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L'abordatge de l'educació afectiva-sexual és clau en l'etapa de l'adolescència, a causa dels canvis biològics i psicosocials que sorgeixen en aquesta etapa vital, les quals donen lloc a noves i diferents formes de vivenciar la sexualitat i les relacions afectives amb la resta de persones. Aquest desenvolupament i la demanda d'informació per part del jovent, deriva en la necessitat d'oferir una educació, formal i no formal, sobre afectivitat i sexualitat al jovent. Tot i això, a Espanya, l'educació afectiva-sexual esdevé una tasca pendent, ja que les famílies deriven aquesta funció als centres educatius i aquests, com que no tenen cap obligació de tractar-la, ho fan d'una manera molt parcial i breu, bàsicament per mitjà de professionals poc formats o aliens als centres educatius. Aquest fet no resol les demandes, dubtes i/o neguits dels i les adolescents i els porta a consultar altres vies informatives, d'entre les quals la principal és Internet, on poden trobar informació educativa de qualitat, però també poc contrastada i esbiaixada, amb tots els efectes negatius que això comporta a l'hora que els i les adolescents visquin la seva sexualitat i afectivitat. A partir d'aquest treball, doncs, es revisa l'actual estat de l'educació afectiva-sexual a Espanya (informació demandada, necessitada, etc.) i els principals continguts sobre afectivitat i sexualitat que els i les adolescents busquen i troben a Internet, emfatitzant quina cabuda pot tenir l'educador/a social com a educador/a afectiu i sexual a les escoles i instituts, tot abastint-se d'Internet com a eina socioeducativa per dur a terme aquesta tasca. L'article de revisió s'ha dut a terme a partir d'una recerca bibliogràfica sobre publicacions, llibres, treballs finals de màster i tesis doctorals, articles d'opinió, projectes, etc. sobre la matèria en concret, així com sobre pàgines webs (portals d'informació, campanyes, etc.) que ofereixen contingut en matèria afectiva-sexual. El abordaje de la educación afectiva-sexual es clave en la etapa de la adolescencia, a causa de los cambios biológicos y psicosociales que surgen en esta etapa vital, las cuales dan lugar a nuevas y diferentes formas de vivenciar la sexualidad y las relaciones afectivas con el resto de personas. Este desarrollo y la demanda de información por parte de la juventud, deriva en la necesidad de ofrecer una educación, formal y no formal, sobre afectividad y sexualidad a la juventud. Aun así, en España, la educación afectiva-sexual acontece una tarea pendiente, puesto que las familias derivan esta función en los centros educativos y estos, como que no tienen ninguna obligación de tratarla, lo hacen de una manera muy parcial y breve, básicamente por medio de profesionales poco formatos o ajenos en los centros educativos. Este hecho no resuelve las demandas, dudas y/o desazones de los y las adolescentes y los lleva a consultar otras vías informativas, de entre las cuales la principal es Internet, donde pueden encontrar información educativa de calidad, pero también poco contrastada y sesgada, con todos los efectos negativos que esto comporta en la hora que los y las adolescentes vivan su sexualidad y afectividad. A partir de este trabajo, pues, se revisa el actual estado de la educación afectiva-sexual en España (información demandada, necesitada, etc.) y los principales contenidos sobre afectividad y sexualidad que los y las adolescentes buscan y encuentran en Internet, enfatizando qué cabida puede tener el educador/en social como educador/a afectivo y sexual en las escuelas e institutos, alcanzándose de Internet como herramienta socioeducativa para llevar a cabo esta tarea. El artículo de revisión se ha llevado a cabo a partir de una investigación bibliográfica sobre publicaciones, libros, trabajos finales de máster y tesis doctorales, artículos de opinión, proyectos, etc. sobre la materia en concreto, así como sobre páginas webs (portales d¿información, campañas, etc.) que ofrecen contenido en materia afectiva-sexual. The approach to affective-sexual education is key in the adolescent stage, due to the biological and psychosocial changes that arise in this vital stage, which give rise to new and different ways of experiencing sexuality and affective relationships with other people. This development and the demand for information on the part of the youth, derives in the need to offer an education, formal and non-formal, on affectivity and sexuality to the youth. Even so, in Spain, affective-sexual education is still a pending task, since the families derive this function to the educational centers and these, since they have no obligation to deal with it, do it in a very partial and brief way, basically through professionals who are not very well trained or are not part of the educational centers. This fact does not solve the demands, doubts and / or misgivings of adolescents and leads them to consult other information channels, of which the main one is the Internet, where they can find quality educational information, but also little contrasted and biased, with all the negative effects that this entails when adolescents live their sexuality and affectivity. This paper reviews the current state of affective-sexual education in Spain (information demanded, needed, etc.) and the main contents on affectivity and sexuality that adolescents look for and find on the Internet, emphasizing what place the social educator can have as an affective and sexual educator in schools and institutes, using the Internet as a socio-educational tool to carry out this task. The review article has been carried out based on a bibliographic research on publications, books, master and doctoral thesis final works, opinion articles, projects, etc. on the specific subject, as well as on web pages (information portals, campaigns, etc.) that offer content on affective-sexual matters.

This systematic review examined the effectiveness in a hybrid telehealth model for adolescents with autism spectrum disorder (ASD), exploring the evidence base, methodology, and outcomes of health and behavior-related interventions for adolescents with ASD. The 11 included studies (a) were quantitative, (b) evaluated interventions delivered through a hybrid telehealth model (i.e., combined remote intervention with minimal in-person procedures), (c) measured health and behavior-related outcomes, and (d) considered adolescence as ages 12 through 25 years. The studies were a mixture of designs, methods, and outcome measures, and participant numbers were extremely low. Results demonstrated an overall lack of empirical evidence on the efficacy of hybrid-delivered interventions for adolescents with ASD, and more studies are needed to explore their effectiveness.

Objective: To investigate the impact of fixed orthodontic treatment on adolescents’ oral hygiene behavior and to examine their food consuption during fixed orthodontic treatment, as well as their motivation to maintain oral hygiene. Materials and methods: This research was carried out in a form of a survey questionnaire consisting of 23 questions. The sample comprised 170 adolescent patients aged from 11 to 19 who underwent the fixed orthodontic treatment at the Orthodontic Clinic of the Zagreb University Hospital Centre. Results: The orthodontic appliance did not interfere with the patients’ maintenance of oral hygiene, but it made the consumption of certain foods more difficult. Most adolescents brushed their teeth twice a day, using medium-soft brushes (35%). Regarding additional oral hygiene aids, 72.4% of the respondents used interdental brushes, more than 50% of the respondents used antiseptic mouthwashes for mouth rinsing, whereas only 31.2% of the tested population used dental floss (4.1% of which daily). The respondents were highly motivated to maintain oral hygiene by their orthodontists (96.5%), but only a small number of the respondents were informed about the importance of an adequate diet while undergoing a fixed orthodontic treatment. Conclusion: Orthodontists should provide their patients with detailed instructions on hygiene maintenance and adequate diet during orthodontic treatment to minimize negative side effects of the fixed orthodontic treatment. Patients should be motivated upon each follow-up examination and encouraged to use as many oral hygiene aids in their daily routines as possible., Svrha rada: Željelo se ispitati kakav je utjecaj fiksne ortodontske terapije na konzumaciju hrane i održavanje oralne higijene kod adolescenata te njihova motiviranost za njezino održavanje. Materijal i metode: U tu je svrhu provedeno istraživanje u obliku anketnog upitnika od 23 pitanja, a sudjelovalo je 170 pacijenata adolescentne dobi od 11 do 19 godina koji su bili na terapiji fiksnim metalnim or-todontskim napravama u Klinici za ortodonciju Kliničkoga bolničkoga centra Zagreb. Rezultati: Istraživanje je pokazalo da ortodontska naprava ne smeta pacijentima u održavanju oralne higijene, ali im otežava konzumaciju određenih namirnica. Najveći broj adolescenata zube pere dva puta na dan i koristi se srednje mekanom četkicom (35 %). Od pomoćnih sredstava 72,4 % ispitanika upotrebljava interdentalne četkice za zube, više od 50 % koristi se antiseptičkom vodicom za ispiranje usne šupljine. Zubnim koncem koristi se tek 31,2 % ispitane populacije (od kojih samo 4,1 % svakodnevno). Ispitanike su uglavnom na održavanje oralne higijene motivirali njihovi ortodonti (96,5 %), ali samo mali dio ispitanika upućen je u važnost pravilne prehrane tijekom fiksne ortodontske terapije. Zaključak: Ortodonti svojim pacijentima trebaju davati detaljne upute o održavanju higijene te o pravilnoj prehrani za trajanja ortodontske terapije kako bi se minimalizirale negativne nuspojave fiksne ortodontske terapije. Pacijenti se trebaju motivirati tijekom svakoga kontrolnog pregleda te poticati da se u svakodnevnoj rutini koriste sa što više pomoćnih sredstava

Highlights • One-in-five adolescents reported suicidality or pain. • Pain was associated with an increased risk of suicidality and vice versa (OR=4.00). • Network analysis supported the pain-suicidality association (aOR=1.39). • This cross-sectional association was not moderated by depression. • Pain should be considered as a key risk correlate of suicidality in adolescents., Background Whilst growing research suggests that pain is associated with suicidality in adolescence, it remains unclear whether this relationship is moderated by co-morbid depressive symptoms. The present study aimed to investigate whether the pain-suicidality association is moderated by depressive symptoms. Methods We performed secondary analyses on cross-sectional, pre-intervention data from the ‘My Resilience in Adolescence’ [MYRIAD] trial (ISRCTN ref: 86619085; N=8072, 11-15 years). Using odds ratio tests and (moderated) network analyses, we investigated the relationship between pain and suicidality, after controlling for depression, anxiety, inhibitory control deficits and peer problems. We investigated whether depression moderates this relationship and explored gender differences. Results Overall, 20% of adolescents reported suicidality and 22% reported pain, whilst nine percent of adolescents reported both. The experience of pain was associated with a four-fold increased risk of suicidality and vice versa (OR=4.00, 95%-CI=[3.54;4.51]), with no gender differences. This cross-sectional association remained significant after accounting for depression, anxiety, inhibitory control deficits and peer problems (aOR=1.39). Depression did not moderate the pain-suicidality association. Limitations The item-based, cross-sectional assessment of pain and suicidality precludes any conclusions about the direction of the effects and which aspects of suicidality and pain may drive this association. Conclusions Our findings underscore the need to consider pain as an independent risk correlate of suicidality in adolescents. Longitudinal research should examine how this relationship develops during adolescence. Clinically, our findings emphasise the need to assess and address suicidality in adolescents with pain, even in the absence of depressive symptoms.

Gambling is legal in most countries. However, despite having some economic benefits, certain characteristics of gambling can have health consequences, rendering it a public health issue. The effects can be summarized according to the following three “laws” of ethical gambling: “Gambling Dynamics Law”: companies’ economic gains come directly from players’ losses; “Expected Loss Law”: the more one gambles, the greater the probability of losing; and “Addiction Law”: the more one gambles, the greater the need to play again, leading to further losses. Ludens is a gambling addiction prevention program that has four goals: inform participants about gambling and gambling addiction; sensitize participants to the risk of gambling for health, especially addiction; promote a change in attitudes toward gambling; and alert participants to risky behaviors that can lead to addiction. The prevention program was implemented during 2017 to 2019. Fourteen psychologists presented it to 2372 adolescents (48.8% females, 51.2% males) aged 14–19 years, none of whom were university students, recruited from 42 Spanish high schools in 132 groups taking different courses. The main dependent variables analyzed were the monthly frequencies of gambling, at-risk gambling, and gambling addiction (as measured by the National Opinion Research Center DSM-IV Screen for Gambling Problems, adapted to diagnose gambling disorder according to DSM-5, in which pathological gambling is considered an addictive disorder). Given that all of the gamblers were adolescents (most were minors), fulfilment of 1–3 the DSM-5 diagnostic criteria was considered to indicate a risk of problem gambling. After the administration of Ludens, statistically significant reductions were observed in the three variables of interest: monthly frequency of gambling, percentage of adolescents with risky gambling, and percentage of adolescents with gambling disorder. The results were analyzed according to sex and age (minors vs. adolescents between 18 and 19 years old). The results obtained after applying the prevention program indicate that Ludens is effective as a universal prevention program for gambling addiction.

Background Self-harm usually begins during adolescence and adolescents that self-harm most commonly confide in friends, yet to date, there is little research from the friend’s perspective. Objective This qualitative study explores adolescents’ experiences of what it is like to have a friend who self-harms by cutting and what this experience means for friendship, the wider peer group and psychological well-being. Methods Semi-structured interviews were conducted face-to-face with a community sample of eight females aged between 13 and 18 years, living in England. Interpretative Phenomenological Analysis was used to analyse the data. Results Four superordinate themes emerged: desperately searching for meaning, I will be there at all costs, too hot to handle and identification. Adolescents were concerned about escalations in their friends’ behaviours and felt a sense of duty to help, but the majority experienced a dilemma as to whether to disclose to others and all reported some form of distress. Conclusions The results highlight the important, yet complex nature of friendship in this context. Friends play a key role in supporting adolescents who self-harm but need greater support managing this role and the effects. Schools/colleges should educate young people about self-harm to increase their knowledge and skills in relation to supporting a friend with this issue. Furthermore, they should promote environments for talking about mental health openly to give young people increased opportunities for help-seeking.

Purpose Prior studies have been inconclusive in documenting whether the prevalence of adolescent anxiety is increasing, given sampling and measurement limitations. This study adds new information on recent time trends in anxiety prevalence, specifically investigating trends among previously unexamined sociodemographic subgroups. Methods Weighted data of 37,360 youth respondents (51.1% female, 71.8% White, 91.3% heterosexual, 99.2% cisgender) from the 2012–2018 Dane County Youth Assessment, a county-wide survey administered to youth in participating school districts, were analyzed to estimate time trends in anxiety prevalence among the whole sample and by sociodemographic subgroups. Results The prevalence of youth meeting anxiety-screening criteria increased from 34.1% (95% CI 33.4–34.9) in 2012 to 44% (95% CI 43.2–44.7) in 2018 (OR for trend = 1.07, P for trend

Highlights • Obsessive-compulsive symptoms (OCS) are associated with risk of suicidality in youth. • Taboo obsessions are more robustly linked with suicidality than other OCS. • OCS in late adolescence prospectively predict suicidality in early adulthood. • Genetic factors explain much of the relationship between OCS and suicidality. • Non-shared environmental factors also contribute to the relationship., Background Obsessive-compulsive disorder (OCD) has been linked with elevated risk of suicidality. However, most previous studies have been cross-sectional, and little is known about the aetiology of the association between obsessive-compulsive symptoms (OCS) and suicidality in young adults. Methods Participants were members of the Child and Adolescent Twin Study in Sweden, at ages 18 (n = 9,162) and 24 (n = 3,466). Twins completed self-report measures, including assessment of OCS, suicidal ideation, and suicidal attempts. Logistic regression models tested concurrent and prospective associations of total OCS and OCS dimensions with suicidality, with and without adjustment for depression and anxiety symptoms. Genetic models tested the extent to which the main phenotypic associations were accounted for by genetic and environmental influences. Results Total OCS were significantly associated with concurrent reports of suicidality at age 18 and 24, even when controlling for depressive and anxiety symptoms. Taboo obsessions (e.g., sexual and aggressive thoughts) were more robustly associated with suicidality than other OCS dimensions, and prospectively predicted suicidality symptoms over time, even when controlling for baseline suicide attempts. Genetic factors accounted for most of the concurrent and longitudinal covariance between OCS and suicidality, with substantial non-shared environmental influences. Limitations We relied on self-report measures and did not include diagnostic assessment of OCD. Conclusions OCS, particularly taboo obsessions, are associated with significantly elevated risk of suicidality in late adolescence and early adulthood. This relationship is explained by a combination of common genetic liability and non-shared environmental effects, suggesting that effective OCS treatment might reduce suicidality risk in this group.

Background: Evidence suggests social media use is associated with mental health in young people but underlying processes are not well understood. This paper i) assesses whether social media use is associated with adolescents' depressive symptoms, and ii) investigates multiple potential explanatory pathways via online harassment, sleep, self-esteem and body image. Methods: We used population based data from the UK Millennium Cohort Study on 10,904 14 year olds. Multivariate regression and path models were used to examine associations between social media use and depressive symptoms. Findings: The magnitude of association between social media use and depressive symptoms was larger for girls than for boys. Compared with 1–3 h of daily use: 3 to

Introduction Hemangioblastomas are rare, histologically benign, highly vascularized tumors of the brain, the spinal cord, and the retina, occurring sporadically or associated with the autosomal dominant inherited von Hippel-Lindau (VHL) disease. Children or adults with VHL disease have one of > 300 known germline mutations of the VHL gene located on chromosome 3. They are prone to develop hemangioblastomas, extremely rarely starting at age 6, rarely at age 12–18, and, typically and almost all, as adults. There is a plethora of VHL-associated tumors and cysts, mainly in the kidney, pancreas, adrenals, reproductive organs, and central nervous system. Due to a lack of causal treatment, alleviation of symptoms and prevention of permanent neurological deficits as well as malignant transformation are the main task. Paucity of data and the nonlinear course of tumor progression make management of pediatric VHL patients with hemangioblastomas challenging. Methods The Freiburg surveillance protocol was developed by combining data from the literature and our experience of examinations of > 300 VHL patients per year at our university VHL center. Results Key recommendations are to start screening of patients at risk by funduscopy with dilated pupils for retinal tumors with admission to school and with MRI of the brain and spinal cord at age 14, then continue biannually until age 18, with emergency MRI in case of neurological symptoms. Indication for surgery remains personalized and should be approved by an experienced VHL board, but we regard neurological symptoms, rapid tumor growth, or critically large tumor/cyst sizes as the key indications to remove hemangioblastomas. Since repeated surgery on hemangioblastomas in VHL patients is not rare, modern neurosurgical techniques should encompass microsurgery, neuronavigation, intraoperative neuromonitoring, fluorescein dye-based intraoperative angiography, intraoperative ultrasound, and minimally invasive approaches, preceded in selected cases by endovascular embolization. Highly specialized neurosurgeons are able to achieve a very low risk of permanent morbidity for the removal of hemangioblastomas from the cerebellum and spinal cord. Small retinal tumors of the peripheral retina can be treated by laser coagulation, larger tumors by cryocoagulation or brachytherapy. Conclusion We consider management at experienced VHL centers mandatory and careful surveillance and monitoring of asymptomatic lesions are required to prevent unnecessary operations and minimize morbidity.

Adolescents aspire for independence. Successful independence means knowing when to rely on one's own knowledge and when to listen to others. A critical prerequisite thus is a well‐developed metacognitive ability to accurately assess the quality of one's own knowledge. Little is known about whether the strive to become an independent decision maker in adolescence is underpinned by the necessary metacognitive skills. Here, we demonstrate that metacognition matures from childhood to adolescence (N = 107) and that this process coincides with greater independent decision‐making. We show that adolescents, in contrast to children, take on others’ advice less often, but only when the advice is misleading. Finally, we demonstrate that adolescents’ reduced reliance on others’ advice is explained by their increased metacognitive skills, suggesting that a developing ability to introspect may support independent decision‐making in adolescence., Moses‐Payne et al investigated how advice taking develops during childhood and adolescence, and how this is related to metacognition. Children, 8‐9 year olds (yo), and two groups of adolescents, 12‐13 year olds and 16‐17 year olds, took part in a metacognition and advice taking task. Both adolescent groups showed increased ability to identify when they were correct or incorrect (increased metacognitive efficiency, Panel A). The adolescent groups also showed a lower propensity to follow advice than children (Panel B). Importantly, adolescents were less likely to follow false advice but still followed helpful advice (Panel C). In this way, adolescents were more competent advice takers, and this was linked to their metacognitive abilities: resistance to false advice was driven by adolescents' increased metacognitive efficiency (Panel D). The adolescents utilized their new‐found metacognitive abilities to resist false advice from others when they knew they were correct, but still took helpful advice when they knew they were incorrect.

Background Several studies conducted since the beginning of the COVID-19 pandemic have shown its harmful effects on young people’s mental health. In Québec and Canada, few studies have focussed on adolescents, and even fewer of these studies have examined this subject using a methodology that involved comparisons of data obtained before and during the pandemic, which is the purpose of this study. Objective The objective of this study is to determine the impact of the COVID-19 pandemic on the anxiety of secondary 1 and 2 students in Québec, using data obtained before and during the pandemic. Method Participants were 2990 French Canadian students in secondary 1 (grade 7) and secondary 2 (grade 8) in Québec. Two independent samples completed the questionnaires, one sample before the pandemic (fall 2019) and one sample during the pandemic (fall 2020). Their answers were subjected to descriptive analysis and multivariate analysis of variance. Results Results show that the pandemic has had variable impacts on the student’s mental health, with some of them reporting negative effects on their lives, others reporting no effect, and some reporting positive effect. However, the students surveyed during the pandemic generally reported more symptoms of generalized anxiety, and higher levels of test anxiety, fear of judgment and perfectionism than the ones surveyed before the pandemic. Conclusions The discussion puts forward possible explanations for the results obtained, which contribute to a better understanding of young adolescents’ experience during the COVID-19 pandemic. It also discusses the importance of developing interventions for adolescents affected by this pandemic.

In this study, we examined trajectories of specific domains of behavior problems (i.e., attention problems, depression/anxiety, and aggressive behavior) from age 6 to 18 in a sample of 55 children with fragile X syndrome. We also examined autism status and early parenting as predictors of subsequent behavioral trajectories. We found that attention problems and aggressive behavior declined steadily from childhood through adolescence whereas anxious/depressed behavior demonstrated relative stability over the same period. Youth with highly flexible mothers displayed more optional trajectories of improvement in attention problems.

Highlights • Higher cardiovascular risk score at age 15 is associated with depressive symptoms at age 18. • Depressive symptoms at age 12 are not associated with cardiovascular risk score at age 15. • Association between depression and cardiovascular risk in young people may be unidirectional. • IL-6 and CRP levels at age 9 are associated with cardiovascular risk score at age 15. • Adolescent cardiovascular risk mediates the association between childhood inflammation and early-adult depressive symptoms., Background Cardiovascular disease (CVD) and depression are bidirectionally associated in adults. However, the direction of association between CVD risk and depressive symptoms in young people and potential mechanisms are poorly understood. Methods Using longitudinal birth cohort data, we created a CVD risk score age at 15 using age, ethnicity, physical activity, maternal social status, maternal smoking, own smoking, BMI, systolic blood pressure, LDL, HDL and triglycerides. We used regression analysis to test: (1) association between CVD risk score at age 15 and depressive symptoms at ages 12 and 18; (2) association of IL-6 and CRP at age 9 with depressive symptoms at age 12 and CVD risk score at age 15; and (3) mediating effects of CVD risk score on associations of IL-6/CRP at age 9 with depressive symptoms at age 18. Results The risk set comprised 5007 participants. CVD risk score in mid-adolescence was associated with depressive symptoms in early-adulthood (adjusted beta=0.06; standard error (SE)=0.02; p

Background Coronavirus disease 2019 (COVID-19) usually leads to a mild infectious disease course in children, while serious complications may occur in conjunction with both acute infection and neurological symptoms, which have been predominantly reported in adults. The neurological complications in these patients vary based on patient age and underlying comorbidities. Data on clinical features, particularly neurological features, and prognostic factors in children and adolescents are limited. This study provides a concise overview of neurological complications in pediatric COVID-19 cases. Materials and methods The retrospective study reviewed medical records of all patients who were admitted to our hospital and were diagnosed with COVID-19 by real-time reverse-transcription polymerase-chain-reaction (RT–PCR) assay between 11 March 2020 and 30 January 2021. Patients with a positive PCR result were categorized into two groups: outpatient departments patients and inpatient departments (IPD). Results Of the 2530 children who underwent RT–PCR during the study period, 382 (8.6%) were confirmed as COVID-19 positive, comprising 188 (49.2%) girls and 194 (50.8%) boys with a mean age of 7.14±5.84 (range, 0–17) years. Neurological complications that required hospitalization were present in 34 (8.9%) patients, including seizure (52.9%), headache (38.2%), dizziness (11.1%) and meningoencephalitis (5.8%). Conclusion The results indicated that neurological manifestations are not rare in children suffering from COVID-19. Seizures, headaches, dizziness, anosmia, ageusia and meningoencephalitis are major neurological manifestations during acute COVID-19 disease. Although seizures were the most common cause of hospitalization in IPD patients, the frequency of meningoencephalitis was quite high. Seizures were observed as febrile seizures for children under 6 years of age and afebrile seizures for those over 6 years of age. Febrile seizure accounted for half of all seizure children.

Autistic adolescents are at increased risk of mental health difficulties. One potential factor contributing to this is identity development, although this hypothesis has been little explored. These adolescents also have to consider how autism forms their identity, a process called acculturation. This exploratory study examined the relationships between identity, acculturation and mental health in autistic adolescents. Twenty-four participants completed measures investigating identity, acculturation and mental health. Findings suggested mental health was not related to personal identity. Mental health scores did not differ between acculturation groups, however those aligned to non-autistic culture tended to generate more positive self-statements than those aligned to neither culture. These findings suggest autistic adolescents should be encouraged to explore autistic culture and supported in constructing their identity.

Depression is a common comorbidity in autism spectrum disorder (ASD). Little is known about risk factors for depression and depressive symptoms in this population. Ecological momentary assessment (EMA) has been used in the typically developing population to identify risk factors for depression, but has been rarely applied in ASD populations. In this exploratory study, 17 autistic adolescents participated in an EMA protocol in which they reported on their current activities and emotions six times per day for seven consecutive days. Results suggested that negative affect is predicted by momentary quality of social interaction and enjoyment of the current activity (p

PurposeThe relationship between ethnicity and adolescent mental health was investigated using cross-sectional data from the nationally representative UK Millennium Cohort Study.MethodsParental Strengths and Difficulties Questionnaire reports identified mental health problems in 10,357 young people aged 14 (n = 2042 from ethnic minority backgrounds: Mixedn = 492, Indiann = 275, Pakistanin = 496, Bangladeshin = 221, Black Caribbeann = 102, Black Africann = 187, Other Ethnic Groupn = 269). Univariable logistic regression models investigated associations between each factor and outcome; a bivariable model investigated whether household income explained differences by ethnicity, and a multivariable model additionally adjusted for factors of social support (self-assessed support, parental relationship), participation (socialising, organised activities, religious attendance), and adversity (bullying, victimisation, substance use). Results were stratified by sex as evidence of a sex/ethnicity interaction was found (P = 0.0002).ResultsThere were lower unadjusted odds for mental health problems in boys from Black African (OR 0.15, 95% CI 0.04–0.61) and Indian backgrounds (OR 0.42, 95% CI 0.21–0.86) compared to White peers. After adjustment for income, odds were lower in boys from Black African (OR 0.10, 95% CI 0.02–0.38), Indian (OR 0.40, 95% CI 0.21–0.77), and Pakistani (OR 0.49, 95% CI 0.27–0.89) backgrounds, and girls from Bangladeshi (OR 0.18, 95% CI 0.05–0.65) and Pakistani (OR 0.63, 95% CI 0.41–0.99) backgrounds. After further adjustment for social support, participation, and adversity factors, only boys from a Black African background had lower odds (OR 0.16, 95% CI 0.03–0.71) of mental health problems.ConclusionsHousehold income confounded lower prevalence of mental health problems in some young people from Pakistani and Bangladeshi backgrounds; findings suggest ethnic differences are partly but not fully accounted for by income, social support, participation, and adversity. Addressing income inequalities and socially focused interventions may protect against mental health problems irrespective of ethnicity.

Funder: Royal Holloway University of London, Purpose: Young people change substantially between childhood and adolescence. Yet, the current description of behavioural problems does not incorporate any reference to the developmental context. In the current analysis, we aimed to identify common transitions of behavioural problems between childhood and adolescence. Method: We followed 6744 individuals over 6 years as they transitioned from childhood (age 10) into adolescence (age 16). At each stage, we used a data-driven hierarchical clustering method to identify common profiles of behavioural problems, map transitions between profiles and identify factors that predict specific transitions. Results: Common profiles of behavioural problems matched known comorbidity patterns but crucially showed that the presentation of behavioural problems changes markedly between childhood and adolescence. While problems with hyperactivity/impulsivity, motor control and conduct were prominent in childhood, adolescents showed profiles of problems related to emotional control, anxiety and inattention. Transitions were associated with socio-economic status and cognitive performance in childhood Conclusion: We show that understanding behavioural difficulties and mental ill-health must take into account the developmental context in which the problems occur, and we establish key risk factors for specific negative transitions as children become adolescents.

This study examined the development of decision-making and its association with psychological wellbeing and risky behaviours in adolescents with and without autism. Participants included 270 autistic and 9,713 typically developing adolescents. In both samples, those with a diagnosis of attention-deficit/hyperactivity disorder (ADHD) were excluded. Data came from the Millennium Cohort Study, a nationally representative population-based birth cohort. Decision-making was assessed using the Cambridge Gambling Task at ages 11 and 14. Psychological wellbeing (happiness, self-esteem, depressive symptoms and self-harm) and risky/antisocial behaviours were self-reported at age 14. After adjusting for sex, cognitive ability, spatial working memory, socioeconomic status and pubertal status, autistic adolescents showed comparable quality of decision-making to that of their peers at both ages but also a more deliberative decision-making style as they aged. Only in autistic adolescents was this decision-making style associated with positive outcomes. Electronic supplementary material The online version of this article (10.1007/s10803-020-04783-y) contains supplementary material, which is available to authorized users.

We propose a theoretical model of insomnia symptoms and non‐suicidal self‐injury (NSSI) that posits bidirectional linkages. We hypothesised that heightened depressive symptoms and impulsivity that result from insomnia increase NSSI. We also posit that the shame associated with NSSI triggers repetitive negative thinking, in turn increasing insomnia. Using three longitudinal waves of questionnaire data collected annually from a sample of Swedish adolescents (n = 1,457; M age = 13.2, SD = 0.43; 52.7% boys), we assessed the mediating role of depressive symptoms, impulsivity, rumination, and worry on the link between insomnia and NSSI. After controlling for depressive symptoms, we found that insomnia was related to increases in NSSI from the second to the third time point (ß 23 = 0.09, p = .01). NSSI was consistently related to increased insomnia (ß 12 = 0.09, p = .01; ß 23 = 0.11, p

Over the past decade, several studies have investigated the relationship between cognitive distortions and emotion regulation among adolescent gamblers, demonstrating the exacerbating role of alcohol consumption when co-occurring with gambling problems. An important construct, that to date has been largely neglected, is mentalizing (i.e. the ability to reflect on one's own and others' mental states). The aim of the present study was (for the first time) to investigate the relative contribution of mentalization, emotional dysregulation, cognitive distortions, and alcohol consumption among adolescent gamblers. A total of 396 students (69.2% females) aged 14–19 years were recruited from secondary schools in Southern Italy. Assessment measures included the South Oaks Gambling Screen Revised for Adolescents (SOGS-RA), the Reflective Functioning Questionnaire (RFQ-8), the Difficulties in Emotion Regulation Scale (DERS), the Gambling Related Cognitions Scale (GRCS), and the Alcohol Use Disorders Identification Test (AUDIT). Regression analysis showed that, along with male gender, the best predictors of adolescent gambling were scores on two GRCS subscales (i.e., ‘inability to stop gambling’ and ‘interpretative bias’), the RFQ-8’s ‘uncertainty about mental states’ dimension, and the DERS ‘impulse control difficulties’ factor, with the overall model explaining more than one-third of the total variance. The results clearly indicated that, along with gambling-related cognitive distortions, uncertainty about mental states, and difficulties remaining in control of one’s behavior when experiencing negative emotions contributed significantly to problematic gambling among adolescents.

Background Transition from child-centred to adult mental health services has been reported as challenging for young people. It can be especially difficult for young people with autism spectrum disorder (ASD) as they manage the challenges of adolescence and navigate leaving child and adolescent mental health services (CAMHS). Aims This study examines the predictors of transfer to adult mental health services, and using a qualitative analysis, explores the young people’s experiences of transition. Method A UK sample of 118 young people aged 14–21 years, with ASD and additional mental health problems, recruited from four National Health Service trusts were followed up every 12 months over 3 years, as they were discharged from CAMHS. Measures of mental health and rich additional contextual information (clinical, family, social, educational) were used to capture their experiences. Regression and framework analyses were used. Results Regression analysis showed having an attention-deficit hyperactivity disorder diagnosis and taking medication were predictors of transfer from child to adult mental health services. Several features of young people's transition experience were found to be associated with positive outcomes and ongoing problems, including family factors, education transitions and levels of engagement with services. Conclusions The findings show the importance of monitoring and identifying those young people that might be particularly at risk of negative outcomes and crisis presentations. Although some young people were able to successfully manage their mental health following discharge from CAMHS, others reported levels of unmet need and negative experiences of transition.

Highlights • Changes in WHO alcohol risk level are highly variable in youth treated for ADHD/SUD. • Achieving > 2-level reduction in WHO risk is linked to improvements in functioning. • Achieving > 2-level reduction in WHO risk is linked to decreased ADHD symptoms. • > 2-level reduction in WHO risk may be a valid non-abstinent AUD outcome in youth with ADHD/SUD., Introduction Abstinence from drinking represents the primary treatment target for alcohol use disorders (AUD) in youth, but few adolescents who engage in problematic drinking seek treatment. A reduction in World Health Organization (WHO) drinking risk level has been established as valid and reliable non-abstinent treatment target for AUD in adults but remains unstudied in youth. Methods The present study used data from the NIDA-CTN-0028 trial to examine associations between reductions in WHO drinking risk level and changes in global functioning and attention-deficit hyperactivity disorder (ADHD) symptoms during treatment in a sample of adolescents (ages 13–18 years) with ADHD and comorbid substance use disorder (SUD) (n = 297, 61% with AUD) receiving a 16-week intervention that combined ADHD pharmacotherapy (OROS-methylphenidate vs. placebo) and drug-focused cognitive-behavioral therapy. Results Shifts in drinking risk level during treatment were highly variable in adolescents treated for ADHD/SUD, and influenced by AUD diagnostic status. In the total sample, 15% of participants had a 2-level or greater reduction in WHO drinking risk level, with 59% and 24% showing no change or an increase in risk-level during treatment respectively. Achieving at least a 2-level change in WHO drinking risk level during treatment was associated with greater reduction in ADHD symptoms and better functional outcomes. Conclusions These findings parallel the adult AUD literature and provide preliminary support for the use 2-level reductions in WHO risk levels for alcohol use as a clinically valid non-abstinent treatment outcome for youth with ADHD and comorbid AUD.

Background In East Africa, where landlines are used by 1% of the population and access to the internet is limited, owning a cell phone is rapidly becoming essential for acquiring information and resources. Our analysis illuminates the perils and potential promise of mobile phones with implications for future interventions to promote the health of adolescents and young adults (AYAs) and to prevent HIV infection. Objective The aim of this study is to describe the current state of AYAs’ phone use in the region and trace out the implications for mobile health interventions. Methods We identified 2 trading centers that were representative of southern Uganda in terms of key demographics, proportion of cell phone ownership, and community HIV prevalence. We stratified the sample of potential informants by age group (15-19 years and 20-24 years), gender, and phone ownership and randomly sampled 31 key informant interview participants within these categories. In addition, we conducted 24 ethnographic participant observations among AYAs in the communities of study. Results AYA frequently reported barriers to using their phones, such as difficulty accessing electricity. Nearly all AYAs used mobile phones to participate in the local economy and communicate with sexual partners. Phone use was frequently a point of contention between sexual partners, with many AYAs reporting that their sexual partners associated phone use with infidelity. Few AYAs reported using their phones for health-related purposes, with most getting health information in person from health workers. However, most AYAs reported an instance when they used their phone in an emergency, with childbirth-related emergencies being the most common. Finally, most AYAs reported that they would like to use their phones for health purposes and specifically stated that they would like to use their mobile phones to access current HIV prevention information. Conclusions This study demonstrates how mobile phones are related to income-generating practices in the region and communication with sexual partners but not access to health and HIV information. Our analysis offers some explanation for our previous study, which suggested an association between mobile phone ownership, having multiple sexual partners, and HIV risk. Mobile phones have untapped potential to serve as tools for health promotion and HIV prevention.

Purpose Self-identification of having a mental illness has been shown to be an important factor underpinning help-seeking behaviour and may mediate the relationship between personal stigma and mental health service use. This study validates a new scale for the self-identification of having a mental illness among a non-clinical, community cohort of young people in the UK. Methods Following consultation with a group of young person experts with experience of mental health problems, we evaluated the psychometric properties of the self-identification of mental illness scale (SELF-I) among 423 young people aged 13–24 years who are part of an ongoing prospective community cohort. We performed test retest reliability among a subset of 53 participants. Psychometric validation for the scale used measures of Cronbach’s alpha and Pearson’s correlation coefficient. Item performance was assessed along and in relation with each covariate. Results The SELF-I demonstrated robust psychometric properties including high test–retest reliability (0.95) and good internal consistency (0.87 as determined by the Cronbach’s alpha). The inter-total correlations for each item, which ranged from 0.62 to 0.74, supported keeping all items in the scale. Reporting greater psychiatric symptomatology via the SDQ (β: 0.82 95% confidence interval 0.40, 1.23), psychotic-like experiences (β: 0.37 95% confidence interval 0.14, 0.59), and use of mental health services (β: 0.92 95% confidence interval 0.71, 1.13) were associated with a greater self-perception as having a mental illness (p

Background A conflicting body of research suggests that additional investigation is needed to understand how globally watched television shows featuring social and mental health issues, such as 13 Reasons Why, might affect adolescents’ mental wellness. Objective This study aims to investigate adolescents’ viewership of the third season of the Netflix drama 13 Reasons Why (13RW-3) and their engagement with show-related content, paying special attention to mental health outcomes and conversational partners. Methods A panel-based research platform operated by the National Opinion Research Center at the University of Chicago recruited 157 adolescents aged 13 to 17 years from its nationally representative pool of participants. Participants answered questions about how they discussed and learned about social and mental health issues portrayed in 13RW-3 (eg, masculine role pressure and sexual assault) and questions about mental wellness (eg, mental health self-efficacy and depression). After the participants completed the survey (T1), they were directed to either watch 13RW-3 as it aired for the first time (intervention group) or not watch 13RW-3 (control group). Approximately one month later (T2), all the participants were asked to complete the postsurvey. Additional survey questions about conversational partners, information seeking because of watching the show, and use of show-related content were included in the intervention postsurvey. Results Our sample (N=157) was 52.2% (n=82) female and 54.8% (n=86) White, with a mean age of 14.99 (SD 1.4) years. At T2, viewers of 13RW-3 spoke about suicide significantly more frequently than nonviewers (P=.007). From T1 to T2, viewers increasingly discussed issues explored by 13RW-3 (P=.002), especially suicide, mental health, and bullying. Adolescent viewers were most likely to speak with friends, and parents were the second most commonly named. Two variables emerged as consistent moderators of conversational choices—having depressive symptoms and being impacted by sexual assault. There was no association between conversational frequency and information seeking around social and mental health issues, and neither mental health self-efficacy scores nor masculine role pressure scores significantly differed between viewers and nonviewers at T2. Conclusions Viewing 13RW-3, a globally watched television show featuring social and mental health issues, led to adolescent conversations and information searches about topics explored by the show. Depressive symptoms and the impact of sexual assault moderated several relationships, guiding participants toward engaging with certain issues and seeking out specific conversational partners. As 13RW-3’s stories drove conversations—and story-driven conversations can raise awareness, reduce stigma, shift attitudes, normalize certain behaviors, and strengthen supportive relationships—potential wellness implications for television shows featuring social and mental health issues are considerable.

Background Associations between internet gaming disorder (IGD), psychological distress, and sleep have been reported. However, little is known whether such associations exist across siblings; that is, whether adolescents’ IGD symptomatology may impact their siblings’ psychological distress and sleep. This study aimed to examine whether siblings' IGD symptoms may relate to depressive, anxiety symptoms or sleep quality among each other. Methods Using a cross-sectional design with two-stage cluster sampling, 320 dyads of adolescent students and their siblings participated in the study. Each dyad completed the Internet Gaming Disorder Scale-Short Form (IGDS-SF9), the Depression Anxiety Stress Scale-21 (DASS-21), and the Insomnia Severity Index (ISI). The actor–partner interdependence model (APIM) was applied to examine relationships between IGD, psychological well-being, and insomnia severity in the dyadic data. Results Actor effects of IGDS-SF9 scores on depression, anxiety, stress, and insomnia severity were significant in both adolescents (e.g., adolescents’ IGDS-SF9 scores on their depression scores) and their siblings (e.g., IGDS-SF9 scores of adolescents’ siblings’ scores on their depression scores). Partner effects of IGDS-SF9 scores on depression, anxiety, stress, and insomnia severity were significant in both adolescents (e.g., adolescents’ IGDS-SF9 scores on their siblings’ depression scores) and their siblings (e.g., IGDS-SF9 scores of adolescents’ siblings on adolescents’ depression scores). Conclusions The present study demonstrated that adolescent students and their siblings had mutual impacts of IGD on psychological health and sleep. Thus, healthcare providers may consider involving siblings when they design programs reducing IGD-related problems or improving psychological health and sleep for adolescents.

This study investigated the association between mental health problems and academic and behavioral school functioning for adolescent girls in the child welfare system and determined whether school engagement and future orientation meditated the relationship. Participants were 231 girls aged between 12 and 19 who had been involved with the child welfare system. Results indicated that 39% of girls reported depressive symptoms in the clinical range and 54% reported posttraumatic symptoms in the clinical range. The most common school functioning problems reported were failing a class (41%) and physical fights with other students (35%). Participants reported a mean number of 1.7 school functioning problems. Higher levels of depression and PTSD were significantly associated with more school functioning problems. School engagement fully mediated the relationship between depression and school functioning and between PTSD and school functioning, both models controlling for age, race, and placement stability. Future orientation was not significantly associated with school functioning problems at the bivariate level. Findings suggest that school engagement is a potentially modifiable target for interventions aiming to ameliorate the negative influence of mental health problems on school functioning for adolescent girls with histories of abuse or neglect.

Background Self-harm is a significant clinical issue in adolescence. There is little research on the interplay of key factors in the months, weeks, days and hours leading to self-harm. We developed the Card Sort Task for Self-harm (CaTS) to investigate the pattern of thoughts, feelings, events and behaviours leading to self-harm. Methods Forty-five young people (aged 13–21 years) with recent repeated self-harm completed the CaTS to describe their first ever/most recent self-harm episode. Lag sequential analysis determined significant transitions in factors leading to self-harm (presented in state transition diagrams). Results A significant sequential structure to the card sequences produced was observed demonstrating similarities and important differences in antecedents to first and most recent self-harm. Life-events were distal in the self-harm pathway and more heterogeneous. Of significant clinical concern was that the wish to die and hopelessness emerged as important antecedents in the most recent episode. First ever self-harm was associated with feeling better afterward, but this disappeared for the most recent episode. Limitations Larger sample sizes are necessary to examine longer chains of sequences and differences in genders, age and type of self-harm. The sample was self-selected with 53% having experience of living in care. Conclusions The CaTs offers a systematic approach to understanding the dynamic interplay of factors that lead to self-harm in young people. It offers a method to target key points for intervention in the self-harm pathway. Crucially the factors most proximal to self-harm (negative emotions, impulsivity and access to means) are modifiable with existing clinical interventions., Highlights • We have developed the Card Sort Task for Self-harm (CaTS). • Sequence analysis revealed important transitions in the pathway to self-harm. • Factors most proximal to self-harm are amenable to intervention. • For recent episodes, hopelessness and suicidality emerged as significant factors. • First ever self-harm (but not most recent) was associated with feeling better afterward.

Diario della Salute [My Health Diary] is a school-based program designed to enhance the subjective well-being and health of 12- to 13-year-old students. We hypothesized that providing students with the social and emotional skills to fulfill their potential and deal with common developmental tasks of adolescence (e.g., onset of puberty, identity development, increased responsibilities and academic demands) would result in improved well-being and health. The program comprises five standardized interactive lessons concerning common psychosocial and health issues in adolescence, and two narrative booklets addressed to both students and their parents. We evaluated the effectiveness of the program in terms of the students' subjective well-being, aggressive behavior, and health behavior. Using a quasi-experimental study design, schools in the intervention group implemented the full program and those in the comparison group received their regular curriculum. We administered measures of the study's objectives both before and after program implementation. Statistical analyses accounted for within-school clustering, potential socioeconomic and demographic confounding, and pre-implementation levels of these measures. We sampled 62 schools and allocated 2630 students to either an intervention or comparison group. Sociodemographic characteristics and baseline outcomes were balanced across study groups. Unexpectedly, respondents in the intervention group had 0.38 greater mean adjusted score of the WHO/Europe Health Behaviour in School-Aged Children Symptom Checklist instrument than respondents in the comparison group, indicating a reduction in subjective well-being. We did not observe any program effects on aggressive and health behaviors. The apparent reduction in subjective well-being reflected by an increased perception of psychosomatic complaints is suggestive of either increased emotional competence or, potentially, iatrogenic program effects. While greater emotional competence is positively associated with well-being over the course of life, the program in its present form should not be disseminated due to the possibility of adverse unintended effects.

Background Sleep problems in adolescence, such as insomnia and short sleep duration, are associated with physical and mental health problems. However, little is known about the recent trends in sleep problems among adolescents. Therefore, this study examined trends in sleep problems among Japanese adolescents. Methods Using data from the Lifestyle Survey of Adolescents collected in 2004 (n = 102,451), 2008 (n = 95,680), 2010 (n = 98,867), 2012 (n = 101,134), 2014 (n = 85,931), and 2017 (n = 64,417), we calculated the trends of insomnia, shorter sleep duration, late bedtimes, and poor sleep quality. Multivariable logistic regression analysis models were used to examine the association of each sleep problem and survey years. Findings We analyzed data from 545,285 Japanese adolescents. Results indicated that, since 2004, the odds ratio for insomnia have decreased (Adjusted odds ratio [AOR] 0•85, 95% CI 0•82–0•87), as have the odds ratio for poor sleep quality (AOR 0•92, 95% CI 0•88–0•95). However, the odds ratio for shorter sleep duration (AOR 1•13, 95% CI 1•10–1•17) and late bedtimes tended to increase (AOR 1•06, 95% CI 1•03–1•08) during this period. Interpretation The prevalence of insomnia symptoms and poor sleep quality among adolescents decreased from 2004 to 2017. However, there were increasing trends toward shorter sleep duration and late bedtimes. These changes are both relieving and concerning. Teachers, parents, and health professionals should consider educating adolescents regarding sleep hygiene, adjusting schedules of extracurricular activities, and enhancing time management to improve their sleep quantity. Funding This study received funding from Japan's Ministry of Health, Labour and Welfare.

Highlights • Metacognitions and emotion recognition predict IGD in early adolescence. • Re-parenting, building assertiveness skills and metacognitions modification may protect adolescents from IGD., Internet Gaming Disorder (IGD) is associated with considerable psychological distress in adolescents. However, studies which strive to shed light on the developmental background of IGD are still sparse. We aimed to examine the role of metacognitions and emotion recognition in predicting IGD during the early adolescence period. Four hundred and seventy-seven secondary school students were recruited for the study. Participants completed the Internet Gaming Disorder Test (IGDT), the Metacognitions Questionnaire for Children (MCQ-C), and the Children’s Version of Reading the Mind in the Eye Test (RMET). Correlation analyses indicated that three factors of the MCQ-C (positive meta-worry, negative meta-worry, and superstition, punishment, and responsibility) and its total score were positively correlated with the majority of factors of the IGDT. The negative factor of the RMET was positively correlated with the salience, tolerance, and relapse factors and total score of the IGDT. Daily internet use was positively correlated with all factors of the IGDT and its total score. Hierarchical regression analyses indicated that daily internet use and metacognitions (in different combinations) were significant independent predictors of IGDT factors and its total score, and that the negative factor of the RMET was a significant independent predictor of the salience and tolerance factors of IGDT and its total score. The implications of these findings are discussed.

Introduction: The main aim of this study is to improve our knowledge on binge drinking behavior in adolescents. In particular, we tested a model of predictors of binge drinking focusing on boredom proneness; we also examined the predictive and mediating role of drinking expectancies on binge drinking. Methods: A questionnaire designed to assess current drinking behavior, such as binge drinking, drinking expectancies and boredom proneness, was administered to 721 Italian adolescents (61% females) aged between 13 and 19 years (M = 15.98, SD = 1.61). Results: Structural equation modeling confirmed the evidence on drinking expectancies as predicted by boredom proneness and as predictive of adolescents' binge drinking. Interestingly, disinhibition and relief from pain seem to play a more important mediating role between boredom and alcohol outcome. Conversely, no mediation was found for interpersonal and social confidence expectancies on binge drinking. Conclusions: In general, the results suggest that preventative interventions on alcohol misuse should focus on personality traits and underlying drinking expectancies., Highlights • Binge drinking is a very common behavior in Italian adolescents. • Binge drinkers have high scores on boredom and expectancies to drink. • Boredom predicts binge drinking via the mediation of drinking expectancies. • Social confidence has no effect on binge drinking behaviors. • Interventions on boredom and positive alcohol expectancies may reduce drinking.

Telomere shortening occurs when cells divide, both in vitro and in vivo. On the other hand, telomerase is able to maintain telomere length in cells by adding TTAGGG repeats to the ends of telomeres. However, the interrelationships existing among telomere length, telomerase activity and growth in vertebrates remain to be clarified. In the present study we measured telomere length (terminal restriction fragment length), telomerase activity and body growth of Oryzias latipes from the embryo stage until senescence. During the rapid growth stage (age 0-7 months), telomeres shortened in parallel with decreasing telomerase activity. Then, during adolescence (age 7 months - 1 year), telomeres lengthened quickly as growth slowed and telomerase activity increased. In the adult stage (age 1-4 years) characterized by little growth, telomerase activity decreased gradually and telomeres shortened. Our data indicate that telomere attrition and restoration are linked to growth and telomerase activity, and suggest that critical loss of telomere homeostasis is associated with mortality in this animal.

In this large, nationally representative study, children exposed to adverse childhood events had increased rates of chronic pain (8.7%) as compared to their peers (4.8%)., Objective: To evaluate the association between adverse childhood experiences (ACEs) and chronic pain during childhood and adolescence. Methods: Cross-sectional analysis of the 2016-2017 National Survey of Children's Health, including 48,567 child participants of 6 to 17 years of age. Parents of children reported on 9 ACEs. Chronic pain was defined as parents reporting that their children had “frequent or chronic difficulty with repeated or chronic physical pain, including headache or other back or body pain during the past 12 months.” Multivariate logistic regression analysis adjusted for sociodemographic and health-related factors. Results: In this nationally representative sample, 49.8% of children were exposed to one or more ACEs during their lifetime. Children with exposure to 1 or more ACEs had higher rates of chronic pain (8.7%) as compared to those with no reported ACEs (4.8%). In multivariate analysis, children with ACEs had increased odds for chronic pain (adjusted odds ratio [aOR]: 1.6, 95% confidence interval [CI]: 1.3–2.2, for 0 vs 1 ACE and aOR: 2.7, 95% CI: 2.1–3.4 for 0 vs 4+ ACEs). The strongest associations of individually measured ACEs with chronic pain included financial instability (aOR: 1.9, 95% CI: 1.6–2.2), living with a mentally ill adult (aOR: 1.8, 95% CI: 1.5–2.2), and having experienced discrimination based on race (aOR: 1.7, 95% CI: 1.3–2.2). Conclusions: Children and adolescents with ACEs had increased risk for chronic pain, and this association increased in a dose-dependent fashion.

Background Social media is an integral part of human social life. More than 90% of young people use social media daily. Current theories, models, and measures are primarily based on face-to-face conceptions, leaving research out of sync with current social trends. This may lead to imprecise diagnoses and predictions. Objective To develop a theoretically based empirical model of current social interfaces to inform relevant measures. Methods A three-stage, qualitative, data-collection approach included anonymous individual Post-it notes, three full-class discussions, and 10 focus groups to explore 82 adolescents’ relational practices. Data analysis followed a meaning-condensation procedure and a field-correspondence technique. Results We developed an empirical model that categorizes adolescents’ social interactions into five experiential positions. Four positions result from trajectories relating to social media and face-to-face social interaction. Positions are described by match or mismatch dynamics between preferred and actual social platforms used. In matched positions, individuals prefer and use both face-to-face and social media platforms (position 1), prefer and use face-to-face platforms (position 2), or prefer and use social media platforms (position 3). In mismatched positions, individuals prefer face-to-face interactions but use social media platforms (position 4) or prefer social media but use face-to-face platforms (position 5). We propose that matched positions indicate good social functioning while mismatched positions indicate serious social challenges. Conclusions We propose a model that will expand previous unidimensional social interaction constructs, and we hypothesize that the described match and mismatch analyses provide conceptual clarity for research and practical application. We discuss prediction value, implications, and model validation procedures.

Background Cystic fibrosis (CF) continues to be the most common life-limiting chronic pulmonary disease in adolescents and young adults. Treatment of CF demands a high treatment time investment to slow the progression of lung function decline, the most important contributor to morbidity and mortality. Adherence is challenging in CF due to the high treatment burden and the lack of immediate health consequences in case of nonadherence. Lung function decline is particularly pronounced in the transition phase between 12 and 24 years of age. The improvement of self-management and self-responsibility and independence from parents and desire for normalcy are conflicting aspects for many adolescents with CF, which influence adherence to the time-consuming pulmonary therapy. Mobile health (mHealth) care apps could help to support self-management and independence and thereby reconcile seemingly conflicting goals to improve adherence, quality of life, and ultimately CF life expectancy. Objective This study aimed to (1) assess user behavior and satisfaction among adolescents and young adults with CF over an observation period of three months using an mHealth app; (2) identify areas of improvement for this mHealth app; and (3) compare overall and disease-specific satisfaction, lung function, and anthropometry before and after using the mHealth app. Methods A total of 27 adolescents and young adults with CF (age range 12-24 years, mean age 16 years, SD 3 years; 14 females, 11 males) used a free mHealth app for three months of whom 25 provided questionnaire data for analysis at the end of the study. Data collection was carried out using questionnaires on usage characteristics and life satisfaction, and standardized assessment of lung function and anthropometry. Results The use of the reminder function for medication declined from 70% (15/21) of the participants at week 4 to 65% (13/20) at week 8 of the observation period. At the end of the study, only 17% (4/23) of the participants wanted to continue using the app. Nevertheless, 56% (14/25) of participants saw the mobile app as a support for everyday life. Potential improvements targeting hedonistic qualities were identified to improve mHealth app adherence. Comparisons of satisfaction with different life aspects hinted at improvements or stabilization for the subitem respiration and the subitem lack of handicap by CF, suggesting that app use might stabilize certain CF-specific aspects of the weighted satisfaction with life. Lung function and anthropometry were not affected consistently. Conclusions Most of the patients did not want to continue using the app after the study period. Only a few CF-specific aspects of weighted life satisfaction were possibly stabilized by the mHealth app; clinical parameters were not affected. Adaptation of the functions to adolescent-specific needs could improve the long-term use and thus positively affect the disease course.

There are significant gender differences in both play behavior and occupational interests. Play has been regarded as an important medium for development of skills and personal characteristics. Play may also influence subsequent preferences through social and cognitive processes involved in gender development. The present study investigated the association between gender-typed play behavior in early childhood and gender-typed occupational interests in early adolescence. Participants were drawn from a British longitudinal population study, the Avon Longitudinal Study of Parents and Children. Participants were recruited based on their parent-reported gender-typed play behavior assessed at age 3.5 years. There were 66 masculine boys and 61 masculine girls, 82 feminine boys and 69 feminine girls, and 55 randomly selected control boys and 67 randomly selected control girls. At age 13 years, the participants were administered a questionnaire assessing their interest in gender-typed occupations. It was found that masculine children showed significantly more interest in male-typical occupations than did control or feminine children. Compared with control children, feminine children had marginally significantly lower interest in male-typical jobs. Masculine children also had significantly lower interest in female-typical jobs than did control or feminine children. The associations were not moderated by gender and were observed after taking into account sociodemographic background, parental occupations, and academic performance. The degree of gender-typed play shown by preschoolers can predict their occupational interests 10 years later following transition into adolescence. Childhood gender-typed play has occupational implications that transcend developmental stages.

Copyright © 2018 The Author(s). Published by Wolters Kluwer Health, Inc. Introduction: Although the pediatric pain literature has explored the role of developmental factors in young children’s acute pain, relatively less is known about specific developmental challenges in adolescents with chronic pain. Objectives: To meet this knowledge gap, this study sought to adopt an idiographic phenomenological approach to examine how adolescents make sense of their own development in the context of living with chronic pain. Methods: Semistructured interviews were conducted with ten adolescents (12–17 years; 7 females) recruited from a tertiary care pain treatment programme. Interview data were transcribed verbatim and analysed using Interpretative Phenomenological Analysis. Results: Study findings identified 2 themes: “An externally imposed lens on identity” and “Paradoxes of developmental progress.” The first theme highlighted an understanding of how adolescent identity is perceived. Some adolescents perceived identity as distinct from pain, whereas others perceived identity as part of their chronic pain condition. This theme also detailed how identity was negotiated by adolescents and others through engagement with valued activities. The second theme represented an understanding of how chronic pain disrupts and alters adolescent developmental trajectories at an individual level, suggesting possibilities of enhanced and delayed trajectories. Enhanced trajectories were associated with increased management of emotionally difficult situations and resulted in mastery of complex interpersonal skills. Conclusion: Findings provided a nuanced understanding of developmental progress in the context of adolescent chronic pain and suggested challenges with drawing normative comparisons. Future research could extend findings by adopting a longitudinal approach to studying adolescent development and eliciting accounts from broader social groups.

Previous research has shown that gambling is a popular activity among adolescents. Following a rapid expansion of legalized gambling opportunities and the emergence of new forms of gambling, many researchers have carried out studies on adolescent gambling and problem gambling. The present paper reviews studies that have been conducted worldwide since 2000, and then presents a more detailed picture of adolescent gambling research in Europe, by providing a country-by country analysis. After an extensive search on academic databases and following an exclusion process, 44 studies were identified. The findings showed that 0.2–12.3 % of youth meet criteria for problem gambling, notwithstanding differences among assessment instruments, cut-offs, and timeframes. However, despite this variability, several demographic characteristics were associated with adolescent gambling involvement and problem gambling. It is concluded that a small but significant minority of adolescents have gambling-related problems. Such findings will hopefully encourage more research into youth gambling to further understand the determinants of this phenomenon. info:eu-repo/semantics/publishedVersion

Imaging studies have implicated altered functional connectivity in adults with major depressive disorder (MDD). Whether similar dysfunction is present in adolescent patients is unclear. The degree of resting-state functional connectivity (rsFC) may reflect abnormalities within emotional (‘hot’) and cognitive control (‘cold’) neural systems. Here, we investigate rsFC of these systems in adolescent patients and changes following cognitive behavioral therapy (CBT). Functional Magnetic Resonance Imaging (fMRI) was acquired from adolescent patients before CBT, and 24-weeks later following completed therapy. Similar data were obtained from control participants. Cross-sectional Cohort: From 82 patients and 34 controls at baseline, rsFC of the amygdala, anterior cingulate cortex (ACC), and pre-frontal cortex (PFC) was calculated for comparison. Longitudinal Cohort: From 17 patients and 30 controls with longitudinal data, treatment effects were tested on rsFC. Patients demonstrated significantly greater rsFC to left amygdala, bilateral supragenual ACC, but not with PFC. Treatment effects were observed in right insula connected to left supragenual ACC, with baseline case-control differences reduced. rsFC changes were significantly correlated with changes in depression severity. Depressed adolescents exhibited heightened connectivity in regions of ‘hot’ emotional processing, known to be associated with depression, where treatment exposure exerted positive effects, without concomitant differences in areas of ‘cold’ cognition., Highlights • Adjunct study to a large randomized multicentre UK trial of conversational therapies • Robust pre-processing methods reduced head motion artefacts, improving upon those undertaken by the majority of studies. • Aberrant processing in ‘hot’ limbic regions without reductions in cognitive control in ‘cold’ prefrontal regions was found. • Elevated limbic functional connectivity in patients was lowered towards values seen in controls following CBT. This study demonstrates that unlike depressed adults, adolescents have aberrant brain connectivity in regions associated with emotional processing without concomitant differences in areas associated with cognitive control. Moreover, cognitive behavioral therapy restored such aberrant brain connectivity. The brain is thus malleable to conversational therapy, with the degree of change related to improvement in symptoms. This gives the hope that kindling effects – whereby episodes of illness increase vulnerability to further episodes – can be arrested by treatment before the occurrence of indelible changes in brain structure.

The aim of this study was to examine the influence of hormonal status, anthropometric profile, sexual maturity level, and physical performance on the technical abilities of 40 young male soccer players during small-sided games (SSGs). Anthropometric profiling, saliva sampling, sexual maturity assessment (Tanner scale), and physical performance tests (Yo-Yo and vertical jumps) were conducted two weeks prior to the SSGs. Salivary testosterone was determined by the enzyme-linked immunosorbent assay method. Technical performance was determined by the frequency of actions during SSGs. Principal component analyses identified four technical actions of importance: total number of passes, effectiveness, goal attempts, and total tackles. A multivariate canonical correlation analysis was then employed to verify the prediction of a multiple dependent variables set (composed of four technical actions) from an independent set of variables, composed of testosterone concentration, stage of pubic hair and genitalia development, vertical jumps and Yo-Yo performance. A moderate-to-large relationship between the technical performance set and the independent set was observed. The canonical correlation was 0.75 with a canonical R2 of 0.45. The highest structure coefficient in the technical performance set was observed for tackles (0.77), while testosterone presented the highest structure coefficient (0.75) for the variables of the independent set. The current data suggest that the selected independent set of variables might be useful in predicting SSG performance in young soccer players. Coaches should be aware that physical development plays a key role in technical performance to avoid decision-making mistakes during the selection of young players.

Background and Purpose 3,4-Methylenedioxypyrovalerone (MDPV) is a synthetic cathinone with powerful psychostimulant effects. It selectively inhibits the dopamine transporter (DAT) and is 10–50-fold more potent as a DAT blocker than cocaine, suggesting a high abuse liability. The main objective of the present study was to assess the consequences of an early (adolescence) MDPV exposure on the psychostimulant, rewarding and reinforcing effects induced by cocaine in adult mice. Experimental Approach Twenty-one days after MDPV pretreatment (1.5 mg·kg−1, s.c., twice daily for 7 days), adult mice were tested with cocaine, using locomotor activity, conditioned place preference and self-administration (SA) paradigms. In parallel, dopamine D2 receptor density and the expression of c-Fos and ΔFosB in the striatum were determined. Key Results MDPV treatment enhanced the psychostimulant and conditioning effects of cocaine. Acquisition of cocaine SA was unchanged in mice pretreated with MDPV, whereas the breaking point achieved under a progressive ratio programme and reinstatement after extinction were higher in this group of mice. MDPV decreased D2 receptor density but increased ΔFosB expression three-fold. As expected, acute cocaine increased c-Fos expression, but MDPV pretreatment negatively influenced its expression. ΔFosB accumulation declined during MDPV withdrawal, although it remained elevated in adult mice when tested for cocaine effects. Conclusion and Implications MDPV exposure during adolescence induced long-lasting adaptive changes related to enhanced responsiveness to cocaine in the adult mice that seems to lead to a higher vulnerability to cocaine abuse. This particular behaviour correlated with increased expression of ΔFosB.

The aim of this study was to conduct three-year monitoring of bone mineralization (BMC) and bone mineral density (BMD) of adolescent girls engaged in swimming at the time of attaining the peak bone mass and of their counterparts leading a rather sedentary life, considering the intakes of calcium, phosphorus and protein, as well as the proportions among those nutrients. Two groups of girls aged 11-13 years were studied 3 times at yearly intervals: untrained controls (n = 20) and those engaged in competitive swimming (n = 20). Bone density was determined by dual-energy X-ray absorptiometry (DXA) in the lumbar spine (L2 - L4). Nutrient intakes (energy, protein, calcium, phosphorus) were assessed from 24-h recalls. The group of swimmers had significantly lower BMI values than the control group. No systematic, significant between-group differences were found in nutrient intake or in bone mineralization variables. Calcium intake was below the recommended norm in all subjects but mean values of bone mineralization variables (BMC, BMD) steadily increased in both groups. The BMD z-scores proved negative throughout the three-year period of early adolescence in both groups of girls and that decrease was significant in swimmers. This could have been due to insufficient calcium intake as well as to inadequate calcium-to-phosphate and protein-to-calcium ratios and, when continued, might result in a decreased bone mass in adulthood.

Background Adolescent substance use rates in rural areas of the United States, such as upstate New York, have risen substantially in recent years, calling for new intervention approaches in response to this trend. The Mentor Foundation USA conducts the Living the Example (LTE) campaign to engage youth in prevention using an experiential approach. As part of LTE, youth create their own prevention messages following a training curriculum in techniques for effective messaging and then share them via social media. This paper reports on a pilot evaluation of the LTE program. Objective To conduct a pilot test of LTE in two rural high schools in upstate New York. We hypothesized that positive antidrug brand representations could be promoted using social media strategies to complement the Shattering the Myths (STM) in-person, event-based approach (hypothesis 1, H1), and that youth would respond positively and engage with prevention messages disseminated by their peers. We also hypothesized that exposure to the social media prevention messages would be associated with more positive substance use avoidance attitudes and beliefs, reductions in future use intentions, and decreased substance use at posttest (hypothesis 2, H2). Methods We adapted a previously published curriculum created by the authors that focuses on branding, messaging, and social media for prevention. The curriculum consisted of five, one-hour sessions. It was delivered to participating youth in five sequential weeks after school at the two high schools in late October and early November 2016. We designed a pre- and posttest pilot implementation study to evaluate the effects of LTE on student uptake of the intervention and short-term substance use and related outcomes. Working at two high schools in upstate New York, we conducted a pilot feasibility evaluation of LTE with 9th-grade students (ie, freshmen) at these high schools. We administered a 125-item questionnaire online to capture data on media use; attitudes toward social media; next 30-day personal drug use intentions; personal reasons to use drugs; reasons participants believe their peers would use drugs; self-reported exposure to the LTE program; and receptivity to the LTE program, among those reporting exposure. We constructed multivariable logistic regression models to analyze the relationship between program receptivity and outcomes. First, in a cross-sectional logistic regression model, we regressed self-reported LTE message receipt on drug use intent and actions related to LTE messaging. Then, for analysis of participants with matched pre- and posttest responses, we used multilevel generalized estimating equation (GEE) techniques to model changes in behavior from baseline to follow-up. Results Youth reported increased intentions to use marijuana (odds ratio [OR] 2.134, P=.02) between pre- and posttest. However, youth who reported exposure and receptivity to LTE reported a significant decrease in intentions (OR 0.239, P=.008). We observed a similar pattern for sedatives/sleeping pills—an increase in intentions overall (OR 1.886, P=.07), but a decrease among youth who reported exposure and receptivity to LTE (OR 0.210, P=.02). We saw the same pattern for use of any drug—an increase in reported intentions overall (OR 2.141, P=.02), but a decrease among youth who reported exposure and receptivity to LTE (OR 0.111, P=.004). Conclusions We observed some evidence of significant LTE program effects. Social media may be an effective strategy for peer-to-peer substance use prevention in the future. These findings point both to the potential of LTE and the social media diffusion model and to the need for more research on a larger scale with an expanded youth population in the future.

BackgroundThe incentive sensitization theory posits that in the transition from sporadic to problematic alcohol use, the incentive value of alcohol increases (wanting) while its hedonic effects (liking) do not change or decreases. The effect of the OPRM1 c.118A>G polymorphism, associated with liking and wanting, and the DRD4-VNTR polymorphism, related to wanting, on the relation between attentional bias and alcohol use was investigated.MethodsA total of 195 young adolescents (Study 1) and 86 young adult male heavy drinkers (Study 2) completed a visual probe test. Saliva samples were collected to test both polymorphisms.ResultsIn Study 1, attentional bias was positively associated with adolescent alcohol use only for OPRM1 G-allele carriers. In Study 2, attentional bias was positively associated with problem drinking for carriers of a DRD4 long allele.DiscussionIt is tentatively proposed that an attentional bias for alcohol is related most strongly to liking and wanting in early adolescents, while in young adults, an attentional bias may reflect wanting. In addition, individual differences associated with two both genetic markers should be taken into account when examining the relation between attentional bias and alcohol use.

We examined the associations between the parenting dimensions autonomy granting, over control, and rejection and children’s anxiety, in relation to parent and child gender and child age. Elementary school-aged children (n = 179, M age = 10.27, SD = 1.30), adolescents (n = 127, M age = 15.02, SD = 1.54) and both their parents completed questionnaires on parenting and children’s anxiety. Parenting was more strongly related to child anxiety in elementary school children than in adolescents. Maternal over control was uniquely related to elementary school-aged children’s anxiety whereas paternal over control was more important during adolescence. Opposite to our expectations, we found higher levels of parental autonomy granting to be related to higher levels of anxiety for younger elementary school-aged children (age < 10). For adolescents, the association between paternal over control and anxiety was stronger for older adolescents (age > 15), with higher levels of over control related to higher levels of anxiety. For both elementary school-aged children and adolescents, the associations between parenting and child anxiety did not differ as a function of the child’s gender. If we are to understand the associations between parenting and children’s anxiety, it is important to distinguish parental autonomy granting from parental over control and to consider the role of parent gender and the age of the child.

Abnormalities in value-based decision making during adolescence have often been attributed to non-linear, inverted-U shaped development of reward-related processes. This hypothesis is strengthened by functional imaging work revealing an inverted-U shaped relationship between age and reward-related activity in the striatum. However, behavioural studies have mostly reported linear rather than non-linear increases in reward-related performance. In the present study, we investigated the mechanisms underlying the development of reward- and punishment-related processing across four age groups using a reversal learning task previously shown to depend on striatal dopamine. We demonstrate both linear and non-linear age effects on distinct components of reversal learning. Specifically, results revealed a linear shift with age in terms of valence-dependent reversal learning, with children exhibiting better punishment than reward reversal learning, adults exhibiting better reward than punishment reversal learning and adolescents exhibiting an intermediate performance pattern. In addition, we also observed a non-linear, inverted-U shaped relationship between age and valence-independent reversal learning, which was due to aberrant ability of adolescents to update behaviour in response to negative performance feedback. These findings indicate that the (linear or nonlinear) nature of the relationship between age and reward learning depends on the type of reward learning under study.

Background: Cloud-based glucose monitoring programs allow users with diabetes to wirelessly synchronize their glucometers to their mobile phones. They also provide visualization and remote access of their data through its mobile app. There have been very few studies evaluating their effectiveness in managing diabetes among adolescents with type 1 diabetes (T1D). Objective: The purpose of this study was to assess the feasibility of using a mobile app to improve daily average blood glucose (BG) levels and increase BG monitoring frequency. Methods: We used an ABA single-subject prospective study design. We recruited five participants aged 13 to 17 years with uncontrolled T1D, glycated hemoglobin A1c 9.0%-10.7%, self-monitoring behavior of ≤5 checks/day, and on multiple daily insulin injections. The study consisted of 4-week intervals of three phases: (1) phase A: usual glucose monitoring log (fax); (2) phase B: mobile app; and (3) phase A': second phase A. A certified diabetes educator and endocrinologist reviewed logs and provided recommendations weekly. Data were analyzed using a quasi-Poisson model to adjust for overdispersion among individual participants, and a generalized estimating equation model for overall intervention effect in aggregate. Results: For mean daily BG (mg/dL) levels, participant 1 had decreased values on the mobile app (298 to 281, P=.03) and maintained in phase A'. Participant 4 had an increase in mean daily BG in phase A' (175 to 185, P=.01), whereas participant 5 had a decrease in mean daily BG in phase A' (314 to 211, P=.04). For daily monitoring (checks/day), participant 3 increased in phase B (4.6 to 8.3, P=.01) and maintained in phase A'. Participant 5 also had increased daily monitoring at each phase (2.1 to 2.4, P=.01; 2.4 to 3.4, P=.02). For the five participants combined, the overall mean BG and BG checks per day in phase A were mean 254.8 (SD 99.2) and mean 3.6 (SD 2.0), respectively, mean 223.1 (SD 95.7) and mean 4.5 (SD 3.0) in phase B, and mean 197.5 (SD 81.3) and mean 3.7 (SD 2.1) in phase A'. Compared to phase A, mean glucose levels declined during phase B and remained lower during phase A' (P=.002). There was no overall change in BG checks by phase (P=.25). However, mean BG levels negatively correlated with daily BG checks (r=–.47, P