Search

Academic stress is linked to adolescent distress and perfectionism during the final years at school, with girls being at greater risk. The onset of the COVID-19 pandemic was an additional stressor that impacted student learning on a global scale. The present study examines the effectiveness of an intervention targeting Psychological Capital (PsyCap), comprising hope, efficacy, resilience, and optimism (HERO) to increase these HERO resources and assess its impact on mental health symptoms and subjective wellbeing outcomes among a cohort of Year 12 students (n = 82, Mage = 17.09, SD = 0.28, 99 % identifying as female) from a girl's school during the first year of the pandemic. Primary outcomes of anxiety symptoms, depressive symptoms, and flourishing and secondary outcomes of HERO variables and perfectionism were examined. There were no significant changes in primary outcomes. Significant changes in efficacy, optimism, omnibus PsyCap (HERO combined) and perfectionism were found at post-intervention. Findings indicate the intervention targeting HERO constructs may be promising for developing HERO capabilities in youth and reducing common areas of concern for students (e.g., perfectionism). Future research directions addressing limitations are discussed.

BACKGROUND: Obsessive-compulsive disorder (OCD) is an often disabling and chronic condition that is normally assessed using diagnostic interviews or lengthy self-report questionnaires. This makes routine screening in general health settings impractical, and as a result OCD is often under-(or mis-)recognized. The present study reports on the development of an ultra-brief version of the Obsessive-Compulsive Inventory-Child Version (OCI-CV) which may be administered routinely as a screener for pediatric OCD. METHOD: A total of 489 youth diagnosed with OCD, 259 non-clinical controls, and 299 youth with other disorders completed the OCI-CV and other indices of psychopathology. Using item analyses, we extracted five items and examined the measure’s factor structure, sensitivity and specificity, and convergent and discriminant validity. RESULTS: We extracted five items that assess different dimensions of OCD (washing, checking, ordering, obsessing, neutralizing/counting), termed the OCI-CV-5. Results revealed that the measure possesses good to excellent psychometric properties, and a cutoff off (≥2) yielded optimal sensitivity and specificity. LIMITATIONS: Participants were predominantly White. In addition, more research is needed to examine the OCI-CV-5’s test-retest reliability and sensitivity to treatment. CONCLUSIONS: The OCI-CV-5 shows promise as an ultra-brief self-report screener for identifying OCD in youth when in-depth assessment is unfeasible.

The COVID-19 pandemic presents challenges to the provision of community programs and access to mental health services for young people. We examined the feasibility, reach, and acceptability of multi-technology delivery of an integrated system that assesses and provides feedback on youth mental health and wellbeing and connects them to care within the context of a youth sports development program. The system was delivered via computer, telephone, and teleconference with 66 adolescent boys participating in a rugby league development program in three communities in Australia. Young people completed online wellbeing and mental health measures (Assess step), parents were provided with telephone feedback on results, support, and referral options (Reflect step), and youth received teleconferenced workshops and online resources (Connect step). The multi-technology delivery was feasible to implement, and reach was high, with barriers experienced at the Assess step but minimally experienced at the Reflect and Connect steps. Delivering the system via multiple forms of technology was rated as highly beneficial and enjoyable by young people. Players improved in self-reported prosocial behaviour, gratitude, and anxiety symptoms from pre- to post-program. Strong collaboration between researchers, organisational personnel, and community members is important for achieving these outcomes.

Parenting behaviour and rearing style contribute to the intergenerational relationship between parental and child anxiety. Current psychological interventions for child anxiety typically do not adequately address parental mental health, parenting behaviours or the parent–child relationship. The current pilot study examines the effectiveness of a mindful parenting intervention (MPI) for parents of young children with clinical anxiety. It was hypothesised that the intervention would be associated with improvements in parental stress, mental health, and mindfulness, and a reduction in child clinical anxiety symptoms. Twenty-one parents of children aged 3–7 years diagnosed with anxiety disorders participated in an 8-week group MPI program that aimed to increase their intentional moment to moment awareness of the parent–child relationship. Parental (anxiety, depression, hostility, stress, burden, mindfulness, mindful parenting) and child (anxiety diagnoses, anxiety severity, comorbidities) outcomes were assessed at pre- and post-intervention, and at 3-month follow-up. Parents reported a significant increase in mindful parenting and a significant reduction in parent–child dysfunctional interaction, but no change in mental health symptoms. There was a significant reduction in parent-rated child anxiety symptoms, severity of child anxiety diagnosis and number of comorbid diagnoses at post and 3-month follow-up. Limitations include a lack of waitlist control, small sample size, and participants were largely mothers, from intact families and highly educated. There was attrition of 43% and outcomes were predominantly self-report. MPIs offer a novel and potentially effective method of increasing mindful parenting, decreasing dysfunctional parent–child interactions, reducing parenting stress and might also be an effective early intervention for indirectly decreasing young children’s clinical anxiety symptoms. Larger-scale controlled trials of MPIs are needed.

ObjectiveThe current study utilized a single case series, non-concurrent multiple baseline design to examine the efficacy of training parents via telehealth videoconferencing in exposure and response prevention (ERP) for home delivery of the treatment for their children and adolescents with obsessive compulsive disorder (OCD).MethodThere were nine participants aged 8 to 14 years who had received a primary diagnosis of OCD. The design involved a series of AB replications, whereby following pre-treatment assessments participants were randomly assigned to either a 2-week (n = 4) or 3-week (n = 5) baseline condition with weekly monitoring of their child’s OCD symptoms. Following baseline, parents participated four weekly telehealth parent-training modules in delivering FAST (Families Accessing Skills Training) cognitive behavior therapy (CBT) with ERP (CBT-ERP) to children with OCD via videoconferencing with the clinician. Primary outcome measures were OCD symptom severity, diagnostic severity, and global functioning, which were assessed post-treatment and at 2 month follow-up.ResultsThe stability of the baseline period from pre-treatment to week 2 (for the 2-week condition) or to week 3 (for the 3-week condition) was established as there were no significant differences across baseline scores for parent target obsessions or parent target compulsions ratings. Significant improvements on the primary outcomes of clinician assessed symptom severity, diagnostic ratings, and global functioning were observed from baseline to post-treatment, and continued to 2 months follow-up.ConclusionThese data suggest that brief, parent training in FAST CBT-ERP via telehealth provides an overall effective intervention that is likely to be of most benefit to children and youth who are mild to moderate in severity.

Given that threat appraisal and coping are amenable to intervention, we aimed to identify threat appraisals and coping responses of anxious adolescents, relative to less anxious peers, during induc...

To prevent deterioration of paediatric mental health during a pandemic, it is important to understand the various factors that may impact mental health outcomes. This study examined which vulnerability factors predicted poorer anxiety and depression symptoms in Australian children and youth (aged 4-17 years) during the initial lockdown period (May – August 2020), and whether outcomes varied according to gender or age. A parent-report questionnaire was used to investigate parent-related vulnerability factors including parent mental health, family accommodation behaviours, and COVID-19-related worries, and child-related factors including fears about illness/contamination, fears about social distancing, behaviour modification, and virus impact. Data was analysed using four multiple regression models. Greater parent stress and family accommodation predicted increased child anxiety symptoms, whilst family accommodation predicted increased child depression symptoms. Regarding child-specific vulnerability factors, perceived virus impact predicted increased anxiety and depression symptoms. Greater social-distancing fears predicted depression symptoms, but not anxiety symptoms.

Mental health problems affect large numbers of young people. Integrated systems are required that can be applied in diverse settings to reach youth ‘where they are’. We evaluated the process of implementing a three-step youth mental health and wellbeing system in diverse community settings according to three implementation outcomes: feasibility, penetration and acceptability. The study describes 49 applications of the ‘Life-Fit-Learning system’ designed to assess the mental health and wellbeing of youth (Assess step), provide feedback on assessment results (Reflect step), and connect them to resources and services proportionate to their needs (Connect step). Within a participatory research approach, 3798 administrations were conducted with youth between 9 and 18 years and 90 administrations were conducted with adults. Implementation was based on the four phases of the Quality Implementation Framework and was staged to integrate stakeholder and consumer feedback and experience gained from focus groups and two pilot phases before full implementation. Feasibility ratings of successful implementation ranged from 86.7 to 96.4% across applications and settings. High penetration rates were achieved. The Life-Fit-Learning system successfully reached 91.9% to 96% of youth with the Assess and Reflect steps and low intensity Connect step resources. Of those, 14.7% to 23% were identified at-risk for mental health problems and 93% to 97% of those at-risk youth additionally received Connect step co-delivered group-based programs (moderate intensity care) and/or individual treatment (high intensity care). Youth and parents reported high satisfaction across all steps and delivery modes. With strong collaboration, an integrated model of care can be delivered feasibly, effectively and satisfactorily to reach large numbers of young people across settings.

Rejection sensitivity is a bias toward expecting rejection that can result from negative social experiences and degrade emotional adjustment. In this study, rejection sensitivity was expected to predict patterns of adolescent social anxiety over 5 years when considered alongside other known or expected risk and protective factors: peer rejection (peer-reported), emotion dysregulation, self-worth, temperament (parent-reported), female gender, and grade. Participants were 377 Australian students (45% boys; 79% White, 15% Asian) aged 10 to 13 years ( M = 12.0, SD = .90) and their parents (84%) who completed seven repeated surveys across 5 years. In an unconditional latent growth model, social anxiety symptoms had a significant quadratic pattern of growth, with symptoms increasing about midway into the study when adolescents were age 14, on average. In a model with all predictors, rejection sensitivity was uniquely associated with a higher intercept and a more pronounced quadratic growth pattern of social anxiety symptoms. Other predictors of growth in symptoms were the temperamental trait of negativity affectivity and emotion dysregulation; negative affectivity was associated with a higher intercept and a more pronounced quadratic pattern, and emotion dysregulation was associated with a higher intercept and a less pronounced quadratic pattern. Gender was associated with the intercept, with girls higher in symptoms than boys.

Specific phobia (SP) typically onsets in childhood and frequently predicts other mental health disorders later in life. Fortunately, childhood SP can be effectively treated with cognitive behavior therapy (CBT), including the exposure-based one-session treatment (OST) approach. Despite empirical support for CBT and OST, clinicians, for various reasons, frequently fail to implement exposure-based therapy in routine clinical practice, including perceived difficulties in implementing exposure. Virtual reality (VR) exposure therapy may overcome some of these challenges and provides an alternative modality of therapy. This preliminary study examined the efficacy of VR OST for 8 children with a SP of dogs (aged 8-12 years) (M = age 10.25; SD = 2.11) using a multiple-baseline controlled case series. Following a stable baseline period of either 2, 3, or 4 weeks, it was expected that specific phobia severity would significantly decline after VR OST and remain improved over the 3-week maintenance phase. Assessments were conducted posttreatment and at 1-month follow up (study end-point). It was found that phobia symptoms remained relatively stable across the baselines, with significant reductions from pretreatment to posttreatment and to follow-up on clinician severity ratings (pre- to post- g = 1.12; pre- to follow-up g = 2.40), target symptom ratings (g = 1.14; 1.29), and behavioral avoidance (g = -1.27; -1.96). The treatment was also associated with clinically significant outcomes, whereby at one-month follow up, 75% of children were considered "recovered" and 88% completed the BAT (interacted with their feared stimuli). This study provides support for the effectiveness of VR OST.

Psychological capital (PsyCap) comprising the positive psychological resources of hope, efficacy, resilience, and optimism (HERO) has strong empirical associations with increased wellbeing and reduced mental health symptoms in adult samples. Emerging studies of PsyCap among school-age students have also shown preliminary, positive associations between PsyCap and student wellbeing. The present study is the first to examine PsyCap-HERO constructs and associations with both mental health symptoms and subjective wellbeing in school-aged children and adolescents (aged 9-14 years). A convenience sample of Australian school students (N = 456, Mage = 11.54, SD = 1.20, 47% female) completed an online survey during class time. Measures of hope, efficacy, resilience, optimism, flourishing, anxiety, and depression previously well-validated in school samples were used. Significant associations between each HERO construct and flourishing, anxiety and depression symptoms in the expected direction were found, and importantly, the combination of HERO constructs was shown to be a stronger predictor of increased levels of student flourishing, and decreased levels of anxiety and depression symptoms, than individual HERO constructs. Findings indicate that student PsyCap may be a promising area of further investigation for schools, policymakers, clinicians and researchers looking to identify positive psychological resources in youth that may buffer poor mental health and promote wellbeing.

Adolescent dieting and disordered eating (DE) are risks for clinical eating disorders. In this five-wave longitudinal study, we tested gender-specific models linking early risk factors to temporal patterns of DE, considering appearance anxiety as a mediator. Participants were 384 Australian students (age 10 to 13; 45% boys) who reported their purging and skipping meals, experience with appearance-related teasing, media pressure, and appearance anxiety. Parents reported pubertal maturation and height/weight was measured. Gender differences in temporal patterns of DE were found and predictive models were tested using latent-variable growth curve and path models. Boys’ DE was generally stable over time; girls showed stability in purging but an average increase in skipping meals. Peer teasing, media pressure, and pubertal maturation were associated with more elevated initial DE in girls, and pubertal maturation was associated with a steeper increase in DE. For boys, body mass index had a direct positive association with DE. Appearance anxiety was associated with more DE, but there was only one significant indirect effect via anxiety, which was for boys’ pubertal maturation. Findings support the dominant role of social interactions and messages, as well as pubertal maturation, for girls’ DE and the prominence of physical risk factors for explaining boys’ DE.

Linking mental health services to organised sport offers an avenue to identify and improve mental health among adolescents. In this study, we investigated the efficacy, acceptability and feasibility of an integrated mental health system embedded within a junior sports development program. A three-step integrated mental health program for 12- to 15-year-old rugby league players (N = 74) was delivered in urban (n = 44) and rural (n = 33) areas. Specifically, this system (a) assessed participant mental health on primary outcome measures of anxiety, depression, and anger/conduct problems (and secondary outcome measures of personal attributes and relationships), (b) provided feedback to participants, parents and program coordinators, and (c) connected participants and parents to a multi-component intervention including online resources, a group-based workshop program (4 × 30-min sessions), and tailored individual-level follow-up and referral to further care for participants at high risk of mental health problems. From pre- to post-program, boys’ anxiety symptoms declined significantly (with only a trend-level reduction in depression), and there were significant improvements in grit (for urban boys only), efficacy to manage negative emotions, and prosocial behaviour. In addition, when boys reported symptoms associated with high risk for mental health problems, providing parents with feedback enhanced boys’ access to care and was associated with significant declines in anxiety symptoms. The program was generally acceptable and feasible, with very high retention in the youth sports development program. Overall, early findings support further deployment and evaluation of integrated mental health systems embedded within sporting contexts to address mental health problems among adolescent boys.

Parental rearing behaviours characterised by high levels of rejection and overprotection have been implicated in the development and maintenance of child psychopathology, including paediatric obsessive-compulsive disorder (OCD). The Egna Minnen Beträffande Uppfostran (EMBU) is a commonly used measure of perceived parental rearing. Using confirmatory factor analysis, the factor structure of the EMBU child and parent versions were examined in a sample of children and youth with OCD (n = 176), and their mothers (n = 162). Associations between rearing and clinical correlates of OCD were explored. For parents, a 4-factor model provided the best fit. For children, a higher order model was the best fit. Greater parent and child perceived negative rearing behaviours and lower perceived positive behaviours were associated with greater OCD severity, comorbid symptoms and impairment. The EMBU has a conceptually meaningful factor structure and provides a useful measure for assessing perceived rearing behaviours within paediatric OCD.

This study explored the expression, occurrence, and treatment outcomes of comorbid body dysmorphic disorder (BDD) in 107 youth (7–17 years) seeking treatment for primary obsessive–compulsive disorder (OCD). In the overall sample, appearance anxiety (AA) was positively associated with OCD-related impairment, severity, symptom frequency, comorbid symptoms, and maladaptive emotion regulation. Comorbid BDD occurred in 9.35% of youth, equally affected males and females, and was associated with older age. AA negligibly reduced following treatment. Compared to those without (a) comorbid BDD and (b) without any comorbidity, youth with comorbid BDD reported greater social impairment and reduced global functioning but did not differ on the occurrence of comorbid anxiety and mood disorders. OCD response or remission rates did not differ. In youth with comorbid BDD, AA did not significantly reduce following treatment. Results suggest a more severe expression accompanies comorbid BDD in youth with OCD, with BDD persisting following OCD treatment.

Objective To examine the efficacy of weight-adjusted D-cycloserine (DCS) (35 or 70 mg) relative to placebo augmentation of intensive exposure therapy for youth with obsessive-compulsive disorder (OCD) in a double-blind, randomised controlled trial, and examine whether antidepressant medication or patient age moderated outcomes. Methods Youth (n = 100, 7-17 years) with OCD were randomised in a 1:1 ratio to either DCS + exposure (n = 49) or placebo + exposure (n = 51). Assessments occurred posttreatment, 1 month later, and at 3 and 6 months. Pills were ingested immediately before sessions. Results Significant improvements on all outcomes were observed at posttreatment, and to 6-month follow-up. Treatment arms did not differ across time, with no significant time-by-medication interactions on symptom severity (T1 to T2 estimate: 9.3, 95% confidence interval [CI]: -11.2 to -7.4, and estimate -10.7, 95% CI: -12.6 to -8.7), diagnostic severity (T1 to T2 estimate: -2.0, 95% CI: -2.4 to -1.5 and estimate -2.5, 95% CI: -3.0 to -2.0) or global functioning (T1 to T2 estimate: 13.8, 95% CI: 10.6 to 17.0, and estimate 16.6, 95% CI: 13.2 to 19.9). Neither antidepressants at baseline nor age moderated primary outcomes. There were significantly fewer responders/remitters at 1- and 6-month follow-up among youth in the DCS condition stabilised on SSRIs, relative to youth not taking SSRIs. Conclusions DCS augmented intensive exposure therapy did not result in overall additional benefits relative to placebo. Intensive exposure proved effective in reducing symptoms for the overall sample. National Health and Medical Research Council [APP1058025] Published version National Health and Medical Research Council, Grant/Award Number: APP1058025

To ensure the needs of children and families are met for the remainder of the COVID-19 situation and beyond there is a demand for a specific response strategy. This longitudinal study will investigate the impact of COVID-19 on Australian parental and childhood mental health symptoms, particularly OCD symptoms, examining the stability of this relationship over time and the needs and preferences for mental health support in response to child symptoms. A total of 141 parents completed a questionnaire during the lockdown period in Australia (June-September 2020). Thirty-five of them completed a follow-up questionnaire during the post-lockdown period (November 2020-January 2021). The questionnaire assessed COVID-19 experiences/worries/knowledge, child OCD, and child/parental anxiety and depression. Sub-samples of youth were determined based on parent-report of an existing diagnosis of any mental health (n = 24), of OCD (n = 22), or no mental health diagnosis (i.e., healthy, n = 81). Results: Parents reported a significant positive association between increased parental worries regarding COVID-19, and their own as well as their child's mental health symptoms. The current sample of children experienced elevated symptom severity for OCD symptoms during COVID-19. The OCD group reported significant reductions in child OCD symptoms at post-lockdown. The any mental health diagnosed children are at greater risk of developing OCD symptoms and reported strong preferences for increased support as a result. The exploratory nature of this study adds further insight into the impact of the COVID-19 pandemic on child OCD and parent mental health symptoms and the stability of symptoms over time.

One productive avenue for building adolescents' personal strengths and reducing mental health problems is integrating assessment and intervention into organised sports programs. We investigated the efficacy of the RISE program, a rugby league development program for 12- to 15-year-old boys, which integrated a mental health and wellbeing system called Life-Fit-Learning. The Life-Fit System is designed to measure youth's strengths and mental health symptoms and sends mental health feedback to parents, provides group-based workshops, connects youth and parents to online psychoeducation resources, and provides individual telephone follow-up and referral with parents of youth at high-risk for mental health problems. In this study, mental health and wellbeing outcomes were compared in participants who did (RISE, N = 94) and did not (Comparison, N = 82) receive the RISE/Life-Fit-Learning program. RISE players reported their self-satisfaction, grit, gratitude, prosocial behaviour, anxiety, depression, and behavioural problems using the Life-Fit System pre- and post-program. Comparison participants completed measures twice, 6-months apart. Self-satisfaction did not change in RISE participants but declined among comparison participants. In both groups, 26% of players scored in the high-risk range on at least one mental health measure. On mental health measures, high-risk RISE players' depression and behavioural problems improved from pre-to post-program relative to no change among Comparison players. Among participants who were not high-risk, RISE players' anxiety, depression, and behavioural problems did not change whereas Comparison players' behavioural problems increased significantly. Results underscore the value of integrating strengths-based interventions and targeting youth mental health problems within the context of junior sports development programs.

Research on mindfulness-based interventions (MBIs) has proliferated in recent years and the integration of mindfulness-based programs in school settings has been at the forefront of implementation research. Recent reviews of studies evaluating the efficacy of school-based mindfulness programs have produced mixed findings, which may in part be due to methodological differences across studies to date, as well as adaptations of MBIs in order to implement them within school settings. For example, there are vast differences across studies in the content, delivery, and training requirements of school-based MBIs, which may influence both fidelity and efficacy. This systematic review aimed to synthesize the literature on the implementation of school-based MBIs and determine the degree to which the interventions align to standards for MBIs. A systematic search identified studies evaluating the effects of a school-based MBI on mental health outcomes in schools, utilizing quantitative and qualitative designs. The results draw comparison across the identified MBIs in relation to intervention integrity, and teacher training and competence according to existing standards. The findings indicate a poor alignment to all standards; for example, intervention integrity was indicated in 45% of studies that included core mindfulness practices, and standards of teacher training were met in 26% of studies. In addition, the feasibility design of studies is critiqued against recommended standards. Despite claims from many studies, feasibility has not yet been established for school settings. Feasibility studies have failed to adequately assess organizational factors that influence implementation. The lack of detail and consistency in reporting across studies is a particular limitation of the field of research, which may have disadvantaged the assessment of studies against stringent guidelines. The ongoing challenges to developing an evidence base for school-based MBIs as well as to implementation are discussed. Recommendations for future directions in implementation science of mindfulness interventions within a school context are provided.

A new measure specifically designed for adolescents to assess body dysmorphic disorder (BDD) symptoms is needed to identify youth who could benefit from intervention to reduce their BDD-related symptomology. To address this gap, the Multidimensional Youth Body Dysmorphic Inventory (MY BODI) was developed and the psychometric properties were evaluated. Following development and expert assessment, Australian secondary school students (N = 582; 55% female; Mage = 13.62, SD = 1.59, aged 11 to 18 years, grades 7 to 12) completed a survey with the new items and validation measures. Results from the factor analysis supported a 3-factor, 21-items measure, which aligned with the DSM-5 diagnostic criteria of Impairment/avoidance, Preoccupation/repetitive behaviours, and Insight/distress. Supporting the convergent validity of the measure, the MY BODI total score and sub-scale scores correlated with measures of BDD symptoms, including the Appearance Anxiety Inventory (AAI) and Body Dysmorphic Disorder Questionnaire-Adolescent Version (BDDQ-A). This study provides preliminary validation of the MY BODI, a self-report measure of BDD symptoms and symptom severity, using a response set aimed to facilitate more reliable reporting, which may identify risk for BDD, and symptoms of BDD.

Limited research has examined sleep-related problems (SRPs) among children and adolescents with obsessive-compulsive disorder (OCD). The present study addresses this gap by investigating preliminary associations between SRPs, demographic factors (gender and age), family variables (family accommodation and parental stress), and clinical factors (medication status, internalizing and externalizing symptoms, OCD severity, OCD-related impairment), and treatment outcomes in a sample of 103 youth (aged 7 to 17 years; 53% female) with a primary diagnosis of OCD. Clinician, parent, and child measures were used to assess demographic, family, and clinical predictors. SRPs were assessed using an 8-item measure comprising items of the Child Behaviour Checklist, Child Depression Inventory, and Multidimensional Anxiety Scale for Children as used in previous studies. Results showed that SRPs were highly prevalent among this sample and that more SRPs were associated with younger age, internalizing problems, and functional impairment. However, SRPs were not an independent predictor of OCD severity, impairment, or treatment response. Preliminary findings suggest that SRPs among youth with OCD may be more strongly associated with broader internalizing symptoms than with OCD itself. Future longitudinal research is warranted to further explore the complexity of SRPs when co-occurring with pediatric OCD.

Mental health problems affect large numbers of young people. Integrated systems are required that can be applied in diverse settings to reach youth 'where they are'. We evaluated the process of implementing a three-step youth mental health and wellbeing system in diverse community settings according to three implementation outcomes: feasibility, penetration and acceptability. The study describes 49 applications of the 'Life-Fit-Learning system' designed to assess the mental health and wellbeing of youth (Assess step), provide feedback on assessment results (Reflect step), and connect them to resources and services proportionate to their needs (Connect step). Within a participatory research approach, 3798 administrations were conducted with youth between 9 and 18 years and 90 administrations were conducted with adults. Implementation was based on the four phases of the Quality Implementation Framework and was staged to integrate stakeholder and consumer feedback and experience gained from focus groups and two pilot phases before full implementation. Feasibility ratings of successful implementation ranged from 86.7 to 96.4% across applications and settings. High penetration rates were achieved. The Life-Fit-Learning system successfully reached 91.9% to 96% of youth with the Assess and Reflect steps and low intensity Connect step resources. Of those, 14.7% to 23% were identified at-risk for mental health problems and 93% to 97% of those at-risk youth additionally received Connect step co-delivered group-based programs (moderate intensity care) and/or individual treatment (high intensity care). Youth and parents reported high satisfaction across all steps and delivery modes. With strong collaboration, an integrated model of care can be delivered feasibly, effectively and satisfactorily to reach large numbers of young people across settings.

Generalized anxiety disorder (GAD) is a highly prevalent, chronic, and costly mental disorder in children, and there is a comparative lack of research on specific treatments for GAD, relative to other anxiety disorders. Furthermore, treatment programs for child GAD, unlike those for adults, are almost uniformly transdiagnostic in nature and do not specifically target the cognitive variables (e.g., intolerance of uncertainty, negative beliefs about worry, cognitive avoidance, and negative problem orientation) demonstrated to be correlated with the disorder. However, helping children to understand and address these rather complex cognitive factors is difficult. This article describes the development of a disorder-specific, cognitively focused group treatment program for child GAD (the No Worries! Program) that aims to target the cognitive variables and symptoms correlated with the GAD. It provides a detailed discussion of the strategies taught to children and highlights some of the challenges involved. A case study is presented to demonstrate the feasibility of achieving successful outcomes with complex presentations.

Anxiety disorders among preschool-aged children are as prevalent as in older children, yet younger children are even less likely to receive treatment for these frequently impairing childhood disorders (Egger & Angold, 2006). Specific phobias (SPs) are often the earliest form of anxiety to onset, affect 2.3% of preschoolers (Egger & Angold, 2006), and tend to be stable from 3 years of age to at least 6 years of age (Bufferd, Dougherty, Carlson, Rose, & Klein, 2012). Recently, our group developed and piloted a modified intensive one-session treatment (OST) incorporating play therapy for preschoolers with SP (Farrell, Kershaw, & Ollendick, in press). Given that highly fearful young children may find concentrated, rapid exposure therapy highly confronting, we integrated play therapy into the commencement of this treatment to (a) assist with rapid rapport building with the therapist and (b) enhance the child’s motivation through engaging them with play. An initial, controlled, baseline case series (N = 4) provided preliminary evidence of the feasibility, acceptability, and effectiveness of this innovative one-session (3 hours) therapy—POP! Pre-schoolers Overcoming Phobias (POP; Farrell et al., in press). The approach combines child-centered, nondirective play therapy (during Hour 1) and empirically supported OST (during Hours 2 and 3), with 4-year-old preschool children with clinical SPs of dogs. This article presents a case description of POP, describing the assessment approach, cognitive-behavioral case formulation, and intensive treatment of a 4-year-old girl who presented with a severe SP of dogs, along with various other comorbid SPs.

This study utilised a person-centered approach to understand childhood irritability as a transdiagnostic feature of psychopathology. Latent profile analysis was employed within a community sample (n = 93) of 9-11 year olds to identify typologies of self-regulation capabilities, positive wellbeing characteristics of hope and flourishing, and social functioning that cluster with children's irritability to mitigate risk for psychopathology symptoms. Three distinct profiles of youth were derived, High Irritability/Low Self-Regulation of Negative Emotion (9%), Moderate Irritability/Low Behavioural Control (34%) and Low Irritability/High Positive Wellbeing Characteristics (57%). Profiles were empirically validated and differentially related to symptoms of anxiety, depression and conduct problems. Notably, High Irritability/Low Self-Regulation of Negative Emotion children were characterised by the highest levels of irritability and peer problems and the lowest self-regulation of negative emotion, prosocial behaviours, hope and flourishing relative to children within the other profiles, pointing to the potential utility of future targeted, transdiagnostic interventions. Within our community-based sample, a protective profile of Low Irritability/High Positive Wellbeing Characteristics children were also described by the lowest levels of irritability and peer problems and the highest positive and negative emotion self-regulation, behavioural control, prosocial behaviours, hope and flourishing. Findings demonstrate that different levels of irritability severity cluster with different self-regulation capabilities and wellbeing characteristics and predict risk for different types of psychopathology. Targeted interventions should seek to address children's irritability alongside self-regulation and positive wellbeing characteristics to further mitigate risks of psychopathology and associated problems.

Linking mental health services to organised sport offers an avenue to identify and improve mental health among adolescents. In this study, we investigated the efficacy, acceptability and feasibility of an integrated mental health system embedded within a junior sports development program. A three-step integrated mental health program for 12- to 15-year-old rugby league players (N = 74) was delivered in urban (n = 44) and rural (n = 33) areas. Specifically, this system (a) assessed participant mental health on primary outcome measures of anxiety, depression, and anger/conduct problems (and secondary outcome measures of personal attributes and relationships), (b) provided feedback to participants, parents and program coordinators, and (c) connected participants and parents to a multi-component intervention including online resources, a group-based workshop program (4 × 30-min sessions), and tailored individual-level follow-up and referral to further care for participants at high risk of mental health problems. From pre- to post-program, boys' anxiety symptoms declined significantly (with only a trend-level reduction in depression), and there were significant improvements in grit (for urban boys only), efficacy to manage negative emotions, and prosocial behaviour. In addition, when boys reported symptoms associated with high risk for mental health problems, providing parents with feedback enhanced boys' access to care and was associated with significant declines in anxiety symptoms. The program was generally acceptable and feasible, with very high retention in the youth sports development program. Overall, early findings support further deployment and evaluation of integrated mental health systems embedded within sporting contexts to address mental health problems among adolescent boys.

Obsessive-compulsive and related disorders (OCRDs) are a group of diagnoses that center on compulsive behaviors and/or obsessive thoughts. They include obsessive-compulsive disorder (OCD), body dysmorphic disorder (BDD), hoarding disorder, excoriation disorder, and trichotillomania. Each of the OCRDs are associated with significant psychosocial impairment and family/caregiver burden. Furthermore, these disorders frequently co-occur with autism spectrum disorder (ASD) traits and diagnoses, and differential diagnosis can be difficult. OCD represents the most common of the OCRDs, and also the most well researched to date. Consequently, this chapter focuses on the nature and impact of comorbid OCD and ASD across the lifespan. Unfortunately, preliminary research indicates that individuals with OCD and ASD are significantly more disadvantaged by way of poorer psychosocial functioning, increased family burden/accommodation to symptoms, greater number of other comorbid conditions, and more likely to present with comorbid externalizing disorders. Future research is needed to determine what impact these unique complexities may have on treatment success. Preliminary research suggests that cognitive behavioral therapy (CBT) is of benefit to these individuals with comorbid ASD and OCD; however, modification may be necessary to improve engagement and outcomes (e.g., family inclusion in therapy). This chapter presents a case example of modified CBT for a child with comorbid ASD and OCD, delivered intensively. Future research should focus on the related OCRDs in individuals with ASD, as well as improving current assessment and treatment practices.

Psychoeducation is an integral component of evidence-based treatments for anxiety disorders and obsessive-compulsive disorder (O–CD) in children and adolescents. In cognitive-behavioral therapy (CBT) for anxiety and OCD, psychoeducation is used to provide a rationale for exposure therapy for the young person and their family, to build rapport with the child, and to enhance the child’s motivation and engagement in exposure therapy. In this chapter, we provide a practical guide to effectively delivering psychoeducation to anxious youth and their families, including how to provide a rationale for exposure therapy and explain how it is conducted, strategies for building rapport during psychoeducation, ways to maximize success in exposure therapy via psychoeducation, as well as strategies to manage challenges that commonly arise during psychoeducation.

Emotion dysregulation has been associated with increased risks for psychopathology. During adolescence when the onset of mental illnesses peak, emotion dysregulation may be particularly problematic. In this study, we examined transactional associations between young adolescents’ self-report of their emotion dysregulation and symptoms of social anxiety and depression at three assessments over 3 years. Participants were 391 Australian students (56% female; 79% White/Caucasian) in Grades 6 to 8 followed until Grades 9 to 11. Using structural equation modeling (SEM), emotion dysregulation was a latent variable indicated by lack of emotional clarity, nonacceptance of emotional responses, impulse control difficulties, limited access to emotion regulation strategies, and difficulties engaging in goal-directed behavior. A sixth aspect of emotion dysregulation, lack of emotional awareness, which was not correlated with the other five subscales, was examined separately in the SEM. Transactional associations over time were identified between emotion dysregulation and symptoms of social anxiety and depression, with adolescents higher in emotion dysregulation at Time 1 (T1) reporting higher social anxiety and depressive symptoms between T1 and Time 2 (T2), and T2 emotion dysregulation predicting increases in adolescents’ depression, but not social anxiety, symptoms from T2 to Time 3 (T3), after controlling for baseline symptoms. In addition, earlier social anxiety, but not depressive, symptom level at T2 was significantly associated with later emotion dysregulation between T2 and T3, after baseline emotion dysregulation was controlled. Furthermore, girls were higher in emotion dysregulation, social anxiety, and depression than boys, but sex did not moderate temporal links between emotion dysregulation and symptoms.

The 10-item Appearance Anxiety Inventory (AAI; Veale et al., 2013) was developed to assess cognitive processes and behaviours characteristic of Body Dysmorphic Disorder (BDD). Although the AAI has a number of advantages for research and is widely used, the structure of it has only been evaluated in one previous study. The aim of this study was to conduct an independent evaluation of the AAI's factor structure and convergent validity. Two studies were conducted. Participants in Study 1 were 730 Australian university students (Mage = 21 years). Using exploratory and confirmatory factor analyses, results indicated that 9 AAI items loaded highly on a single factor. However, both the 9-item and the 10-item AAI had good reliability. In Study 2, the AAI 9-item measure was confirmed in a sample of 862 Australian adolescents (Mage = 13 years), and the results were compared to using the 10-item AAI. In each study, the 9-item AAI had excellent convergent validity with measures of body dysmorphic symptoms and appearance-based rejection sensitivity. The decision to use the 10 items of the AAI or to exclude the one item focused on “checking appearance (e.g., in mirrors)” to use a 9-item measure should depend on the research purpose.

We write with great concern in response to the recent systematic review and meta-analysis of cognitive-behavioral therapy (CBT) in pediatric obsessive-compulsive disorder (OCD) by Uhre et al.1 Although the authors’ results consistently support the clinical efficacy of CBT for pediatric OCD, we expect that, much like ourselves, readers will be confused by the discordant and inappropriate conclusions that they put forward. These conclusions stem from the authors’ application and interpretation of their particular qualitative methods, which could lead important stakeholders (eg, parents, patients, clinicians, and payers) to wrongly discount clear evidence for what is known to be the best evidence-based therapy for pediatric OCD.

While most students undertaking bachelor level training in psychology will not become registered psychologists, as graduates they join a large pool of well‐educated and psychologically literate cit...

In this study, we examined whether peer appearance-related victimization was associated with adolescents' increasing body dysmorphic disorder (BDD) symptoms over 12 months. Also, given emotion regulation and mindfulness have been associated with less body dissatisfaction, we expected that they would protect against the negative impact of peer victimization on BDD symptoms. Participants were 367 Australian adolescents (Mage=13years). In multiple regressions, two aspects of emotion regulation, strategies and clarity, and two components of mindfulness, acting with awareness and being non-judgmental, were uniquely associated with fewer BDD symptoms at T2 relative to T1. There was evidence that one mindfulness component, observing, was a risk factor for more BDD symptoms. Further, acting with awareness and observing moderated the prospective relationship between victimization and BDD symptoms; low acting with awareness and high observing were risks for symptoms regardless of victimization, whereas high acting with awareness and low observing appeared protective of BDD symptoms, but only for adolescents who reported lower victimization.

The purpose of this review is to provide an up-to-date summary of the treatment of anxiety disorders in children and adolescents. We review the evidence in relation to treatments deemed to be efficacious followed by novel interventions that hold promise as potentially efficacious treatments. The latest research suggests that cognitive-behavioural therapy is an efficacious treatment, whether delivered individually, in groups, via the computer or internet, within the classroom, or in brief, intensive formats or over longer durations. Pharmacological treatments such as SSRIs and SNRIs are also efficacious but negative side events may dampen enthusiasm for their use. Augmentation of exposure therapy with D-Cycloserine, cognitive bias modification interventions, interpersonal therapy and ACT/mindfulness are promising but require more research to establish their efficacy. The main conclusion is that personalised approaches are needed to identify the most effective intervention, or combination thereof, for each anxious youth within a stepped model of care that provides access to evidence-based services for different levels of need.

Very little is known about the comorbid presentation of obsessive-compulsive disorder (OCD) in youth with autism spectrum disorder (ASD) despite the high rates of comorbidity in clinical samples (Ivarsson and Melin, 2008; Stewart et al., 2016). This study examined the clinical expression and treatment response among children and adolescents with OCD with (n = 25) and without (n = 25) comorbid ASD (n = 50; aged 7–17 years). Youth were assessed on gold-standard measures of OCD severity and associated symptoms including functioning, mood, anxiety, comorbidity and family accommodation. The results indicated that comorbid OCD and ASD was associated with significantly higher functional impairment across school, social and home domains; significantly more externalising disorders and more comorbid disorders overall than OCD without comorbid ASD. Furthermore, families of comorbid OCD and ASD children and adolescents engaged in significantly more accommodating behaviours, and moreover, these comorbid youth had poorer treatment response at six-month follow-up. Findings from this study may be helpful in designing more targeted treatment protocols for children and adolescents with comorbid OCD and ASD.

Adolescents’ appearance-related concerns can provoke increasing emotional, social, and eating-related problems. The aims of this five-wave (2.5-year), multiple-informant longitudinal study were to (a) examine growth trajectories of appearance anxiety symptoms and appearance esteem, (b) identify whether trajectories differed by gender, and (c) examine several launching factors including parent-reported physical maturation, peer-rated physical appearance, body mass index, and appearance teasing by parents and peers. Participants were 387 adolescents (44% boys) aged 10 to 13 years at the first assessment. Steep growth in appearance anxiety symptoms was found for both girls and boys, but there was no average change in appearance esteem. Girls had more elevated appearance anxiety symptoms and lower appearance esteem than boys, girls’ body mass index was associated with symptoms, and earlier physical maturation and teasing about appearance, alone and in combination, were associated with growth in appearance anxiety symptoms for girls and boys. Earlier maturing boys who were highly teased by parents, but even more so when teased by peers, were at utmost risk for elevated appearance anxiety symptoms and increasing symptoms over time. In contrast, all girls exhibited elevated or increasing appearance anxiety symptoms across time, with the exception of girls with the latest maturation who also reported little teasing about their appearance.

Research has shown high rates of comorbid psychiatric disorders among samples of youth with obsessive-compulsive disorder (OCD) (Farrell et al., Psychiatry Res 199(2):115-123, 2012; Lewin et al., Psychiatry Res 178(2):317-322, 2010; POTS Team, J Am Med Assoc 292(16):1969-1976, 2004). Autism and autistic traits co-occur at high rates within clinical samples of youth with OCD (Ivarsson and Melin in J Anxiety Disord 22(6):969-978, 2008; Stewart et al. in Child Psychiatry Hum Dev 1-9, 2016). This study extends the literature by examining the relationship between ASD traits, family accommodation, and functional impairment in a sample of youth with OCD across a wide age range (n = 80; aged 7-17 years). Results indicated that autistic traits, as measured by the social responsiveness scale (SRS), were elevated in 32.5% of youth (based on a T-score of 66T and above) relative to typically developing youth, as well as youth with non-autism-related psychiatric disorders (Constantino and Gruber in Social responsiveness scale, Western Psychogical Services, Torrance, 2012). Furthermore, 27.5% of youth scored within a moderate range (66T-75T) and 5% of youth scored within a severe range (76T or higher) on the SRS, typical of children with ASD (Constantino and Gruber in Social responsiveness scale, Western Psychogical Services, Torrance, 2012). Additionally, ASD traits were associated with greater functional impairment above OCD severity. Furthermore, family accommodation mediated the relationship between ASD traits and functional impairment. Implications of these findings are discussed in the context of clinical assessment and direction for further research.

Blood-Injection-Injury (BII) Phobia is a severe and impairing disorder that has been understudied in youth. The present study aimed to define patterns of response and remission following a modified One-Session Treatment (OST) including an e-therapy maintenance program for children and adolescents with BII Phobia. Moreover, characteristics of different responder groups were examined in order to determine correlates of a poorer response. Youth (n = 20; 8–18 years) were categorized into four responder groups (e.g., immediate remitter, delayed remitter, partial responder, and nonresponder) based upon defined criteria for remission. Immediate remitters to treatment were more likely to have a primary diagnosis of injection phobia, rather than a combined blood and injection phobia. Nonresponders reported significantly greater disgust sensitivity at pretreatment and were more likely to have a comorbid diagnosis of Social Phobia. In regards to within session change, youth who achieved the exposure goal of having a blood test during treatment had a significantly stronger treatment response. These preliminary findings may assist clinicians in the planning and delivering of intensive Cognitive Behavioral Treatment (CBT) approaches for BII Phobia in youth.

Contains fulltext : 174490.pdf (Publisher’s version ) (Open Access) Importance: Whether and under which conditions D-cycloserine (DCS) augments the effects of exposure-based cognitive behavior therapy for anxiety, obsessive-compulsive, and posttraumatic stress disorders is unclear. Objective: To clarify whether DCS is superior to placebo in augmenting the effects of cognitive behavior therapy for anxiety, obsessive-compulsive, and posttraumatic stress disorders and to evaluate whether antidepressants interact with DCS and the effect of potential moderating variables. Data Sources: PubMed, EMBASE, and PsycINFO were searched from inception to February 10, 2016. Reference lists of previous reviews and meta-analyses and reports of randomized clinical trials were also checked. Study Selection: Studies were eligible for inclusion if they were (1) double-blind randomized clinical trials of DCS as an augmentation strategy for exposure-based cognitive behavior therapy and (2) conducted in humans diagnosed as having specific phobia, social anxiety disorder, panic disorder with or without agoraphobia, obsessive-compulsive disorder, or posttraumatic stress disorder. Data Extraction and Synthesis: Raw data were obtained from the authors and quality controlled. Data were ranked to ensure a consistent metric across studies (score range, 0-100). We used a 3-level multilevel model nesting repeated measures of outcomes within participants, who were nested within studies. Results: Individual participant data were obtained for 21 of 22 eligible trials, representing 1047 of 1073 eligible participants. When controlling for antidepressant use, participants receiving DCS showed greater improvement from pretreatment to posttreatment (mean difference, -3.62; 95% CI, -0.81 to -6.43; P = .01; d = -0.25) but not from pretreatment to midtreatment (mean difference, -1.66; 95% CI, -4.92 to 1.60; P = .32; d = -0.14) or from pretreatment to follow-up (mean difference, -2.98, 95% CI, -5.99 to 0.03; P = .05; d = -0.19). Additional analyses showed that participants assigned to DCS were associated with lower symptom severity than those assigned to placebo at posttreatment and at follow-up. Antidepressants did not moderate the effects of DCS. None of the prespecified patient-level or study-level moderators was associated with outcomes. Conclusions and Relevance: D-cycloserine is associated with a small augmentation effect on exposure-based therapy. This effect is not moderated by the concurrent use of antidepressants. Further research is needed to identify patient and/or therapy characteristics associated with DCS response. 10 p.