We investigated the relationship between social media and loneliness in early adolescents in Per & uacute; across 15 months of COVID-19 lockdowns (grades 6-8; 56% female in May 2020). Cross-sectional analyses with data from May 2020 (n = 1613) found that higher social media intensity was associated with higher feelings of loneliness. In a longitudinal follow-up study (n = 455), we investigated bidirectional associations in May 2020, November 2020 and July 2021, and found that feelings of loneliness in girls were associated with a subsequent increase in social media intensity. Social media intensity was not associated with changes in feelings of loneliness in either gender. Our findings with adolescents in low- and middle-income urban settings in Per & uacute; underscore the importance of longitudinal research and contribute to understanding these issues globally.

Little work has examined associations between interpersonal factors and changes in the therapeutic alliance. We examined the association between baseline youth family and peer interpersonal characteristics and therapeutic alliance throughout treatment in a sample of anxious youths who received cognitive behavioral therapy or client-centered therapy. Youths (N = 135; M = 10.94; SD = 1.46) were in a randomized clinical trial for anxiety disorders. Interpersonal characteristics were assessed via parent-report, youth self-report, and observational methods. Lower levels of parent-rated shyness, higher levels of positive interpersonal style, and being female were associated with higher early therapist-rated alliance. Being female was associated with more rapid increases in therapist-rated alliance. Friendship quality, younger age, and lower aggressive interpersonal style predicted higher baseline youth-rated alliance. Positive interpersonal style and stronger family functioning were associated with more rapid increases in youth-rated alliance. Therapists should be aware of client interpersonal characteristics when working with youth.

Wellbeing is shaped by an interplay of genetic and environmental factors and is associated with both health and functioning. It remains unclear whether genetic influences on wellbeing are linked to brain structure and, in turn, early-life psychopathology. Here, we investigated associations between wellbeing polygenic scores (PGS), magnetic resonance imaging (MRI)-derived measures of brain structure, and parent-reported measures of child psychopathology in a large cross-sectional sample of children from the Adolescent Brain Cognitive Development (ABCD) Study (n = 8844; 8.9-11.0 years old). Preregistered analyses revealed no significant associations between wellbeing PGS and regional cortical thickness or subcortical volumes and only a small negative association with surface area of the parahippocampal cortex (β = -0.03, p=.002), while an exploratory analysis identified a small positive association with intracranial volume (ICV; β = 0.04, p<.001). Preregistered analyses showed small negative associations between wellbeing PGS and general psychopathology (β = -0.09, p<.001) and both internalizing (β = - 0.09, p<.001) and externalizing problems (β = -0.07, p<.001). ICV partially mediated the relationships between wellbeing PGS and psychopathology, accounting for 1.3-3.3% of these relationships. The findings suggest that while wellbeing PGS have limited associations with regional brain structure in children, they exhibit small protective effects against psychopathology.

Alterations in reward-related brain activity have been linked to response to psychological treatment in adolescents with anxiety disorders. However, it remains unknown whether these effects are driven by reward anticipation or feedback, which reflect different functional roles in motivated behavior, or whether brain activity changes as a function of treatment response. The current study investigated these questions in the context of a randomized controlled trial of cognitive-behavioral therapy (CBT) for anxiety disorders in adolescents. This study used an fMRI paradigm to investigate reward-related brain activity in youth aged 9-14 with anxiety disorders (ANX; N = 133; 57 female) before and after 16 weeks of CBT or an active comparison (child-centered therapy, CCT). Age- and sex-matched healthy comparison (HC) youth (N = 38; 17 female) completed scans on a similar timeline. A subset of ANX youth completed a 2-year follow-up assessment of depressive symptoms. At pretreatment, ANX compared to HC youth demonstrated reduced brain activity in reward-related regions (e.g. dorsal striatum, thalamus) during reward anticipation, and elevated activity in angular gyrus, PCC and inferior frontal gyrus during reward feedback. Reduced pretreatment activation in the precuneus/cuneus and pre-to-post reductions in left angular gyrus corresponded with treatment response. Finally, pre-to-post increases in posterior cingulate cortex (PCC) corresponded with increased depressive symptoms at 2 years. Our results suggest that reward-related brain activity outside of striatal reward regions, including PCC, precuneus and angular gyrus, plays a role in treatment response in youth with anxiety disorders. Trial registration: ClinicalTrials.gov NCT00774150.

Wanting to matter—to feel socially recognized, appreciated, and capable of actions that benefit others—represents a fundamental motivation in human development. The motivational salience of mattering appears to increase in adolescence. Evidence suggests this is related to pubertal increases in the incentive salience for gaining social value and personal agency. This can provide a useful heuristic for understanding motivational proclivities (i.e. wanting to matter) that influence action-outcome learning as young adolescents are exploring and learning how to navigate increasingly complex social and relational environments. Adolescence also brings new capacities, motives, and opportunities for learning to care about and contribute to the benefit of others. Together, these create a window of opportunity: a sensitive period for learning to gain salient feelings of mattering through caring prosocial actions and valued societal contributions. Successfully discovering ways of mattering by doing things that matter to others may contribute to formative socio-emotional learning about self/other. Advances in understanding these social and relational learning processes and their neurodevelopmental underpinnings can inform strategies to improve developmental trajectories of social competence and wellbeing among adolescents growing up in a rapidly changing and increasingly techno-centric world.

STUDY OBJECTIVES:Healthy sleep is important for adolescent neurodevelopment, and relationships between brain structure and sleep can vary in strength over this maturational window. Although cortical gyrification is increasingly considered a useful index for understanding cognitive and emotional outcomes in adolescence, and sleep is also a strong predictor of such outcomes, we know relatively little about associations between cortical gyrification and sleep. We aimed to identify developmentally invariant (stable across age) or developmentally specific (observed only during discrete age intervals) gyrification-sleep relationships in young people. METHODS:A total of 252 Neuroimaging and Pediatric Sleep Databank participants (9-26 years; 58.3% female) completed wrist actigraphy and a structural MRI scan. Local gyrification index (lGI) was estimated for 34 bilateral brain regions. Naturalistic sleep characteristics (duration, timing, continuity, and regularity) were estimated from wrist actigraphy. Regularized regression for feature selection was used to examine gyrification-sleep relationships. RESULTS:For most brain regions, greater lGI was associated with longer sleep duration, earlier sleep timing, lower variability in sleep regularity, and shorter time awake after sleep onset. lGI in frontoparietal network regions showed associations with sleep patterns that were stable across age. However, in default mode network regions, lGI was only associated with sleep patterns from late childhood through early-to-mid adolescence, a period of vulnerability for mental health disorders. CONCLUSIONS:We detected both developmentally invariant and developmentally specific ties between local gyrification and naturalistic sleep patterns. Default mode network regions may be particularly susceptible to interventions promoting more optimal sleep during childhood and adolescence.

Background Adverse life experiences require a broader range of adaptive behavioral strategies to cope with related stressors. The association between intensity, duration, type of stress and impacts on mental health is important for effective programming aimed at increasing resilience in the face of stress. This study examines adverse life experiences, coping strategies, and associations with mental health outcomes among very young adolescent orphans.Methods The analytic sample was collected between January and March of 2019 and included 350 adolescent orphans ages 10-15 years old from three districts in Tanzania. Participants completed survey interviews, 75-90 minutes in length, that measured adverse life experiences, stigma, coping strategies, and psychological symptoms.Results A four-factor dimensional structure of the KidCope survey fits these data and distinguished between distraction and resignation coping strategies. Use of distraction as a coping dimension was the most frequently used coping dimension and was associated with lower reported symptoms of depression, anxiety, and externalizing behaviors. Resignation was positively associated with adverse life experiences including emotional abuse, emotional neglect, and physical neglect. Problem-focused coping was not associated with study outcomes and social support coping was associated with externalizing behaviors only.Conclusion Results from adolescent orphans in a low-resource context suggest that distraction coping strategies may be adaptive in response to stress. Implications for intervention programming that aims to target acquisition of coping skills and mindsets among vulnerable populations are discussed.

Sleep-related problems (SRPs) are a common precursor to anxiety disorders, especially during peri-adolescence, and may be a predictor of treatment response. However, evidence-based anxiety treatments do not alleviate SRPs to a clinically significant degree. The current study examines whether improving sleep in a sample of young adolescents previously treated for anxiety disorders can further reduce anxiety severity. Participants include 46 adolescents (65% female, ages 9-14 years) previously treated for anxiety disorders who self-selected to participate in a 6-week open trial of targeted sleep enhancement (TIGERS). Measures of parent- and child report on SRPs, and clinician-rated anxiety severity, were collected at several time points of the study: pre-, and postanxiety treatment, pre- and post-TIGERS, and at four yearly follow-ups. Two hierarchical mediation models were run using either parent- or child report on sleep. On the between-subjects level, participants with higher overall average SRPs also had higher overall anxiety severity over all time points. On the within-subjects level, participation in TIGERS was not directly associated with change in anxiety severity-however, participation in TIGERS was associated with a drop in SRPs, which was associated with a drop in anxiety severity. Improving sleep in anxious peri-adolescents further improves anxiety above and beyond anxiety treatment. Further research is needed to confirm the effects of improving sleep on clinical anxiety in a randomized controlled trial.

OBJECTIVE:Evaluate the preliminary effectiveness of a school-based intervention to promote digital citizenship (DC) in Perú.METHODS:We piloted a translation and cultural adaptation of a DC curriculum originally designed for the U.S. with students in Perú. Students were assigned to either the Intervention group (n = 136, 52% female; mean age = 13.3) or Control group (n = 130, 55% female; mean age = 13.4). Students in the Control group continued with "business-as-usual" during their advisory period while the Intervention group received the DC curriculum.RESULTS:We found limited evidence that the DC curriculum can promote positive online experience and online conflict resolution skills, as well as increase knowledge regarding DC terms and concepts. However, the lack of strong effects suggests the need to revise materials, improve implementation and consider further adaptations. Nonetheless, results from this proof-of-concept study provide building blocks for future implementations of DC interventions for youth in Latin America.

OBJECTIVE Positive associations between therapeutic alliance and outcome (e.g. youth symptom severity) have been documented in the youth anxiety literature; however, little is known about the conditions under which early alliance contributes to positive outcomes in youth. The present study examined the relations between therapeutic alliance, session attendance, and outcomes in youths (N = 135; 55.6% female) who participated in a randomized clinical trial testing the efficacy of cognitive-behavioral therapy or client-centered therapy for anxiety. METHOD We evaluated a conceptual model wherein: (1) early alliance indirectly contributes to positive outcomes by improving session attendance; (2) alliance-outcome associations differ by intervention type, with stronger associations in cognitive-behavioral therapy compared to client-centered therapy; and (3) alliance-outcome associations vary across outcome measurement timepoints, with the effect of early alliance on outcomes decaying over time. RESULTS Contrary to hypotheses, provider ratings of early alliance predicted greater youth-rated anxiety symptom severity post-treatment (i.e. worse treatment outcomes). Session attendance predicted positive youth-rated outcomes, though there was no indirect effect of early alliance on outcomes through session attendance. CONCLUSIONS Results show that increasing session attendance is important for enhancing outcomes and do not support early alliance as a predictor of outcomes.

The goal of this study was to examine the relationship between real-world socioemotional measures and neural activation to parental criticism, a salient form of social threat for adolescents. This work could help us understand why heightened neural reactivity to social threat consistently emerges as a risk factor for internalizing psychopathology in youth. We predicted that youth with higher reactivity to parental criticism (versus neutral comments) in the subgenual anterior cingulate cortex (sgACC), amygdala, and anterior insula would experience (a) less happiness in daily positive interpersonal situations and (b) more sadness and anger in daily negative interpersonal situations. Participants (44 youth ages 11-16 with a history of anxiety) completed a 10-day ecological momentary assessment protocol and a neuroimaging task in which they listened to audio clips of their parents’ criticism and neutral comments. Mixed-effects models tested associations between neural activation to critical (vs. neutral) feedback and emotions in interpersonal situations. Youth who exhibited higher activation in the sgACC to parental criticism reported less happiness during daily positive interpersonal situations. No significant neural predictors of negative emotions (e.g., sadness, anger) emerged. These findings provide evidence of real-world correlates of neural reactivity to social threat that may have important clinical implications.

Neurobiological sensitivity to peer interactions is a proposed marker of risk for adolescent depression. We investigated neural response to peer rejection and acceptance in relation to concurrent and prospective depression risk in adolescent and pre-adolescent girls. Participants were 76 girls (Mage=13, 45% racial/ethnic minorities) varying in depression risk: 22 with current major depressive disorder (MDD), 30 at High Risk for MDD based on parental history, and 24 at Low Risk with no psychiatric history. Girls participated in the Chatroom-Interact task—involving rejection and acceptance feedback from fictitious peers—while undergoing functional magnetic resonance neuroimaging. Activation in response to peer rejection and acceptance was extracted from regions of interest. Depressive symptoms were assessed at 6- and 12-month follow-up. Girls with MDD showed blunted left subgenual anterior cingulate response to acceptance versus girls in High and Low Risk groups. Girls in the High Risk group showed greater right temporo-parietal junction (rTPJ) and right anterior insula (AI) activation to both acceptance and rejection versus girls in the MDD (rTPJ) and Low Risk (rTPJ, AI) groups. Greater rTPJ response to rejection was associated with fewer depressive symptoms at 12-months and mediated the association between High Risk group status and 12-month depressive symptoms; greater rTPJ response to acceptance mediated the association between High Risk and increased 12-month depressive symptoms. Our finding of associations between altered neural response to peer interactions and concurrent and prospective depression risk/resilience highlights the importance of neural underpinnings of social cognition as risk and compensatory adaptations along the pathway to depression.

Objective: The goal of this study was to examine whether neural sensitivity to peer rejection, a potent form of social evaluative threat in adolescence, conveys risk for depression among anxious youth. We hypothesized that brain activation in regions that process affective salience in response to rejection from virtual peers would predict depressive symptoms one year later and would be associated with ecological momentary assessment (EMA) reports of real-world peer connectedness. Method: Participants were 38 adolescents ages 11-16 (50% female) with a history of anxiety, recruited from a previous clinical trial. The present study was a prospective naturalistic follow-up of depressive symptoms assessed 2 years (Wave 2) and 3 years (Wave 3) following treatment. At Wave 2, participants completed the Chatroom Interact Task during neuroimaging and 16 days of EMA. Results: Controlling for depressive and anxiety symptoms at Wave 2, subgenual anterior cingulate (sgACC;\ \beta=.39, p=.010) and nucleus accumbens activation (NAcc;\beta=.30, p=.041) to peer rejection (vs. acceptance) predicted depressive symptoms at Wave 3. SgACC activation to rejection (vs. acceptance) was highly correlated with EMA reports of connectedness with peers in daily life (r=-.71, p<.001). Conclusion: Findings suggest that elevated sgACC and NAcc activation to rejection may serve as a risk factor for the development of depressive symptoms among anxious youth, perhaps by promoting vigilance or reactivity to potential social evaluative threats and subsequent avoidance behaviors. SgACC activation to simulated rejection appears to have implications for understanding how adolescents experience their daily social environments in ways that could contribute to depressive symptoms.

Abstract Background Utu is a Kiswahili term with a long history of cultural significance in Tanzania. It conveys a value system of shared, collective humanity. While variants of Utu have been studied in other contexts, a measure of Utu that captures this important collective asset has not been developed in Tanzania. The aims of this study were to (1) examine dimensional constructs that represent Utu, (2) validate a measurement scale of Utu for use with adolescents, (3) examine differences between orphan and non-orphan adolescents in self-reported Utu and, (4) examine structural paths between adverse life experiences, coping strategies, Utu, and resilience. Methods This study collected survey data from adolescents from three districts in peri-urban Tanzania in two samples: 189 orphan adolescents ages 10–17 in May 2020 and 333 non-orphan adolescents ages 10–14 in August 2020. Confirmatory factor analysis was used to validate the hypothesized factor structure of the developed Utu measure. Structural equation models were used to examine path associations with adverse life experiences, coping and resilience. Results The five dimensional constructs comprising the Utu measure included Resource Sharing, Group Solidarity, Respect and Dignity, Collectivity, and Compassion. Confirmatory factor analysis of the Utu measure demonstrated excellent fit (CFI = 0.98; TLI = 0.97; SRMR = 0.024; RMSEA = 0.046) and internal consistency (α = 0.94) among adolescents in this study. Positive, significant associations were found between Utu and coping (β = 0.29, p < 0.001) and Utu and intra/interpersonal and collective resilience (β = 0.13, p < 0.014). Utu was not significantly associated with adverse life experiences, age or gender. Conclusions A five-dimensional measurement scale for Utu was validated in a sample of orphan and non-orphan adolescents in Tanzania. Utu is a collective asset associated with higher levels of reported resilience in both orphan and non-orphan adolescent populations in Tanzania. Promoting Utu may be an effective universal public health prevention approach. Implications for adolescent programming are discussed.

Background Research has demonstrated the importance of understanding risk factors for mental health and wellbeing. Less research has focused on protective factors that protect mental health and promote wellbeing in diverse contexts. Estimating structural paths from risk protective factors to psychopathology and wellbeing can inform prioritization of targeted investment in adolescent health programs that seek to modify factors that are most closely associated with mental wellbeing. Study objective The purpose of this study was to examine risk factors (e.g. emotional neglect, emotional abuse, physical neglect, stigma) and protective factors (e.g. community relationships, self-esteem, and autonomy) among adolescent orphans, protective associations with depression, anxiety and externalizing behaviors and promotive associations with hope, happiness, and health. Methods The analytic sample was collected between January and March of 2019 and included 350 adolescent orphans ages 10-15 from three districts in Tanzania. Participants completed survey interviews, 75-90 min in length, that measured risk and protective factors, psychological symptoms, and mental wellbeing measures. Results Results of the fitted structural equation model indicated that structural paths from protective factors to psychopathology (beta = -0.53, p = 0.015) and mental wellbeing (beta = 0.72, p = 0.014) outcomes were significant. Structural paths from risk factors to psychopathology (beta = -0.34, p = 0.108) and mental wellbeing (beta = -0.24, p = 0.405) were not significant. Conclusion In a sample of vulnerable youth, protective factors (e.g. community relationships, self-esteem, and autonomy) were significantly associated with reduced depression, anxiety and externalizing behaviors and increased hope, happiness, and health in a structural equation model that included risk factors (emotional neglect, emotional abuse, physical neglect). Results suggest that strong community relationships, self-esteem and autonomy may be important modifiable factors to target in intervention programs aimed at supporting adolescent mental wellbeing.

Introduction: Adolescence is a period of vulnerability for emotion regulation and sleep difficulties, risks that might be compounded by intense COVID-19 lockdowns and challenges. The aim of this study was to investigate how sleep quality related to emotion regulation difficulties in adolescents during lockdown in Perú. Methods: Participants were 2563 adolescents enrolled in Innova school in Perú (11 – 17 years) in May 2020. Hypotheses were derived from exploring one half of the sample, preregistered at https://osf.io/fuetz/, and then confirmed in the second half of the sample. Participants completed subjective surveys of sleep quality (short PSQI) and the Difficulties in Emotion Regulation Scale Short Form (DERS-SF). Results: Worse sleep quality was robustly associated with more difficulties in emotion regulation across both samples. The association was found particularly for emotional regulation subscales related to the ability to engage in goal directed behavior in the face of distress, emotional clarity and strategies to deal with feeling distressed. In contrast, there was no robust association between sleep and the ability to regulate impulses in the context of negative emotions, and no association with the ability to accept emotions. Girls and older adolescents robustly endorsed worse sleep quality and more difficulties in emotion regulation. Limitations: The cross-sectional nature of this study prevents us from determining the direction of the association. Data was collected using adolescent self-report which, while informative of adolescent perceptions, might diverge from objective measures of sleep or emotion regulation difficulties. Conclusions: Our findings with adolescents in Perú contribute to our understanding of the association between sleep an emotion regulation at a broader global scale.

Growth mindset, persistence, and self-efficacy are important protective factors in understanding adolescent psychopathology, including depression, anxiety, and externalising behaviours. Previous studies have shown that dimensions of self-efficacy (academic, social, and emotional) have differential protective effects with mental health outcomes and these differences vary by sex. This study examines the dimensional mediation of self-efficacy from motivational mindsets on anxiety, depression, and externalising behaviours in a sample of early adolescents ages 10-11. Surveys were administered to participants to measure growth mindset and persistence on internalising and externalising symptoms. The Self-Efficacy Questionnaire for Children (SEQ-C) was used to measure domains of self-efficacy for mediation analysis. Multi-group structural equation modelling by sex indicated that structural paths were not invariant by sex. Significant direct effects were identified from persistence to externalising behaviours in boys, and significant direct effects were identified from growth mindset to depression in girls. In a sample of Tanzanian early adolescents, self-efficacy mediates the protective association between motivational mindsets on psychopathology. Higher academic self-efficacy was associated with reduced externalising problems in both boys and girls. Implications for adolescent programmes and future research are discussed.

Purpose: We examined whether interindividual differences in naturalistic sleep patterns correlate with any deviations from typical brain aging.Methods: Our sample consisted of 251 participants without current psychiatric diagnoses (9 -25 years; mean [standard deviation] = 17.4 +/- 4.52 yr; 58% female) drawn from the Neuroimaging and Pediatric Sleep Databank. Participants completed a T1-weighted structural magnetic reso-nance imaging scan and 5-7 days of wrist actigraphy to assess naturalistic sleep patterns (dura-tion, timing, continuity, and regularity). We estimated brain age from extracted structural magnetic resonance imaging indices and calculated brain age gap (estimated brain age -chronological age). Robust regressions tested cross-sectional associations between brain age gap and sleep patterns. Exploratory models investigated moderating effects of age and biological gender and, in a subset of the sample, links between sleep, brain age gap, and depression severity (Patient-Reported Outcomes Measurement Information System Depression).Results: Later sleep timing (midsleep) was associated with more advanced brain aging (larger brain age gap), b = 0.1575, puncorr = .0042, pfdr = .0167. Exploratory models suggested that this effect may be driven by males, although the interaction of gender and brain age gap did not survive multiple comparison correction (b = 0.2459, puncorr = .0336, pfdr = .1061). Sleep duration, conti-nuity, and regularity were not significantly associated with brain age gap. Age did not moderate any brain age gap-sleep relationships. In this psychiatrically healthy sample, depression severity was also not associated with brain age gap or sleep.

The COVID-19 pandemic has touched the lives of adolescents around the world. This short-term longitudinal, observational study followed 1,334 adolescents (11 - 17 yo) to investigate whether social-ecological resilience relates to intra- and inter-personal resources and/or the caregiver relationship relates to changes in internalizing symptoms during five stressful weeks of COVID-19 lockdown in Perú. In this work, we contextualize social-ecological resilience in relation to culturally-relevant personal and caregiver resources that youth can use to adapt to stressful situations. We found that adolescents who reported higher levels of personal, caregiver, and overall resilience had lower levels of anxiety and depressive symptoms at week six. We also find that personal, caregiver, and overall resilience moderated the change in anxiety symptoms from week 6 to week 11 of lockdown in 2020. Our findings underscore the importance of social-ecological resilience related to both intra/interpersonal resources and the caregiver relationship for minimizing the harmful impacts of COVID-19 on adolescent internalizing symptoms.