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OBJECTIVE: To advance understanding of early childhood bed-sharing and its clinical significance, we examined reactive bed-sharing rates, sociodemographic correlates, persistence, and concurrent and longitudinal associations with sleep disturbances and psychopathology. METHODS: Data from a representative cohort of 917 children (mean age 3.8 years) recruited from primary pediatric clinics in a Southeastern city for a preschool anxiety study were used. Sociodemographics and diagnostic classifications for sleep disturbances and psychopathology were obtained using the Preschool Age Psychiatric Assessment (PAPA), a structured diagnostic interview administered to caregivers. A subsample of 187 children was re-assessed approximately 24.7 months after the initial PAPA interview. RESULTS: Reactive bed-sharing was reported by 38.4% of parents, 22.9% nightly and 15.5% weekly, and declined with age. At follow-up, 48.9% of nightly bed-sharers and 88.7% of weekly bed-sharers were no longer bed-sharing. Sociodemographics associated with nightly bed-sharing were Black and (combined) American Indian, Alaska Native and Asian race and ethnicity, low income and parent education less than high school. Concurrently, bed-sharing nightly was associated with separation anxiety and sleep terrors; bed-sharing weekly was associated with sleep terrors and difficulty staying asleep. No longitudinal associations were found between reactive bed-sharing and sleep disturbances or psychopathology after controlling for sociodemographics, baseline status of the outcome and time between interviews. CONCLUSIONS: Reactive bed-sharing is relatively common among preschoolers, varies significantly by sociodemographic factors, declines during the preschool years and is more persistent among nightly than weekly bed-sharers. Reactive bed-sharing may be an indicator of sleep disturbances and/or anxiety but there is no evidence that bed-sharing is an antecedent or consequence of sleep disturbances or psychopathology.

Today's teachers experience high levels of stress and fatigue that can negatively affect their well-being. Teacher burnout is not a new educational phenomenon, but it has been exacerbated by the COVID-19 pandemic. In this article, we discuss the prevalence of teacher stress and its impact on teacher well-being and student achievement. We call for more attention to the social and emotional learning of special education teachers of students with emotional and behavioral disorders. After addressing myths and misconceptions regarding current expectations for educators, we propose a new framework for establishing individual and systemic interventions to support teacher well-being.

Objectives This is a pilot study of the Vermont Family Based Approach, an innovative health promotion program designed to address behavioral health prevention in primary care, adapted for perinatal women. We aimed to determine the acceptability of the intervention across socioeconomic strata, and to identify if participation improves perinatal mental health. Methods Recruitment occurred at a general obstetrics practice. Women 12-25 weeks gestation were paired with a wellness coach who administered a wellness assessment and used motivational interviewing to facilitate individualized plans based on evidence-based domains of health promotion. Participants were offered access to free, co-located wellness activities through the peripartum, and referred to behavioral health services if appropriate. Results 93 women consented; 16 Medicaid Insured women (MI) and 30 Privately Insured (PI) were randomized to the intervention. Of all activities, yoga and parenting activities were most appealing, with 58% of women attending. PI (M = 12.30, SD = 11.71) attended significantly more activities than MI (M = 3.81, SD = 12.30; p = .001). Trauma exposure was inversely associated with attendance (p = .004). Randomization to the intervention was not associated with improvements in internalizing symptoms or perceived stress at 12 months postpartum, however, attending three or more wellness activities was associated with a decrease in perceived stress between baseline and 12 months postpartum. Conclusion This program appeared acceptable and engaging to women with private insurance, but less so with Medicaid. The trial failed to demonstrate improvement in internalizing scores, but of those randomized to the intervention, higher engagement was associated with decreased stress one year after giving birth., Author(s): Sarah Guth [sup.1] , Ellen McGinnis [sup.1] , William Copeland [sup.1] , James Hudziak [sup.1] Author Affiliations: (1) grid.59062.38, 0000 0004 1936 7689, Vermont Center for Children, Youth and [...]

In response to a burgeoning pediatric mental health epidemic, recent guidelines have instructed pediatricians to regularly screen their patients for mental health disorders with consistency and standardization. Yet, gold-standard screening surveys to evaluate mental health problems in children typically rely solely on reports given by caregivers, who tend to unintentionally under-report, and in some cases over-report, child symptomology. Digital phenotype screening tools (DPSTs), currently being developed in research settings, may help overcome reporting bias by providing objective measures of physiology and behavior to supplement child mental health screening. Prior to their implementation in pediatric practice, however, the ethical dimensions of DPSTs should be explored. Herein, we consider some promises and challenges of DPSTs under three broad categories: accuracy and bias, privacy, and accessibility and implementation. We find that DPSTs have demonstrated accuracy, may eliminate concerns regarding under- and over-reporting, and may be more accessible than gold-standard surveys. However, we also find that if DPSTs are not responsibly developed and deployed, they may be biased, raise privacy concerns, and be cost-prohibitive. To counteract these potential shortcomings, we identify ways to support the responsible and ethical development of DPSTs for clinical practice to improve mental health screening in children. [ABSTRACT FROM AUTHOR]

Efforts to identify biological correlates of internalizing symptoms in childhood have involved examinations of HPA-axis functioning, namely Cortisol Awakening Response (CAR). However, research has not assessed the relationship between CAR and internalizing problems among children younger than 8 years. Findings with older samples have been somewhat equivocal, perhaps due to high rates of co-occurring externalizing symptoms during childhood and/or due to age-related differences. This cross-sectional study examined CAR in an at-risk sample of children aged 22 months to 8 years at various levels of risk for internalizing symptoms. Internalizing symptoms were associated with blunted CAR, but only after controlling for externalizing problems. The relationship between CAR and internalizing symptoms disappeared with age. Results demonstrate that a negative association between CAR and internalizing exists during early childhood and illustrate the importance of accounting for comorbid externalizing disorders and developmental stage when assessing the HPA-internalizing link.

Some children are unaffected by mental illness despite exposure to childhood adversity. These children are typically considered resilient. The objective of this study was to follow up such resilient children in adulthood to characterize mental health status, substance use, and functional outcomes. The analysis was based on the prospective, representative Great Smoky Mountains Study (N=1,420). Participants were assessed for psychiatric disorders and exposure to adversity with the structured Child and Adolescent Psychiatric Assessment interview up to eight times in childhood (ages 9–16; 6,674 observations). In total, 1,266 participants (86.3%) were followed up in adulthood at ages 25 and 30 to assess psychiatric disorders, substance use disorders, and functional outcomes. Seventy-five percent of the sample had met criteria for a psychiatric disorder or displayed subthreshold psychiatric problems by age 16. The number of adverse childhood experiences was strongly associated with childhood psychiatric status. Of children exposed to multiple adversities (N=650), 12.2% (N=63) did not display psychiatric problems. This group meets common definitions of childhood resilience. In adulthood, these individuals showing childhood resilience had greater risk of anxiety (risk ratio=2.9, 95% CI=1.0–9.1) and depressive (risk ratio=4.5, 95% CI=1.1–16.7) disorders, as well as worse physical health (means ratio=0.7, 95% CI=0.5–0.9) and financial or educational functioning (means ratio=0.6, 95% CI=0.5–0.7), compared with individuals exposed to fewer childhood adversities. These individuals showing childhood resilience did not have elevated risk for substance use disorders. Resilience to childhood adversity was uncommon. Individuals who appeared resilient in childhood were at risk for delayed poorer outcomes in adulthood. Public health efforts should prioritize minimizing early adversity exposure over promoting resilience. [ABSTRACT FROM AUTHOR]

This randomized controlled trial tested the Vermont Family Based Approach (VFBA) in primary care pediatrics. The VFBA is a model of healthcare delivery that shifts the focus from the individual to the family, emphasizes emotional and behavioral health, and uses evidence-based health promotion/prevention along with the treatment of emotional and behavioral problems. Participants were 81 families of 3–15-year-olds. For children, the VFBA was associated with greater reductions than the Control condition on the Child Behavior Checklist Emotionally Reactive, Withdrawn, Sleep Problems, Aggressive Behavior and Total Problems scales. For parents, the VFBA was associated with greater reductions than the Control condition on the Adult Self-Report Anxious/Depressed, Rule-Breaking Behavior, Internalizing Problems and Total Problems scales. The VFBA was also associated with greater improvement than the Control condition in the parents' health-related quality of life, as indicated by all scales of the Medical Outcomes Study Health Survey. [ABSTRACT FROM AUTHOR]

Schools have widely used suspension and related punitive practices, in spite of their proven ineffectiveness. This article discusses the role of Aggression Replacement Training (ART) as part of a schoolwide positive behavior support initiative. Grounded in theory and research, ART focuses on the proactive teaching of acceptable behaviors to replace actions of aggression, uses strategies to teach anger control, and further enhances students' moral development.

Background: There is evidence of unmet psychiatric needs in children under 6. These young children are dependent on their parents to identify their mental health needs. This study tested child and parent associations with parent perception of young child mental health need. Method: Parents of 917 children (aged 2–6 years) completed a diagnostic interview about their child assessing depression, anxiety, ODD/CD, ADHD, and impairment. Parents were surveyed about their own depression, anxiety, and asked about their psychiatric impairment. Parents were also asked whether they perceived their child as having a mental health need. Results: Only 38.8% of children who met criteria for a diagnosis were perceived by their parents as having a need, similar to previously studied rates in school‐aged children. Perception of need was associated with higher levels of symptoms and impairment. Thresholds for at least half of parents perceiving their child as having a need were relatively high: 19 or more symptoms, or 4 or more impairments. There was evidence of specificity: children with depressive disorders were more likely to be perceived as in need compared with other disorders. In terms of parent factors, more parental depressive symptoms were associated with higher perception of child need when the child had a diagnosis. Parental psychological impairment was associated with higher perception of need when the child had no diagnosis. Conclusions: Most preschool children that meet criteria for a psychiatric disorder are not perceived as needing help by their parents, which is dependent on both child and parent factors. [ABSTRACT FROM AUTHOR]