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A new psychotherapy called The Cortina Method (TCM) has been developed to treat PTSD in one session, offering relief to patients with persistent symptoms of PTSD. This therapy, based on memory reconsolidation, does not require patients to recall past traumas in detail, making it more accessible to those who find reciting traumatic experiences too painful. Testimonials from patients and therapists suggest that TCM has been effective in providing relief from anxiety and trauma-related symptoms, with a reported effectiveness rate of 90%. Further research is needed to compare TCM with other standard therapies and to assess long-term results. [Extracted from the article]

The present paper aims to conduct an experiment that compares different methods of detecting objects in images. Programs were developed to evaluate the efficiency of SURF, BRISK, MSER, and ORB object detection methods. Four static gray images with sufficiently different histograms were used. The experiment also highlighted the need for image preprocessing to improve feature extraction and detection. Thus, a programmed method for adjusting pixel groups was developed. This method proved useful when one of the listed algorithms failed to detect the object in the original image, but succeeded after adjustment. The effectiveness of detection methods and the evaluation of their performance depend on the application, image preparation, algorithms used, and their implementation. Results of the detection methods were presented numerically (similarities, gradients, distances, etc.) and graphically.

Background: 3q29 deletion syndrome (3q29del) is a rare (~1:30 000) genomic disorder associated with a wide array of neurodevelopmental and psychiatric phenotypes. Prior work by our team identified clinically significant executive function (EF) deficits in 47% of individuals with 3q29del; however, the nuances of EF in this population have not been described. Methods: We used the Behavior Rating Inventory of Executive Function (BRIEF) to perform the first in-depth assessment of real-world EF in a cohort of 32 individuals with 3q29del (62.5% male, mean age = 14.5 ± 8.3 years). All participants were also evaluated with gold-standard neuropsychiatric and cognitive assessments. High-resolution structural magnetic resonance imaging was performed on a subset of participants (n = 24). Results: We found global deficits in EF; individuals with 3q29del scored higher than the population mean on the BRIEF global executive composite (GEC) and all subscales. In total, 81.3% of study subjects (n = 26) scored in the clinical range on at least one BRIEF subscale. BRIEF GEC T scores were higher among 3q29del participants with a diagnosis of attention deficit/hyperactivity disorder (ADHD), and BRIEF GEC T scores were associated with schizophrenia spectrum symptoms as measured by the Structured Interview for Psychosis-Risk Syndromes. BRIEF GEC T scores were not associated with cognitive ability. The BRIEF-2 ADHD form accurately (sensitivity = 86.7%) classified individuals with 3q29del based on ADHD diagnosis status. BRIEF GEC T scores were correlated with cerebellar white matter and subregional cerebellar cortex volumes. Conclusions: Together, these data expand our understanding of the phenotypic spectrum of 3q29del and identify EF as a core feature linked to both psychiatric and neuroanatomical features of the syndrome. [ABSTRACT FROM AUTHOR]

Qur'anic methods are the beacon of linguistic methods and the arena of scientific linguistic research for applied stylistic studies and others. The Qur'an is everyone's table, and through it valleys flow to their capacity; Therefore, our modest research stream has adopted in the first place the method of interpretive brevity in the Holy Qur'an, which is a method that summarizes the details or summarizes the discourse to clarify the intended meaning through convincing linguistic brevity, thus giving confirmation, clarification, or an addition to the statement, with artistic repetition that is not boring because it rearranges the words that it summarizes in a new formulation. Whether the speech he summarizes is long or short, here it lies The importance of revealing these aesthetic methods, with the aim of showing the aspects of enjoyment and creativity in the methods of the Holy Qur'an, as well as its eloquence and miracle. Surah Al-Baqarah - specifically - was the field of research. It has been shown that interpretive brevity has an impact on interpretation in terms of assistance in clarifying what is meant and that it It is completely consistent with the human nature of speech, as each speaker, after detail, summarizes the intended meaning in a statement, which is what we are doing now in this summary of the research (that is, this is the summary of the research.) Keywords: (brief / summary / stylistic / application / brevity in the Holy Qur'an / Surah Al-Baqarah / interpretation). [ABSTRACT FROM AUTHOR]

We created a brief version of The Index, a validated patient-reported measure that has potential to quickly identify patients at risk for poor retention. We analyzed Index scores from 2406 patients from 2016 to 2017 in a national cohort of patients in human immunodeficiency virus (HIV) care. Index scores predicted poor retention 12 months after administered.

The project Correspondence of Early Romanticism is dedicated to the potential of digitally supported analyses of letters from the years 1790 to 1802. It uses letter editions of key players in early Romanticism, closes gaps and provides full texts and homogeneous metadata. The gradually emerging corpus of around 7,500 letters will be evaluated using network analysis. In this contribution, initial graphical representations, using the example of greeting instructions in letters, shed light on the structure of the Romantic network of communication. The article discusses techniques of semantic annotation as a form of knowledge representation with a focus on the connexions we have introduced, which reproduce letter statements in the form of triples or quadruples.

The present paper aims to conduct an experiment that compares different methods of detecting objects in images. Programs were developed to evaluate the efficiency of SURF, BRISK, MSER, and ORB object detection methods. Four static gray images with sufficiently different histograms were used. The experiment also highlighted the need for image preprocessing to improve feature extraction and detection. Thus, a programmed method for adjusting pixel groups was developed. This method proved useful when one of the listed algorithms failed to detect the object in the original image, but succeeded after adjustment. The effectiveness of detection methods and the evaluation of their performance depend on the application, image preparation, algorithms used, and their implementation. Results of the detection methods were presented numerically (similarities, gradients, distances, etc.) and graphically. [ABSTRACT FROM AUTHOR]

The Pediatric Quality of Life Inventory-Cognitive Functioning Scale (PedsQLTM-CFS) was developed as a brief, general, symptom-specific tool to measure cognitive function. The 6-item PedsQL™ Cognitive Functioning Scale and PedsQL 3.0 Cancer Module answered 369 parents and 330 children with 5–18 years. Parents also completed Behavior Rating Inventory of Executive Function (BRIEF). The PedsQL™ Cognitive Functioning Scale evidenced excellent reliability (parent proxy-report α = 0.980/Fleiss Kappa: 0.794; children self-report α = 0.963/Fleiss Kappa: 0.790). Both child self-report and parent proxy-report PedsQL™ Cognitive Functioning Scale scores exhibited significant correlations with all parent-report BRIEF summary and subscale scores (p < .05). Both child self-report and parent proxy-report PedsQL™ Cognitive Functioning Scale scores exhibited significant correlations with PedsQL 3.0 Cancer Module total score and subscale scores (p < .05). The PedsQLTM-CFS can be used in high-risk populations with substantial to perfect reliability, both in regards to total/subcategory scores as well as in children with cancer. [ABSTRACT FROM AUTHOR]

Purpose: Most children who enter out-of-home care (OHC) have been subjected to prolonged maltreatment. Maltreatment potentially contributes to a cumulative deficit in neurocognitive maturation and development that is likely to proceed with the child's placement into OHC and persist throughout adulthood. From the theoretical perspective of how maltreatment may affect the developing brain, this study examines the IQ and executive function of children placed in OHC on standardized, norm-referenced measures. Furthermore, the study investigates the prevalence of serious cognitive delays, defined by scores in the clinical range on the administered instruments. Methods: The study included 153 children in foster care (66% female), aged 6–15 (M = 10.5, SD = 2.1). Independent two-sample t-tests were run to test for significant differences between the sample and the norm population on the applied neuropsychological measures. Results: The results showed that discrepancies in cognitive development were global in scope, with the children lagging significantly behind the norm population on all applied measures with discrepancies ranging from 0.61 to 2.10 SD (p <.001). Also, serious developmental delays in all cognitive domains were vastly overrepresented in the sample ranging from 11.3% (IQ) to 66.0% (executive function). Conclusions: The results document a very high prevalence of cognitive deficits and delays among the children in the sample. The implications of identifying the neurocognitive effects of maltreatment in the practices of the child welfare system are discussed in terms of developing suitable assessment and intervention strategies. [ABSTRACT FROM AUTHOR]

Biometric cryptosystem (BCS) is an emerging field which performs user authentication in a secured environment. User authentication is handled using Biometrics and security using Cryptography, thus together forms BCS. Furthermore, the use of biometrics eliminates the need to remember passwords. The features extracted from the user's biometric are used in place of a password for user authentication. BCS unleashes the key from the secured place upon successful user authentication. This paper proposes a novel method called binary robust independent elementary features based biometric cryptosystem (BRIEFBCS) for biometric key generation. The proposed method relies on a well known cryptographic construct, Fuzzy vault scheme, for data security. The motivation behind using BRIEF scheme for biometric cryptosystem is that the obtained descriptor are compact in size, faster to implement and suitable for low memory devices. BRIEFBCS comprises of three levels, i.e., Key generation, Enrollment and Authentication. The experiments have been carried on five ear databases viz. AMI, CP, IITD-v1, IITD-v2 and USTB-v2. The proposed method's performance is evaluated and compared to state-of-the-art methods in terms of accuracy, false reject rate, vault construction time, key recovery time and Receiver Operating Characteristics curve. The proposed method has been demonstrated to outperform numerous state-of-the-art methods in both qualitative and quantitative aspects. [ABSTRACT FROM AUTHOR]

The objective of this study was to assess the efficacy of the Play Nicely brief intervention in diminishing both the utilization of physical punishment and the beliefs that endorse such behavior among a sample of Colombian parents with children aged 2 to 6. Utilizing a quasi-experimental design, the research included pretest and posttest evaluations and involved both an intervention group (n = 37) and a control group (n = 29). The assessment tools used were a scale to measure beliefs about the positive impacts of physical punishment and the Physical Assault subscale of the Spanish version of the Conflict Tactics Scale Parent–Child (CTSPC). Parents participated in a single online session, which offered eight interactive options and lasted 10 min. The results highlighted a high prevalence of physical punishment within the sample (81.8%) and established statistically significant correlations between the justification of physical punishment and its actual use. Approximately one month following the intervention, there was a significant reduction in the employment of physical punishment among the intervention group (p = 0.009), and a notable decrease in the belief that "Punishment is the best alternative to control children's behavior" (p = 0.010) was observed. Consequently, the Play Nicely intervention proved effective in curtailing the use of physical punishment among parents of young children, demonstrating both efficacy and cost-effectiveness within a brief timeframe. [ABSTRACT FROM AUTHOR]

Replicated evidence shows a weak or non-significant correlation between different methods of evaluating executive functions (EF). The current study investigates the association between rating scales and cognitive tests of EF in a sample of children with ADHD and executive dysfunction.

Abstract Background The access to and uptake of evidence-based behavioral parent training for children with behavioral difficulties (i.e., oppositional, defiant, aggressive, hyperactive, impulsive, and inattentive behavior) are currently limited because of a scarcity of certified therapists and long waiting lists. These problems are in part due to the long and sometimes perceived as rigid nature of most evidence-based programs and result in few families starting behavioral parent training and high dropout rates. Brief and individually tailored parenting interventions may reduce these problems and make behavioral parent training more accessible. This protocol paper describes a two-arm, multi-center, randomized controlled trial on the short- and longer-term effectiveness and cost-effectiveness of a brief, individually tailored behavioral parent training program for children with behavioral difficulties. Methods Parents of children aged 2–12 years referred to a child mental healthcare center are randomized to (i) three sessions of behavioral parent training with optional booster sessions or (ii) care as usual. To evaluate effectiveness, our primary outcome is the mean severity of five daily ratings by parents of four selected behavioral difficulties. Secondary outcomes include measures of parent and child behavior, well-being, and parent–child interaction. We explore whether child and parent characteristics moderate intervention effects. To evaluate cost-effectiveness, the use and costs of mental healthcare and utilities are measured. Finally, parents’ and therapists’ satisfaction with the brief program are explored. Measurements take place at baseline (T0), one week after the brief parent training, or eight weeks after baseline (in case of care as usual) (T1), and six months (T2) and twelve months (T3) after T1. Discussion The results of this trial could have meaningful societal implications for children with behavioral difficulties and their parents. If we find the brief behavioral parent training to be more (cost-)effective than care as usual, it could be used in clinical practice to make parent training more accessible. Trial registration The trial is prospectively registered at ClinicalTrials.gov (NCT05591820) on October 24th, 2022 and updated throughout the trial.

Abstract Background Preliminary evidence shows promising treatment outcomes at short-term follow-up for intensive posttraumatic stress disorder (PTSD) treatment, but long-term follow-up studies are sparse. This study is a sequel to a previous pilot study and open trial, set out to investigate treatment outcomes at 12-month follow-up for outpatients completing an 8-day intensive treatment for PTSD. Methods All patients were diagnosed with PTSD and had multiple previous psychotherapy attempts (M = 3.1). Patients were assessed at pre-treatment, post-treatment, 3- and 12-month follow-up. Of 35 treated patients, 32 (91.4%) attended the long-term follow-up assessment. The treatment programme combined prolonged exposure therapy, eye movement desensitization and reprocessing, and physical activity. Results The effect sizes indicated large reductions in symptoms of PTSD, depression, anxiety, interpersonal problems, and well-being. Changes in functioning showed a small-medium effect. Results were stable across the follow-up period. The treatment response rates showed that 46–60% of patients achieved recovery with respect to PTSD symptoms, and that 44–48% no longer met diagnostic criteria for PTSD. Conclusions Time-limited and concentrated outpatient treatment for PTSD can yield large and enduring positive outcomes. Controlled trials are needed to establish relative efficacy. Trial registration The study was registered in Current Research Information System In Norway (Cristin). Cristin-project-ID: 654,790. Date of registration: 18.03.2019.

The aim of the present investigation was to provide insight into how postconcussion symptomatology may be altered in individuals exhibiting attention-deficit/hyperactivity disorder (ADHD)-related behaviors and examine factors that may be responsible for driving such relationships. A total of 99 individuals were assessed during the subacute phase of concussion recovery. Inattentive symptomatology, but not diagnosis of ADHD, was related to greater concussion-symptom severity and overall symptoms endorsed. Cluster and factor analyses highlighted that the relationship between ADHD symptomatology and concussion symptomatology was not a function of overlapping constructs being assessed (i.e., concussion-related symptomatology was not a proxy of ADHD-related symptomatology). These relationships were not mediated by parental observations of impairments in behaviors associated with executive functioning (i.e., executive dysfunction was not driving the greater concussion-related symptomatology associated with ADHD-related symptomatology). These findings highlight the importance of moving beyond categorical frameworks of ADHD to, instead, consider the continuum of underlying behaviors. [ABSTRACT FROM AUTHOR]

Background: There are many barriers to engaging in current psychological treatments, including time, cost, and availability. Ultra-brief treatments overcome some of these barriers by delivering therapeutic information and skills using significantly less time than standard-length treatments. We developed a therapist-guided online ultra-brief treatment for depression and anxiety and compared it to an existing 8-week, 5-lesson therapist-guided standard-length treatment and a waitlist control. Methods: In a randomized controlled trial, adults with self-reported depression or anxiety were randomized (1:1:1) to the ultra-brief treatment, standard-length treatment, or waitlist control. The primary outcomes were depression symptoms and anxiety symptoms assessed at baseline, 5-weeks later, 9-weeks later (primary timepoint), and 3-months later. The trial was prospectively registered. Results: Between 7 February 2022, and 16 August 2022, 242 participants were enrolled in the ultra-brief treatment (n = 85), standard-length treatment (n = 80), and waitlist control (n = 77). Participants were mostly women with an average age of 48.56 years. At 9-weeks post-baseline, participants in the ultra-brief treatment group reported significantly lower depression (between groups d = 0.41) and anxiety (d = 0.53) than the waitlist control. The ultra-brief treatment was non-inferior for anxiety at both 9-weeks and 3-months follow-up. Non-inferiority for depression was observed at 9-weeks. Conclusions: The online ultra-brief treatment resulted in significant reductions in depression and anxiety that were non-inferior to a longer treatment course after 9-weeks. Remotely delivered ultra-brief treatments have the potential to provide accessible and effective care for those who cannot, or would prefer not to, access longer psychological interventions. [ABSTRACT FROM AUTHOR]

Problems with executive function (EF) are considered a hallmark of Attention-Deficit/Hyperactivity Disorder (ADHD) and Autism Spectrum Disorder (ASD). However, little is known about the developmental pathway of everyday EF in these two groups, and whether the two groups follow a similar or different developmental course. In this longitudinal study, children and adolescents with ADHD (n = 84, Mage = 11.6, SD = 2.0), ASD (n = 38, Mage = 12.0, SD = 2.3), and typically developing children (TDC; n = 50, Mage = 11.6, SD = 2.0) were clinically diagnosed and assessed with parent-ratings of everyday EF at baseline and at two-year follow-up (97% retention). Results showed that both individuals with ADHD and individuals with ASD displayed elevated levels of everyday EF problems relative to the TDC at baseline (Hedges g = 1.99 to 2.99). Over the two-year period, everyday EF improved in individuals with ADHD relative to the TDC, whereas individuals with ASD displayed no improvement relative to the TDC. At two-year follow-up, individuals with ADHD and individuals with ASD continued to display elevated levels of everyday EF problems relative to the TDC (Hedges g = 1.61 to 3.19). [ABSTRACT FROM AUTHOR]

Background: Preliminary evidence shows promising treatment outcomes at short-term follow-up for intensive posttraumatic stress disorder (PTSD) treatment, but long-term follow-up studies are sparse. This study is a sequel to a previous pilot study and open trial, set out to investigate treatment outcomes at 12-month follow-up for outpatients completing an 8-day intensive treatment for PTSD. Methods: All patients were diagnosed with PTSD and had multiple previous psychotherapy attempts (M = 3.1). Patients were assessed at pre-treatment, post-treatment, 3- and 12-month follow-up. Of 35 treated patients, 32 (91.4%) attended the long-term follow-up assessment. The treatment programme combined prolonged exposure therapy, eye movement desensitization and reprocessing, and physical activity. Results: The effect sizes indicated large reductions in symptoms of PTSD, depression, anxiety, interpersonal problems, and well-being. Changes in functioning showed a small-medium effect. Results were stable across the follow-up period. The treatment response rates showed that 46–60% of patients achieved recovery with respect to PTSD symptoms, and that 44–48% no longer met diagnostic criteria for PTSD. Conclusions: Time-limited and concentrated outpatient treatment for PTSD can yield large and enduring positive outcomes. Controlled trials are needed to establish relative efficacy. Trial registration: The study was registered in Current Research Information System In Norway (Cristin). Cristin-project-ID: 654,790. Date of registration: 18.03.2019. [ABSTRACT FROM AUTHOR]

Background: The access to and uptake of evidence-based behavioral parent training for children with behavioral difficulties (i.e., oppositional, defiant, aggressive, hyperactive, impulsive, and inattentive behavior) are currently limited because of a scarcity of certified therapists and long waiting lists. These problems are in part due to the long and sometimes perceived as rigid nature of most evidence-based programs and result in few families starting behavioral parent training and high dropout rates. Brief and individually tailored parenting interventions may reduce these problems and make behavioral parent training more accessible. This protocol paper describes a two-arm, multi-center, randomized controlled trial on the short- and longer-term effectiveness and cost-effectiveness of a brief, individually tailored behavioral parent training program for children with behavioral difficulties. Methods: Parents of children aged 2–12 years referred to a child mental healthcare center are randomized to (i) three sessions of behavioral parent training with optional booster sessions or (ii) care as usual. To evaluate effectiveness, our primary outcome is the mean severity of five daily ratings by parents of four selected behavioral difficulties. Secondary outcomes include measures of parent and child behavior, well-being, and parent–child interaction. We explore whether child and parent characteristics moderate intervention effects. To evaluate cost-effectiveness, the use and costs of mental healthcare and utilities are measured. Finally, parents' and therapists' satisfaction with the brief program are explored. Measurements take place at baseline (T0), one week after the brief parent training, or eight weeks after baseline (in case of care as usual) (T1), and six months (T2) and twelve months (T3) after T1. Discussion: The results of this trial could have meaningful societal implications for children with behavioral difficulties and their parents. If we find the brief behavioral parent training to be more (cost-)effective than care as usual, it could be used in clinical practice to make parent training more accessible. Trial registration: The trial is prospectively registered at ClinicalTrials.gov (NCT05591820) on October 24th, 2022 and updated throughout the trial. [ABSTRACT FROM AUTHOR]

Objective: We leveraged common genetic variation underlying ADHD, educational attainment (EA) and cognition (COG) to understand the nature of the Behavior Rating Inventory for Executive Functions (BRIEF) and its relationship to academic functioning. Method: Participants were 991 youth, ages 7 to 17, consecutively referred for neuropsychiatric evaluation. Polygenic scores (PGS) for ADHD, EA, and COG were related to the BRIEF using regression analyses. Structural equation models were used to examine the associations between the PGS, BRIEF and academic outcomes (math, reading, and special education services [EDPLAN]). Results: After modeling the PGS together, only the EA and ADHD PGS significantly associated with the BRIEF. The BRIEF partially mediated the relationships between EA PGS with math and EDPLAN and fully mediated the relationship between ADHD PGS and EDPLAN. Conclusion: Genetic data extend evidence that the BRIEF measures a construct relevant to educational success that differs from what is indexed by cognitive testing. [ABSTRACT FROM AUTHOR]

Executive functions (EF) deficits are well documented in children at familial high risk of schizophrenia (FHR-SZ), and to a lesser degree in children at familial high risk of bipolar disorder (FHR-BP). The aim of this study was to assess EF development in preadolescent children at FHR-SZ, FHR-BP and population-based controls (PBC) using a multi-informant rating scale. A total of 519 children (FHR-SZ, n = 201; FHR-BP, n = 119; PBC, n = 199) participated at age 7, at age 11 or at both time points. Caregivers and teachers completed the Behavior Rating Inventory of Executive Functions (BRIEF). The developmental pattern from age 7 to age 11, did not differ between groups. At age 11, caregivers and teachers rated children at FHR-SZ as having widespread EF deficits. A higher proportion of children at FHR-SZ had clinically significant scores on the General executive composite (GEC) and all BRIEF indices compared to PBC. According to the caregivers, children at FHR-BP had significantly more EF deficits than PBC on 9 out of 13 BRIEF scales, whereas according to teachers, they only had significantly more deficits on one subdomain (Initiate). Likewise, caregivers rated a significantly higher proportion of children at FHR-BP above the clinical cut-off on the GEC and Metacognition index, compared to PBC, whereas there were no significant differences according to teachers. This study highlights the relevance of including multi-informant rating scales in the assessment of EF in children at FHR-SZ and FHR-BP. The results imply a need to identify children at high risk who would benefit from targeted intervention. [ABSTRACT FROM AUTHOR]

Nowadays, most artificial intelligence applications are feature-based. Hence, the feature extraction field is regarded as a broad, constantly evolving research field. Many of these applications, including image classification, retrieval, and others, depend on the feature extraction as a crucial step. The feature extraction algorithms encounter several difficulties related to image type, content, size, and others. These difficulties directly influence the efficiency, accuracy, scalability, and speed of applications. Thus, a thorough research of the entire domain of feature extraction methods is required to close the gap between the performance of such methods and the requirements of different applications, especially with the substitution of several feature detection and extraction methods. This paper is a step forward in accommodating and understanding the majority of the visual feature traits to make the choice between extraction methods easier. It introduces a detailed assessment of several feature extraction methods under different conditions and from different perspectives. Consequently, several contributions are included. First, the vulnerability of methods to image redundancy is evaluated through the measurement of similarity matching between calculated descriptors by each method for different types of image content. Second, the method strength is examined against object rotation and flipping within the images. Finally, the efficacy of object distinguishability is assessed in noisy and rotated flipped images. Furthermore, the computational complexity of the methods involved is examined to assess their influence on system complexity, and their efficiency is also ensured. [ABSTRACT FROM AUTHOR]

Background: Health literacy is the degree to which individuals can obtain, process, understand, and communicate health-related information. Health literacy among pregnant women, in particular, may have a significant impact on maternal and child health. In the United Arab Emirates, no previous studies have been carried out to investigate the health literacy levels of pregnant women. Objective: This study aimed to investigate antenatal health literacy levels and identify associated factors among pregnant Emirati women in the United Arab Emirates. Design: This analysis was based on the baseline cross-sectional data for pregnant women participating in the prospective cohort Mutaba'ah Study, recruited between May 2017 and August 2022. Methods: Participants completed a self-administered questionnaire during their antenatal visits that collected sociodemographic and pregnancy-related information. Adequacy of health literacy was assessed using the BRIEF health literacy screening tool with adequate health literacy defined as a score ⩾ 17. Regression modeling investigated the association between the pregnant women characteristics with having adequate health literacy level (ability to read and comprehend most patient education materials). Results: A total of 2694 responses to the BRIEF health literacy screening tool were analyzed. Approximately, three-quarters (71.6%) of respondents showed adequate health literacy, followed by marginal (22.8%), and limited (5.6%) health literacy levels, respectively. Higher education levels (adjusted odds ratio (aOR) = 1.74, 95% confidence interval = 1.46–2.08), employment (adjusted odds ratio = 1.35, 95% confidence interval = 1.10–1.65), and adequate social support (adjusted odds ratio = 1.69, 95% confidence interval = 1.26–2.28) were associated with adequate health literacy levels. Participants who expressed worry about birth were less likely to have adequate literacy levels (adjusted odds ratio = 0.70, 95% confidence interval = 0.58–0.85). Conclusion: Nearly three-quarters of pregnant women have adequate health literacy. Nevertheless, measures including policies to sustain and enhance health literacy levels among all expectant mothers are required, with a specific focus on those having limited health literacy. [ABSTRACT FROM AUTHOR]

ObjectiveThe current study applies a precision medicine approach to trigeminal nerve simulation (TNS), a Food and Drug Administration-approved neuromodulation treatment for attention-deficit/hyperactivity disorder (ADHD), by testing secondary outcomes of cognitive and electroencephalographic [EEG] predictors of treatment response among subjects from the original randomized controlled trial.MethodChildren aged 8 to 12 years with ADHD, were randomized to 4 weeks of active or sham TNS treatment, after which the sham group crossed over into 4 weeks of open-label treatment. TNS treatment responders (RESP) had an ADHD Rating Scale (ADHD-RS) Total score reduction of ≥25%, whereas nonresponders (NR) had

RationaleChronic health conditions (CHCs) are costly and difficult to manage. Patients often struggle with behavioral adherence to complex treatment regimens and experience psychiatric distress. Acceptance and Commitment Therapy (ACT) is a transdiagnostic behavioral approach that aims to improve functioning and quality of life (QoL), which are important treatment outcomes for this population. Preliminary efficacy of multi-session ACT in patients with CHCs has been demonstrated, and single-session ACT interventions have since been developed to increase feasibility, acceptability, and accessibility. The purpose of this systematic review and meta-analysis was to describe the literature on single-session ACT intervention studies in CHC populations with regards to (1) study design and methodology, (2) patient characteristics and conditions targeted, and (3) efficacy for outcomes across various domains, using narrative and quantitative methods.MethodsPsycINFO, PubMed, and Web of Science were systematically searched in August 2020. Studies of single-session ACT interventions in adult patients with CHCs that reported quantitative outcomes in any of the following domains were included: (a) functioning and related domains (e.g., disability, QoL, well-being); (b) mental health; (c) physical health; (d) ACT processes. Both controlled and uncontrolled studies were included. Study quality was assessed using the Psychotherapy Outcome Study Methodology Rating Scale (POMRF). Between-group random effects meta-analysis was conducted on general functioning outcomes.ResultsFourteen manuscripts reporting outcomes from 13 studies (N = 793) met inclusion criteria. Ten studies were identified by their authors as pilot or feasibility trials. Eight studies used comparison or control groups. Twelve studies delivered the ACT content in workshop format. Studies recruited for a variety of conditions. Narrative review found that between- and within-group effect sizes showed generally positive results favoring single-session ACT overall (69%), especially for measures of functioning and related domains (88%), mental health (67%), and ACT processes (73%). Meta-analysis found that ACT did not significantly outperform comparison groups on measures of general functioning (Hedges' g: -0.51, 95% confidence interval: [-1.19, 0.16]; I 2 = 86%; K = 5) despite a medium-sized pooled effect.DiscussionUse of single-session ACT interventions in CHC populations is an emergent field. There is preliminary evidence for the acceptability, feasibility, and efficacy of these interventions, which provides support for further testing in fully-powered RCTs. Additional RCTs will enable larger meta-analyses and stronger conclusions about efficacy. Recommendations for future trials are provided.

The objective of this study was to assess the efficacy of the Play Nicely brief intervention in diminishing both the utilization of physical punishment and the beliefs that endorse such behavior among a sample of Colombian parents with children aged 2 to 6. Utilizing a quasi-experimental design, the research included pretest and posttest evaluations and involved both an intervention group (n = 37) and a control group (n = 29). The assessment tools used were a scale to measure beliefs about the positive impacts of physical punishment and the Physical Assault subscale of the Spanish version of the Conflict Tactics Scale Parent–Child (CTSPC). Parents participated in a single online session, which offered eight interactive options and lasted 10 min. The results highlighted a high prevalence of physical punishment within the sample (81.8%) and established statistically significant correlations between the justification of physical punishment and its actual use. Approximately one month following the intervention, there was a significant reduction in the employment of physical punishment among the intervention group (p = 0.009), and a notable decrease in the belief that “Punishment is the best alternative to control children’s behavior” (p = 0.010) was observed. Consequently, the Play Nicely intervention proved effective in curtailing the use of physical punishment among parents of young children, demonstrating both efficacy and cost-effectiveness within a brief timeframe.

BackgroundThe development of mobile computing technology has enabled the delivery of psychological interventions while people go about their everyday lives. The original visions of the potential of these "ecological momentary interventions" were presented over a decade ago, and the widespread adoption of smartphones in the intervening years has led to a variety of research studies exploring the feasibility of these aspirations. However, there is a dearth of research describing the different dimensions, characteristics, and features of these interventions, as constructed.ObjectiveTo provide an overview of the definitions given for "ecological momentary interventions" in the treatment of common mental health disorders, and describe the set of technological and interaction possibilities which have been used in the design of these interventions.MethodsA systematic search identified relevant literature published between 2009 and 2020 in the PubMed, PsycInfo, and ACM Guide to the Computing Literature databases. Following screening, data were extracted from eligible articles using a standardized extraction worksheet. Selected articles were then thematically categorized.ResultsThe search identified 583 articles of which 64 met the inclusion criteria. The interventions target a range of mental health problems, with diverse aims, intervention designs and evaluation approaches. The studies employed a variety of features for intervention delivery, but recent research is overwhelmingly comprised of studies based on smartphone apps (30 of 42 papers that described an intervention). Twenty two studies employed sensors for the collection of data in order to provide just-in-time support or predict psychological states.ConclusionsWith the shift towards smartphone apps, the vision for EMIs has begun to be realised. Recent years have seen increased exploration of the use of sensors and machine learning, but the role of humans in the delivery of EMI is also varied. The variety of capabilities exhibited by EMIs motivates development of a more precise vocabulary for capturing both automatic and human tailoring of these interventions.

Background: Postpartum depression (PPD) affects up to one in five mothers and birthing parents, yet as few as 10% access evidence-based treatment. One-day cognitive behavioral therapy (CBT)-based workshops for PPD have the potential to reach large numbers of sufferers and be integrated into stepped models of care. Methods: This randomized controlled trial of 461 mothers and birthing parents in Ontario, Canada with Edinburgh Postnatal Depression Scale (EPDS) scores ⩾10, age ⩾18 years, and an infant <12 months of age compared the effects of a 1-day CBT-based workshop plus treatment as usual (TAU; i.e. care from any provider(s) they wished) to TAU alone at 12-weeks post-intervention on PPD, anxiety, the mother–infant relationship, offspring behavior, health-related quality of life, and cost-effectiveness. Data were collected via REDCap. Results: Workshops led to meaningful reductions in EPDS scores (m = 15.77 to 11.22; b = −4.6, p < 0.01) and were associated with three times higher odds of a clinically significant decrease in PPD [odds ratio (OR) 3.00, 95% confidence interval (CI) 1.93–4.67]. Anxiety also decreased and participants had three times the odds of clinically significant improvement (OR 3.20, 95% CI 2.03–5.04). Participants reported improvements in mother–infant bonding, infant-focused rejection and anger, and effortful control in their toddlers. The workshop plus TAU achieved similar quality-adjusted life-years at lower costs than TAU alone. Conclusions: One-day CBT-based workshops for PPD can lead to improvements in depression, anxiety, and the mother–infant relationship and are cost-saving. This intervention could represent a perinatal-specific option that can treat larger numbers of individuals and be integrated into stepped care approaches at reasonable cost. [ABSTRACT FROM AUTHOR]

Executive function and processing speed difficulties are observed in children living with sickle cell anemia (SCA). The influence of processing speed on executive function is not well understood. We recruited 59 children living with SCA and 24 matched controls aged 8–18 years between 2010 and 2016 from clinics in the UK. Children completed tests in processing speed and cognitive flexibility, subdomains of executive function. MRI scans were conducted within one year of testing; oxygen saturation was obtained on the day of testing. Hemoglobin levels were obtained from medical records. Caregivers completed the executive function questionnaire. Hierarchical linear regressions found that hemoglobin, oxygen saturation, age, infarct status, and processing speed were not independent predictors for any model. However, for all cognitive flexibility tests, there was a significant interaction between infarct status and processing speed; children without silent cerebral infarction (SCI) with faster processing speed had better cognitive flexibility. Our findings indicate that, when interpreting executive function difficulties, it is important to account for the relationship between SCI status and processing speed. More research is needed to elucidate the mechanisms, but clinically, including executive function testing as part of clinic visits by embedding psychologists within the healthcare team would appear to be a critical step. [ABSTRACT FROM AUTHOR]

The Conners' Continuous Performance Test – Second Edition (CPT-II) has demonstrated utility as a performance validity test (PVT). Early research also identified several benefits of repeat administration. This study was designed to evaluate the potential of repeat administrations of the CPT-II to enhance its clinical utility in detecting ADHD or non-credible responding. Data were collected from a consecutive case sequence of 100 patients (MAge = 41.5; MEducation = 13.8) referred for neuropsychological assessment. Performance validity was psychometrically defined using a combination of free-standing and embedded PVTs. The CPT-II was administered twice to all patients: once in the morning and once at the end of the testing appointment. Data supported previously identified validity cutoffs for the CPT-II, with the notable exception of Commission errors. Patients with ADHD were less likely to fail validity cutoffs than those without ADHD, suggesting that ADHD alone does not explain failure on PVTs. At Time 1, the CPT-II was insensitive to a clinical diagnosis of ADHD; at Time 2, only one significant contrast emerged. Self-report measures more effectively differentiated between patients with and without ADHD. Test-retest reliability was generally higher in patients with valid performance (0.33-0.83) compared to those with invalid performance (0.38-0.77), with notable variation across scales. Two sets of CPT-II scores increased confidence in the ADHD diagnosis and the remainder of the neurocognitive profile. The CPT-II is self-administered and automatically scored, making routine double administration more practical than might first be thought. [ABSTRACT FROM AUTHOR]

Objectives: The public health impact of the Irish Making Every Contact Count (MECC) brief intervention programme is dependent on delivery by health care professionals. We aimed to identify enablers and modifiable barriers to MECC intervention delivery to optimize MECC implementation. Design: Online cross‐sectional survey design. Methods: Health care professionals (n = 4050) who completed MECC eLearning were invited to complete an online survey based on the Theoretical Domains Framework (TDF). Multiple regression analysis identified predictors of MECC delivery (logistic regression to predict delivery or not; linear regression to predict frequency of delivery). Data were visualized using Confidence Interval‐Based Estimates of Relevance (CIBER). Results: Seventy‐nine per cent of participants (n = 283/357) had delivered a MECC intervention. In the multiple logistic regression (Nagelkerke's R2 =.34), the significant enablers of intervention delivery were 'professional role' (OR = 1.86 [1.10, 3.15]) and 'intentions/goals' (OR = 4.75 [1.97, 11.45]); significant barriers included 'optimistic beliefs about consequences' (OR =.41 [.18,.94]) and 'negative emotions' (OR =.50 [.32,.77]). In the multiple linear regression (R2 =.29), the significant enablers of frequency of MECC delivery were 'intentions/goals' (b = 10.16, p =.02) and professional role (b = 6.72, p =.03); the significant barriers were 'negative emotions' (b = −4.74, p =.04) and 'barriers to prioritisation' (b = −5.00, p =.01). CIBER analyses suggested six predictive domains with substantial room for improvement: 'intentions and goals', 'barriers to prioritisation', 'environmental resources', 'beliefs about capabilities', 'negative emotions' and 'skills'. Conclusion: Implementation interventions to enhance MECC delivery should target intentions and goals, beliefs about capabilities, negative emotions, environmental resources, skills and barriers to prioritization. [ABSTRACT FROM AUTHOR]

Executive dysfunction is prevalent in children with epilepsy, and associated with poor psychosocial outcome. Sensitive and time effective tools are needed, which capture executive dysfunction across a wide range of impairment. The present study evaluates the applicability of EpiTrack Junior® (EpiTrackJr) as a screening tool at a tertiary epilepsy center, and explore how EpiTrackJr in combination with a subjective measure of everyday attention and executive functions (EFs) may provide clinically important information. Retrospective study including 235 pediatric patients admitted to the Norwegian National Centre for Epilepsy. EpiTrackJr and Behavioral Rating Inventory of Executive Functioning (BRIEF) were used to assess attention and EFs. 27,7% obtained a score categorized as "average/unimpaired", 23% as "mildly impaired", and 47.7% as "significantly impaired" on EpiTrackJr. The distribution of age-corrected EpiTrackJr scores was satisfactory. Performance was related to numbers of anti-seizure medication (ASM load), comorbidity and IQ. We found a significant, but weak correlation between EpiTrackJr performance and the BRIEF Metacognitive Index (r = −0.236, n = 108, p=.014), but no significant correlation with the Behavioral Regulation Index (r = −0.178, n = 108, p=.065). Our results indicate that EpiTrackJr is applicable as a screening tool for attention and EFs in pediatric patients at a tertiary epilepsy center. Impaired test performance was associated with greater ASM load, comorbidity and lower IQ. Performance based measures and behavior ratings likely capture different aspects of EFs. In combination, the two provide important and nonredundant information about the child's EFs in different settings. • EpiTrack Junior is applicable as a screening tool for attention and executive function in pediatric patients with complex epilepsy. • Impaired executive function is associated with anti-seizure medication load and comorbid disorders. • Performance based measures and behavior ratings likely capture different aspects of executive functioning. • Together performance based measures and behavior ratings provide valuable information about the child's executive functioning. [ABSTRACT FROM AUTHOR]

• Brief daily imaginal exposure only can be an effective treatment for PTSD. • Distress during imaginal exposure decreased linearly and predicted better outcome. • Mechanism of action may mirror extinction processes seen in full prolonged exposure. • Clinically, daily sessions may build on one another and facilitate gains. • Viable option for settings where brief PTSD treatment is needed. Preliminary evidence shows that brief, condensed imaginal exposure only interventions can be effective in the treatment of PTSD, but we need to understand its mechanisms of action. Consistent with extinction learning and retrieval processes, the present study examined whether a pattern of between-session distress reduction observed during standard prolonged exposure (PE) therapy would be observed and predict outcome. Sixty-three patients with PTSD were enrolled in two clinical trials using our treatment protocol consisting of six daily 50-min sessions focusing on imaginal exposure and processing only. Individual patient trajectories of distress reduction were examined over the course of the five imaginal exposure sessions (Sessions 2-6). Overall, significant linear distress reduction was observed for anticipatory (d = 1.18), peak (d = 1.83), and ending imaginal exposure distress (d = 1.21). Consistent with extinction learning, the steeper slope of peak distress (d = 1.03) and end distress (d = 0.68) across imaginal exposure sessions strongly predicted decreases in PTSD symptoms. Distress reduction across sessions was predicted by higher baseline avoidance and hyperarousal but not reexperiencing symptoms. This condensed format of daily 50-min sessions without in vivo exposure may be operating via similar extinction learning processes as longer protocols. Our clinical observations suggest that the brief daily format may offer the advantage of allowing each session to build on the previous one to promote meaningful shifts in the retrieval of the trauma memory. Brief imaginal exposure and processing may be a viable option for PTSD patients in settings where brief interventions are needed. Understanding potential change processes and baseline predictors of change brings us closer toward precision medicine in treating PTSD. [ABSTRACT FROM AUTHOR]

Objectives: During the pandemic, establishing effective interventions to mitigate burnout is essential to ensure the provision of stable healthcare. This study examined the efficacy of a 4-week online mindfulness program on healthcare workers' burnout to explore whether brief online programs can influence healthcare workers' wellbeing by decreasing signs and symptoms of burnout. Methods: We examined differences between healthcare workers' burnout (emotional exhaustion, depersonalization, and personal accomplishment) at three time points (baseline, post-intervention, and follow-up survey) using linear regression analyses accounting and without accounting for covariates. Covariates included demographic (age, sex), work-related (year of work experience, mode of care), resiliency (the ability to bounce back from hardship), and mindfulness-related factors (number of practices per week, prior experience of mindfulness, number of sessions attended). A total of n = 130 healthcare workers in Ontario, Canada, participated in the study (October 2020 to March 2021). Results: Without accounting for the covariates, the two components of burnout, emotional exhaustion (feelings of being emotionally overextended and exhausted by one's work) and depersonalization (an unfeeling and impersonal response toward recipients of one's service, care, treatment, or instruction) levels, were significantly lower after the 4-week mindfulness program compared to the baseline and remained lower after 4 weeks. However, the personal accomplishment level (feelings of competence and achievement in one's work) remained unchanged after the mindfulness program. Resiliency significantly contributed to reducing emotional exhaustion. Number of mindfulness practices contributed to reducing emotional exhaustion, depersonalization, and enhancing personal accomplishment. Conclusions: The findings provide a basis for healthcare organizational development decision-makers to consider employee-facing mindfulness programs. It also informs curriculum designers of mindfulness education and training programs to create online programs for maximum efficacy. [ABSTRACT FROM AUTHOR]

Impairments in family functioning are associated with more severe depressive and manic symptoms, earlier recurrences, and more suicidal behaviors in early-onset bipolar disorder. This study examined whether family-focused treatment for adolescents (FFT-A) with BD I or II disorder led to greater increases in family cohesion and adaptability and decreases in conflict over 2 years compared to a briefer psychoeducational treatment (enhanced care, EC). Participants were 144 adolescents (mean age: 15.6 ± 1.4 years) with BD I or II with a mood episode in the previous 3 months. Adolescents and parents were randomized to either FFT-A (21 sessions) or EC (three sessions). Patients received guideline-based pharmacotherapy throughout the 2-year study. Trajectories of adolescent- and parent-rated family cohesion, adaptability, and conflict were analyzed over 2 years. FFT-A had greater effects on adolescent-rated family cohesion compared to EC over 2 years. Participants in FFT-A and EC reported similar improvements in family conflict across the 2 years. In the FFT-A group, low-conflict families had greater adolescent-rated family cohesion throughout the study compared to high-conflict families. High-conflict families in both treatment groups tended to show larger reductions in conflict over 2 years than low-conflict families. Family psychoeducation and skills training may improve family cohesion in the early stages of BD. Measuring levels of family conflict at the start of treatment may inform treatment responsiveness among those receiving FFT-A.

After ten years of running (2012–2021) the digital edition of August Wilhelm Schlegel’s correspondence, the project team would like to present the initial situation and the goals, the results and experiences of the joint work as well as share the methodological findings and put them up for discussion. The work packages as well as the workflow will be explained in detail and the working methods will be reflected. The three project partners are presented in equal detail.

Background: Depression symptoms are among the most common psychological problems in students. Short-term treatments are important in preventing depression from turning into a disorder. Objectives: The current study aimed to investigate the effectiveness of interpersonal counseling (IPC) in depression symptoms, emotional expression, and social skills of students in comparison to interpersonal psychotherapy (IPT). Methods: A pretest and posttest design with follow-up was used in this study, with two experimental groups and a control group conducted in Mashhad, Iran, in 2021. A total of 51 subjects who scored 14 or higher on the Beck Depression Inventory-Second Edition (BDI-II) were randomly assigned to two experimental and control groups. Finally, the information obtained from 41 subjects was analyzed. The experimental groups underwent 7 sessions of 45 minutes of IPC and 12 sessions of 90 minutes of IPT every week. At the beginning of the study, after the end of the intervention, and after one- and three-month follow-up periods, all the subjects were evaluated with the BDI-II, emotional expressiveness, and social skills questionnaires. The findings were analyzed using the repeated measurement method and Kruskal-Wallis and Mann-Whitney U tests. All the analyses were carried out with SPSS software (version 23). Results: Both IPC and IPT treatments were effective in depression symptoms (M: 31.76, 20.41, 22.94, and 24), emotional expression (M: 32.94, 40.26, 38.47, and 37.23), and social skills (M: 224.9, 265.2, 254.4, and 253.7) (P < 0.05). The comparison of the two treatments showed no significant difference in the variables (P > 0.05). Conclusions: The findings of the present study can be considered a useful step in the field of short-term and effective interventions. [ABSTRACT FROM AUTHOR]

The Ambivalent Sexism Inventory (ASI) has been widely used in applied research and sometimes modified versions have been proposed, 'lhe current research aimed to test the internal structure and reliability of the ASI for adolescents (ASI-A) and Brief ASI (B-ASI) versions in the adolescent population. Two analogue samples of Mexican secondary students (Study 1: »i = 975; Study 2: m -- 1020) composed the sample. lhe ASI-A showed that the two-dimension model omitting items 1 to 4 is the most recommendable model and it presents an acceptable fitting to the data (Study 1). The B-ASI bidimensional model showed an appropriate fitting to the data and no modifications were required (Study 2). 'lhe ASI-A is a valid measure of ambivalent sexism when some of its items are omitted, but the demonstrated validity of the original items in the adolescent population supports that there was no theoretical or empirical reason for developing a specific version for adolescents of the ASI. [ABSTRACT FROM AUTHOR]

The current investigation reports the results of a randomized controlled trial of a brief, relational intervention for maltreated preschool-aged children and their mothers, called Reminiscing and Emotion Training (RET). RET facilitates elaborative and emotionally supportive parent-child communication, which is an essential component of the parent-child relationship and is especially relevant for the preschool age period. Participants were 248 children between the ages of 3- to 6-years-old and their mothers. Following a baseline assessment, 165 maltreating families were randomized into RET or a Community Standard (CS) condition in which families received case management and written parenting information; 83 families participated in the nonmaltreating comparison condition. Results indicated that the key mechanisms targeted by the RET interventions were enhanced, such that mothers who participated in RET were significantly better in elaboration and sensitive guidance during reminiscing at the posttest than were maltreating mothers who did not receive the intervention, with medium to large effect sizes; additionally, mothers in the RET group were more elaborative than mothers from the nonmaltreatment group. Children in the RET condition also contributed significantly more memories and had better emotional knowledge than did children in the CS condition, controlling for baseline values and language, and approximated the functioning of nonmaltreated children. These findings add to a growing literature underscoring the benefits of brief, focused, relational interventions for maltreated children and their caregivers. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

According to prominent models of child development, parental factors may contribute to individual differences in children's executive functioning (EF). Here, we examine the relative importance of parents' socio-economic status, mental health, and parenting as predictors of EF development, drawing on a large (n = 1,070) community sample of Norwegian children who received biennial EF assessments from 6 to 10 years of age. We measure EF by means of the Behavior Rating Inventory of Executive Function. We assess parenting through observer ratings of parent-child interactions and parental mental health via the Beck Anxiety Inventory, Beck Depression Inventory, and Hopkins Symptom Checklist. When we adjust for all time-invariant unmeasured confounders, higher parental education predicts superior EF development, whereas harsh parenting forecasts poorer EF development. However, parenting does not mediate the effect of parental education. These results indicate that harsh parenting should be targeted in interventions aimed at improving EF. Statement of contribution What is already known on this subject? Parental factors seem to affect child development of executive functions (EF). Specifically, parental socio-economic status, mental health, and their parenting seem to influence the developmental course of child EF. What does this study add? To what degree the parental influence on EF development is likely to be driven by time-invariant factors, for example, genetics. The relative influence of positive and negative parenting on EF development.

BackgroundWhile family interventions have shown efficacy in improving mood symptoms and family functioning in pediatric bipolar disorder, few studies have examined the effects of comorbid psychiatric conditions on patients' symptomatic or functional responses to treatment.Methods145 adolescents with bipolar I or II disorder were randomly assigned to family-focused therapy (FFT-A) or a brief psychoeducational therapy (enhanced care; EC) and followed over 2 years. Participants received pharmacotherapy for the study's duration. We examined whether comorbid anxiety disorders, attention-deficit/hyperactivity disorder (ADHD), and disruptive behavior disorders (DBDs; i.e., oppositional defiant and conduct disorder) predicted the proportion of weeks that participants experienced mood symptoms during follow-up, and whether comorbid disorders moderated the effects of treatment assignment on mood symptoms and family conflict.ResultsComorbid anxiety was associated with a greater proportion of weeks with depressive symptoms, more severe (hypo)manic symptoms during follow-up, and greater family conflict over the 2-year study. Comorbid ADHD was associated with a greater proportion of weeks with (hypo)manic symptoms, more severe (hypo)manic symptoms, and greater family conflict. Additionally, youth with comorbid ADHD who received FFT-A had more favorable trajectories of (hypo)manic symptoms and family functioning than youth with comorbid ADHD who received EC. Comorbid DBDs were consistently associated with more severe depressive symptoms and greater family conflict throughout the study.LimitationsRandomization to treatments was not stratified on comorbid disorders. The longitudinal trajectories of anxiety, attentional, and disruptive behavior symptoms were not examined.ConclusionsThe course of bipolar disorder in adolescents is strongly affected by comorbid disorders. Future research should examine whether adolescents with more complex presentations of bipolar disorder should be treated with different or more intensive psychosocial protocols than adolescents without these presentations.