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Family-based CBT has been shown to be effective in controlled settings for an array of youth mental health difficulties, yet disparities in treatment engagement and outcomes across culturally diverse groups remain. In practice, cultural minority families are less likely to reap the demonstrated benefits of supported programs. Although there have been tremendous advances in case conceptualization, leading models have largely ignored cultural factors, contributing to observed disparities. The present paper reviews recent advances in science-informed case conceptualization and highlights how such advances nonetheless have failed to provide guidance on systematically incorporating cultural formulation into assessment and treatment planning. We then build upon Christon et al. (2015) useful 5-stage model of science-based case conceptualization in an effort to move the field toward culturally informed case conceptualization. We highlight how leveraging cultural assessment—such as with the use of the Cultural Formulation Interview (CFI)—can facilitate the incorporation of cultural factors into each of the five stages of science-based case conceptualization. A case example is utilized to illustrate key opportunities for strategically incorporating relevant information gleaned from the CFI into culturally responsive care with youth and families.

Disparities in child mental health service engagement suggest traditional evidence-based practices do not properly consider cultural and contextual factors relevant for marginalized families. We propose a person-centered approach to improve the cultural responsiveness of services. Preliminary research supports broadening standard assessments to include a person-centered evaluation of patient cultural factors, however, controlled studies have not been conducted in the context of children's mental health care.Participants included families (N = 89; 89% racial/ethnic minority) receiving services for child externalizing problems. Prior to intake, caregivers were randomized to receive either Assessment as Usual (AAU) or AAU augmented with the Cultural Formulation Interview (CFI+AAU), a brief caregiver assessment of cultural factors affecting their child's problems and family help-seeking.Implementation data showed strong provider fidelity and clinical utility. Following assessments, CFI+AAU caregivers (relative to AAU caregivers) reported feeling better understood by their provider, and providers reported better understanding CFI+AAU families' values. Caregiver satisfaction was rated highly overall, yet providers reported being more satisfied with the assessment when the CFI was incorporated. Engagement outcomes found CFI+AAU families were significantly more likely than AAU families to subsequently complete the first phase of treatment. Further, among families receiving services in Spanish, CFI+AAU, relative to AAU, was associated with significantly higher treatment attendance, homework completion, and treatment response.The results underscore the utility of incorporating a brief cultural assessment in pretreatment assessments. To improve the cultural responsiveness of services, efforts may do well to promote the uptake of person-centered approaches such as cultural assessment into usual care. Registered at clinicaltrials.gov (NCT03499600).

NOCD is a mobile application that was developed as an adjunct to evidence-based treatment for individuals diagnosed with OCD. NOCD is not a stand-alone treatment, but rather a resource for patients to access supported strategies outside of treatment sessions. NOCD allows users to assess OCD symptom severity, create exposure and response prevention treatment plans, participate in planned weekly out-of-session exposure exercises, receive guidance during unexpected OCD episodes, share assessment and treatment data, as well as communicate with other NOCD users in an online community. Despite some challenges with initial set-up and inflexibility with varying OCD presentations, we believe this application has strong potential to enhance treatment for patients with OCD. At present, NOCD has not been adequately evaluated in a controlled manner. Although quite promising, research is now needed to examine the extent to which NOCD indeed improves engagement and clinical outcomes relative to traditional evidence-based treatment options.

ImportanceEarly behavior problems in children with developmental delay (DD) are prevalent and impairing, but service barriers persist. Controlled studies examining telehealth approaches are limited, particularly for children with DD.ObjectiveTo evaluate the efficacy of a telehealth parenting intervention for behavior problems in young children with DD.Design, Setting, and ParticipantsA randomized clinical trial was conducted from March 17, 2016, to December 15, 2020, in which children with DD and externalizing behavior problems were recruited from early intervention and randomly assigned to a telehealth parenting intervention or control group and evaluated through a 12-month follow-up. Most children were from ethnic or racial minoritized backgrounds. Over one-half of children were in extreme poverty or low income-need ratio categories.InterventionsInternet-delivered parent-child interaction therapy (iPCIT), which leverages videoconferencing to provide live coaching of home-based caregiver-child interactions. Families received 20 weeks of iPCIT (provided in English or in Spanish) or referrals as usual (RAU).Main Outcomes and MeasuresObservational and caregiver-report measures of child and caregiver behaviors and caregiving stress were examined at preintervention, midtreatment, and postintervention and at 6- and 12-month follow-ups.ResultsThe sample included a total of 150 children (mean [SD] age, 36.2 [1.0] months; 111 male children [74%]) and their caregivers with 75 each randomly assigned to iPCIT or RAU groups. Children receiving iPCIT relative to RAU displayed significantly lower levels of externalizing problems (postintervention Cohen d = 0.48; 6-month Cohen d = 0.49; 12-month Cohen d = 0.50) and significantly higher levels of compliance to caregiver direction after treatment. Of those children with data at postintervention, greater clinically significant change was observed at postintervention for children in the iPCIT group (50 [74%]) than for those in the RAU group (30 [42%]), which was maintained at the 6-month but not the 12-month follow-up. iPCIT did not outperform RAU in reducing caregiving stress, but caregivers receiving iPCIT, relative to RAU, showed steeper increases in proportion of observed positive parenting skills (postintervention odds ratio [OR], 1.10; 95% CI, 0.53-2.21; 6-month OR, 1.31; 95% CI, 0.61-2.55; 12-month OR, 1.64; 95% CI, 0.70-3.07) and sharper decreases in proportion of observed controlling/critical behaviors (postintervention OR, 1.40; 95% CI, 0.61-1.52; 6-month OR, 1.72; 95% CI, 0.58-1.46; 12-month OR, 2.23; 95% CI, 0.53-1.37). After treatment, iPCIT caregivers also self-reported steeper decreases in harsh and inconsistent discipline than did than RAU caregivers (postintervention Cohen d = 0.24; 6-month Cohen d = 0.26; 12-month Cohen d = 0.27).Conclusions and RelevanceResults of this randomized clinical trial provide evidence that a telehealth-delivered parenting intervention with real-time therapist coaching led to significant and maintained improvements for young children with DD and their caregivers. Findings underscore the promise of telehealth formats for expanding scope and reach of care for underserved families.Trial RegistrationClinicalTrials.gov Identifier: NCT03260816

Objective Very few controlled trials have evaluated targeted treatment methods for childhood selective mutism (SM); the availability of evidence-based services remains limited. This study is the first controlled trial to evaluate an intensive group behavioral treatment (IGBT) for children with SM. Method Twenty-nine children with SM (5-9 years; 76% female; 35% ethnic minority) were randomized to immediate SM 5-day IGBT or to a 4-week waitlist with psychoeducational resources (WLP), and were assessed at Week 4 and again 8 weeks into the following school year. Results IGBT was associated with high satisfaction and low perceived barriers to treatment participation. At Week 4, 50% of the immediate IGBT condition and 0% of the WLP condition were classified as "clinical responders." Further, Time × Condition interactions were significant for social anxiety severity, verbal behavior in social situations, and global functioning (but not for SM severity, verbal behavior in home settings, or overall anxiety). School-year follow-up assessments revealed significant improvements across all outcomes. Eight weeks into the following school year, 46% of IGBT-treated children were free of an SM diagnosis. In addition, teachers in the post-IGBT school year rated less school impairment and more classroom verbal behavior relative to teachers in the pre-IGBT school year. Conclusions Findings provide the first empirical support for the efficacy and acceptability of IGBT for SM. Further study is needed to examine mechanisms of IGBT response, and other effective SM treatment methods, in order to clarify which treatment formats work best for which affected children. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Research on families of young children with developmental delay and disruptive behavior problems has failed to examine caregiver stress in the context of cultural factors.Families of 3-year-old children with developmental delay and behavior problems were recruited from Early Intervention sites. All caregivers in the current analysis (n = 147) were from immigrant and/or cultural minority backgrounds. Regarding income-to-needs, most families (57.8%) fell into the extreme poverty, poor, or low-income categories. Caregivers reported on their own experiences of acculturation and enculturation as well as their child's problems.Path analyses revealed that higher caregiver acculturation was associated with less parenting-specific stress, and higher caregiver enculturation was associated with less caregiver general stress. Severity of child problems was associated with more parenting-specific stress and general stress. Exploratory analysis yielded significant differences in associations between acculturation, enculturation, and caregiver stress in Black/African American caregivers versus Hispanic White caregivers.Findings suggest that among cultural minority caregivers of young children with developmental and behavioral problems, acculturation and enculturation may influence caregiver stress. While the cross-sectional nature of the study precludes causal conclusions, clinicians should consider how cultural factors can be harnessed to strengthen caregiver resiliency and improve engagement in parenting interventions.Introducción: La investigación acerca de la familia de niños pequeños con retardos en el desarrollo y problemas de conducta disruptivos no ha examinado el estrés de quien presta el cuidado dentro del contexto de factores de identidad cultural. Métodos: Se reclutaron familias de niños de 3 años de edad con retardos en el desarrollo y problemas de conducta provenientes de lugares de Intervenciones Tempranas. Todos los cuidadores en el presente análisis (n = 147) tenían trayectorias inmigrantes y/o de grupo cultural minoritario. Con respecto al equilibrio entre entradas económicas y necesidades, la mayoría de las familias (57.8%) se clasificaban dentro de las categorías de extrema pobreza, pobre, o de bajos recursos económicos. Los cuidadores reportaron acerca de sus propias experiencias de aculturación y enculturación, así como de los problemas de sus niños. Resultados: Los análisis de trayectoria revelaron que una más alta aculturación del cuidador se asociaba con menos estrés relacionado con la crianza, y una más alta enculturación del cuidador se asociaba con un menor estrés del cuidador en general. La severidad de los problemas del niño se asoció con más estrés de crianza específicamente y estrés general en los cuidadores. Los análisis exploratorios ofrecieron diferencias significativas en la asociación entre aculturación, enculturación y el estrés del cuidador en cuanto a los cuidadores Negros/Afroamericanos versus cuidadores Hispanos Blancos. Conclusión: Los resultados sugieren que, entre cuidadores de grupos minoritarios de niños pequeños con retardos en el desarrollo y problemas de conducta, la aculturación y la enculturación pudieran proteger contra altos niveles de estrés del cuidador. A los profesionales clínicos se les aconseja considerar cómo los factores culturales pueden ser aprovechados para fortalecer la resistencia y mejorar la participación en las intervenciones de crianza.Les recherches sur les familles de jeunes enfants avec des retards du développement et des problèmes de comportement perturbateur n'ont pas réussi à examiner le stress de la personne prenant soin des enfants dans le contexte de facteurs d'identité culturelle. Méthodes: Des familles d'enfants de trois ans avec des retards de développement et des problèmes de comportement ont été recrutées sur des sites d'Intervention Précoce. Toutes les personnes prenant soin des enfants dans cette analyse (n = 147) étaient issues de milieux immigrés et/ou d'une minorité culturelle. Pour ce qui concerne le rapport revenu-besoins, la plupart des familles (57,8%) tombaient dans les catégories de pauvreté extrême, pauvre, ou revenus faibles. Les personnes prenant soin des enfants ont fait état de leurs propres expériences d'acculturation et d'enculturation ainsi que des problèmes de leur enfant. Résultats: Les analyses de pistes causales ont révélé qu'une acculturation plus élevée de la personne prenant soin de l'enfant était liée à un moindre stress spécifique au parentage, et une enculturation de la personne prenant soin de l'enfant plus élevée était liée à moins de stress général de la personne prenant soin de l'enfant. La sévérité des problèmes de l'enfant était liée à plus de stress spécifique au parentage et ainsi que de stress général de la personne prenant soin de l'enfant. Des analyses exploratoires ont montré des différences importantes dans le lien entre l'acculturation, l'enculturation et le stress de la personne prenant soin de l'enfant chez les populations noires/afro-américaines par rapport aux hispaniques blancs.Les résultats suggèrent que personnes issues des minorités prenant soin de jeunes enfants avec des problèmes de développement et de comportement, l'acculturation et l'enculturation peut protéger contre des niveaux élevés de stress de la personne prenant soin de l'enfant. On conseille aux cliniciens de considérer la manière dont les facteurs culturels peuvent être exploités afin de renforcer la résilience de la personne prenant soin de l'enfant et d'améliorer la participation aux intervention de parentage.Betreuungsstress und kulturelle Identität in Familien von Vorschulkindern mit Entwicklungsverzögerung und Verhaltensproblemen Einleitung: Die Forschung zu Familien von Kleinkindern mit Entwicklungsverzögerung und störenden Verhaltensproblemen hat den Stress der Erziehungsberechtigten im Kontext kultureller Identitätsfaktoren bislang vernachlässigt. Methoden: Familien von 3-jährigen Kindern mit Entwicklungsverzögerung und Verhaltensproblemen wurden aus Frühinterventionsstellen rekrutiert. Alle Erziehungsberechtigten in der aktuellen Analyse (n = 147) stammten aus migrantischen und/oder kulturellen Minderheiten. Gemessen am Verhältnis von verfügbarem Einkommen zum (häuslichen/familiären) Bedarf fielen die meisten Familien (57,8%) in die Kategorien extreme Armut, Armut oder niedriges Einkommen. Die Erziehungsberechtigten berichteten über ihre Erfahrungen mit Akkulturation und Enkulturation sowie über die Probleme ihres Kindes. Ergebnisse: Pfadanalysen ergaben, dass eine höhere Akkulturation der Erziehungsberechtigten mit weniger elternspezifischem Stress assoziiert war. Eine höhere Enkulturation hingegen war mit weniger allgemeinem Stress der Erziehungsberechtigten assoziiert. Die Schwere der kindlichen Probleme war mit mehr elternspezifischem und allgemeinem Stress bei den Erziehungsberechtigten assoziiert. Eine explorative Analyse ergab signifikante Unterschiede in der Assoziation zwischen Akkulturation, Enkulturation und Betreuungsstress bei schwarz / afroamerikanischen Erziehungsberechtigten im Vergleich zu hispanischen weißen Erziehungsberechtigten. Fazit: Die Ergebnisse deuten darauf hin, dass bei Erziehungsberechtigten von Kleinkindern mit Entwicklungs- und Verhaltensproblemen aus kulturellen Minderheiten Akkulturation und Enkulturation vor einem hohen Maß an Betreuungsstress schützen können. Medizinischem Fachpersonal wird empfohlen, zu prüfen, wie kulturelle Faktoren genutzt werden können, um die Resilienz der Erziehungsberechtigten zu stärken und das Engagement innerhalb von Elterninterventionen zu verbessern.発達の遅れや行動上の問題のある就学前の子どもをもつ家族における、養育者のストレスと文化的アイデンティティ はじめに:発達の遅れと破壊的な行動上の問題のある年少児を持つ家族に関する研究は、文化的アイデンティティ因子という文脈からの養育者のストレスの検証してこなかった。方法:発達の遅れと行動上の問題のある3歳の子どもの家族を、いくつかの早期介入に関わるサイトから募った。現在の解析では、全養育者 (N=147) に移民および/または文化的少数派の背景があった。ニーズに対する収入については、ほとんどの家族(57.8%)が極度の貧困、貧困あるいは低所得者層に分けられた。養育者は、子どもの問題と自分自身の文化的適応と文化化について報告した。結果:パス分析によると、養育者の文化的適応がより高いほど子育て特有のストレスが少ないという関連があり、養育者の文化化がより高いほど養育者の一般的なストレスが少ないという関連があった。子どもの問題の深刻さは、より強い子育て特有のストレスと養育者の一般的なストレスと関連性があった。探索的分析の結果、黒人/アフリカ系アメリカ人養育者とヒスパニック系白人養育者では、文化適応、文化化、養育者のストレスの関連性に有意な差が認められた。結論:知見から、発達の遅れや行動上の問題のある年少児を持つ少数派層の養育者にとって、文化適応と文化化が養育者の高レベルのストレスを保護できることが示唆された。臨床家には、養育者のレジリエンシーを強化し、子育て介入の関与を改善するために文化的要因をどのように利用できるかの検討をお薦めする。.研究简介:对具有发育迟缓和破坏性行为问题的幼儿家庭的研究未能在文化认同因素的背景下考察看护者的压力。研究方法:从早期干预机构招募了具有发育迟缓和行为问题的3岁儿童的家庭。本文分析中的所有看护者 (n = 147) 均来自移民或具有少数民族文化背景。关于收入与需求, 大多数家庭 (57.8%) 属于极端贫困、贫困或低收入类别。看护者报告了他们自己的涵化和濡化经历, 以及他们孩子的问题。研究结果:路径分析显示, 较高的看护者涵化能力与较低的育儿特定压力有关, 而较高的看护者濡化能力与较低的看护者日常压力有关。儿童问题的严重程度与看护者的育儿特定压力和日常压力有关。探索性分析表明, 黑人或非裔美国人看护者与西班牙裔白人看护者的涵化、濡化和看护者压力之间的关联存在显著差异。研究结论:研究结果表明, 在其幼儿有发育和行为问题的少数民族看护者中, 涵化和濡化可以防止看护者压力过大。建议临床医生考虑如何利用文化因素来增强看护者的适应力, 并提高参与育儿干预的程度。.إجهاد مقدمي الرعاية والهوية الثقافية في أسر الأطفال في مرحلة ما قبل المدرسة الذين يعانون من تأخر النمو والمشاكل السلوكية مقدمة: فشلت الأبحاث حول أسر الأطفال الصغار الذين يعانون من تأخر النمو ومشاكل السلوك المضطرب في دراسة إجهاد مقدمي الرعاية في ضوء عوامل الهوية الثقافية. طريقة البحث: اشترك في الدراسة عائلات الأطفال البالغين من العمر 3 سنوات الذين يعانون من تأخر النمو ومشاكل السلوك من مواقع التدخل المبكر. وكان كل مقدمي الرعاية في التحليل الحالي (العدد = 147) ينتمون إلى أقليات مهاجرة أو ثقافية. وفيما يتعلق بتناسب الدخل مع الاحتياجات، فإن معظم الأسر (57.8 في المائة) كانوا في مستوى الفقر الشديد أو الدخل المنخفض. وأفاد مقدمو الرعاية عن تجاربهم الخاصة في التأقلم والاندماج الثقافي وكذلك مشاكل أطفالهم. النتائج: كشفت تحليلات المسار أن ارتفاع التأقلم الثقافي عند مقدمي الرعاية كان مرتبطا بالإجهاد العصبي الأقل في عملية الرعاية الوالدية، في حين ارتبط ارتفاع الاندماج الثقافي عند مقدمي الرعاية بإجهاد عصبي أقل بشكل عام. وارتبطت شدة مشاكل الأطفال بالمزيد من الإجهاد المرتبط بالرعاية الوالدية والإجهاد العام لدى مقدمي الرعاية. وأسفر التحليل الاستكشافي عن اختلافات كبيرة في الارتباط بين التأقلم الثقافي، والاندماج الثقافي، والإجهاد العصبي عند مقدمي الرعاية من السود/الأميركيين الأفارقة بالمقارنة مع مقدمي الرعاية من البيض من أصل إسباني. الاستنتاج: تشير النتائج إلى أنه من بين مقدمي الرعاية من الأقليات للأطفال الصغار الذين يعانون من مشاكل في النمو والسلوك، قد يحمي التأقلم والاندماج الثقافي من المستويات العالية من إجهاد مقدمي الرعاية. وينصح الأطباء بالتفكير في كيفية تسخير العوامل الثقافية لتعزيز مرونة مقدمي الرعاية وتحسين المشاركة في تدخلات الأبوة والأمومة.

Despite recent advances in the treatment of early child social anxiety, the broad accessibility of brick-and-mortar services has been limited by traditional barriers to care, and more recently by new obstacles related to efforts to slow the spread of COVID-19. The present waitlist-controlled trial examined the preliminary efficacy of a family-based behavioral parenting intervention (i.e., the iCALM Telehealth Program) that draws on Parent-Child Interaction Therapy and videoconferencing to remotely deliver clinician-led care for anxiety in early childhood. Young children (3–8 years) with a diagnosis of social anxiety disorder (N = 40; 65% from ethnic/racial minority backgrounds) were randomly assigned to iCALM or waitlist. Intent-to-treat analyses found that at post, independent evaluators classified roughly half of the iCALM-treated children, but only 6% of waitlist children, as “Responders” (Wald test = 4.51; p = .03). By Post, iCALM led to significantly greater reductions than waitlist in child anxiety symptoms, fear, discomfort, and anxiety-related social impairment, and also led to greater improvements in child soothability. By 6-month follow-up, the percentage of iCALM-treated children classified as “Responders” rose to roughly 60%. Exploratory moderation tests found iCALM was particularly effective in reducing life impairments and parental distress among families presenting with higher, relative to lower, levels of baseline parental accommodation. The present findings add to a growing body of research supporting the promise of technology-based strategies for broadening the portfolio of options for delivering clinician-led mental health services.

This chapter provides an overview of principles, practices, and procedures associated with the exposure-based treatment of childhood selective mutism (SM), a relatively rare but highly impairing anxiety disorder characterized by persistent failure to speak in certain social settings. Recent research has clarified that anxiety and associated avoidance is at the center of SM. In light of growing consensus regarding the critical role of exposure therapy in the treatment of childhood SM, this chapter offers a guiding overview of the key elements of exposure-based treatment for SM—including proper assessment, psychoeducation, reinforcement, stimulus fading, shaping, coping strategies, development of a fear hierarchy, graduated exposures, reinforcement, and homework. We consider important developmental factors throughout, and discuss issues related to promoting generalization of skills in the community, collaborating with schools, calibrating for comorbidity, and improving treatment access. We conclude with a discussion of future directions in the exposure-based treatment of childhood SM.

Objective Given problems and disparities in the use of community-based mental health services for youth, school personnel have assumed frontline mental health service roles. To date, most research on school-based services has evaluated analog educational contexts with services implemented by highly trained study staff, and little is known about the effectiveness of school-based mental health services when implemented by school professionals. Method Random-effects meta-analytic procedures were used to synthesize effects of school-based mental health services for elementary school-age children delivered by school personnel and potential moderators of treatment response. Forty-three controlled trials evaluating 49,941 elementary school-age children met the selection criteria (mean grade 2.86, 60.3% boys). Results Overall, school-based services demonstrated a small-to-medium effect (Hedges g = 0.39) in decreasing mental health problems, with the largest effects found for targeted intervention (Hedges g = 0.76), followed by selective prevention (Hedges g = 0.67), compared with universal prevention (Hedges g = 0.29). Mental health services integrated into students’ academic instruction (Hedges g = 0.59), those targeting externalizing problems (Hedges g = 0.50), those incorporating contingency management (Hedges g = 0.57), and those implemented multiple times per week (Hedges g = 0.50) showed particularly strong effects. Conclusion Considering serious barriers precluding youth from accessing necessary mental health care, the present meta-analysis suggests child psychiatrists and other mental health professionals are wise to recognize the important role that school personnel, who are naturally in children’s lives, can play in decreasing child mental health problems.

Parasympathetic nervous system influences on cardiac functions-commonly indexed via respiratory sinus arrhythmia (RSA)-are central to self-regulation. RSA suppression during challenging emotional and cognitive tasks is often associated with better emotional and behavioral functioning in preschoolers. However, the links between RSA suppression and child behavior across various challenging interpersonal contexts remains unclear. The present study experimentally evaluated the relationship between child RSA reactivity to adult (mother vs. study staff) direction and disruptive behavior problems in children ages 3-8 with varying levels of disruptive behavior problems (N = 43). Reduced RSA suppression in the context of mothers' play-based direction was associated with more severe child behavior problems. In contrast, RSA suppression in the context of staff play-based direction was not associated with behavior problems. Findings suggest that the association between RSA suppression and child behavior problems may vary by social context (i.e., mother vs. other adult direction-givers). Findings are discussed in regard to RSA as an indicator of autonomic self-regulation that has relevance to child disruptive behavior problems.

Intolerance of Uncertainty (IU), defined as the dispositional interpretation of uncertain or ambiguous events as stressful and problematic, has been linked to excessive worry and other anxiety-related problems in adults and youth. IU has been conceptualized as a vulnerability factor for excessive worry and anxiety, but the historical absence of a supported measure of IU in young children has hampered longitudinal research needed to evaluate temporal relationships between IU and anxiety and the differential developmental pathways of IU leading to different anxiety disorders and depression. The present study evaluated the psychometric properties of a newly developed 17-item parent-report measure of younger children's Responses to Uncertainty and Low Environmental Structure (i.e., the RULES questionnaire). We examined the preliminary structure, reliability, and validity of the RULES within a treatment-seeking sample of children aged 3-10 (N=160) with anxiety. Findings from an exploratory factor analysis supported a one-factor model that retained all 17 items. The RULES demonstrated strong internal consistency, and predictive, convergent, and divergent validity. In this early childhood sample, the RULES also showed stronger associations with anxiety than did a previously supported measure of IU developed for older youth, and showed preliminary sensitivity to treatment-related change. Findings provide preliminary psychometric support for the RULES as a parent-report measure of children's responses to uncertainty and low environmental structure that may inform etiologic models of anxiety.

We introduce the Automatic Learning for the Rapid Classification of Events (ALeRCE) broker, an astronomical alert broker designed to provide a rapid and self--consistent classification of large etendue telescope alert streams, such as that provided by the Zwicky Transient Facility (ZTF) and, in the future, the Vera C. Rubin Observatory Legacy Survey of Space and Time (LSST). ALeRCE is a Chilean--led broker run by an interdisciplinary team of astronomers and engineers, working to become intermediaries between survey and follow--up facilities. ALeRCE uses a pipeline which includes the real--time ingestion, aggregation, cross--matching, machine learning (ML) classification, and visualization of the ZTF alert stream. We use two classifiers: a stamp--based classifier, designed for rapid classification, and a light--curve--based classifier, which uses the multi--band flux evolution to achieve a more refined classification. We describe in detail our pipeline, data products, tools and services, which are made public for the community (see \url{https://alerce.science}). Since we began operating our real--time ML classification of the ZTF alert stream in early 2019, we have grown a large community of active users around the globe. We describe our results to date, including the real--time processing of $9.7\times10^7$ alerts, the stamp classification of $1.9\times10^7$ objects, the light curve classification of $8.5\times10^5$ objects, the report of 3088 supernova candidates, and different experiments using LSST-like alert streams. Finally, we discuss the challenges ahead to go from a single-stream of alerts such as ZTF to a multi--stream ecosystem dominated by LSST., Comment: Submitted to AAS on Jun 29th. Preview for LSST PCW 2020. Comments welcome

The relationship between intolerance of uncertainty (IU) and anxiety has been extensively studied in adults, while research on child IU is nascent. Despite recent advances in the evaluation of IU and clinical correlates in youth, little is known about familial patterns of IU and intergenerational links between parent and child IU. The present study provides a preliminary evaluation of the relationship between maternal IU and child IU in a sample of community youth (N = 90; ages 7–13 years). Analyses showed a significant, medium association between maternal and child IU (r = .42, p

Objective Remote technologies are increasingly being leveraged to expand the reach of supported care, but applications to early child-behavior problems have been limited. This is the first controlled trial examining video-teleconferencing to remotely deliver behavioral parent training to the home setting with a live therapist. Method Racially/ethnically diverse children ages 3-5 years with disruptive behavior disorders, and their caregiver(s), using webcams and parent-worn Bluetooth earpieces, participated in a randomized trial comparing Internet-delivered parent-child interaction therapy (I-PCIT) versus standard clinic-based PCIT (N = 40). Major assessments were conducted at baseline, midtreatment, posttreatment, and 6-month follow-up. Linear regressions and hierarchical linear modeling using maximum-likelihood estimation were used to analyze treatment satisfaction, diagnoses, symptoms, functioning, and burden to parents across conditions. Results Intent-to-treat analyses found 70% and 55% of children treated with I-PCIT and clinic-based PCIT, respectively, showed "treatment response" after treatment, and 55% and 40% of children treated with I-PCIT and clinic-based PCIT, respectively, continued to show "treatment response" at 6-month follow-up. Both treatments had significant effects on children's symptoms and burden to parents, and many effects were very large in magnitude. Most outcomes were comparable across conditions, except that the rate of posttreatment "excellent response" was significantly higher in I-PCIT than in clinic-based PCIT, and I-PCIT was associated with significantly fewer parent-perceived barriers to treatment than clinic-based PCIT. Both treatments were associated with positive engagement, treatment retention, and very high treatment satisfaction. Conclusion Findings build on the small but growing literature supporting the promising role of new technologies for expanding the delivery of behavioral parent training. (PsycINFO Database Record

Children’s mental health problems are highly prevalent and impose enormous burdens at the individual, family, and societal level. Fortunately, the past few decades have witnessed tremendous advances in the development and evaluation of developmentally sensitive cognitive behavioral procedures with demonstrated success in treating a considerable share of mental health problems presenting in youth. In this chapter, we provide a brief overview of the cognitive behavioral treatment (CBT) model for youth mental health problems, followed by a discussion of key developmental considerations and distinguishing attributes of CBT when targeting mental health problems in youth. We then turn attention to how CBT differentially addresses specific domains of child mental health problems and review major advances and innovations in recent years that hold great promise for meaningfully expanding the reach and quality of CBT for an even a larger proportion of affected children and adolescents. These innovations include the development of transdiagnostic, modular, and intensive CBT formats, as well as the promising role of technology for improving the accessibility of CBT for traditionally underserved child populations. We conclude by highlighting areas in need of continued empirical attention and lay out an agenda for future research seeking to optimize the public health impact of CBT procedures for redressing children’s mental health problems.

Background Social networking services (SNS) have rapidly become a central platform for adolescents’ social interactions and media consumption patterns. The present study examined a representative sample of publicly accessible content related to deliberate self-injurious cutting across three SNS platforms: Twitter, Tumblr, and Instagram. Methods Data collection simulated searches for publicly available deliberate self-injury content on Twitter, Tumblr, and Instagram. Over a six-month period at randomly generated time points, data were obtained by searching “#cutting” on each SNS platform and collecting the first 10 posts generated. Independent evaluators coded posts for presence of the following: (a) graphic content, (b) negative self-evaluations, (c) references to mental health terms, (d) discouragement of deliberate self-injury, and (e) recovery-oriented resources. Differences across platforms were examined. Results Data collection yielded a sample of 1,155 public posts (770 of which were related to mental health). Roughly 60% of sampled posts depicted graphic content, almost half included negative self-evaluations, only 9.5% discouraged self-injury, and

Objective Despite advances in supported treatments for early onset obsessive-compulsive disorder (OCD), progress has been constrained by regionally limited expertise in pediatric OCD. Videoteleconferencing (VTC) methods have proved useful for extending the reach of services for older individuals, but no randomized clinical trials (RCTs) have evaluated VTC for treating early onset OCD. Method RCT comparing VTC-delivered family based cognitive-behavioral therapy (FB-CBT) versus clinic-based FB-CBT in the treatment of children ages 4-8 with OCD (N = 22). Pretreatment, posttreatment, and 6-month follow-up assessments included mother-/therapist-reports and independent evaluations masked to treatment condition. Primary analyses focused on treatment retention, engagement and satisfaction. Hierarchical linear modeling preliminarily evaluated the effects of time, treatment condition, and their interactions. "Excellent response" was defined as a 1 or 2 on the Clinical Global Impressions-Improvement Scale. Results Treatment retention, engagement, alliance and satisfaction were high across conditions. Symptom trajectories and family accommodation across both conditions showed outcomes improving from baseline to posttreatment, and continuing through follow-up. At posttreatment, 72.7% of Internet cases and 60% of Clinic cases showed "excellent response," and at follow-up 80% of Internet cases and 66.7% of Clinic cases showed "excellent response." Significant condition differences were not found across outcomes. Conclusions VTC methods may offer solutions to overcoming traditional barriers to care for early onset OCD by extending the reach of real-time expert services regardless of children's geographic proximity to quality care. (PsycINFO Database Record

Intolerance of uncertainty (IU), a dispositional negative orientation toward uncertainty and its consequences, has been studied in adults, but research has only recently examined IU in youth. Despite some advances, little is known about the factor structure of measures of IU in youth. The present study used confirmatory factor analysis to examine the structure of IU as measured by the Intolerance of Uncertainty Scale for Children (IUSC; Comer et al., 2009) in a sample of youth (N=368) 9-18 years of age (Mage=12.47) with and without anxiety disorders and their mothers. Findings demonstrated multiple acceptable factor structures: a correlated factors 2-factor structure and a bifactor model where a general factor underlies all items. While the bifactor model provides better fit and reliability to the data, multivariate analyses indicated that the 2-factor structure distinguishes apprehensive anxiety regarding future events (prospective IU) from present-focused inhibition of behavior due to uncertainty and negative reactions to the presence of uncertainty (inhibitory IU); a total IU score predicted all anxiety domains for self- and parent-reports except for parent-report harm avoidance. Findings are discussed in terms of consistency of IU across adult and youth samples, and how results can inform treatment efforts and etiologic models of IU and anxiety.

Teacher-Child Interaction Training (TCIT), adapted from Parent-Child Interaction Therapy (PCIT), is a classroom-based program designed to provide teachers with behavior management skills that foster positive teacher-student relationships and to improve student behavior by creating a more constructive classroom environment. The purpose of this pilot study was to evaluate TCIT in more classrooms than previously reported in the literature, with older children than previously reported, using random assignment of classrooms to TCIT or to a no-TCIT control condition and conducting all but two sessions within the classroom to enhance feasibility. Participants included 11 kindergarten and first grade classroom teachers and their 118 students from three urban, public schools in Manhattan, with five classrooms randomly assigned to receive TCIT and six to the no-TCIT control condition. Observations of teacher skill acquisition were conducted before, during, and after TCIT for all 11 teachers, and teacher reports of student behavior were obtained at these same time points. Teacher satisfaction with TCIT was assessed following training. Results suggested that after receiving TCIT, teachers increased rates of positive attention to students' appropriate behavior, decreased rates of negative attention to misbehavior, reported significantly less distress related to student disruptive behavior, and reported high satisfaction with the training program. Our study supports the growing evidence-base suggesting that TCIT is a promising approach for training teachers in positive behavior management strategies and for improving student disruptive behavior in the classroom.