Objective: Depression is among the most common disorders in adolescence and is closely linked to sleep behavior and quality of life. Long-term studies examining the course of depressive symptoms after inpatient treatment are scarce. The present study investigated changes in depressive symptoms among adolescents following inpatient treatment, focusing on associations with sleep-wake rhythm and subjective quality of life. Method: The sample comprised n = 38 adolescents (Mage = 18.63, SDage = 1.71; 85.4 % female) who had previously been hospitalized for a depressive disorder. The follow-up study spanned 5 years, during which sociodemographic data as well as the values from the Beck Depression Inventory-II (BDI-II), the Morningness-Eveningness Questionnaire (MEQ), and the KIDSCREEN were collected annually online. Results: Significant reductions in depressive symptoms and increases in life satisfaction were observed between follow-up II and the catamnesis assessment. BDI-II and MEQ scores were significantly correlated, whereas changes in depressive symptoms were not associated with alterations in sleep behavior. The MEQ indicated a significant shift in chronotype from eveningness to morningness over time. Conclusion: Symptom improvement was evident at the catamnesis timepoint. Due to the small sample size, no generalizable conclusions can be drawn. Further follow-up studies are needed to examine symptom trajectories after inpatient treatment.

IntroductionConduct disorders are characterized by emotional dysregulation. Both callous-unemotional traits and social anxiety are heightened in conduct disorder patients and are associated with different mechanisms of emotion regulation. Previous evidence has proposed that secondary emotions, such as shame, might also be affected in conduct disorder and that callous-unemotional traits and social anxiety might be related to shame as well as to shame coping. Therefore, the current study investigated links between callous-unemotional traits, social anxiety, shame proneness, and shame coping in adolescent inpatients with conduct disorder.MethodsForty adolescent inpatients with conduct disorders (M = 12.4, SD = 1.4) filled in questionnaires on callous-unemotional traits, social anxiety, shame proneness, and shame coping. Correlational and regression analyses, as well as mediation analyses were performed.ResultsCallous-unemotional traits were not associated with any other construct. Social anxiety showed positive correlations with shame proneness and internalizing as well as externalizing shame coping. Social anxiety was also a significant predictor of internalizing shame coping while controlling for shame proneness and callous-unemotional traits. No predictors emerged for externalizing shame coping. Mediation analyses confirmed that neither shame proneness nor social anxiety mediated the relationship between CU traits and shame coping, as CU traits were not significantly associated with either variable.DiscussionThe findings suggest that social anxiety plays a key role in internalizing shame coping in conduct disorder patients. CU traits appear to be unrelated to shame proneness and shame coping, either directly or indirectly, in conduct disorder.

Transcranial direct current stimulation (tDCS) has potential as a treatment for adult depression, but its effectiveness in adolescents remains unexplored. This study evaluated the feasibility, safety, and efficacy of tDCS in young in-patients with depression. In a randomized, double-blind, sham-controlled trial, 34 adolescent in-patients (mean age 15.48 years) received ten sessions of either tDCS or sham stimulation over two weeks, alongside standard treatment. Depression severity, quality of life, emotional and behavioral issues, and executive functions were assessed before, immediately after, and two weeks post-treatment. The results indicated that tDCS was feasible and well-tolerated, with 28 patients completing at least eight sessions. Side effects were reported in nearly half of the sessions (45% sham, 48% tDCS), primarily mild to moderate, and no sessions were interrupted due to discomfort. Both groups experienced significant improvements in depressive symptoms and high treatment satisfaction, but no significant differences were found between the tDCS and sham groups. In conclusion, while tDCS appears to be a safe treatment option for adolescents with depression, this study could not show it to be superior to sham treatment. Further research with greater statistical power is needed to control for covariates.

OBJECTIVE:This study examines associations between sleep problems, screen time, physical activity, and deficient emotional self-regulation (DESR) in children with and without attention-deficit hyperactivity disorder (ADHD). METHODS:A total of 74 children aged 6 to 10 years participated in this cross-sectional study, including 43 inpatients diagnosed with ADHD and 31 control participants. DESR was assessed using a composite derived from Child Behavior Checklist subscales. Parents provided information on children's sleep, screen time, and physical activity using questionnaire measures. Hierarchical regression and group comparisons were conducted to examine associations between lifestyle factors and DESR. RESULTS:Children with ADHD exhibited more sleep problems and higher screen time than controls. Sleep problems were strongly associated with DESR after adjusting for ADHD diagnosis. Screen time was positively correlated with DESR but was not independently associated with DESR in multivariate models. Physical activity was not associated with DESR, and no group differences in physical activity were observed. CONCLUSION:In this inpatient sample, sleep problems showed the most robust association with DESR, particularly among children with ADHD. These findings highlight sleep as a potentially important clinical target. Future studies should use longitudinal designs and objective measures to clarify directionality and mechanisms.

OBJECTIVE:Research suggests that patients with anorexia nervosa (AN) focus on subjectively unattractive parts of their own and others' bodies. This attentional bias has been explained by increased anxiety, which is observed in patients with AN. The present study therefore examined whether attentional bias towards unattractive body parts is stronger in AN patients than in clinical and non-patient controls. METHODS:After high and low anxiety induction, female adolescents with AN (n = 27), depression without an eating disorder (n = 18), and non-patient participants (n = 14) viewed images of their own bodies and those of an underweight and an overweight individual while eye-tracking data were recorded. After viewing the images, participants rated body parts regarding attractiveness. RESULTS:Mixed ANOVAs revealed that all participants looked longer at unattractive parts of the overweight body and fixated earlier on attractive parts of the overweight and own body than on unattractive parts. Unattractive body parts were visited more frequently for the overweight and own bodies. Compared to the two control groups, AN patients fixated more on subjectively unattractive body parts and were more likely to focus on the overweight body. DISCUSSION:This preference for subjectively unattractive body parts in AN patients is linked to increased body dissatisfaction, with gaze patterns indicating anxiety-related hyperscanning of their own and the overweight body.

Abstract Background This German multicenter study aimed to analyze the efficacy of telephone-assisted self-help (TASH) and changes during subsequent adaptive treatment in children with mild-to-moderate ADHD. Methods Participants were children (6;0–11;11 years) with mild-to-moderate ADHD. Study Step 1 comprised a randomized waitlist-controlled trial on the efficacy of three-month, parent-directed TASH. Depending on their response to TASH, in Step 2, children were assigned to booster TASH (full response), behavior therapy (partial response), or pharmacotherapy plus behavior therapy or counseling (non-response) for six months. The primary outcome was the change in blinded-clinician-rated ADHD symptoms; for subsequent changes (Step 2), we considered semi-blinded ratings. The primary analyses were by intention-to-treat. Results Of the 163 included children (77.9% boys), 80 were randomized to TASH and 83 to the waitlist control group. Following TASH, 12 children (8.8%) were classified as full responders, 40 (29.2%) as partial responders, and 85 (62.0%) as non-responders. An analysis of covariance did not yield an effect of TASH on the primary outcome (mean between-group difference = 0.00 ± 0.07, 95% CI [− 0.14, 0.13]; p = 0.95; d = –0.01, 95% CI [− 0.37, 0.34]). During Step 2, full responders demonstrated a stable symptom level (piecewise mixed-effects model for repeated measures; d = − 0.07, 95% CI [− 0.61, 0.47], p = 0.80), partial responders a small increase in ADHD symptoms ( d = 0.29, 95% CI [0.00, 0.59], p = 0.05), and non-responders a large decrease ( d = − 1.00, 95% CI [− 1.27, − 0.73], p < 0.001). Conclusions TASH is not effective in reducing blinded-clinician-rated ADHD symptoms in children with mild-to-moderate ADHD. Based on the changes within the response groups during Step 2, hypotheses are generated for adaptive treatment after TASH. Trial registration German Clinical Trials Register (DRKS): DRKS0000897; URL: https://drks.de/search/de/trial/DRKS00008973/details ; registered on December 18th 2015.

Parent training and assisted self-help have proven effective in preschool-age children with attention-deficit/hyperactivity disorder (ADHD). This study analysed a stepped-care approach combining these interventions. Participants were children (3–6 years) with either ADHD or oppositional defiant disorder (ODD) plus substantial ADHD symptoms. Study Step 1 (three months) comprised a randomised, waitlist-controlled trial on the efficacy of parent-directed telephone-assisted self-help (TASH). Based on the response to TASH, in Step 2 (six months), participants either received TASH booster sessions (full responders) or participated in another randomized controlled trial (partial/non-responders) comparing parent management and preschool teacher training (PMPTT) with treatment as usual (TAU). The primary outcome was change in blinded-clinician-rated ADHD and ODD symptoms. The primary analyses were by intention-to-treat. 189 children (79.9

Abstract Background Body image disturbance (BID) is increasingly recognized as a transdiagnostic factor. Beyond its established role in anorexia nervosa (AN), specific components of BID are also associated with the development and maintenance of psychopathology in adolescent Major Depressive Disorder (MDD). However, measurements of different body image components (perceptual, affective, cognitive, and behavioral)—especially objective behavioral measures—remain scarce; the assessment of attentional biases (AB) represents a promising tool to fill this gap. Methods In the present study, two clinical groups of adolescent inpatients (MDD: n = 28; AN: n = 34) and non-clinical controls (NCC: n = 39; aged 13–19 years) completed a body-related Stroop task and a free-viewing task including a body appraisal. Participants also completed questionnaires assessing shape concerns, social appearance anxiety, body checking, avoidance, and reassurance. Results The AN and the NCC groups revealed a significant body-related AB, whereas the MDD group did not. Regarding body appraisal, the clinical groups rated their bodies more negatively than the NCC group. On shape concerns, anxiety, and body avoidance/checking, the AN group showed elevated scores compared to the MDD group. Notably, the NCC only differed significantly from the AN group regarding shape concerns. Conclusions The three groups exhibited distinct BID profiles, identifying pathological body appraisal as a transdiagnostic feature that suggests body dissatisfaction interventions could also mitigate adolescent depressive symptoms. Furthermore, the lack of behavioral differences between healthy adolescents and the AN group underscores the need for early prevention targeting checking and avoidance to prevent the progression into clinical eating disorders.