). Regarding child-level predictors, male sex, sleep duration, subjective health, and number of friends were positive predictors. Maternal education was a positive family-level predictor, whereas maternal stress was a negative predictor. In terms of sex differences, the happiness levels of both males and females remained significantly below the pre-pandemic levels. Overweight/obesity, sleep duration, maternal education level, and paternal subjective health were significant predictors among females but not among males. Conclusion: Although we found a decline in happiness with age, we confirmed that COVID-19 had a significant impact on children's subjective happiness. Our findings underscore the need to identify the key predictors of happiness and to consider proactive strategies to prepare for future infectious disease outbreaks.
This study aims to trace the historical origins and conceptual divergence of "autism" as employed in autism spectrum disorder (ASD) and schizophrenia spectrum disorder (SSD), and to examine their recent rapprochement through the lens of phenomenological psychopathology. A narrative review was conducted to analyze primary historical sources, including works by Bleuler, Kanner, and their predecessors, along with contemporary literature on neurodevelopmental perspectives, social cognition, and phenomenological psychopathology. The analysis focused on comparing the structures of self-experience between patients with ASD and those with SSD using frameworks such as ipseity disturbance and anomalous self-experience. Bleuler's "Autismus" (1911) denoted active withdrawal from reality and construction of an inner fantasy world in schizophrenia, whereas Kanner's "infantile autism" (1943) described innate deficits in forming affective bonds. Despite strict diagnostic separation since DSM-III, recent research reveals shared genetic pathways, social cognitive impairments, and clinical presentations. Phenomenological analysis revealed that while both conditions share common predicaments in being-in-the-world, they manifest qualitatively distinct patterns of self-disorder. Patients with SSD exhibit ipseity disturbance characterized by instability of the minimal self, diminished self-affection, and hyperreflexivity, whereas patients with ASD generally show preserved minimal self but deficient intersubjective attunement. Social withdrawal in SSD represents a defensive retreat against ontological anxiety and self-dissolution, whereas in ASD it reflects involuntary isolation arising from impaired intuitive connections with others. ASD and SSD share common predicaments in being-in-the-world, yet manifest qualitatively distinct forms of self-disorder. This phenomenological framework offers a promising transdiagnostic approach for clarifying the relationship between these two conditions and understanding the essence of "autism."
Objectives: Cyberbullying is a modern form of violence involving intentional harassment through electronic devices. We aimed to investigate how psychological characteristics differ based on cyberbullying involvement, identify the psychological factors associated with cyberbullying, and examine whether these factors vary by gender. Methods: A survey was conducted with 449 middle school students in Cheongju, Korea. Participants were categorized into four groups based on their involvement: Neither (N), Victim (V), Perpetrator (P), and Victim-Perpetrator (VP). Psychological characteristics were assessed using the Beck Depression Inventory (BDI), Self-Esteem Scale, and Strengths and Difficulties Questionnaire (SDQ). We compared these characteristics across the four groups and examined their influence on cyberbullying involvement by gender. Results: Overall, 31.8% of participants were involved in cyberbullying, with the VP group being the largest (17.1%) among them. The VP group exhibited more severe psychopathology than the N group across most internalizing and externalizing problems. SDQ-Conduct Problems subscale scores were significantly associated with victimization and perpetration. For female participants, high SDQ-Emotional Symptoms subscale scores were associated with greater victimization, and high BDI scores increased the risk of belonging to the VP group. No variables significantly increased the risk of belonging to the VP group among male participants. Conclusion: Adolescents who are both victims and perpetrators of cyberbullying face the most significant psychological difficulties. Factors associated with cyberbullying involvement vary by gender, highlighting the need for tailored gender-specific prevention and intervention strategies.
Objectives:PEERS® for Preschoolers (P4P) is an evidence-based, parent-assisted social skills program for young autistic children and children with other social challenges. The program aims to promote age-appropriate social skills and improve peer relationships. Parent employment status and cultural background may influence families' engagement in the program and their relationship with providers, which can affect use of P4P skills outside weekly sessions. This study examined whether these parent demographic characteristics predicted program response in P4P. Methods:Participants were 46 autistic children (mean age=4.50 years; 78.3% male) and their caregivers who completed P4P between 2015 and 2019. Families took part in a 16-week curriculum with parallel child and parent groups. Program outcomes were measured using parent-report instruments, including the Social Responsiveness Scale-Second Edition, Social Skills Improvement System subscales of Social Skills and Problem Behaviors, Quality of Play Questionnaire, and Parenting Stress Index, Fourth Edition, Short-Form. Results:Significant improvements were found in child social responsiveness, social skills, behavior problems, number of playdates, and parenting stress from pre- to post-P4P. Parent employment status and race/ethnicity did not significantly predict any program outcomes. Conclusion:Results indicate that P4P benefits families broadly, with no observed effect of parent employment status or race/ethnicity on outcomes. Future research should replicate these findings in a larger, more diverse sample and examine additional potential predictors of program response to inform clinical decision-making.
Grief in children and adolescents is a complex and often misunderstood process, distinct from adult mourning in both its expression and developmental impact. Young people may struggle to articulate their emotions, leading to behavioral changes that are frequently misinterpreted or overlooked in clinical practice. This review explores how grief manifests across developmental stages, highlighting age-specific responses, common clinical presentations, and factors that influence resilience or vulnerability. Drawing on current evidence and clinical insight, we examine assessment strategies and therapeutic approaches tailored to the needs of grieving children and adolescents. Case illustrations are used to provide context and deepen understanding. By emphasizing a developmentally sensitive, emotionally attuned, and culturally aware perspective, this article aims to equip clinicians with practical tools to better support children and adolescents coping with loss.
Disruptive behavior disorder (DBD), which includes oppositional defiant disorder and conduct disorder, is among the most common externalizing disorders in childhood and adolescence. This review aimed to identify evidence-based psychotherapies for DBD and summarize their empirical foundations and characteristics. We searched for randomized controlled trials and systematic reviews using PubMed, PsycINFO, and Google Scholar, focusing on major evidence-based guidelines from the National Institute for Health and Care Excellence (NICE), American Psychological Association (APA), and Agency for Healthcare Research and Quality (AHRQ). Six interventions demonstrated the strongest empirical support: Incredible Years, Triple P, Parent-Child Interaction Therapy, Parent Management Training-Oregon Model, Multisystemic Therapy, and Treatment Foster Care-Oregon Model. These programs share a behavioral foundation that emphasizes parent-centered interventions as the core therapeutic mechanism. Considering treatment resistance and legal implications, multisystemic and community-based approaches are recommended for adolescents with severe antisocial behavior. In Korea, existing studies have primarily applied cognitive-behavioral, child-focused, and group interventions with limited fidelity assessments and few parent-focused trials. Future priorities include disseminating and validating parent-based behavioral therapies, establishing long-term follow-up systems, and adapting digital or telehealth platforms to enhance accessibility. Strengthening evidence-based, scalable behavioral interventions is crucial for improving the outcomes of Korean youths with DBD.
Objectives:The brain and autonomic nervous system are tightly interconnected and may be involved in various psychiatric conditions. We explored whether electroencephalographic (EEG) coherence and vagally mediated heart rate variability (vmHRV) differ between male children with autism spectrum disorder (ASD) and typically developing (TD) children, and how these measures are associated with the clinical characteristics of ASD. Methods:We recorded resting-state EEG and vmHRV in 14 male children with ASD and 14 TD children. The Social Responsiveness Scale (SRS) was used to assess the clinical characteristics of the ASD group. Results:vmHRV measures (root mean square of successive RR intervals [RMSSD], percentage of successive RR intervals that differ by more than 50 ms [pNN50], and high-frequnecy power) did not differ between the ASD and TD groups. By contrast, the beta1 coherence between the T5 and T6 electrodes (beta1 coherence [T5-T6]) was lower in the ASD group than in the TD group, even after correction for multiple comparisons. This coherence measure demonstrated a positive correlation with RMSSD and a negative correlation with the SRS social motivation subscale score (SRS-Motivation). Moreover, pNN50 acted as a moderator of the association between beta1 coherence (T5-T6) and SRS-Motivation. Conclusion:Resting-state EEG coherence may be associated with the clinical characteristics of ASD, and vmHRV may exert a moderating effect on this relationship. These preliminary findings suggest that the concurrent evaluation of brain and autonomic functions can be useful for elucidating the pathophysiology of ASD.
Bullying among children and adolescents is a complex and widespread problem with profound psychological, social, and legal implications. It includes physical, verbal, relational, sexual, and cyber forms involving perpetrators, victims, and bully-victims. This narrative literature review synthesizes findings from studies published between 2000 and 2024 across disciplines including psychology, education, public health, and law. Data were sourced from PubMed, Scopus, and Google Scholar, focusing on global and Indonesian contexts. Bullying arises from a combination of individual traits (e.g., impulsivity and poor emotional regulation), family dynamics (e.g., insecure attachment and low cohesion), and school and cultural influences. Theoretical frameworks such as the social learning and attachment theories help explain how bullying behaviors are learned and reinforced. Neurobiologically, bullying acts as a chronic stressor that dysregulates the hypothalamic-pituitary-adrenal axis, thereby increasing the vulnerability to anxiety, depression, and behavioral disorders. Legally, many countries, including Indonesia, have implemented child protection laws that emphasize restorative justice. Interventions such as Mindfulness-Based Cognitive Therapy for Children, Cognitive-Behavioral Play Therapy, and school-based programs such as KiVa and Olweus have effectively reduced bullying and promoted psychosocial well-being. Addressing bullying requires a comprehensive multilevel approach that integrates psychological, educational, familial, and legal strategies. Sustainable and culturally relevant interventions supported by collaboration among schools, families, and policymakers are crucial for fostering safe and supportive environments for children and adolescents.
Emotion dysregulation is a transdiagnostic risk factor in childhood psychopathology that contributes to externalizing behaviors. To address this, regulation-focused psychotherapy for children (RFP-C) has been developed as a manualized, short-term psychodynamic intervention for 5- to 12-year-olds with externalizing behaviors rooted in underlying emotion dysregulation and affective conflict. The therapy follows a structured protocol comprising 16 child play therapy sessions and 4 parent sessions. Therapists use symbolic play, identify defense-based play disruptions, and adopt affect labeling to enhance implicit emotion regulation. In parent sessions, the "triangle of conflict" was deployed to reframe behavior as defensive, strengthen reflective functioning, and scaffold regulatory growth. Pilot data (n=3) and a randomized controlled trial (n=43) demonstrated feasibility, high adherence, and statistically significant reductions in oppositional defiant symptoms, with maintenance at the three- and six-month follow-ups. The limitations included a small sample size, reliance on waitlist controls, and scarce long-term durability data. Future research is needed to conduct multisite trials with active comparators, assess applicability across diverse conditions, and examine changes in defense mechanisms. To implement RFP-C across broader clinical settings, it is crucial to train specialized clinicians, identify children who are well suited for RFP-C, and integrate appropriate interventions tailored to each child's unique challenges.
Objectives:Adolescent non-suicidal self-injury (NSSI) is a marker of severe emotional distress and a significant public health concern. This narrative review aimed to synthesize major theoretical models explaining the psychopathology of NSSI and critically evaluate the efficacy of evidence-based psychotherapies using the most recent high-level evidence. Methods:We searched articles in major academic databases published from January 2000 up to June 2025. We prioritized studies on adolescents, including efficacy studies (randomized controlled trials and meta-analyses) addressing NSSI as a primary outcome, and key theoretical papers. Results:NSSI was understood through integrated models, prominently featuring emotion dysregulation (biosocial theory), experiential avoidance (cognitive-behavioral models), impaired mentalization (attachment theory), and operant conditioning (functional model). The synthesis of high-level evidence, including a 2021 review from Cochrane, indicated that dialectical behavior therapy (DBT) had the strongest empirical support (high-certainty evidence) for reducing adolescent NSSI. However, while mentalization-based treatment, acceptance and commitment therapy, and attachment-based family therapy offered promising mechanism-specific approaches, evidence for their effectiveness for NSSI was preliminary or uncertain. Conclusion:DBT is currently the first-line treatment for NSSIs in adolescents. However, the field must move toward personalized care. Future research should focus on validating alternative therapies through head-to-head randomized controlled trials, identifying the core change mechanisms across treatments, and implementing stepwise care models to improve accessibility.
Objectives:Autism spectrum disorder (ASD) is a major neurodevelopmental disorder characterized by persistent deficits in social communication along with restricted, repetitive patterns of behaviour and interests. FMR1 gene, which causes Fragile X syndrome (FXS), is the most common single-gene contributor to ASD. Variations in CGG repeat length within the 5' untranslated region of FMR1 are central to the etiology of FXS. Given the established connection between FXS and ASD, this study investigated whether the trinucleotide repeat region of FMR1 is associated with ASD in Bangladeshi children. Methods:Seventy-one children participated in the study, including 39 with ASD and 32 age-matched controls. The FMR1 region was amplified using polymerase chain reaction and subsequently sequenced. Results:There was no statistically significant difference in the number of CGG repeats between patients with ASD and controls (p>0.01), with the most common repeat number being 27 in both groups. Interspersion of the two AGG trinucleotides among the CGG repeats was the most common pattern found in the study participants, with frequencies of 56.67% and 50.00% in the ASD and the control groups, respectively. Conclusion:This study provides preliminary evidence that CGG repeat expansion in the FMR1 gene is unlikely to represent a major genetic contributor to ASD in Bangladeshi children. However, given the limited sample size, further investigations with a larger cohort are required to confirm these findings.
