rss_2.0Scandinavian Journal of Child and Adolescent Psychiatry and Psychology FeedSciendo RSS Feed for Scandinavian Journal of Child and Adolescent Psychiatry and Psychology Journal of Child and Adolescent Psychiatry and Psychology 's Cover a Brief Parent Training Intervention to Prevent Anxiety in Offspring<abstract><title style='display:none'>Abstract</title><p>Offspring of parents with anxiety disorders have an increased risk of developing anxiety themselves. Very few studies have evaluated interventions aiming to prevent anxiety in offspring of anxious parents. This study was a small (<italic>N</italic>=40) randomized pilot study with three arms evaluating the feasibility of a novel parent support group for anxious parents, the Supporting Anxious Parents Program (SAPP). The primary objective was to evaluate the acceptability of the SAPP. In addition, we also evaluated preliminary effects on child anxiety, parent risk factors, and quality of life, and feasibility of the study design. Excessive parental worry and anxiety and having a child not meeting criteria for an anxiety disorder (6-12 years old), served as inclusion criteria. Thirteen parents were randomly allocated to a group-based intervention, 14 to an individual Internet-based version of the intervention, and 13 to a waitlist control condition. The intervention was developed to target three risk factors involved in the parent-child transmission of anxiety; criticism/low warmth, overprotective behaviors, and modeling of anxiety. The results showed that parents were generally very satisfied with the intervention. We did not find any significant decreases in child anxiety in the intervention conditions. However, for the parents, we found preliminary support for reduced overprotective behaviors, reduced worry, and increased quality of life. The study design was found to be feasible. According to the results, a revision of the intervention is recommended before a full randomized controlled trial could be conducted.</p></abstract>ARTICLE2022-11-30T00:00:00.000+00:00Psychometric properties of Malay obsessive-compulsive inventory-child version (OCI-CV) in Malaysian perspectives<abstract><title style='display:none'>Abstract</title> <sec id="j_sjcapp-2022-0012_s_007"><title style='display:none'>Background</title> <p>This study aimed to examine the psychometric properties of reliability and validity of OCI-CV in a non-clinical sample of Malaysian children and adolescents.</p></sec> <sec id="j_sjcapp-2022-0012_s_008"><title style='display:none'>Method</title> <p>Participants of school-age and adolescent students from Klang Valley School completed the 21-item Malay OCI-CV using Google Form. OCI-CV English version was translated backward and forward to the Malay language. Face validity was conducted first before distributing the questionnaire to the participants. Exploratory Factor analysis (EFA) and Confirmatory Factor Analysis (CFA) was conducted to evaluate the psychometric properties of OCI-CV.</p> </sec> <sec id="j_sjcapp-2022-0012_s_009"><title style='display:none'>Results</title> <p>A total of 102 school-age children and adolescents with a mean age of 15.96 years (male: 41.2%, female: 58.8%) participated in the study. The Malay OCI-CV showed high internal consistency, with Cronbach Alpha values of 0.90 for the whole scale. EFA showed multifactorial components. Five factors were labelled as “Washing / Ordering, Doubting, Obsessions, Checking, and Hoarding,”. In the CFA, the five-factor model indicates adequate fit indices of (χ2/df = 1.51, RMSEA = .071, GFI = .824, AGFI = .769, NFI = .724, CFI = .880).</p> </sec> <sec id="j_sjcapp-2022-0012_s_010"><title style='display:none'>Conclusion</title> <p>The Malay OCI-CV has good psychometric properties and is suitable for use in the Malaysian context. Further validation studies should be conducted among a clinical population to enhance the generalization of this finding.</p> </sec> </abstract>ARTICLE2022-11-30T00:00:00.000+00:00A possible anti-anxiety effect of appetitive aggression and a possible link to the work of Donald Winnicott<abstract> <title style='display:none'>Abstract</title> <p>Various pleasant sensations that give a particularly intense pleasure are able to improve anxiety. In the present study I consider the possibility that their anti-anxiety action depends on the strong pleasure they provide, and I propose a possible mechanism of this action. According to some studies, also appetitive aggression (an aggression that provokes a strong pleasure and that is performed only for the pleasure it provides) can improve anxiety, and in this article I consider the possibility that the pleasure of appetitive aggression is able to reduce anxiety by the same mechanism I have proposed for other intense pleasurable sensations.</p> <p>The aggression performed by a child against the mother or against a substitute for the mother in the first period of life (a period in which this aggression is not dangerous) is a recurring theme throughout the work of of Donald Winnicott. Winnicott stresses that this aggression is necessary for the normal development of the child, and that the child must be free to practise it. According to Winnicott, this aggression is highly pleasurable and is not a response to unpleasant or hostile external situations. For these characteristics it seems to correspond to appetitive aggression in the adult that has been found to be able to reduce anxiety. Consequently, aggression performed by the child in the first period of life may also relieve anxiety, in the same way that appetitive aggression helps against anxiety in the adult.</p> <p>In his writings, Winnicott returns several times to an unthinkable or archaic anxiety that children experience when they feel abandoned by their mother for a period that is too long for them, and all children, according to Winnicott, live on the brink of this anxiety. In this study I propose the hypothesis that aggression in the early period of life may be necessary for children because the intense pleasure it provides may help them against this continuously impending anxiety.</p></abstract>ARTICLE2022-08-30T00:00:00.000+00:00Diagnosis-Specific Group CBT Treating Social Anxiety in Adolescents: A Feasibility Study<abstract> <title style='display:none'>Abstract</title> <sec id="j_sjcapp-2022-0010_s_007"><title style='display:none'>Background</title> <p>Social anxiety disorder (SAD) is one of the most common anxiety disorders among adolescents. It is associated with extensive distress and negative long-term consequences. Generic cognitive behavioral therapy (CBT) is one of the preferred treatments for anxiety disorders, but it has shown poorer outcome for adolescents with SAD than for other anxiety disorders.</p></sec> <sec id="j_sjcapp-2022-0010_s_008"><title style='display:none'>Aim</title> <p>As preparation for a randomized controlled trial the aim of the present study was to examine the feasibility of an adjusted diagnosis-specific CBT group intervention for adolescents with SAD, and provide preliminary information on adolescent and family outcomes.</p></sec> <sec id="j_sjcapp-2022-0010_s_009"><title style='display:none'>Method</title> <p>Thirteen adolescents (age 12-17 years) diagnosed with SAD received a group therapy version of the Cool Kids Anxiety Program, Social Enhanced (CK-E), a program developed at Macquarie University, Sydney, Australia. The treatment is a diagnosis-specific manualized CBT treatment for adolescents with SAD. Semi-diagnostic interviews and questionnaires were completed at baseline, post, 3-month follow-up and 1-year follow-up.</p></sec> <sec id="j_sjcapp-2022-0010_s_010"><title style='display:none'>Results</title> <p>Thirteen adolescents participated with no drop-outs. Most families attended all 10 intervention sessions. The families were generally satisfied with the treatment and would recommend it to others in need. Preliminary outcomes showed that participants had marked improvements in their anxiety symptoms and life interference, with significant medium to large baseline-post effect sizes durable at 1-year follow-up. Two of the adolescents were free of their SAD diagnosis at 3-month follow-up.</p></sec> <sec id="j_sjcapp-2022-0010_s_011"><title style='display:none'>Conclusion</title> <p>Results from this feasibility study indicate that the Danish-translated and revised version of Cool Kids Anxiety Program - Social Enhanced could be a feasible intervention for Danish adolescents with SAD. The intervention will be investigated further in a randomized controlled trial.</p></sec> </abstract>ARTICLE2022-08-30T00:00:00.000+00:00Severe hyperprolactinemia during lurasidone treatment in a 16-year old girl with schizophrenia – a case report<abstract> <title style='display:none'>Abstract</title> <sec id="j_sjcapp-2022-0009_s_004"><title style='display:none'>Background</title> <p>Increase of serum prolactin is a common adverse effect to antipsychotic medication, potentially leading to galactorrhea, menstrual cycle disturbances or sexual adverse effects. Lurasidone is commonly associated with a low risk of prolactin change.</p></sec> <sec id="j_sjcapp-2022-0009_s_005"><title style='display:none'>Objective</title> <p>To describe a case of severe hyperprolactinemia in a 16-year old female with schizophrenia.</p></sec> <sec id="j_sjcapp-2022-0009_s_006"><title style='display:none'>Method</title> <p>Case report.</p></sec> <sec id="j_sjcapp-2022-0009_s_007"><title style='display:none'>Results</title> <p>We saw a severe and sustained prolactin increase during treatment with lurasidone.</p></sec> <sec id="j_sjcapp-2022-0009_s_008"><title style='display:none'>Conclusions</title> <p>Although lurasidone is usually considered not to increase prolactin, some patients may experience this adverse effect. As related subjective consequences may be falsely attributed to the disease or as direct effects of the antipsycotic agent, serum prolactin measurements should be made prior to and during antipsychotic treatment regardless of medication choice.</p></sec></abstract>ARTICLE2022-07-03T00:00:00.000+00:00The three-year outcome of emotional symptoms in clinically referred youth with ADHD and their relationship to neuropsychological functions<abstract> <title style='display:none'>Abstract</title> <sec id="j_sjcapp-2022-0008_s_007"> <title style='display:none'>Background</title> <p>Further knowledge is needed regarding long-term outcome of emotional symptoms, and the interplay between these symptoms and neuropsychological functioning in youth with attention deficit hyperactivity disorder (ADHD).</p> </sec> <sec id="j_sjcapp-2022-0008_s_008"> <title style='display:none'>Objective</title> <p>We aimed to explore the effect of performance-based neurocognitive functions and parent-rated behavioral executive functioning (EF) on self-rated and parent-rated internalizing symptoms longitudinally in clinically referred youth with ADHD (n = 137; mean age = 12.4 years). We also aimed to examine the change in self-rated emotional symptoms in the ADHD group and a Control group (n = 59; mean age = 11.9 years).</p> </sec> <sec id="j_sjcapp-2022-0008_s_009"> <title style='display:none'>Method</title> <p>At baseline, and three years later, parents completed rating scales of their child’s ADHD symptoms (Swanson Nolan Pelham Scale, Version IV – SNAP-IV), emotional symptoms (Five To Fifteen Questionnaire, Strengths, and Difficulties Questionnaire), and EF (Behavior Rating Inventory of Executive Function). At the same time, the child completed self-report measures of Anxiety, Depression, and Anger Inventories (the Beck Youth Inventories) and neurocognitive measures (Conner’s Continuous Performance Test, Version II (CPT-II), Working Memory and Processing Speed composites (Wechsler Intelligence Scales). Statistical analyses were linear and logistic mixed models.</p> </sec> <sec id="j_sjcapp-2022-0008_s_010"> <title style='display:none'>Results</title> <p>Using longitudinal data, parent- and self-ratings of emotional symptoms were associated with parent-ratings of EF behavior in youth with ADHD. Plan/organizing deficits were associated with Anxiety and Anger over and above other metacognitive subscales, while Emotional Control was related to Anger over and above other behavior regulation subscales. In the ADHD group, Anger symptoms improved across measuring points. When controlling for age, Anxiety, and Depression symptoms were largely stable in both groups, however at higher levels in the ADHD group. The differences in anxiety and depression symptoms across groups decreased over time.</p> </sec> <sec id="j_sjcapp-2022-0008_s_011"> <title style='display:none'>Conclusions</title> <p>The current study emphasizes the importance of identification, monitoring, and treatment of emotional symptoms, and behavioral aspects of EF in youth with ADHD.</p></sec> </abstract>ARTICLE2022-07-03T00:00:00.000+00:00Measuring Parent Rated Interest and Deprivation type Curiosity in Swedish Young Children - are they meaningfully distinct?<abstract> <title style='display:none'>Abstract</title> <sec id="j_sjcapp-2022-0007_s_007"> <title style='display:none'>Background</title> <p>Proxy ratings of young children’s curiosity has the potential to be useful for research in Sweden. One such proxy rating is the parent-rating Interest/Deprivation Young Children scale. This scale has previously only been validated in Dutch samples, where it differentiated curiosity dimensions of interest (joyful exploration) and deprivation (reduction of aversive feelings of not knowing).</p> </sec> <sec id="j_sjcapp-2022-0007_s_008"> <title style='display:none'>Objective</title> <p>The objective of this study was to investigate internal and construct validity of the Swedish version of the Interest/Deprivation Young Children scale.</p></sec> <sec id="j_sjcapp-2022-0007_s_009"> <title style='display:none'>Method</title> <p>A translation of the Interest/Deprivation Young Children scale was conducted and then administered to 266 parents in Sweden, who rated their children (4-6-years old) on 10 items, with 5 items each for subscales of interest and deprivation dimensions of epistemic curiosity. Responses were analyzed using confirmatory factor analysis.</p></sec> <sec id="j_sjcapp-2022-0007_s_010"> <title style='display:none'>Results</title> <p>Results indicate acceptable internal reliability for deprivation-curiosity items (α = 0.78) and for interest-curiosity items (α = 0.79). For the combined scale score alpha was found good (α = 0.84). However, confirmatory factor analysis failed to differentiate interest and deprivation dimensions of curiosity.</p></sec> <sec id="j_sjcapp-2022-0007_s_011"> <title style='display:none'>Conclusions</title> <p>Item revisions are suggested which could be implemented for further investigations. Also, the possibility of using the I/D-YC total score as a more general measure of child curiosity is argued for. An open question is how other dimensions of curiosity might be more viable for proxy ratings of child curiosity.</p></sec> </abstract>ARTICLE2022-06-19T00:00:00.000+00:00Pediatric mental health emergency visits during the COVID-19 pandemic<abstract> <title style='display:none'>Abstract</title> <sec id="j_sjcapp-2022-0005_s_005"><title style='display:none'>Introduction</title> <p>Paediatric and adult psychiatric emergency department (ED) visits decreased during the initial COVID-19 outbreak. Long-term consequences of the COVID-19 pandemic will include increases in mental healthcare needs, especially among vulnerable groups such as children and adolescents.</p></sec> <sec id="j_sjcapp-2022-0005_s_006"><title style='display:none'>Aim</title> <p>This study examined changes in the number of overall and diagnosis-specific mental health ED visits among patients aged &lt;18 years following the onset of the COVID-19 pandemic in Madrid, Spain.</p></sec> <sec id="j_sjcapp-2022-0005_s_007"><title style='display:none'>Methods</title> <p>Using clinical records from all psychiatric ED visits at a major teaching hospital between October 2018 and April 2021, we conducted interrupted time-series analyses and compared trends before and after the day of the first ED COVID-19 case (1st March 2020).</p></sec> <sec id="j_sjcapp-2022-0005_s_008"><title style='display:none'>Results</title> <p>A total of 663 patients were included. In March 2020, there was a marked initial decrease of -12.8 (95% CI -21.9, - 7.9) less monthly mental health ED visits. After April 2020, there was a subsequent increasing trend of 3.4 (95% CI 2.6, 4.2) additional monthly mental health ED visits.</p></sec> <sec id="j_sjcapp-2022-0005_s_009"><title style='display:none'>Conclusion</title> <p>After the onset of the COVID-19 pandemic, there was an increase in paediatric psychiatric ED visits, especially due to suicide-related reasons. These data reinforce the crucial role of the ED in the management of acute mental health problems among youth and highlight the need for renovated efforts to enhance access to care outside of and during acute crises during the pandemic and its aftermath.</p></sec> </abstract>ARTICLE2022-06-12T00:00:00.000+00:00Anxiety, Addiction to Social Networks, Internet and Smartphones in Paraguayan Adolescents: A Brief Report<abstract> <title style='display:none'>Abstract</title> <sec id="j_sjcapp-2022-0006_s_005"> <title style='display:none'>Background</title> <p>Several authors have pointed out that the use of smartphones might have an impact on mental health in general. Most of the evidences are focused on the incorrect or overblown use of smartphones, videogame or Internet, particularly focusing on related addiction problems among adolescents.</p> </sec> <sec id="j_sjcapp-2022-0006_s_006"><title style='display:none'>Objective</title> <p>The present study, although preliminary, aims to report the first evidence in Paraguay regarding the association between anxiety and addiction to social networks/internet as well as the use of smartphones among adolescents.</p></sec> <sec id="j_sjcapp-2022-0006_s_007"><title style='display:none'>Method</title> <p>Participants (100 adolescents, aged 12- 17 years old) were assessed in a school setting with the Beck Anxiety Inventory (BAI) and the Scale of risk of Addiction to Social Networks and Internet for adolescents (ERA-RSI). Categorical variables and associations were statistically assessed.</p></sec> <sec id="j_sjcapp-2022-0006_s_008"><title style='display:none'>Results</title> <p>The average smartphone use in boys rated 8.06 ±3.81 hours and in girls 9.46 ±4.4 hours. The BAI mean score was 20.71 ± 13.2. Of the participants, 27% reported moderate anxiety, and 36% severe anxiety and scores on this scale were not associated with hours of smartphone use. The ERA-RSI mean score was 1.94 ± 0.46 and anxiety was related to the symptoms-addiction, social-use, and nomophobia dimensions of the scale.</p></sec> <sec id="j_sjcapp-2022-0006_s_009"><title style='display:none'>Conclusion</title> <p>The misuse of smartphones in the Paraguayan pediatric population has been reported to be closely related to anxious symptoms. Our results suggest further research with an impact on possible public health policies aimed at preserving the mental health of children and adolescents exposed to internet and electronic devices.</p></sec> </abstract>ARTICLE2022-06-12T00:00:00.000+00:00Parent-child relationship outcomes of the Incredible Years Parents and Babies Program: A Pilot Randomized Controlled Trial<abstract> <title style='display:none'>Abstract</title> <sec id="j_sjcapp-2022-0004_s_005"><title style='display:none'>Background</title> <p>A warm, sensitive, and responsive relationship to a caregiver is essential for healthy child development.</p></sec> <sec id="j_sjcapp-2022-0004_s_006"><title style='display:none'>Objective</title> <p>This paper examines the effects of the Incredible Years Parents and Babies (IYPB) program on the parent-child relationship at post-intervention when offered as a universal parenting intervention to parents with newborn infants.</p></sec> <sec id="j_sjcapp-2022-0004_s_007"><title style='display:none'>Method</title> <p>We conducted a pragmatic, two-arm, parallel pilot randomized controlled trial; 112 families with newborns were randomized to IYPB intervention (<xref ref-type="bibr" rid="j_sjcapp-2022-0004_ref_076">76</xref>) or usual care (<xref ref-type="bibr" rid="j_sjcapp-2022-0004_ref_036">36</xref>). The IYPB program is a group intervention with eight two-hour sessions. In addition to parent-reported questionnaires, we collected a six-minute-long video at post-intervention from 97 families to assess the parent-child relationship, which was then coded with the Coding Interactive Behavior system.</p></sec> <sec id="j_sjcapp-2022-0004_s_008"><title style='display:none'>Results</title> <p>There were no significant intervention effects on either the total score or any of the seven subscales at post-intervention when the children were around 5.5 months old. For parental sensitivity, results were significant at the 10% level, favoring the IYPB group. When examining the lowest-functioning mothers in moderator analyses, we also found no significant differences between the two groups.</p></sec> <sec id="j_sjcapp-2022-0004_s_009"><title style='display:none'>Conclusion</title> <p>In line with parent-report outcomes, we did not find any statistically significant differences between the IYPB program and usual care on parent-child relationship when offered as a universal intervention for a relatively well-functioning group of parents with infants in a setting with a high standard of usual care. However, there was a positive trend for the total score, parental sensitivity and reciprocity with effect sizes in the range of .41-.51. It is possible that a larger sample would have resulted in significant differences for these outcomes.</p></sec> <sec id="j_sjcapp-2022-0004_s_010"><title style='display:none'>Trial registration</title> <p> NCT01931917 (registration date August 27, 2013)</p></sec> </abstract>ARTICLE2022-06-07T00:00:00.000+00:00Metacognitive awareness and emotional resilience in children with Attention Deficit Hyperactivity Disorder<abstract> <title style='display:none'>Abstract</title> <sec id="j_sjcapp-2022-0003_s_005"><title style='display:none'>Background</title> <p>This study explored the metacognitive awareness and emotional resilience levels of children suffering from attention deficit hyperactivity disorder (ADHD) (n=60) with typically developing children (n=30).</p></sec> <sec id="j_sjcapp-2022-0003_s_006"><title style='display:none'>Methods</title> <p>Measures included Metacognitive Awareness Inventory and Resiliency Scales for Children and Adolescents filled out by participants, the List of Adverse Life Events, Turgay DSM-IV-Based Disruptive Behavior Disorders Scale, and Revised Child Anxiety and Depression Scale—Parent Form filled out by parents.</p></sec> <sec id="j_sjcapp-2022-0003_s_007"><title style='display:none'>Results</title> <p>Metacognitive awareness and emotional resilience were found to be low in the children with ADHD. Emotional resilience increases as metacognitive awareness increases. Metacognitive awareness decreased in the presence of heightened ADHD, anxiety, and/or depression symptoms expressed by the parents' questionnaires (p &lt; 0.001, r = −0.438; p &lt; 0.001, r = −0.403; and p &lt; 0.001, r = −0.421).</p></sec> <sec id="j_sjcapp-2022-0003_s_008"><title style='display:none'>Conclusions</title> <p>Findings identified that metacognitive skills and emotional resilience are affected in ADHD.</p></sec> </abstract>ARTICLE2022-06-07T00:00:00.000+00:00The complete guide to ADHD: nature, diagnosis, and treatment<abstract><title style='display:none'>Abstract</title><p>I kindly received a copy of this new textbook from the authors some months ago, and now finally found the time to study it in more detail. Authors Katerina Maniadaki and Efthymios Kakouros are Professors of Developmental Psychopathology at the University of West Attica, and summarize here 25 years of clinical experience of working for children and adolescents with ADHD and relatives. Still the guide is also richly and excellently taking into account the perspective on ADHD in adulthood. The cover and foreword of the guide tells that it has already been endorsed by several recognized authorities in the field, such as Edmund Sonuga-Barke, Russell A. Barkley, Rosemary Tannock, and others which increased both my expectancies and excitement when starting to read. To make a long story short, I can sincerely recommend it to Scandinavian clinicians and researchers in the field. </p></abstract>ARTICLE2019-05-30T00:00:00.000+00:00Changes in delinquency according to socioeconomic status among Finnish adolescents from 2000 to 2015<abstract><title style='display:none'>Abstract</title><p><bold>Background:</bold>Scientific literature suggests that the prevalence of delinquency amongst adolescents has decreased internationally in past decades. However, whether this change is consistent across all socioeconomic groups has not yet been studied.</p><p><bold>Objective:</bold>The aim of this study was to examine changes in delinquency amongst Finnish adolescents according to socioeconomic status between 2000 and 2015.</p><p><bold>Method:</bold>A population-based school survey was conducted biennially amongst 14-16-year-old Finns between 2000 and 2015 (<italic>n</italic>= 761,278). Distributions for delinquency and socioeconomic adversities (low parental education, not living with both parents and parental unemployment in the past year) were calculated using crosstabs. Associations between delinquency, time, and socioeconomic adversities were studied using binomial logistic regression results shown by odds ratios with 95 % confidence intervals.</p><p><bold>Results:</bold>Delinquency was positively associated with all three socioeconomic adversities studied and cumulative socioeconomic adversity. Although the prevalence of delinquency varied only slightly between 2000 and 2015 in the overall population, it increased significantly amongst adolescents with most socioeconomic adversities.</p><p><bold>Conclusions:</bold>The findings indicate that socioeconomic differences in delinquency have increased amongst Finnish adolescents in past decades. Delinquency prevention and intervention programs should take socioeconomic adversities into account.</p></abstract>ARTICLE2019-08-19T00:00:00.000+00:00The shortened version of the Adolescent Stress Questionnaire (ASQ-S; Sweden): a validation study in United Kingdom adolescents<abstract><title style='display:none'>Abstract</title><sec id="j_sjcapp-2019-011_s_001"><title style='display:none'>Background:</title><p>Stress is an important variable of consequence, particularly in adolescence, a period of intense physical and psychological change. The measurement of stress in adolescence has been widely discussed, and a number of versions of the Adolescent Stress Questionnaire (ASQ) have been developed and validated. The present study sought to examine the psychometric properties (model fit, invariance, internal consistency, and construct validity) of the ASQ-S, which was recently developed in a Swedish context.</p></sec><sec id="j_sjcapp-2019-011_s_002"><title style='display:none'>Objective:</title><p>The study was a secondary analysis of data gathered on the full ASQ. The ASQ-S retained nine of the ten ASQ scales, and a study in Swedish adolescents suggested that the scale was psychometrically valid, gender invariant, and that scores were internally consistent. This is the first study to examine the properties of the ASQ-S in an English-speaking population. Participants were high school children in the UK (N = 610, 61.0% girls) from school year 8 through 12.</p></sec><sec id="j_sjcapp-2019-011_s_003"><title style='display:none'>Results:</title><p>Confirmatory factor analysis (CFA) revealed that the nine factor solution fit the data well (χ<sup>2s-b</sup>(288) = 751.60, CFI = 0.958, TLI = 0.948, SRMR = 0.040, RMSEA = 0.051 [90% CI = 0.047, 0.056]), and that scores were gender, school type (academic versus comprehensive), and school stage (junior versus middle high school) invariant. The nine scales correlated negatively with academic, social, and emotional self-efficacy scores, and self-esteem scores, to varying degrees. Girls reported higher stress levels than boys in six of the nine scales. A regression analysis, adjusted for gender and year in school, suggested that only the stress of peer pressure (negatively) was significantly related to adolescent alcohol use.</p></sec><sec id="j_sjcapp-2019-011_s_004"><title style='display:none'>Conclusions:</title><p>Overall this study suggests that the ASQ-S could be a valid measure of adolescent stress, although concerns remain regarding the convergent validity of scale scores.</p></sec></abstract>ARTICLE2019-12-11T00:00:00.000+00:00Validation of the Diagnostic Infant and Preschool Assessment in a Danish, trauma-exposed sample of young children<abstract><title style='display:none'>Abstract</title><sec id="j_sjcapp-2019-007_s_005"><title style='display:none'>Background:</title><p>There exist only few developmentally sensitive assessment instruments for identifying posttraumatic stress disorder (PTSD) and other potentially comorbid affective and behavioral symptomatology in preschool children. Consequently, young children who exhibit post-trauma symptomatology risk not being identified and not receiving the appropriate treatment. One of the few instruments that exist is the Diagnostic Infant and Preschool Assessment (DIPA).</p></sec><sec id="j_sjcapp-2019-007_s_006"><title style='display:none'>Objective:</title><p>To examine internal reliability and convergent validity of the Danish version of the DIPA, a semi-structured interview of caregivers about their child’s mental health.</p></sec><sec id="j_sjcapp-2019-007_s_007"><title style='display:none'>Method:</title><p>In total, 62 caregivers of trauma-exposed children aged 1-6 years were interviewed with the DIPA and completed the Strengths and Difficulties Questionnaire (SDQ).</p></sec><sec id="j_sjcapp-2019-007_s_008"><title style='display:none'>Results:</title><p>The children had experienced between one and eight traumas (Mdn = 3). Based on the DIPA, 48.4% of the children exhibited PTSD. The DIPA showed good to excellent internal consistency for the disorders of major depressive disorder, attention deficit hyperactivity disorder, oppositional defiant disorder, separation anxiety disorder and overall internal consistency of PTSD and reactive attachment disorder. Internal consistency was lower for each symptom cluster of PTSD and the overall consistency of sleep disorder with Cronbach’s alpha ranging between 0.54 and 0.69. Correlations between continuous scores of eight disorders of the DIPA and SDQ scales provided support for convergent validity of the DIPA.</p></sec><sec id="j_sjcapp-2019-007_s_009"><title style='display:none'>Conclusion:</title><p>The study provides preliminary evidence to support the Danish version of DIPA as a valid measure of symptoms of young children exposed to psychological trauma. As a standardized assessment tool, the DIPA can aid in early and structured assessment of young children exposed to trauma and can help guide treatment for those in need.</p></sec></abstract>ARTICLE2019-08-19T00:00:00.000+00:00Burden sharing in families to children, adolescents and young adults with ADHD: Analysis of ADHD Helpline in Swedish Clinical Services<abstract><title style='display:none'>Abstract</title><sec id="j_sjcapp-2019-012_s_001"><title style='display:none'>Background:</title><p>ADHD causes impairment in several life contexts and may increase stress and burden of care amongst family members. There is a lack of studies regarding gender inequalities in burden sharing in families of individuals with ADHD.</p></sec><sec id="j_sjcapp-2019-012_s_002"><title style='display:none'>Objective:</title><p>The aim of this study was to investigate gendered burden sharing in families who were in contact with an ADHD telephone helpline in Sweden. A further aim was to identify perceived difficulties that prompted contact with the helpline.</p></sec><sec id="j_sjcapp-2019-012_s_003"><title style='display:none'>Methods:</title><p>During a period of 28 months (from January 2013 to April 2015), calls were consecutively registered by psychologists manning the helpline through an anonymous digital form. After exclusion of 60 incomplete forms out of 1,410 (4%), information on 1,350 calls was analysed.</p></sec><sec id="j_sjcapp-2019-012_s_004"><title style='display:none'>Results:</title><p>The analysis indicated that mothers (82.7% of all callers) had a more important role as information-coordinators for children or adolescents with ADHD, as compared to fathers (13%) or other callers (4.3%). This pattern was also observed among the calls regarding young adults with ADHD. Helpline calls primarily concerned entitlement to academic support (57.9% of calls concerning children or adolescents) and healthcare services (80.6% of calls concerning young adults and adults).</p></sec><sec id="j_sjcapp-2019-012_s_005"><title style='display:none'>Conclusion:</title><p>The study concludes that a perceived lack of accessibility to and/or coordination of the school and health care services may be a major stressor for parents of individuals with ADHD. The burden of care through coordination of services and information-seeking may be especially increased in mothers of children, adolescents, and young adults with ADHD.</p></sec></abstract>ARTICLE2019-12-12T00:00:00.000+00:00The efficacy of manualized Cognitive Behavior Therapy conducted by student-therapists treating Danish youths with anxiety using a benchmark comparison<abstract><title style='display:none'>Abstract</title><sec id="j_sjcapp-2019-010_s_009"><title style='display:none'>Background:</title><p>Several systematic reviews have demonstrated the efficacy of cognitive behavioral therapy (CBT) treating anxiety disorders in children and adolescents (hereafter referred to as youths). Treatment of anxiety disorders conducted by student therapists (ST) has been found to be an effective alternative, to treatment conducted by psychologists.</p></sec><sec id="j_sjcapp-2019-010_s_010"><title style='display:none'>Objective:</title><p>The primary aim of the study is to investigate the effects of ST treating youths, using a group-based CBT program. Second, the study aims to compare these results with outcomes achieved by professional-therapists (PT).</p></sec><sec id="j_sjcapp-2019-010_s_011"><title style='display:none'>Method:</title><p>The study investigate in an open trial design, the treatment outcome from a manualized CBT program (Cool Kids) in a group of youths (n = 54) treated by ST. Results are benchmarked against the outcomes of a group of youths (n = 56) treated by PT using the same program, derived from a separate randomized controlled trial.</p></sec><sec id="j_sjcapp-2019-010_s_012"><title style='display:none'>Results:</title><p>There was a significant reduction of both self-reported and clinician rated measures of youth anxiety over time in the ST group, with small to large effect sizes. No significant differences of improvements in self-report measures were found between the ST and the PT groups. There was no significant difference in remission rates for participants’ primary anxiety disorder between the ST (50.0%) and the PT (66.1%) at post-treatment or at three-month follow-up (ST: 74.1%, PT: 76.8%). There was a significant difference regarding number of youths free of all anxiety disorder between the ST (14 [25.9%]) and PT (27 [48.2%]) group at post-treatment. This difference was not significant at three-month follow-up (ST: 25 [46.3%], PT: 33 [58.9%]).</p></sec><sec id="j_sjcapp-2019-010_s_013"><title style='display:none'>Conclusion:</title><p>The findings support previous findings, suggesting that student-therapists, receiving training and supervision, can successfully treat youths with anxiety disorders using a manualized CBT program. The outcomes following CBT treatment conducted by ST are comparable to outcomes achieved by PT.</p></sec></abstract>ARTICLE2019-11-20T00:00:00.000+00:00Towards a definition of multiple and complex needs in children and youth: Delphi study in Flanders and international survey<abstract><title style='display:none'>Abstract</title><sec id="j_sjcapp-2019-009_s_009"><title style='display:none'>Background:</title><p>Multiple and complex needs (MCN) in children and youth jeopardize their development and pose significant challenges to the different professionals they meet. However, there is no agreed-upon definition of this vulnerable population.</p></sec><sec id="j_sjcapp-2019-009_s_010"><title style='display:none'>Objectives:</title><p>To develop a definition of ‘MCN in children and youth’ that is meaningful for all professionals involved in care delivery for this population.</p></sec><sec id="j_sjcapp-2019-009_s_011"><title style='display:none'>Method:</title><p>A cross-sector, multidisciplinary, and geographically spread panel of 47 experts representing mental health, youth care, juvenile justice, and education in Flanders participated in an online Delphi study. Qualitative analysis of answers in the first round yielded four definition possibilities that participants then ranked in the second round. In the last round, participants rated their agreement with the highest ranked definition. An additional survey asked 25 international experts to rate and comment their agreement with the final definition.</p></sec><sec id="j_sjcapp-2019-009_s_012"><title style='display:none'>Results:</title><p>The final definition was: Children and adolescents with profound and interacting needs in the context of issues on several life domains (family context, functioning and integration in society) as well as psychiatric problems. The extent of their needs exceeds the capacity (expertise and resources) of existing services and sequential interventions lead to discontinuous care delivery. As such, existing services do not adequately meet the needs of these youths and their families. Cross-sector, integrated and assertive care delivery is necessary for safeguarding the wellbeing, development and societal integration of these young people. Response rates to the three Delphi rounds were 76.6, 89.1, and 91.3%. The definition was widely endorsed among Flemish (93.2% agreement) and international experts (88% agreement).</p></sec><sec id="j_sjcapp-2019-009_s_013"><title style='display:none'>Conclusion:</title><p>A definition of MCN in children and youth was constructed using the Delphi method and further evaluated for international relevance in an additional survey. Such an agreed-upon definition can be valuable for optimizing care delivery and conducting research.</p></sec></abstract>ARTICLE2019-11-08T00:00:00.000+00:00“Resilience” – is this the new black in psychiatric health care and prevention? and general risk-taking in externalizing adolescent inpatients versus non-externalizing psychiatric controls<abstract><title style='display:none'>Abstract</title><sec id="j_sjcapp-2019-013_s_001"><title style='display:none'>Background:</title><p>Interpersonal trust is an important target for the conceptualization, identification, and treatment of psychiatric disorders marked by interpersonal difficulties. A core feature of adolescent externalising disorders is interpersonal impairment. However, research investigating trust is scarce. A relatively novel approach for studying trust in psychopathology is through examination of social decision making using behavioural economic games.</p></sec><sec id="j_sjcapp-2019-013_s_002"><title style='display:none'>Objective:</title><p>To employ a modified trust game in order to determine whether externalising adolescents exhibit perturbed decision making in social and/or nonsocial contexts.</p></sec><sec id="j_sjcapp-2019-013_s_003"><title style='display:none'>Methods:</title><p>Externalising inpatient adolescents (<italic>n</italic>= 141) and non-externalising psychiatric controls (<italic>n</italic>= 122) completed self-report measures of psychopathology and invested in an iterative trust game played under two conditions: social (trust) and nonsocial (lottery condition), each consisting of five consecutive trials.</p></sec><sec id="j_sjcapp-2019-013_s_004"><title style='display:none'>Results:</title><p>Externalising adolescents showed a limited increase in trust investments, compared to a significant increase in lottery investments, across early game trials relative to psychiatric controls. This significant three-way interaction between experimental group, game condition, and trials became most evident at the second trial of games. Between-group differences on trust investments were non-significant. However, externalising adolescents invested significantly less in the trust relative to lottery condition, an effect unobserved in psychiatric controls.</p></sec><sec id="j_sjcapp-2019-013_s_005"><title style='display:none'>Conclusions:</title><p>This study tentatively suggests that adolescent externalising disorders may be associated with an insensitivity to normative social exchange which may arise, in part, from a lack of anticipated co-player reciprocity. It is not the level of trust that may distinguish externalising adolescents but perhaps the form of which the trust exchange takes shape. Conclusions are tempered by the fact that the employed trust game did not include feedback in the form of co-player repayments.</p></sec></abstract>ARTICLE2019-12-12T00:00:00.000+00:00en-us-1