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This study identified typologies of specific non-suicidal self-injury (NSSI) functions among youth admitted for psychiatric hospitalization and investigated clinically relevant correlates. Inpatient youth (n = 68) aged 10-17 years reported on their reasons to engage in NSSI, frequency and severity of NSSI, and symptoms of borderline personality disorder (BPD). A latent class analysis using youth's specific NSSI functions as indicators found two NSSI function typologies, which were differentially associated with clinical correlates. The Multiple Functions class (n = 28) endorsed to "feel something," "punish self," "escape feelings," "relieve anxiety," "stop feeling self-hatred," "stop feeling angry," "show much they are hurting," and "create a hurt that can be soothed." Conversely, the Single/Avoidant Function class (n = 40) endorsed one primary function-i.e., to "escape feelings." Youth in the Multiple Functions class reported significantly more frequent self-injury and greater BPD symptomology. The present study illustrates the importance of examining constellations of specific NSSI functions in inpatient care settings, given their unique associations with NSSI frequency and features of BPD. These findings could inform targeted psychological screening and, in turn, guide the implementation of interventions for elevated NSSI frequency and BPD symptomology among inpatient youth, based on NSSI functions endorsed.

This study examined mothers’ and fathers’ ( N = 102) beliefs about emotion and emotion expression in boys and girls aged 8 to 12 years using a mixed-methods design. Parents attended two focus group sessions 2 weeks apart. A thematic analysis of the group transcripts resulted in six themes: value in the experience and expression of emotion, vulnerability in the experience and expression of emotion, multiple influences on children’s learning about emotion, distinct expectations for emotion displays at home versus in public, gender roles influence emotion expectations, and generational shift in emotion-related expectations. Identified themes were consistent with previous research, yet new themes emerged relevant to gender and gender roles within society. Implications of gender-related roles and expectancies are discussed.

We examined practitioners’ use of the transdiagnostic Modular Approach to Therapy for Children (MATCH) 7 years after learning MATCH for a clinical trial. The practitioners (N = 29; Mage = 52.10, SD = 12.29, 86% women, 97% white) reported using MATCH with 55% of their caseload; use of the various MATCH modules ranged from 39 to 70%. Use was positively associated with amount of MATCH experience in the trial, perceived effectiveness, and ease of implementation. Patterns of specific module use did not consistently match strength of prior evidence (e.g., exposure was least used of the anxiety modules), suggesting challenges for implementation science.

The overarching aim of this study was to develop and validate a new scale (i.e., the Praise, Indulgence, and Status Parenting Scale [PISPS]) to measure modern parenting practices and behaviors consistent with instilling ideals of specialness (i.e., the notion that one is special), self-esteem, and status in children. In 2 studies on emerging adults (Study 1: N = 582, M(age) = 19.46; Study 2: N = 464, M(age) = 19.58), the PISPS was developed and validated using classical test theory (Study 1) and further refined using item–response theory (Study 2). Results from both studies indicated a 3-factor structure with factors differentially linked with correlates of interest including parenting strategies, self-esteem, narcissism, entitlement, and internalizing symptoms. Study 3 further validated the PISPS in a sample of parents (N = 638, M(age) = 35.79) reporting on their parenting and their child’s emotion regulation and symptoms of psychopathology. Overall, findings support the PISPS, its psychometric properties, and its unique contribution to child symptoms.

The current study tested a preliminary cascade model of parent dysfunction-i.e., internalizing psychopathology and emotion dysregulation-whereby parent dysfunction is transmitted to children through the impact of parental emotion socialization on child emotion regulation. Participants were 705 mothers (M age = 36.17, SD = 7.55) and fathers (M age = 35.43, SD = 6.49) of children aged 8 to 12 years who self-reported on their internalizing psychopathology, emotion regulation difficulties, and emotion socialization practices, and on their child's internalizing psychopathology and emotion regulation. Using a split sample method, we employed a data-driven approach to develop a conceptual model from our initially proposed theoretical model with the first subsample (n = 352, 51% mothers), and then validated this model in a second subsample (n = 353, 49% mothers). Results supported a model in which the transmission of dysfunction from parent to child was sequentially mediated by unsupportive parental emotion socialization-but not supportive parental emotion socialization-and child emotion dysregulation. The indirect effects from the final model did not differ by parent gender. Findings provide preliminary support for a mechanism by which maternal and paternal internalizing psychopathology and emotion dysregulation disrupt parental emotion socialization by increasing unsupportive emotion socialization practices, which impacts children's development of emotion regulation skills and risk for internalizing psychopathology.

In many societies, the iconic image of the family is that of a White, American middle-class, first-marriage nuclear family with two heterosexual parents and biological children. Research, however, ...

This study examined profiles of specific emotion deficits, including poor emotion awareness, reluctance to express emotion, sadness inhibition and dysregulation, and anger inhibition and dysregulation. Self-report questionnaires assessed adolescents' emotion skills and nonsuicidal self-injury (NSSI) engagement, frequency, severity, methods, and age of onset. Latent profile analysis yielded a three-profile solution: Low Deficit (LD; n = 49), Unaware/Anger Dysregulated (UAD; n = 24), and Anger Inhibited (AI; n = 20) profiles. Adolescents in the UAD profile were more likely to engage in NSSI, displayed a higher NSSI frequency, and reported a higher number of NSSI methods when compared to adolescents in the LD profile. No links emerged for NSSI severity or age of onset.

This study examined three potential moderators of the relations between maternal parenting stress and preschoolers' adjustment problems: a genetic polymorphism-the short allele of the serotonin transporter (5-HTTLPR, ss/sl allele) gene, a physiological indicator-children's baseline respiratory sinus arrhythmia (RSA), and a behavioral indicator-mothers' reports of children's negative emotionality. A total of 108 mothers (Mage = 30.68 years, SDage = 6.06) reported on their parenting stress as well as their preschoolers' (Mage = 3.50 years, SDage = 0.51, 61% boys) negative emotionality and internalizing, externalizing, and sleep problems. Results indicated that the genetic sensitivity variable functioned according to a differential susceptibility model; however, the results involving physiological and behavioral sensitivity factors were most consistent with a diathesis-stress framework. Implications for prevention and intervention efforts to counter the effects of parenting stress are discussed.

Pica is the persistent consumption of non-nutritive, nonfood substances and is associated with adverse health complications. However, there is limited research on interventions for pica in youth. The objective of this study is to systematically review the empirical evidence for the effectiveness of behavioural interventions for pica in children and adolescents and to generate treatment recommendations. A systematic search yielded 823 articles extracted from five databases: CINALH, Family and Society Studies Worldwide, Medline, PsycINFO, and Web of Science. Two reviewers completed initial sorting based on article titles and abstracts. Five reviewers completed sorting based on full article review. Thirty articles were included and double coded for demographic information, co-morbid conditions, and intervention characteristics. These studies were case studies involving behavioural treatments for pica. Seventeen behavioural interventions were categorized into four treatment approaches: reinforcement-based, response interruption, "other" interventions, and punishment-based procedures. Interventions that resulted in near-zero rates of pica were deemed effective. Findings showed support for contingent reinforcement, discrimination training as part of a combination treatment, physical restraint, time out, and contingent aversive stimulus. No evidence supported the effectiveness of response interruption procedures, including response blocking and visual facial screen. Other coded procedures did not appear effective. We recommend that the least restrictive procedures are implemented first, including a combination treatment with contingent reinforcement and discrimination training. As needed, more restrictive procedures can be added to the treatment package. This review will facilitate future empirical work and assist clinicians with treatment options for pica in youth. High-quality trials are needed.

OBJECTIVES: The aim of the current research was to develop and validate a parent, self-report questionnaire to measure parents’ gendered beliefs about emotion. METHODS: Scale items were first developed based on a previous qualitative study examining emotions, parenting, and gender in a sample of parents. The Parents’ Gendered Emotion Beliefs scale (PGEB) was validated in a sample of 704 parents of middle childhood youth. RESULTS: Item-response theory analyses indicated a three-factor solution with factors measuring beliefs consistent with: gendered emotion expression, gender-neutral emotion expression, and gendered emotion socialization. All factors showed good internal consistency with alphas ranging from 0.79 to 0.90. Analyses then examined convergent validity by correlating PGEB factors to established measures of broad emotion beliefs, emotion socialization, family expressiveness, and child emotion regulation and psychopathology. CONCLUSIONS: Overall, findings support the PGEB, its factor structure and psychometric properties, and its potential to contribute to our understanding of the role of gender in emotion socialization and children’s emotional development.

The Trier Social Stress Test (TSST) is known to reliably induce physiological stress responses in adult samples. Less is known about its effectiveness to elicit these responses in youth samples. We performed a meta-analysis of stress responses to the TSST in youth participants. Fifty-seven studies were included representing 5026 youth participants. Results indicated that the TSST was effective at eliciting stress responses for salivary cortisol (sCort; effect size [ES] = 0.47, p = 0.006), heart rate (HR; ES = 0.89, p 0.001), pre-ejection period (PEP; ES = -0.37, p 0.001), heart rate variability (HRV; ES = -0.33, p = 0.028), and systolic blood pressure (ES = 1.17, p 0.001), as well as negative affect (ES = 0.57, p = 0.004) and subjective anxiety (ES = 0.80, p = 0.004) in youth samples. Cardiac output (ES = 0.15, p = 0.164), respiratory sinus arrhythmia (ES = -0.10, p = 0.064), and diastolic blood pressure (ES = 2.36, p = 0.072) did not reach statistical significance. Overall, effect sizes for the TSST varied based on the physiological marker used. In addition, several physiological markers demonstrated variance in reactivity by youth age (sCort, HR, HRV, and PEP), gender (sCort), type of sample (i.e., clinical versus community sample; sCort and HR), duration of TSST (sCort, HR, HRV, negative affect, and subjective anxiety), number of judges present in TSST (HR and subjective anxiety), gender of judges (sCort), and time of day the marker was assessed (morning versus afternoon/evening; sCort). Overall, the findings provide support for the validity of the TSST as a psychosocial stressor for inducing physiological and psychological stress responses in children and adolescents, but also highlight that some markers may capture the stress response more effectively than others.

Exposure tasks are a key ingredient in the treatment of anxiety symptoms and disorders in youth. Because exposure tasks involve the purposeful induction of a stress response, ethical considerations are warranted. In the current article, specific ethical considerations in the implementation of exposure tasks with youth populations are discussed, including those that are relevant prior to the use of exposures (i.e., clinician judgment and competence and informed consent) and those that are relevant as exposures are being implemented (i.e., avoiding harm, deception, debriefing, and limits of confidentiality). Suggestions and recommendations for keeping with standards and guidelines of the American Psychological Association Ethical Principles of Psychologists and Code of Conduct are offered.

This study identified profiles of parental responses to children's positive and negative emotion expression using latent profile analysis and examined socio-cultural, family, parent, and child correlates of these profiles. Parents (N = 870) of children aged 8–12 completed self-report measures of their responses to children's positive and negative emotion expression, ethnicity, income, family expressivity, parent and child emotion regulation and psychopathology. Four profiles of parental emotion socialization emerged: the teach and problem-focused parent, supportive parent, balanced parent, and hyper-engaged parent. These profiles significantly differed by income, ethnicity, family expressivity, parent and child emotion dysregulation and psychopathology symtoms. Parents in the supportive and teach and problem-focused profiles reported enhanced child emotion regulation and fewer child psychopathology symptoms compared to the balanced and hyper-engaged parents. Findings highlight the importance of considering constellations of parent responses to children's broad range of emotions, and socio-cultural, family, parent, and child correlates of these patterns.

OBJECTIVE. An emerging trend in youth psychotherapy is measurement-based care (MBC): treatment guided by frequent measurement of client response, with ongoing feedback to the treating clinician. MBC is especially needed for treatment that addresses internalizing and externalizing problems, which are common among treatment-seeking youths. A very brief measure is needed, for frequent administration, generating both youth- and caregiver-reports, meeting psychometric standards, and available at no cost. We developed such a measure to monitor youth response during psychotherapy for internalizing and externalizing problems. METHOD. Across 4 studies, we used ethnically diverse, clinically relevant samples of caregivers and youths aged 7–15 to develop and test the Behavior and Feelings Survey (BFS). In Study 1, candidate items identified by outpatient youths and their caregivers were examined via an MTurk survey, with item response theory methods used to eliminate misfitting items. Studies 2–4 used separate clinical samples of youths and their caregivers to finalize the 12-item BFS (6 internalizing and 6 externalizing items), examine its psychometric properties, and assess its performance in monitoring progress during psychotherapy. RESULTS. The BFS showed robust factor structure, internal consistency, test-retest reliability, convergent and discriminant validity in relation to three well-established symptom measures, and slopes of change indicating efficacy in monitoring treatment progress during therapy. CONCLUSIONS. The BFS is a brief, free, youth- and caregiver-report measure of internalizing and externalizing problems, with psychometric evidence supporting its use for MBC in clinical and research contexts.

The Trier Social Stress Test (TSST) has become one of the most widely-used protocols for inducing moderate psychosocial stress in laboratory settings. Observational coding has been used to measure a range of behavioral responses to the TSST including performance, reactions to the task, and markers of stress induced by the task, with clear advantages given increased objectivity of observational measurement over self-report measures. The current review systematically examined all TSST and TSST-related studies with children and adolescents published since the original work of Kirschbaum et al. (1993) to identify behavioral observation coding approaches for the TSST. The search resulted in 29 published articles, dissertations, and master's theses with a wide range of coding approaches used. The take-home finding from the current review is that there is no standard way to code the Trier Social Stress Test for Children (TSST-C), which appears to stem from the uniqueness of investigators' research questions and sample demographics. This lack of standardization prohibits conclusive comparisons between studies and samples. We discuss relevant implications and offer suggestions for future research.

One avenue for improving access to quality mental health care for children, adolescents, and their families is to provide services in the communities where they live. There has been growing support for the implementation of evidence-based practice in community mental health settings to address the complex needs of diverse young clients. Evidence-based practice encompasses psychometrically sound assessments and empirically supported treatments with appreciation of the culture of communities in which they are provided. This chapter reviews the background of the community mental health movement, describes community mental health settings and the current status of youth evidence-based practices in community care contexts, and explores barriers to and prospects for bringing tested practices for youths into community-based care.

OBJECTIVE We assessed sustainability of an empirically supported, transdiagnostic youth psychotherapy program when therapist supervision was shifted from external experts to internal clinic staff. METHOD One hundred sixty-eight youths, aged 6-15 years, 59.5% male, 85.1% Caucasian, were treated for anxiety, depression, traumatic stress, or conduct problems by clinicians employed in community mental health clinics. In Phase 1 (2.7 years), 1 group of clinicians, the Sustain group, received training in Child STEPs (a modular transdiagnostic treatment + weekly feedback on youth response) and treated clinic-referred youths, guided by weekly supervision from external STEPs experts. In Phase 2 (2.9 years), Sustain clinicians treated additional youths but with supervision by clinic staff who had been trained to supervise STEPs. Also in Phase 2, a new group, External Supervision clinicians, received training and supervision from external STEPs experts and treated referred youths. Phase 2 youths were randomized to Sustain or External Supervision clinicians. Groups were compared on 3 therapist fidelity measures and 14 clinical outcome measures. RESULTS Sustain clinicians maintained their previous levels of fidelity and youth outcomes after switching from external to internal supervision; and in Phase 2, the Sustain and External Supervision groups also did not differ on fidelity or youth outcomes. Whereas all 34 group comparisons were nonsignificant, trends with the largest effect sizes showed better clinical outcomes for internal than external supervision. CONCLUSIONS Implementation of empirically supported transdiagnostic treatment may be sustained when supervision is transferred from external experts to trained clinic staff, potentially enhancing cost-effectiveness and staying power in clinical practice. (PsycINFO Database Record

Efforts to identify empirically supported treatments (ESTs) for youth's mental health problems are valuable, but the descriptor empirically supported does not guarantee that a treatment will work well in everyday clinical use. The voltage drop often seen when ESTs move from efficacy studies to clinical practice contexts may reflect limited exposure to real-world conditions during development and testing. One result may be interventions that are focused more narrowly and are more linear than the clinical practice they are designed to enhance. In this article, we suggest three strategies for building and refining ESTs that are robust for real-world application: (a) designing interventions to fit the contexts of youth treatment, (b) structuring interventions that can be tailored to fit individual youth characteristics, and (c) building programs for nontraditional intervention contexts. In addition, we describe how to develop interventions that are ready for practical implementation: the deployment-focused model.

Most youth psychotherapy research involves conditions quite unlike the clinical practice it is designed to strengthen. Most studies have not tested interventions with clinically referred youths and practicing clinicians in clinical care settings, nor have they tested whether new treatments produce better outcomes than usual practice. Limited exposure to real-world conditions and questions may partially explain why empirically supported treatments show such modest effects when tested under more representative conditions, against usual care. Our deployment-focused model calls for intervention development and testing with the kinds of participants (e.g., clients and clinicians) and in the contexts (e.g., clinics) for which the interventions are ultimately intended, and for randomized comparisons to usual clinical care. Research with the Child STEPs (system and treatment enhancement projects) treatment approach illustrates the methods and potential benefits of the deployment-focused model. Findings supporting Child STEPs are but one part of a rich research matrix needed to shrink the gap between intervention research and clinical practice.

Difficulties with emotion regulation are a core feature of anxiety disorders (ADs) in children and adults. Interventions with a specific focus on emotion regulation are gaining empirical support. Yet, no studies to date have compared the relative efficacy of such interventions to existing evidence-based treatments. Such comparisons are necessary to determine whether emotion-focused treatments might be more effective for youth exhibiting broad emotion-regulation difficulties at pretreatment. This study examined an emotion-focused cognitive-behavioral therapy (ECBT) protocol in comparison to traditional cognitive-behavioral therapy (CBT) in a sample of children with a primary anxiety disorder diagnosis. Moderation analyses examined whether children with higher levels of emotion dysregulation at pretreatment would show greater levels of improvement in ECBT than CBT. Ninety-two youth ages 7 to 12 years (58% male) with a primary diagnosis of separation anxiety disorder, generalized anxiety disorder, or social phobia were included. Participants were randomly assigned to ECBT or CBT. Results showed that youth in both conditions demonstrated similar improvements in emotion regulation and that pretreatment levels of emotion dysregulation did not moderate treatment outcomes. Additional analyses showed that ECBT and CBT were similarly effective on diagnostic, severity, and improvement measures. Future work is needed to further explore the ways that emotion regulation is related to treatment outcome for anxious youth.

Children's emotion dysregulation and depressive symptoms are known to be affected by a range of individual (parent, child) and systemic (parent-child, marital, and family) characteristics. The current study builds on this literature by examining the unique role of coparental affect in children's emotion dysregulation, and whether this association mediates the link between parent and child depressive symptoms. Participants were 51 mother-father-child triads with children aged 7 to 12 (M age = 9.24 years). Triads discussed a time when the child felt sad and a time when the child felt happy. Maternal and paternal displays of positive affect were coded, and sequential analyses examined the extent to which parents were congruent in their displays of positive affect during the emotion discussions. RESULTS indicated that interparental positive affect congruity (IPAC) during the sadness discussion, but not the happiness discussion, uniquely predicted parent-reported child emotion dysregulation, above and beyond the contributions of child negative affect and parental punitive reactions. The degree of IPAC during the sadness discussion and child emotion dysregulation mediated the association between maternal, but not paternal, depressive symptoms and child depressive symptoms. FINDINGS highlight the unique role of coparental affect in the socialization of sadness in youth and offer initial support for low levels of IPAC as a risk factor for the transmission of depressive symptoms in youth. Language: en