Search

Youth with anxiety often experience significant impairment in the school setting. Despite the relevance and promise of addressing anxiety in schools, traditional treatment approaches to school-based anxiety often do not adequately address generalization to the school setting, or they require removing the student from the classroom to deliver time- and staff-intensive programs. Such programs often leave teachers and caregivers feeling ill-equipped to support the student with anxiety throughout the natural course of the school day. Given the heavy demands placed on teachers and documented burnout among school professionals, providing effective school supports requires collaborative partnerships among outpatient therapists/specialists, school personnel, and caregivers. Drawing from literature on collaborative models for externalizing problems, we offer recommendations for outpatient therapists and specialists working to implement evidence-based supports in school settings and promote home-school partnerships to benefit youth with anxiety in the school setting. Our recommendations touch upon several components of such school consultation, including (a) identification of key parties involved, (b) conducting a needs assessment, (c) collaborative goal setting and development of a fear hierarchy, (d) plan development and implementation (e.g., facilitating a school-based exposure mindset, promoting home-school communication, enhancing school relationships), and (e) progress monitoring and ongoing support. We conclude with a case example to bring these recommendations to life.

Student anxiety is less frequently identified and treated in school settings relative to other mental health concerns (e.g., externalizing behavior problems). Considering the perspectives of school-based mental health providers is critical for improving supports for students with anxiety in schools. The present study examined patterns and predictors of school-based provider perceptions of student anxiety, as well as factors influencing provider self-efficacy when addressing student anxiety concerns. Participants (N = 87) were providers working in a very large school district serving students from highly diverse socioeconomic and racial/ethnic backgrounds. Providers reported on their perceptions of the top-ranking student mental health concerns, as well as their own emotional exhaustion, beliefs about accommodating students who experience anxiety, and perceived self-efficacy responding to student anxiety. 71.3% of providers identified student anxiety within their top five student mental health concerns. Providers in schools with higher proportions of economically disadvantaged students were significantly less likely to consider anxiety a top five concern. On average, providers reported feeling somewhat confident addressing anxiety. Greater emotional exhaustion predicted poorer self-efficacy, whereas prior training in anxiety predicted higher self-efficacy. Beliefs about accommodating anxious students in ways that run counter to anxiety guidelines was not significantly associated with provider self-efficacy. Although anxiety is a well-recognized student mental health concern among school providers, student anxiety is less commonly perceived as a top five concern by providers working with economically disadvantaged students, which may underscore the importance of addressing acute stressors and trauma exposure in such populations. Offering more anxiety-specific training and efforts to reduce emotional exhaustion may improve provider self-efficacy for addressing anxiety. To provide more equitable mental health services and supports for anxiety in school settings, more work is needed to improve identification of student anxiety as well as provider self-efficacy for addressing it within districts serving predominately racial and ethnic minority students.

Purpose Loneliness has been a known severe public health concern among the elderly population during the COVID-19 pandemic. This paper aims to discuss the practicalities of using emerging technologies to address elderly loneliness and its implications and adaptations to the outbreak of corona virus disease–2019. Design/methodology/approach The authors draw on examples from the literature and their own observations from working with older adults, to provide an overview of possible ways technology could help this population in the current COVID-19 pandemic. Findings Technological advancements have offered remarkable opportunities to deliver care and maintain connections despite the need to stay physically separated. These tools can be integrated into crisis communications, public health responses and care programs to address loneliness among the elderly. However, it must be done strategically and informed by the type of loneliness at play, environmental factors, socioeconomics and technological literacy. Practical implications Care-providing organizations and policymakers should consider the risk of loneliness while responding to COVID-19 outbreak, particularly within elderly populations. As a part of a broader plan, technological solutions and low-tech approaches can make a difference in mitigating loneliness. Solutions should be accessible to and usable by older adults. Provision of equipment, training and guidance may be necessary to execute a technology-centric plan; for some communities and individuals, approaches that do not rely on advanced technology may be more effective. Originality/value Technological advancements can be a valuable tool in addressing known public health concerns, such as loneliness among the elderly populations. However, the use of this tool should be governed by the specific situation at hand, taking into consideration individual needs and environmental factors, especially the compounded effects caused by the coronavirus pandemic. Different technological programs and approaches are appropriate for different types of loneliness. For example, online therapy such as internet-based cognitive behavior therapy may mitigate loneliness caused by fear and online interaction such as videoconferencing may relieve loneliness caused by lack of social engagement.

Objective: Although research has examined negatively reinforcing patterns of parental accommodation of youth anxiety, limited research considers school staff-led accommodations for students with anxiety. Further, the extent to which patterns of school staff-led accommodations/supports for anxiety align with anxiety expert perspectives remains unclear.Method: School staff across elementary, middle, and high schools who identified anxiety as their top student concern (N = 134) were surveyed about their use of 23 anxiety-focused accommodations/supports, as well as their own mental health literacy and emotional exhaustion. A youth anxiety expert panel (N = 28) independently rated the extent to which each of the 23 school-based accommodations/supports could (1) promote youth avoidance of anxiety, and (2) promote youth approach toward anxiety-provoking situations/experiences.Results: School staff reported using a broad range of accommodations/supports to address student anxiety, but these accommodations were mixed in alignment with anxiety expert perspectives. Although the two most commonly endorsed school-based accommodations/supports were rated by the expert panel as highly approach-oriented, 92.5% of school staff reported using at least one accommodation or support rated by the expert panel as highly avoidance-oriented. Higher emotional exhaustion among school staff predicted greater use of avoidance-oriented supports whereas higher mental health literacy predicted greater use of approach-oriented supports.Conclusions: Strategies may be needed to reduce the use of avoidance-oriented accommodations/supports with anxious students in school settings. In addition to promoting school staff awareness of expert perspectives on anxiety-focused accommodations/supports, efforts to curb staff burnout may have indirect effects on the quality of anxiety-focused accommodations and supports in school settings.

Background Despite progress in youth anxiety assessment, there is need for a measure that is simultaneously (a) free, (b) brief, (c) focused broadly on anxiety and avoidance severity, frequency, and interference, and (d) concerned with the past week. The adult overall anxiety severity and impairment scale (OASIS) was adapted to yield a caregiver-report of past week youth anxiety and interference (OASIS-Y). Methods In a sample of diverse youth seeking anxiety services (N=132; 67% racial/ethnic minority) and their caregivers, analyses examined the OASIS-Y factor structure, internal consistency, and convergent and divergent validity. Hierarchical linear modeling in a participant subset examined OASIS-Y sensitivity to treatment-related change. Results OASIS-Y internal consistency was high and confirmatory factor analysis supported a single-factor structure similar to that found in adults. OASIS-Y convergent validity was supported by a medium-sized association with an established, commercially available measure of youth anxiety, and divergent validity was supported by the absence of unique associations with measures of youth attention and externalizing problems. In a sample subset, session-by-session OASIS-Y scores significantly declined across treatment, and declined at a steeper rate among treatment "responders" versus "non-responders," providing evidence of OASIS-Y sensitivity to treatment-related change. Limitations This study focused on a clinical sample and cannot speak to OASIS-Y performance in community settings. Shared method-variance may have also influenced findings. Conclusions This study offers the first psychometric evaluation of the OASIS-Y, and underscores the promising clinical utility of the measure for assessing past week youth anxiety and impairment and for supporting routine outcome monitoring.

Within pediatric anxiety, accommodation describes ways caregivers modify their behavior in an effort to alleviate distress shown by anxious youth. In schools, accommodation refers to school-based supports (SBS) placed to increase academic success for students with disabilities. The present study, using school documents provided at treatment, examined the types of SBS provided to youth (N = 76; ages 7-17; mean age 11.07; 47.4 % female) diagnosed with an anxiety disorder. SBS were rated by a panel of youth anxiety experts on the degree to which each SBS promoted (a) approach or (b) avoidance. School documents were coded for the presence of SBS and each SBS received a (a) total approach and (b) total avoidance score. Analyses revealed (a) approach and (b) avoidance promoting SBS were differentially associated with diagnostic status: youth with social anxiety disorder were more likely to be recommended SBS promoting avoidance and youth with a specific phobia were more likely to be recommended SBS promoting approach. Overall, the present study characterizes types of SBS being received by anxious youth and finds that SBS recommended to anxious youth vary in type and quality. Discussion considers the need for observations in schools to further address the merits/demerits of anxiety-related SBS.

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.

BACKGROUND: People differ in their affective styles, which refers to habitual use of emotion regulation (ER) strategies. Previous research has shown that mental health is associated with an individual’s adaptive flexibility of emotion regulation strategies rather than any one particular ER strategy. METHODS: The present study employed a person-centered approach using latent profile analyses to distinguish patients with generalized anxiety disorder based on their responses on an affective styles measure. RESULTS: Results of the latent profile analysis supported a three-class solution. Class 1 (26% of participants) identified individuals with the lowest scores of each affective style; class 2 (10%) included individuals with the highest scores of each style; and class 3 (64%) consisted of individuals who scored in the mid-range of each affective style. Greater ER flexibility was associated with better emotional functioning and quality of life. CONCLUSIONS: Patients with GAD differ in ER flexibility. The vast majority of patients appear to have only moderate or low ER flexibility. Those individuals with high ER flexibility show a greater quality of life and less emotional distress.

To assess prevalence and severity of emotional dysregulation (ED) in psychiatrically referred youth with autism spectrum disorder (ASD). ASD youth (N = 123) were compared to youth with attention-deficit/hyperactivity disorder (ADHD) and controls. The majority of psychiatrically referred youth with ASD had positive Child Behavior Checklist-ED (CBCL-ED) profile that was significantly higher than in youth with ADHD (82 vs. 53%; p

The COVID-19 pandemic has impacted the world in ways not seen since the 1918–1920 Spanish Flu. Disinformation campaigns targeting health crisis communication during this pandemic seek to cripple the medical response to the novel coronavirus and instrumentalize the pandemic for political purposes. Propaganda from Russia and other factions is increasingly infiltrating public and social media in Ukraine. Still, scientific literature has only a limited amount of evidence of hybrid attacks and disinformation campaigns focusing on COVID-19 in Ukraine. We conducted a review to retrospectively examine reports of disinformation surrounding health crisis communication in Ukraine during the COVID-19 response. Based on the themes that emerged in the literature, our recommendations are twofold: 1) increase transparency with verified health crisis messaging and, 2) address the leadership gap in reliable regional information about COVID-19 resources and support in Ukraine.

The present chapter provides an overview of (and supporting evidence for) leading formats of technology-involved youth mental health intervention, followed by a discussion of key cautions and concerns that warrant careful consideration at this early stage of digital technology-involved care. Although there has been much progress in the development and evaluation of evidence-based treatments for child and adolescent mental health problems, limitations in the accessibility and acceptability of supported care have significantly restricted actual service utilization among affected youth. In recent years, extraordinary advances in telecommunications and the increasing ubiquity of digital technologies in daily life afford new opportunities for meaningfully extending the reach and scope of supported youth mental health care. Remote technologies have potential to liberate mental health treatments from their traditional geographic confines and overcome geographic disparities in the mental health workforce, increase the cost-effectiveness of care, and expand the ecological validity and generalizability of care by affording in situ intervention, and systematically extend treatment engagement and skill rehearsal to children’s natural settings. The authors conclude by examining exciting new frontiers on the horizon for the incorporation of digital technologies into children’s mental health care.

Importance Findings suggest that the efficacy of D-cycloserine (DCS) for enhancing exposure therapy may be strongest when administered after sessions marked by low fear at the conclusion of exposure practice. These findings have prompted investigation of DCS dosing tailored to results of exposure sessions. Objective To compare tailored postsession DCS administration with presession DCS administration, postsession DCS administration, and placebo augmentation of exposure therapy for social anxiety disorder. Design, Setting, and Participants This double-blind randomized clinical trial involved adults with social anxiety disorder enrolled at 3 US university centers. Symptom severity was assessed at baseline, weekly during treatment, and at 1-week and 3-month follow-up. Data analysis was performed from September 2019 to March 2020. Interventions Participants completed a 5-session treatment and received pills commensurate with their condition assignment at sessions 2 through 5, which emphasized exposure practice. Main Outcomes and Measures Symptom severity was evaluated by the Liebowitz Social Anxiety Scale and Social Phobic Disorders-Severity Form as administered by independent evaluators. Results A total of 152 participants were enrolled (mean [SD] age, 29.24 [10.16] years; 84 men [55.26%]). Compared with placebo, presession and postsession conditions showed greater symptom improvement (b = −0.25; 95% CI, −0.37 to −0.13;P Conclusions and Relevance Administration of DCS enhanced exposure therapy for social anxiety disorder when given before or after the exposure session. However, the study failed to achieve the aim to develop a tailored clinical application. Trial Registration ClinicalTrials.gov Identifier:NCT02066792

Highlights • Human connectome project examining adolescent anxiety and depression. • N = 225 planned, clinical and control adolescents, ages 14–17. • Description of clinical and functional imaging measures from first 140 participants. • Data publicly available via national institute of health data archive., We present a Human Connectome Project study tailored toward adolescent anxiety and depression. This study is one of the first studies of the Connectomes Related to Human Diseases initiative and is collecting structural, functional, and diffusion-weighted brain imaging data from up to 225 adolescents (ages 14–17 years), 150 of whom are expected to have a current diagnosis of an anxiety and/or depressive disorder. Comprehensive clinical and neuropsychological evaluations and longitudinal clinical data are also being collected. This article provides an overview of task functional magnetic resonance imaging (fMRI) protocols and preliminary findings (N = 140), as well as clinical and neuropsychological characterization of adolescents. Data collection is ongoing for an additional 85 adolescents, most of whom are expected to have a diagnosis of an anxiety and/or depressive disorder. Data from the first 140 adolescents are projected for public release through the National Institutes of Health Data Archive (NDA) with the timing of this manuscript. All other data will be made publicly-available through the NDA at regularly scheduled intervals. This article is intended to serve as an introduction to this project as well as a reference for those seeking to clinical, neurocognitive, and task fMRI data from this public resource.

Highlights • Human Connectome Project examining adolescent anxiety and depression. • N = 225 planned, clinical and control adolescents, ages 14–17. • Description of acquisition protocols and quality assurance measurements. • Harmonized protocols with HCP projects related to anxiety and/or depression. • Data publicly available via National Institute of Mental Health Data Archive., The Connectomes Related to Human Diseases (CRHD) initiative was developed with the Human Connectome Project (HCP) to provide high-resolution, open-access, multi-modal MRI data to better understand the neural correlates of human disease. Here, we present an introduction to a CRHD project, the Boston Adolescent Neuroimaging of Depression and Anxiety (BANDA) study, which is collecting multimodal neuroimaging, clinical, and neuropsychological data from 225 adolescents (ages 14–17), 150 of whom are expected to have a diagnosis of depression and/or anxiety. Our transdiagnostic recruitment approach samples the full spectrum of depressed/anxious symptoms and their comorbidity, consistent with NIMH Research Domain Criteria (RDoC). We focused on an age range that is critical for brain development and for the onset of mental illness. This project sought to harmonize imaging sequences, hardware, and functional tasks with other HCP studies, although some changes were made to canonical HCP methods to accommodate our study population and questions. We present a thorough overview of our imaging sequences, hardware, and scanning protocol. We detail similarities and differences between this study and other HCP studies. We evaluate structural-, diffusion-, and functional-image-quality measures that may be influenced by clinical factors (e.g., disorder, symptomatology). Signal-to-noise and motion estimates from the first 140 adolescents suggest minimal influence of clinical factors on image quality. We anticipate enrollment of an additional 85 participants, most of whom are expected to have a diagnosis of anxiety and/or depression. Clinical and neuropsychological data from the first 140 participants are currently freely available through the National Institute of Mental Health Data Archive (NDA)., Graphical abstract Image, graphical abstract

Trait mindfulness appears to be related to lower levels of negative affective symptoms, but it remains uncertain which facets of mindfulness are most important in this relationship. Accordingly, the present meta-analysis examined studies reporting correlations between affective symptoms and trait mindfulness as assessed by the Five Facet Mindfulness Questionnaire. A comprehensive search yielded 148 eligible studies, comprising 157 distinct samples and 44,075 participants. The weighted mean correlation for affective symptoms and overall trait mindfulness was r = −0.53. Among mindfulness facets, Nonjudge (r = −0.48) and Act with Awareness (r = −0.47) demonstrated the largest correlations, followed by Nonreact (r = −0.33) and Describe (r = −0.29). Observe was not significantly correlated with affective symptoms. No significant differences in the strength of correlations were found between anxiety, depression and posttraumatic stress disorder (PTSD) symptoms, though symptoms of generalized anxiety disorder exhibited a weaker negative relationship with the Describe facet compared to PTSD symptoms. Describe also showed a stronger relationship with affective symptoms in Eastern samples compared to Western samples, whereas Western samples had a stronger relationship with Nonjudge. These results provide insight into the nature of the association between trait mindfulness and negative affect.

This prospective 12-week open-label trial evaluates the tolerability and efficacy of memantine hydrochloride for the treatment of core social and cognitive deficits in adults with high-functioning autism spectrum disorder (ASD). Measures for assessment of therapeutic response included the Social Responsiveness Scale-Adult Research Version (SRS-A), disorder-specific Clinical Global Impression scales, Behavior Rating Inventory of Executive Functioning-Adult Self-Report, Diagnostic Analysis of Nonverbal Accuracy Scale, and Cambridge Neuropsychological Test Automated Battery. Eighteen adults (mean age, 28 ± 9.5 years) with high-functioning ASD (SRS-A raw score, 99 ± 17) were treated with memantine (mean dose, 19.7 ± 1.2 mg/d; range, 15-20 mg), and 17 (94%) completed the trial. Treatment with memantine was associated with significant reduction on informant-rated (SRS-A, -28 ± 25; P < 0.001) and clinician-rated (Clinical Global Impression-Improvement subscale ≤2, 83%) measures of autism severity. In addition, memantine treatment was associated with significant improvement in ADHD and anxiety symptom severity. Significant improvement was noted in nonverbal communication on the Diagnostic Analysis of Nonverbal Accuracy Scale test and in executive function per self-report (Behavior Rating Inventory of Executive Functioning-Adult Self-Report Global Executive Composite, -6 ± 8.8; P < 0.015) and neuropsychological assessments (Cambridge Neuropsychological Test Automated Battery). Memantine treatment was generally well tolerated and was not associated with any serious adverse events. Treatment with memantine appears to be beneficial for the treatment of ASD and associated psychopathology and cognitive dysfunction in intellectually capable adults. Future placebo-controlled trials are warranted.

Background We previously described the high prevalence and burden of significant autistic traits (ATs) in youth with attention-deficit/hyperactivity disorder (ADHD). These traits are associated with significantly greater impairment in psychopathological, interpersonal, educational, and neuropsychological functioning. Because the sample consisted of referred ADHD youth, uncertainty remained regarding whether these findings are generalizable to non-referred populations of youths with and without ADHD. Objective The aim of the current study was to assess the prevalence and implications of ATs in a non-referred population of siblings of probands with and without ADHD. Method Participants were non-referred siblings of probands with ADHD (N = 257) and control probands (N = 234) of longitudinal, case-control family studies conducted at Massachusetts General Hospital. Assessments included measures of psychiatric, psychosocial, educational, and cognitive functioning. The presence of significant ATs was operationalized using the Child Behavior Checklist AT profile, which consists of combined aggregate T-scores of ≥ 195 on the Withdrawn, Social, and Thought Problems subscales. Results ATs were significantly more prevalent among the siblings of probands with ADHD as compared with siblings of control probands (6% vs. 1%; P = .02). Siblings of probands with ADHD with a positive AT profile (N = 15) were significantly more impaired than those without an AT profile (N = 242) with regard to psychopathological, interpersonal, educational, and neuropsychological functioning. Conclusions The current study reports a higher-than-expected prevalence of ATs in a non-referred sample of siblings of youth with ADHD, which is consistent with previous findings regarding ATs in a referred sample of youth with ADHD. The presence of ATs is associated with higher levels of morbidity and dysfunction.