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Internalizing disorders in adolescence have been associated with disturbances in autonomic and endocrine functioning. Because the prefrontal cortex and the limbic system play a central role in regulating both the autonomic and the endocrine systems, their joint functioning is hypothesized to provide information about the potential development of internalizing symptoms throughout adolescence, notably in the preclinical stage. This hypothesis was tested in a sample of 198 adolescents from the general population. Heart rate variability (HRV) and skin conductance levels (SCLs) were measured before, during, and after a public speaking task. These autonomic parameters were associated with cortisol response to the task in the complete sample as well as in low- and high-anxiety adolescents separately. Self-reported social anxiety, low HRV, and high SCL recovery values were predictive of cortisol response. Importantly, in low-anxiety adolescents, only HRV during the task predicted the cortisol response, whereas, in their highly anxious peers, both HRV and SCL were strongly associated with this response. In the latter finding, age was a prominent factor. Additional analyses supported the idea that the interaction of autonomic and endocrine reactivity is subject to natural development. These findings provide evidence that adolescence might be a period of highly interactive emotional–neurobiological development, particularly with respect to the development of stress management skills.

Background and Objectives: Now more than ever, there is an obvious need to reduce the overall burden of disease and risk of premature mortality that are associated with mental health and substance use disorders among young people. However, the current state of research and evidence-based clinical care for high-risk substance use among youth is fragmented and scarce. The objective of the study is to establish consensus for the prevention, treatment, and management of high-risk substance use and overdose among youth (10 to 24 years old). Materials and Methods: A modified Delphi technique was used based on the combination of scientific evidence and clinical experience of a group of 31 experts representing 10 countries. A semi-structured questionnaire with five domains (clinical risks, target populations, intervention goals, intervention strategies, and settings/expertise) was shared with the panelists. Based on their responses, statements were developed, which were subsequently revised and finalized through three iterations of feedback. Results: Among the five major domains, 60 statements reached consensus. Importantly, experts agreed that screening in primary care and other clinical settings is recommended for all youth, and that the objectives of treating youth with high-risk substance use are to reduce harm and mortality while promoting resilience and healthy development. For all substance use disorders, evidence-based interventions should be available and should be used according to the needs and preferences of the patient. Involuntary admission was the only topic that did not reach consensus, mainly due to its ethical implications and resulting lack of comparable evidence. Conclusions: High-risk substance use and overdoses among youth have become a major challenge. The system’s response has been insufficient and needs substantial change. Internationally devised consensus statements provide a first step in system improvement and reform.

Targeted school-based programs seem to be a promising approach to help adolescents in need. Nevertheless, successful implementation and evaluation of such programs is challenging. However, there is limited knowledge about (overcoming) the challenges of implementation and experimental evaluation of school-based programs. The goal of the present paper is, therefore, to improve future research by describing the challenges encountered and lessons learned during two randomized controlled trials (RCTs) to study the effectiveness of two skills-training programs reducing school or social stress. In this way, we aim to inform others who plan to implement and evaluate such programs in schools using an RCT design. Some of the challenges encountered apply to all effectiveness studies, such as the recruitment and retention of participants; others are more "intervention at school" specific, such as scheduling the programs and assessments. Our experiences show that it is possible to effectively implement and evaluate targeted programs promoting adolescent mental health in secondary schools with RCTs, even during a worldwide health pandemic, but that it requires investing sufficient time in keeping close and regular contact as well as clear communication between the involved parties. Moreover, high levels of flexibility are needed in adjusting scheduled meetings for intervention and research while keeping track of the entire process for each school and individual participant. [ABSTRACT FROM AUTHOR]

Background: Given that high levels of stress during adolescence are associated with negative consequences, it is important that adolescents with psychological needs are supported at an early stage, for instance with interventions at school. However, knowledge about the potential of school-based programs targeting adolescents with psychological needs, aimed at reducing school or social stress, is lacking. Objective: The current study aimed to investigate the effectiveness of two targeted school-based skills-training programs, addressing either skills to deal with performance anxiety or social skills. Methods: Two randomized controlled trials were performed with participants who self-selected to one of the programs. The sample comprised of N = 361 adolescents (Mage = 13.99 years, SD = 0.83) from various educational levels and ethnic identity backgrounds. The performance anxiety program included N = 196 participants (N = 95 in the experimental group), while the social skills program included N = 165 participants (N = 86 in the experimental group). MANCOVA's were performed. Results: The performance anxiety program had a small effect on reducing adolescents' test anxiety. Furthermore, for adolescents who attended more than half of the sessions, the program had small effects on reducing test anxiety and fear of failure. The program did not improve adolescents' coping skills or mental health. The social skills program was not effective in improving social skills, social anxiety, and mental health. Conclusions: A relatively short, targeted program addressing skills to deal with performance anxiety can have the potential to reduce adolescents' performance anxiety. Trial registration: International Clinical Trials Registry Platform (Netherlands Trial Register, number NTR7680). Registered 12 December 2018. Study protocol van Loon et al., (2019). [ABSTRACT FROM AUTHOR]

Internalizing disorders in adolescence have been associated with disturbances in autonomic and endocrine functioning. Because the prefrontal cortex and the limbic system play a central role in regulating both the autonomic and the endocrine systems, their joint functioning is hypothesized to provide information about the potential development of internalizing symptoms throughout adolescence, notably in the preclinical stage. This hypothesis was tested in a sample of 198 adolescents from the general population. Heart rate variability (HRV) and skin conductance levels (SCLs) were measured before, during, and after a public speaking task. These autonomic parameters were associated with cortisol response to the task in the complete sample as well as in low- and high-anxiety adolescents separately. Self-reported social anxiety, low HRV, and high SCL recovery values were predictive of cortisol response. Importantly, in low-anxiety adolescents, only HRV during the task predicted the cortisol response, whereas, in their highly anxious peers, both HRV and SCL were strongly associated with this response. In the latter finding, age was a prominent factor. Additional analyses supported the idea that the interaction of autonomic and endocrine reactivity is subject to natural development. These findings provide evidence that adolescence might be a period of highly interactive emotional–neurobiological development, particularly with respect to the development of stress management skills. [ABSTRACT FROM AUTHOR]

Chronic stress is associated with dysregulations in the physiological stress system, resulting in diverse negative developmental outcomes. Since adolescence is a period characterized by increased stress‐sensitivity, and schools are an important environment for the developing adolescent, school‐based interventions promoting psychosocial functioning are of particular interest to prevent adverse outcomes. The present study therefore aimed to investigate the effectiveness of such interventions on hypothalamic pituitary adrenal‐axis (i.e., cortisol) and cardiovascular (i.e., blood pressure [BP] and heart rate [HR]/heart rate variability [HRV]) parameters of stress in adolescents, and examined moderators of effectiveness. The search resulted in the inclusion of k = 9 studies for cortisol, k = 16 studies for BP, and k = 20 studies for HR/HRV. The results indicated a significant small overall effect on reducing BP, but no significant effect for HR/HRV. For cortisol, large methodological variation in the few primary studies did not allow for quantitative analyses, but a qualitative review demonstrated inconsistent results. For BP and HR/HRV, larger effects were observed for intervention programs with a mindfulness and/or meditation component, for interventions without a cognitive‐behavioural component and for interventions with a higher intensity. Providing adolescents with techniques to improve indicators of physiological stress may prevent emerging mental health problems. [ABSTRACT FROM AUTHOR]

To identify adolescents who may be at risk for adverse outcomes, we examined the extent of COVID‐19‐related concerns reported by adolescents and investigated which prepandemic risk and protective factors predicted these concerns during the COVID‐19 pandemic. Dutch adolescents (N = 188; Mage = 13.49, SD =.81) were assessed before the pandemic and at eight and ten months into the pandemic. Results demonstrated that adolescents' most frequently reported COVID‐19‐related concerns were about social activities and getting delayed in school. Adolescents that have specific vulnerabilities before the pandemic (i.e., higher stress, maladaptive coping, or internalizing problems) experience more concerns during the pandemic, stressing the importance of guiding and supporting these adolescents in order to prevent adverse developmental outcomes. [ABSTRACT FROM AUTHOR]

Background and Objectives: Interpretation bias (IB), defined as the tendency to interpret ambiguous social situations in a threatening manner, has increasingly been studied in children and adolescents. Compared to Western samples, the relation between IB and social anxiety in Chinese youth has received little attention. The present study was to mainly examine the relationship between IB and social anxiety among Chinese adolescents. Design: Cross-sectional design was utilized. Methods: IB, measured by the Adolescents' Interpretation Bias Questionnaire (AIBQ), and social anxiety were surveyed among a group of high socially anxious Chinese adolescents (n = 25) and a control group (n = 29). Participants were asked to rate the likelihood of interpretations coming to mind in social/non-social situations and to choose the most believable interpretation. Results: The high social anxiety group had more negative interpretations and beliefs in social situations, and the interpretation bias was particular to social anxiety versus depression. Additionally, the cognitive content-specificity hypothesis was supported; the high anxious group showed interpretation bias in social situations, but didn't have more negative interpretations of non-social situations, after controlling for depression. Conclusions: The present study yielded comparable findings as found in Western samples regarding the relation between IB and social anxiety. [ABSTRACT FROM AUTHOR]

Introduction: Low emotional clarity, that is, problems in understanding and identifying one's own emotions, is generally seen as related to depression. Most empirical studies on this topic focused on the link between low levels of emotional clarity predicting depression problems, fewer studies on depression symptoms predicting low emotional clarity. All studies were restricted to unidirectional associations. The present study evaluated the reciprocal associations between emotional clarity and depression symptoms. Additionally, we tested the role of rumination as a mediator of the links between depression symptoms and emotional clarity.Methods: For the main analyses, data of 230 Dutch participants (Mage = 13.40, SD = 2.24; 48% girls) over three time points of a 5-year longitudinal study were used. Depression symptoms, emotional clarity, and rumination were self-reported. Cross-lagged panel analysis was used to test a model of reciprocal associations between depression symptoms and emotional clarity against models of unidirectional associations. The role of rumination as mediator and sex as moderator in the links between depression symptoms and emotional clarity were evaluated in separate analyses on a subsample (n = 151).Results& Conclusions: A model of reciprocal associations where depression symptoms and low emotional clarity predict relatively high scores of the other over time offered a good representation of the data. Rumination mediated the link between depression symptoms predicting prospective emotional clarity for both sexes. These findings suggest a vicious cycle between depression symptoms and low emotional clarity. We discuss possible implications of these results for the treatment of depression in youth. [ABSTRACT FROM AUTHOR]

This cohort-sequential study examined developmental trajectories of social anxiety in a nonclinical sample ( N = 331, 161 girls) aged 9 to 17 years at initial and 12 to 21 years at final assessment. We tested whether variables assessing cognition, social competence, and temperament discriminated between the trajectories. Variables were collected from different sources: participants, independent observers, parents, and teachers. Using Latent Class Growth Modeling (LCGM) we identified three distinct social anxiety trajectory groups: i) high and changing; ii) moderate and decreasing; and iii) low and decreasing. Multinomial regression analyses showed that the cognition variables, negative interpretations of ambiguous social situations and self-focused attention, differentiated between all three trajectories. A lack of social skills and having social problems at school were specifically related to the chance of following the high trajectory versus the moderate trajectory. Neuroticism differentiated between the low and moderate trajectories. Findings indicate that adolescents at risk of belonging to a high social anxiety trajectory can be discriminated from peers belonging to a less anxious trajectory using both cognition and social competence variables. [ABSTRACT FROM AUTHOR]

Self-concept and ego development, two intertwined aspects of self-indicating well-being and social-cognitive maturation, respectively, were examined in a representative sample of deaf adolescents of normal intelligence (N = 68), using translated and adapted versions of Harter’s (1988, Manual for the self-perception profile for adolescents. Denver, CO: University of Denver) multidimensional measure of self-concept and Loevinger’s (1998, Technical foundations for measuring ego development. Mahwah, NJ: Lawrence Erlbaum) measure of ego development. Compared to hearing norm groups, deaf adolescents showed lower levels of self-perceived social acceptance, close friendships and ego development and higher physical appearance. Hierarchical multiple regression analyses controlling for sociodemographic variables showed positive associations of global self-worth with support for signing during childhood and quality of parent-child communication and of ego development with attending a regular school. Cluster analysis identified three social competence profiles: uniformly low competence, uniformly high competence, and low social acceptance with high physical appearance. Cluster membership was associated with school type, ego development, and (past) neurological disorder. The results are discussed in reference to interventions aimed at the well-being of deaf youth. [ABSTRACT FROM PUBLISHER]

Age and gender differences in perceived social support from parents, friends, classmates, and teachers were investigated in 304 boys and 351 girls aged 9–18 years. The social support scale for children and adolescents was used for this purpose. Analyses showed that the level of perceived social support from parents and friends was similar across age groups. The study of the prominence of social support sources showed that parents and friends were perceived as equally supportive; only for the ages 16–18 years did friend support exceed parent support. Support from teachers was lower in the older age groups, and this was related to the transition from primary to secondary school. Finally, girls perceived more support from teachers, classmates and friends than boys did. [ABSTRACT FROM AUTHOR]

Abstract: Common folklore seems to suggest that adolescents are particularly susceptible to peer influence. However, from the literature the exact age differences in susceptibility to peer influence remain unclear. The current study''s main focus was to chart the development of general susceptibility to peer pressure in a community sample of 10–18 year olds (N =464) with the recently developed Resistance to Peer Influence Scale (RPI). The one-factor structure of the RPI was cross-validated in the present sample, and the RPI was equally reliable at all ages. As expected, general resistance to peer influence increased during adolescence. In addition, gender differences were most pronounced during mid-adolescence, when girls were more resistant to peer influence than boys. These findings are explained in terms of psychosocial maturation during adolescence. [Copyright &y& Elsevier]

Abstract: This study addressed the question if socially anxious adolescents have a negatively biased perception of the way they are treated by their peers. A total of 998 high school students from Grades 8–10 were categorized as socially low, middle, or high anxious on the basis of their SAS-A score. The perceived behavior of classmates was measured using three lists that described class behaviors during oral presentations of students, one list was concerned with the behaviors directed towards the student him/herself and the other two with behaviors directed towards a hypothetical high and low socially anxious peer, respectively. The results indicated that high socially anxious students felt negatively treated by their peers and that the other students too perceived that socially anxious classmates were treated more negatively. This suggests that the perception of the high socially anxious students is not distorted but based on the actual treatment they receive from their classmates. [Copyright &y& Elsevier]

The frequently reported decline in the overall frequency and intensity of fears during late childhood and adolescence may mask different developmental patterns for two broad subclasses of fears: fears concerning physical danger and fears concerning social evaluation. It was investigated if physical fears decrease between late childhood and mid-adolescence, while social-evaluative fears increase during this period. It was also studied if changes in both sets of fears are more strongly related to socio-cognitive maturity than to age, which itself is only a proxy measure of maturity. A non-clinical sample of 882 children and adolescents (ages 8–18) was recruited for study. Fears were assessed using the Ollendick Fear Survey Schedule for Children – Revised (FSSC-R). A Principal Components Analysis (PCA) was conducted to study the factor structure of the Failure and Criticism subscale of the FSSC-R. Level of development was assessed using the Sentence Completion Test for Youth (SCT-Y), a measure of socio-cognitive maturity that is based on Loevinger's model, and measure, of ego development. The PCA of the Failure and Criticism subscale revealed three factors: Social Evaluation, Achievement Evaluation, and Punishment. As predicted, the significant decrease of overall fearfulness obscured two contradictory developmental patterns: (a) fears of physical danger and punishment decreased with age, whereas (b) fears of social and achievement evaluation increased with age. Hierarchical regression analyses showed that the age effect for social-evaluative fears was explained entirely on the basis of developmental differences in socio-cognitive maturity (controlling for verbal ability). In contrast, age was a better predictor of the decrease of physical and punishment fears (although socio-cognitive maturity still added to the predictive value of age). The expression of social evaluation fears during adolescence appears not atypical and might be a corollary of socio-cognitive maturation. At the same time, the natural presence of those fears during adolescence appears to constitute a vulnerability for developing a social anxiety disorder. [ABSTRACT FROM AUTHOR]

Contradictory findings have been reported on the relation between social anxiety and the cortisol response to social evaluation in youth. The present longitudinal study aimed to clarify this relation by taking pubertal development into account. Data were collected in two waves, two years apart, for a community sample of 196 participants, aged 8–17 years at Time 1. Pubertal development and social anxiety were assessed with self-report questionnaires. Salivary cortisol was obtained before and after participants completed the Leiden Public Speaking Task. Data were analyzed using regression analysis with clustered bootstrap. The dependent variable was the cortisol area under the curve. Social anxiety and pubertal development scores were decomposed into between- and within-participants components. Between participants, the relation between social anxiety and the cortisol response to public speaking varied with pubertal development: socially anxious individuals showed higher responses at low levels of pubertal development, but lower responses at high levels of pubertal development. Within participants, an increase in social anxiety over time was associated with a lower cortisol response. The results are in line with the suggestion that the responses of socially anxious individuals change from elevated in childhood to attenuated in adolescence and adulthood. Attenuation of the cortisol response is explained by theories proposing that the stress response changes with the duration of the stressor. [ABSTRACT FROM AUTHOR]

Adolescents become increasingly sensitive to social evaluation. Some previous studies have related this change to pubertal development. The present longitudinal study examined the role of sociocognitive development. We investigated whether or not the transition to recursive thinking, the ability to think about (others') thoughts, would be associated with changes in the magnitude and timing of the cortisol response to social evaluation. Salivary cortisol was obtained during the Leiden Public Speaking Task. The task was administered twice with a 2-year interval to 221 participants, aged 9-17 years at Time 1. The area under the curve was computed to assess the magnitude of the overall cortisol response. Two difference scores, reflecting speech anticipation and speech delivery, were computed to assess the timing of the cortisol response. Recursive thinking was measured with a cartoon description task. Regression analyses with clustered bootstrap controlling for pubertal development, age, and general cognitive functioning showed that the transition to recursive thinking predicted an increase in the cortisol response to speech anticipation, but was unrelated to the magnitude of the overall cortisol response. This is in line with the view that increasing sensitivity to social evaluation in adolescence is mainly due to the effects of pubertal hormones on affective regions of the brain. Sociocognitive development affected the timing rather than the magnitude of the cortisol response. The results suggest that recursive thinking enables earlier realization of social-evaluative threat. [ABSTRACT FROM AUTHOR]

Abstract: In contrast with the original version of the Self-Restraint Scale (SRS; [Weinberger, D.A., & Schwartz, G.E. (1990). Distress and restraint as superordinate dimensions of self-reported adjustment: A typological perspective. Journal of Personality, 58, 381–417]), confirmatory factor analysis did not support a four-factor solution. In the current study an exploratory factor analysis revealed a three-factor structure. Although the original subscales suppression of aggression, consideration of others, and impulse control were confirmed by the data, responsibility did not fit within the overall concept of self-restraint. These results provide some indication that although the subscales can be used independently, the way self-restraint is conceptualized should be reconsidered. Future studies are needed to confirm the factor structure observed in the current study. [Copyright &y& Elsevier]

Abstract: This study focused on the relation between adolescents’ social anxiety and the way they are treated by classmates. The link between class behavior during oral presentations and the social anxiety of the speakers was investigated. Social anxiety was measured both as a trait variable and as manifest in two state anxiety characteristics. A group of 55 students from Grades 8 and 9 were selected to participate in the study. Class behavior during their presentations was rated by the students themselves, their teacher, and an independent observer. Results showed that negative class behavior was related to social anxiety, particularly when behavior was rated by the independent observer. The data suggested that this negative social outcome is related to longer lasting social interactions in the classroom and not to specific state anxiety characteristics. [Copyright &y& Elsevier]

This three-wave longitudinal study spanning five years evaluated the mediating roles of negative social self-perception and social interpretation bias in the link between adolescent shyness and social anxiety. Participants were 331 (pre-)adolescents aged 9 to 17 years old at Wave 1, with data from 261 participants available for the main analyses. The study used a parent-reported measure of shyness. Social anxiety and the mediator variables were self-reported. Results showed that shyness predicted a relative increase in social anxiety over time. Negative social self-perception mediated the shyness social anxiety link, but social interpretation bias did not. The results suggest that shy adolescents who think negatively about their social performance may become socially anxious. Boosting the social self-perception of shy (pre-)adolescents may help to prevent the development of social anxiety. • Shyness in (pre-)adolescents predicts later social anxiety. • Negative social self-cognitions mediate the shyness - social anxiety link. • Social interpretation bias does not mediate the shyness - social anxiety link. • Prevention should address the negative self-cognitions of shy (pre-)adolescents. [ABSTRACT FROM AUTHOR]

The current study examined mean level and change in extraversion and neuroticism across adolescence in relation to physiological stress reactivity to social evaluation. Adolescents ( n = 327) from the Dutch general population reported on personality measures at five annual assessments. At age 17 years, adolescents participated in a psychosocial stress procedure characterized by social evaluation during which cortisol, heart rate, pre-ejection period (PEP) and heart rate variability were assessed. Dual latent growth curve models were fitted in which the intercepts (mean level) and slopes (change) of personality across adolescence predicted the intercepts (baseline) and slopes (reactivity) of the physiological stress measures. Most comparisons revealed no relation between personality and stress reactivity. Adolescents with higher mean level scores on extraversion did show lower cortisol reactivity. Adolescents with higher mean level neuroticism scores showed higher PEP reactivity. Our findings lend partial support for a relation between personality and physiological stress reactivity. [ABSTRACT FROM AUTHOR]

The present study adds to the emerging literature on the development of social cognition in adolescence by investigating the development of recursive thinking (i.e., thinking about thinking). Previous studies have indicated that the development of recursive thinking is not completed during childhood. The present study focused on late childhood and adolescence and presents the first longitudinal data on recursive thinking. At Time 1, 299 participants, aged 8 to 17 years, completed a revised version of the recursive thinking test developed by Miller, Kessel and Flavell (1970). At Time 2, two years later, 221 participants completed the test again. Psychometric properties of the revised test were found to be adequate. The developmental analysis showed that scores increased with age—both between- and within participants-, indicating that recursive thinking continues to develop throughout adolescence and does not level off before 18 years of age. Verbal abilities only partially explained this development. [ABSTRACT FROM AUTHOR]

It is argued that the adolescent onset of social anxiety disorder (SAD) may be partly attributable to an increase in avoidance of social situations across this period. The current cohort-sequential study investigated developmental pathways of social avoidance in adolescence and examined the explanatory role of social anxiety and negative cognitive processes. A community sample of youth (9–21 years, N = 331) participated in a four-wave study. Trajectory analyses revealed two pathways: an increased avoidance pathway and a low avoidance pathway. The pathways were hardly distinguishable at age 9 and they steadily diverged across adolescence. Logistic regression analyses showed that social anxiety and post-event rumination were significantly related to the increased avoidance pathway; anticipatory processing and self-focused attention were not. The findings suggest that adolescence is a key developmental period for the progression of social avoidance among youth who show relatively high levels of social anxiety and post-event rumination. [ABSTRACT FROM AUTHOR]

Abstract: The main objectives were to evaluate efficacy and acceptability of a developmentally sensitive cognitive behavioral therapy for anxiety-based school refusal in adolescence. Twenty school-refusing adolescents meeting DSM-IV anxiety disorder criteria participated in a non-randomized trial, together with parents and school staff. Outcome was assessed at post-treatment and 2-month follow-up. Treated adolescents showed significant and maintained improvements across primary outcome variables (school attendance; school-related fear; anxiety), with medium to large effect sizes. Half of the adolescents were free of any anxiety disorder at follow-up. Additional improvements were observed across secondary outcome variables (depression; overall functioning; adolescent and parent self-efficacy). The treatment was rated as acceptable by adolescents, parents, and school staff, which may help explain the very low attrition rate. Social anxiety disorder was the most common disorder among adolescents still meeting anxiety disorder criteria at follow-up. Treatment modifications to improve efficacy for school-refusing adolescents presenting with social anxiety disorder are suggested. [Copyright &y& Elsevier]