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Florian D Zepf,1,2 Pradeep Rao,1,3 Kevin Runions,3,4 Richard M Stewart,1 Julia K Moore,1,5 Janice WY Wong,1,4 Maike Linden,1,2,6 Idil Sungurtekin,7 Franziska Glass,8 Linda Gut,8 Dirk Peetz,9,10 Gudrun Hintereder,11 Michael Schaab,12 Fritz Poustka,8 Lars Wöckel8,13 1Centre and Discipline of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, University of Western Australia, 2Specialised Child and Adolescent Mental Health Services (CAMHS), Department of Health in Western Australia, 3Community Child and Adolescent Mental Health Services, Department of Health in Western Australia, 4Telethon Kids Institute, University of Western Australia, 5Paediatric Consultation-Liaison Program, Child and Adolescent Mental Health Services, Department of Health in Western Australia, Perth, WA, Australia; 6Clinic for Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, RWTH Aachen University, Aachen, 7Department of Child and Adolescent Psychiatry and Psychotherapy, Central Institute of Mental Health, Mannheim, 8Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy, Goethe University, Frankfurt am Main, 9Institute of Laboratory Medicine, HELIOS Klinikum Berlin-Buch, Berlin, 10Department of Clinical Chemistry and Laboratory Medicine, University Center of the Johannes Gutenberg University Mainz, Mainz, 11Department of Laboratory Medicine, Goethe University, Frankfurt am Main, 12Institute of Laboratory Medicine, Clinical Chemistry and Molecular Diagnostics, University of Leipzig, Leipzig, Germany; 13Center of Child and Adolescent Psychiatry and Psychotherapy, Clienia Littenheid AG, Littenheid, Switzerland Background: Research has implicated that changes in zinc (Zn) metabolism may be associated with the biological underpinnings of eating disorders, in particular anorexia nervosa. However, to date research on the role of Zn in patients with bulimia nervosa (BN) is scarce.Objective: We aimed to explore serum Zn concentrations in young patients with BN, with a focus on the stage of the disorder, comparing acutely ill and recovered patients with BN with healthy controls.Methods: Serum Zn concentrations were obtained from healthy controls and from acutely ill and remitted young patients with BN. Mean duration of remission was 4.0±3.5 years.Results: Remitted patients showed elevated serum Zn concentrations when compared to controls (Cohen’s d=2.022), but concentrations were still in the normal range. Acutely ill patients also had higher serum Zn levels when compared to controls (all values still being within the reference range, Cohen’s d=0.882). There was no difference between acutely ill and remitted patients with BN in serum Zn concentrations. Of note, remitted patients had a significantly higher body weight when compared to the other two groups. Overall, there were no significant differences in dietary preferences with regard to Zn containing foods between the groups.Conclusion: The present study provides preliminary evidence that the underlying factors for changes in Zn serum concentrations in young patients with BN do not vary with regard to the stage of illness (acute versus remitted BN). Further prospective research is needed in order to disentangle the possible interplay between serum Zn status and bulimic eating behaviors. Keywords: bulimia nervosa, zinc, serum concentrations, remission, eating disorders

Living with a long-term medical condition is associated with heightened risk for mental health and psychosocial difficulties, but further research is required on this risk for children and adolescents with a rare disease in the educational setting. The aim of this study is to describe parents' perceptions of the psychosocial impact of rare diseases on their school-aged children in Western Australia. A cross-sectional survey of 41 parents of school-aged children and adolescents diagnosed with a rare disease completed an online questionnaire. Questions related to their perceptions of health-related stigma, bullying, social competencies and mental health difficulties faced by their child. Results showed that stigmatisation was experienced by 75.6% of participants, and almost half (46.4%) reported their child was bullied. In this sample, parents reported high sensory (vision and hearing) abilities, but low to moderate self-care competence in relation to social activities and peer relations. Almost half of the respondents (43.9%) reported mental health difficulties among their children. Children and adolescents with a rare disease have unique psychological and social issues. These findings highlight the need for greater efforts to meet the diverse psychosocial, physical and emotional needs of children diagnosed with a rare disease who attend mainstream schools in Western Australia.

Objective: The role of serotonin (5‐HT) in human aggression has been the subject of a large number of studies, mostly with adults. Meta‐analyses indicate a small but significant inverse relationship between central nervous 5‐HT availability and aggression, but genetically informed studies suggest two pathways: one to reactive aggression and the other to proactive aggression. Method: We conducted a systemic review on central nervous 5‐HT function in children and adolescents, with attention to the function of aggression. Results: In total, 675 articles were screened for relevance, with 45 reviewed. These included blood assays (e.g. plasma, 5‐HIAA; platelet 5‐HTR2A), epigenetic studies, retrospective PET studies and 5‐HT challenge paradigms (e.g. tryptophan depletion). Overall, findings were mixed, with support both for negative and for positive associations of central nervous 5‐HT function with aggression in children and adolescents. Conclusion: We propose factors that may be blurring the picture, including problems in the conceptualization and measurement of aggression in young people, the lack of prospective designs and the bias towards clinical samples of boys. Research needs to account for variance in the both motivation for and implementation of aggression, and look to the behavioural economics literature to consider the roles of reward, vengeance and self‐control more clearly. [ABSTRACT FROM AUTHOR]

The article discusses research which showed that people with attention-deficit/hyperactivity disorder (ADHD) struggle with emotional social information processing (SIP) including the encoding of affective information from prosodic aspects of verbal communication. Topics discussed include the struggle of patients with ADHD with anger-signaling information in voices and specific auditory processing deficit for adults with ADHD.

The article presents a study on reactive aggression in young patients with attention deficit and hyperactivity disorder (ADHD). Topics covered include reactive aggression being conceptualized as a response to some perceived provocation and is enacted in an impulsive manner and the results of a study showing a positive correlation between aggression during the point subtraction aggression game (PSAG) with dopamine activity in the striatum and midbrain.

Background: Individuals with borderline personality disorder (BPD) are at a substantial risk of harm to themselves and others, experience high levels of functional impairment and typically are high users of tertiary healthcare to address their mental health concerns. As indicators for BPD typically emerge in adolescence, a day therapy service in Bentley, Western Australia, Touchstone Child and Adolescent Mental Health Service (CAMHS), was developed as an intensive intervention for adolescents with indicators for BPD and its associated symptomology. Touchstone utilizes mentalization-based therapy (MBT) in a therapeutic community setting, where the current study sought to document the anecdotal outcomes using the data provided at Touchstone, to enable a greater understanding of this treatment approach for adolescents with indicators for BPD., Method: Forty-six participants attended the Touchstone programme between 2015 and 2020. The programme involved 6 months of MBT (group and individual), occupational therapy, education and creative therapies. Measures of self-injury, mood and emergency department presentations were collected pre- and post-programme., Results: Results indicate that participants show a reduction in non-suicidal acts and thoughts, as well as a reduction in negative moods and feelings from pre-Touchstone to post-Touchstone. There is also a decrease in participant presentation to tertiary emergency departments for mental health concerns., Conclusions: The current study shows evidence for the efficacy of Touchstone as an MBT therapeutic community intervention to reduce symptoms of emerging BPD and effectively reduce presentations to emergency departments for mental health presentations, alleviating pressure on tertiary hospitals and reducing economic impact of adolescents within this demographic., (© 2023 The Authors. Clinical Psychology & Psychotherapy published by John Wiley & Sons Ltd.)

Bidirectional associations between bullying and cyberbullying have consistently identified during adolescence. However, little is known about how this relationship works on the within-person level, after controlling for potential overlap at the between-person level. This study examined the bidirectional longitudinal associations between bullying and cyberbullying perpetration and victimization during 18-month period over four time points. A total of 2835 participants, aged 11 to 16 years in time 1 (50% girls; M age  = 13.13, SD = 1.06) were surveyed. Random intercept cross-lagged analyses revealed the stability of bullying perpetration and victimization. Cyberbullying victimization predicted inversely bullying and cyberbullying perpetration. The results indicate spirals of positive long-term associations between bullying (perpetration and victimization) and cyberbullying perpetration but no long-terms spirals of victimization., (© 2022. The Author(s).)

Rationale: School bullying is a public health concern affecting the physical and mental health of children and young people. While school-based interventions to prevent bullying have been developed internationally, the effectiveness of many interventions has been mixed and modest. Despite a growing recognition that the school built environment may impact bullying behaviour, few anti-bullying interventions have addressed the built environment., Objective: This systematic scoping review explored existing literature for evidence that the school built environment influences bullying behaviour in school students., Methods: The review was guided by Arksey and O'Malley's methodological framework for scoping reviews. A search of six databases (Medline, PsycINFO, ERIC, EMBASE, CINAHL Plus and The Cochrane Library) identified studies addressing primary, middle and secondary school students, bullying, school bullying locations, and school built environments. Peer-reviewed journal articles published in English prior to July 19, 2021, were included., Results: In total, 7568 documents were screened by title and abstract. Following a full-text review, 61 studies (63 articles) were selected; 43 studies identified school bullying locations, and 19 studies linked features of the school built environment to bullying behaviour. Classrooms, playgrounds, and corridors were identified as common bullying locations. Features of the school built environment linked to bullying behaviour included security cameras, architectural design, aesthetics, seating, and vandalism., Conclusions: This review identified key school settings for anti-bullying interventions and identified gaps in existing built environment and bullying literature. Further analyses of published studies will inform anti-bullying policy and practice., (Copyright © 2022 Elsevier Ltd. All rights reserved.)

Purpose: Children who are Deaf and Hard of Hearing (DHH), their parents, Teachers of the Deaf, and other community stakeholders were involved in co-designing a web-based resource to support students' social-emotional well-being. The resource was designed to provide families and teachers with strategies to enhance the social and emotional well-being of Grade 4-6 students who are DHH. This study reports outcomes of a pilot study of the web-based resource intervention., Method: A pre-post pilot study was conducted to quantitatively examine reported anxiety, well-being, social relationships, school experience, student-teacher relationship, and parent and teacher self-efficacy. A total of 37 students, their parents ( n = 37), and their classroom teachers ( n = 40) participated in the intervention program and were provided access to the resource., Results: In total, 19 students, 22 parents, and 17 teachers completed both pre- and postsurvey measures. Paired t tests revealed that there was a statistically significant increase in parents' self-efficacy scores from pre- to posttest. Multivariate analysis of covariance revealed a significant association between parent use of the website and student-reported improved peer support and reduced school loneliness. No other statistically significant differences were found., Conclusions: The use of a web-based resource codeveloped with students who are DHH, their parents, and teachers could potentially be beneficial for the well-being of students who are DHH as well as parents' self-efficacy. Further research is needed to confirm the benefits.

Purpose: To explore the perceptions of parents who had a child or adolescent (6-18 years) diagnosed with a rare disease who attended a mainstream school in Western Australia., Design and Methods: A cross-sectional online survey was conducted with 41 parents of children with a rare disease. Here we report the findings of 14 open-ended questions on their experience of illness-related factors and impact on school-related social activities, such as sports, school camps and leadership roles whilst their child with a rare disease attended a mainstream school in Australia. Responses were analysed using an inductive thematic content approach., Results: We identified three themes (resources, experiences and needs), seven categories (illness, support, knowledge, acceptance, isolation, activities of daily living and adjunctive therapy) and 24 codes from the parents' responses describing the experiences of their child at school. Parents want the government and educational systems to provide the necessary funding and resources to reflect an inclusive curricula and supportive environment that can meet the learning needs of children with a rare disease at a mainstream school., Conclusions: Further research, policy development and interventions are needed to explore how schools can meet the diverse psychosocial physical and emotional needs of children diagnosed with a rare disease who attend a mainstream school in Australia., Practice Implications: A child needs to be viewed from a holistic ecological viewpoint; future research with larger representative samples to explore rare disease experiences and a critical review of existing legislation, interventions and initiatives is required., Competing Interests: Declaration of Competing Interest No conflict of interest has been declared by the author(s)., (Copyright © 2021 Elsevier Inc. All rights reserved.)

Precursors and consequences of bullying have been widely explored, but much remains unclear about the association of moral and motivational factors. This study examined longitudinal associations between need for popularity, moral disengagement, and bullying perpetration. A total of 3017 participants, aged 11 to 16 years in wave 1 (49% girls; M age  = 13.15, SD = 1.09), were surveyed across four waves with six-month intervals. At the between-person level, cross-lagged modeling revealed a positive bidirectional association between moral disengagement and need for popularity; bullying perpetration was predicted by both need for popularity and moral disengagement. From the within-person level, random intercept cross-lagged analyses revealed that need for popularity predicted both moral disengagement and bullying perpetration. The results highlight the interplay between motivational and moral mechanisms that underlies bullying behavior., (© 2021. The Author(s).)

Bullying is a perplexing and persistent problem with negative consequences for all involved. Schools are assigned considerable responsibility for the management of bullying because of its prevalence amongst youth. Despite considerable efforts over decades to curtail bullying through the use of anti-bullying policies and other school-based interventions, the rates of young people who frequently bully has not decreased significantly. Motivational Interviewing (MI) is a relational and affirming conversational method that strengthens an individual's motivation and commitment to change, overcoming ambivalence toward the problem. The aim of the current study was to provide preliminary insight into the feasibility of incorporating MI into student service repertoires for addressing bullying. Ten staff participants from six secondary schools, who had roles in bullying intervention within their respective schools, were offered training in MI and invited to use and monitor this method in their practice as an intervention for students who perpetrate bullying. Results indicated a number factors which influenced the uptake of MI in schools. Facilitators enabling the use of MI included practitioner's professional background, administrative support, training and implementation of MI. Barriers to the use of MI included time pressure and administrative expectations, school roles and system limitations, and preconceptions and the stigma of bullying., (© 2018 Scandinavian Psychological Associations and John Wiley & Sons Ltd.)

Currently, there is little research investigating how schools can support the mental health and social development of young people with cystic fibrosis (CF), given their heightened risk of mental illness. Few studies have examined the relationship between bullying and mental health in populations of children with CF. This study describes the peer bullying experiences of young people with CF, and examines associations between school bullying and the psychological well-being of these young people. A sequential mixed-methods approach was used to collect data from 26 young people with CF (10-16 years of age). These data were compared with large samples of healthy children. Following an online survey, 11 young people, through online focus groups, expanded on the survey findings, describing their experiences within the school environment. Young people with CF reported lower involvement in bullying victimization and perpetration relative to the comparison population. For older adolescents with CF, victimization was associated with less connectedness to school and less peer support, and more school loneliness, anxiety, and depression. Young people with CF reported they generally liked the school environment, and were happy with their friendships, whereas some older adolescents reported that bullying evoked anxiety and mood problems. Reported bullying was primarily verbal and targeted characteristics of their CF, including their coughing, noninvolvement in certain activities because of shortness of breath, use of medication, and being underweight (for boys only). The findings provide some recommendations for interventions to promote mental health and school engagement among young people with CF. (PsycINFO Database Record, ((c) 2018 APA, all rights reserved).)

Background: Although developed for adults, the Depression Anxiety Stress Scales-Short Version (DASS-21) has been used in many research studies with adolescent samples. Evidence as to the applicability of the DASS subscale scores to represent the distinct states of depression, anxiety, and stress as experienced by adolescents is mixed, and the age at which it may be possible to differentiate these 3 states using the DASS-21 has not yet been determined., Objective: This study evaluated evidence for a multifactor structure in the DASS-21 in adolescents and the specificity of the 3 subscales for adolescents in general and at different ages., Method: Data were from a large cross-sectional survey of 2,873 school students in Grades 6-12 (aged 12-18 years) in Australia. We conducted confirmatory bifactor analyses testing a general mental health distress factor and 3 domain-specific factors for anxiety, depression, and stress for the whole sample and across gender by age groups. The internal consistency reliability of the DASS total and subscale scores was determined using omega coefficients., Results: Analyses identified that most of the variation in the items was explained by the dominance of a single, general factor and the subscales lacked specificity across all age groups., Conclusion: The DASS-21 can be reliably used to measure general distress in adolescents, but the subscales fail to discriminate between the 3 states. Our results indicate that this lack of discrimination does not reduce with increasing age. These findings caution against the use of adult theoretical models and measures within adolescent populations., (© 2016 Wiley Periodicals, Inc.)

Background: Despite growing consensus on nosology and epidemiology of bipolar disorder (BD) in minors, differences remain. We contribute to this discussion by measuring long-term trends in the inpatient discharge rates of BD in minors., Methods: Nationwide German inpatient discharge diagnoses of BD and other related psychiatric disorders were mapped between 2008 and 2013 using registry data from the German Federal Health Monitoring System. This was compared with previously published data, 2000-2007, to assess long-term trends in diagnosis of BD at discharge. Long-term trends (2000-2013) were also computed., Results: Discharge diagnosis of BD increased by 18% (2.02-2.46 per 100,000) in minors. There was a significant increase of 24.1% in adolescents 15-19 years old (6.56-8.14 per 100,000). BD, at discharge, as a proportion of all psychiatric disorders, increased from 0.26% in 2008 to 0.27% in 2013. When analysing long-term trends (2000-2013), the rates for BD increased significantly as did trends for all mental disorders, except for psychotic disorders, which fell by almost 14%. Between 2000 and 2013, the rate for depression in minors increased by 730%., Limitations: The dataset consisted of cross-sectional administrative data points with diagnoses based on clinical criteria., Conclusions: The rate of BD as a discharge diagnosis in German minors has increased significantly, consistently exceeding the general trend for a rise in rates for mental disorders. Overall, the rate of discharge diagnosis of BD from inpatient units in Germany remains a small proportion of all psychiatric diagnoses.

Background: Adolescence is a time of great change. For most young people, this is a healthy and happy experience; however, for some it is characterized by many health, social, and academic challenges. A student's feeling of connectedness to school helps meet these challenges. Little is known, however, about the school characteristics that promote this connection and, more importantly, how this connection occurs. This article reviews the connectedness literature and integrates health promotion, adolescent development, and ecological frameworks to describe how a school context fosters this connection., Method: A systematic search and review process was used to retrieve scholarly articles pertaining to the research topic., Results: Each retrieved article was summarized, and a subsequent model was developed to define a school ecology and describe how this ecology influences a student's need to feel connected to school and the positive influence this connection has on adolescent health and well-being., Conclusions: Integrating developmental, ecological, and health promotion intervention theories and frameworks assists in the identification of interpersonal and organizational aspects of a school environment, which satisfy an individual's needs to feel autonomous, competent, and connected, and to improve health and well-being outcomes for adolescents.