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BackgroundPopulation-based studies show that the risk of mental ill health is highest among young people aged 10 to 24 years, who are also the least likely to seek professional treatment because of a number of barriers. Electronic mental (e-mental) health services have been advocated as a method for decreasing these barriers for young people, among which text-based online counseling (TBOC) is a primary intervention used at many youth-oriented services. Although TBOC has shown promising results, its outcome variance is greater in comparison with other electronic interventions and adult user groups. ObjectiveThis pilot study aimed to explore and confirm e-mental health professional’s perspectives about various domains and themes related to young service users’ (YSUs) motivations for accessing TBOC services and factors related to higher and lower effectiveness on these modalities. MethodsParticipants were 9 e-mental health professionals who were interviewed individually and in focus groups using a semistructured interview. Thematic analysis of qualitative themes from interview transcripts was examined across the areas of YSU motivations for access and factors that increase and decrease TBOC effectiveness. ResultsA total of 4 domains and various subthemes were confirmed and identified to be related to YSUs’ characteristics, motivations for accessing TBOC, and moderators of service effectiveness: user characteristics (ie, prior negative help-seeking experience, mental health syndrome, limited social support, and perceived social difficulties), selection factors (ie, safety, avoidance motivation, accessibility, and expectation), and factors perceived to increase effectiveness (ie, general therapeutic benefits, positive service-modality factors, and persisting with counseling despite substantial benefit) and decrease effectiveness (ie, negative service-modality factors). ConclusionsParticipants perceived YSUs to have polarized expectations of TBOC effectiveness and be motivated by service accessibility and safety, in response to several help-seeking concerns. Factors increasing TBOC effectiveness were using text-based communication, the online counselor’s interpersonal skills and use of self-management and crisis-support strategies, and working with less complex presenting problems or facilitating access to more intensive support. Factors decreasing TBOC effectiveness were working with more complex problems owing to challenges with assessment, the slow pace of text communication, lack of nonverbal conversational cues, and environmental and connectivity issues. Other factors were using ineffective techniques (eg, poor goal setting, focusing, and postcounseling direction) that produced only short-term outcomes, poor timeliness in responding to service requests, rupture in rapport from managing service boundaries, and low YSU readiness and motivation.

BackgroundChronic respiratory illnesses are the most common group of childhood chronic health conditions and are overrepresented in socially isolated groups. ObjectiveTo conduct a randomized controlled pilot trial to evaluate the efficacy of Breathe Easier Online (BEO), an Internet-based problem-solving program with minimal facilitator involvement to improve psychosocial well-being in children and adolescents with a chronic respiratory condition. MethodsWe randomly assigned 42 socially isolated children and adolescents (18 males), aged between 10 and 17 years to either a BEO (final n = 19) or a wait-list control (final n = 20) condition. In total, 3 participants (2 from BEO and 1 from control) did not complete the intervention. Psychosocial well-being was operationalized through self-reported scores on depression symptoms and social problem solving. Secondary outcome measures included self-reported attitudes toward their illness and spirometry results. Paper-and-pencil questionnaires were completed at the hospital when participants attended a briefing session at baseline (time 1) and in their homes after the intervention for the BEO group or a matched 9-week time period for the wait-list group (time 2). ResultsThe two groups were comparable at baseline across all demographic measures (all F < 1). For the primary outcome measures, there were no significant group differences on depression (P = .17) or social problem solving (P = .61). However, following the online intervention, those in the BEO group reported significantly lower depression (P = .04), less impulsive/careless problem solving (P = .01), and an improvement in positive attitude toward their illness (P = .04) compared with baseline. The wait-list group did not show these differences. Children in the BEO group and their parents rated the online modules very favorably. ConclusionsAlthough there were no significant group differences on primary outcome measures, our pilot data provide tentative support for the feasibility (acceptability and user satisfaction) and initial efficacy of an Internet-based intervention for improving well-being in children and adolescents with a chronic respiratory condition. Trial registrationAustralian New Zealand Clinical Trials Registry number: ACTRN12610000214033; http://www.anzctr.org.au/trial_view.aspx?ID=308074 (Archived by WebCite at http://www.webcitation.org/63BL55mXH)

Research using mind-body practices in autism is limited but suggests a trend for ruminative reduction and improved behavioral-emotional outcomes. Following random assignment (N = 67), effects of a weekly six-session pilot yoga-based group program combined with third-wave cognitive behavioral therapy elements on self-regulation for children on the autism spectrum (aged 8-12 years) was assessed. The primary outcome was executive functions. Secondary outcomes were sleep, anxiety, and emotion awareness. After attrition, assessment results from participants in the intervention (n = 31) and the waitlist conditions (n = 30) completed at baseline, post-intervention, and 6-week follow-up were evaluated. For the intervention group, the between-group mean score differences suggest a decrease in parent-reported global executive difficulties from baseline to post-intervention (-2.61; 95% confidence interval -5.13 to -0.09, p = 0.047, d = -0.39) and baseline to follow-up (-4.17; 95% confidence interval -6.72 to -1.62, p = 0.017, d = -0.59) with small-to-medium effect sizes. Small-to-medium effects were found for a few parent-reported children's sleep issues, child-reported aspects of emotion awareness, and performance anxiety. Non-significant findings are discussed in this article. Preliminary findings suggest mixed results and should be interpreted cautiously. The yoga-informed program may complement existing treatments and will benefit from ongoing evaluation.

Background: Emotion regulation difficulties have been associated with depression and anxiety in typically developing individuals. However, until recently, the impact of emotion regulation difficulties for adolescents and young adults with autism spectrum disorder (ASD) has received little attention. We investigated emotion regulation difficulties from the perspective of those who would experience the sequelae. This included parents, teachers, and psychologists. Method: Seven focus groups with parents, teachers, and psychologists, and 7 interviews with adolescents and young adults with ASD were conducted. Results: Across the groups, participants discussed their triggers of distressing emotions, difficulties with emotional awareness, emotion regulation strategies, and the consequences of their distressing emotions. Both depression and anxiety were perceived as the most experienced distressing issues with the greatest consequences. Conclusions: The implications of the themes revealed in the interviews and focus groups are discussed in light in previous literature and may help to inform future interventions.

Adolescent depression is serious and common. As adolescents spend approximately 15,000 h in school, this setting is a logical place to seek etiological factors. Research suggests there are negative associations between school climate and adolescent depressive symptoms. However, such studies typically use "student" reports of both climate and depressive symptoms; this is problematic because common method variance results when the same individual provides information on all variables, contributing to overestimations of associations between depressive symptoms and school climate. Therefore, the purpose of this study is to examine the association between "teacher"-reported school climate and adolescent-reported depressive symptoms. Thus, 2545 Australian high school students participated in this 5-year longitudinal study. Students completed a measure of depressive symptoms annually; their teachers (N = 882) completed a questionnaire to evaluate the quality of the school environment (i.e., safe/orderly and supportive relationships). Multi-group latent growth models revealed that more positive teacher-reported school climate was cross-sectionally associated with fewer student-reported depressive symptoms in both boys and girls, although this association was significantly stronger for girls. Longitudinally, positive school climate was associated with lower depressive symptoms but a higher rate of change of symptoms for both boys and girls. The overall findings are consistent with previous findings with "student"-reported school climate. However, the gender difference and the directionality of the longitudinal association between school climate and depressive symptoms over time demonstrate that additional studies of mechanisms by which school climate is connected to adolescents' depressive symptoms are needed.

Purpose: To explore the experiences and needs of parents with an infant diagnosed at risk of cerebral palsy (CP) and to receive feedback on a new online support program (Parenting Acceptance and Commitment Therapy; PACT). Materials and methods: Eleven parents from eight family dyads (8 mothers, 3 fathers) with infants under 24 months of age (age range 10-24 months) recently diagnosed as at risk of CP as well as fourteen clinicians participated in this qualitative study through interviews. Results: Parents reported conflicting emotions and grief. Further, they reported that they wanted honesty, support and normalisation of their experiences from clinicians. Parents pointed to a gap in service delivery in terms of non-pathologising psychological support specific to their needs. Clinicians reported a lack of skills in supporting distressed parents. Parent feedback on PACT was positive, with parents receptive to the online delivery. Conclusions: Parents want acceptance without pathologisation, honesty, and flexible support. Clinicians working with children at risk of CP need training in grief awareness and support for their own coping. Health services should consider building better parental support into their systems of care. [ABSTRACT FROM AUTHOR]

Depression is a potentially life threatening affective disorder that is highly prevalent in individuals with autism spectrum disorders (ASD). This study aimed to evaluate the feasibility, acceptability and preliminary efficacy of a cognitive behavioural intervention for depression in adolescents with ASD. Participants were randomly assigned to the intervention group, or wait-list control group. Although recruitment was extremely difficult, attendance was favourable and attrition was low, and participants reported being satisfied with the programme. No significant treatment effect was revealed on the Beck Depression Inventory or Emotion Regulation Questionnaire. However despite the small sample size (n = 20), there was a trending treatment effect measured by the Depression Anxiety Stress Scale: Depression Subscale. Limitations and areas of future research are discussed.

Children with Asperger's syndrome are often reported by their parents as having difficulties communicating affection. This study aimed to develop a valid measure of affectionate behaviour that could be used to investigate and quantify these anecdotal reports and then be used in further intervention research. Using parent and expert focus groups, three measures (Affection for Others Questionnaire, Affection for You Questionnaire and General Affection Questionnaire) were developed with reference to the existing affection literature. The measures were completed by 131 parents of children with a clinician-confirmed diagnosis of Asperger's syndrome. Psychometric assessment of the measures revealed clear factor structures with high internal consistencies and significant concurrent validities. The findings suggest many children with Asperger's syndrome have difficulties with affectionate behaviour that significantly impact their daily functioning and relationships with others, signalling future research needs to develop interventions in this area. Limitations of the research are also discussed.

Currently, Australian boarding schools undertake to provide a home away from home for around 20,000 adolescents. Research documenting the boarding school experience is scarce, and, with few exceptions, exists as a less significant aspect of more general research into private school education. Such school-based research focuses on the positive, character-building benefits of the boarding experience. However, case studies of former boarders paint quite a different picture. In order for boarding schools to best support boarders' development, it is vital that adults who fulfil a parenting role undertake appropriate training. This paper draws together available information to present a comprehensive picture of boarding in Australian schools, with a focus on the challenges faced by the "in loco parentis" role of staff. It is apparent that more skills-based training is vital to better equip staff in this very important role.

Depression is a potentially life threatening affective disorder that is highly prevalent in individuals with autism spectrum disorders (ASD). This study aimed to evaluate the feasibility, acceptability and preliminary efficacy of a cognitive behavioural intervention for depression in adolescents with ASD. Participants were randomly assigned to the intervention group, or wait-list control group. Although recruitment was extremely difficult, attendance was favourable and attrition was low, and participants reported being satisfied with the programme. No significant treatment effect was revealed on the Beck Depression Inventory or Emotion Regulation Questionnaire. However despite the small sample size (n = 20), there was a trending treatment effect measured by the Depression Anxiety Stress Scale: Depression Subscale. Limitations and areas of future research are discussed., Author(s): Damian Santomauro[sup.1] , Jeanie Sheffield[sup.2] , Kate Sofronoff[sup.2] Author Affiliations: (1) Queensland Centre for Mental Health Research, School of Public Health, The University of Queensland, Locked Bag 500, 4108, [...]

Researchers and theorists (e.g., Shneidman, Stengel, Kovacs, and Beck) hypothesized that suicidal people engage in an internal debate, or struggle, over whether to live or die, but few studies have tested its tenability. This study introduces direct assessment of a suicidal debate, revealing new aspects of suicidal ideation. Results, from an online survey (N = 1,016), showed nearly all suicide-risk respondents engaged in the debate. In addition, debate frequency accounted for 54% of the variance in suicidality scores, and showed significant associations with other indicators of suicide risk. Likely factors of the debate, reasons for living and dying, showed significant differences by suicidality, and most suicide-risk participants reported going online for such purposes, demonstrating a behavioral component of the debate.

Whilst the Triple P Positive Parenting Program has a large evidence base (Sanders, "Clinical Child and Family Psychology Review" 2:71-90, 1999; Sanders, "Journal of Consulting and Clinical Psychology" 68:624-640, 2000) and preliminary evidence indicates that Stepping Stones Triple P is also efficacious (Roberts, "Journal of Clinical Child and Adolescent Psychology," 35(2):180-193, 2006), to date Stepping Stones has not been evaluated with the ASD population. Fifty-nine families with a child with ASD aged between 2 and 9 participated in this randomized controlled trial. The results demonstrate significant improvements in parental reports of child behaviour and parenting styles with the treatment effects for child behaviour, parental over reactivity and parental verbosity being maintained at follow-up 6 months later. Further, the results suggest significant improvements in parental satisfaction and conflict about parenting as well as a sleeper effect for parental efficacy. The results indicate that Stepping Stones Triple P is a promising intervention for parents of children with ASD. Limitations and future research are also addressed.

This study was conducted in conjunction with a randomised controlled trial of the parenting program Stepping Stones Triple P for parents of children with autism spectrum disorders (ASDs). Fifty-nine families with a child with ASD participated. This study focussed upon the role of parental attributions in predicting treatment outcome. Stepping Stones altered parental attributions such that following participation in Stepping Stones parents were significantly less likely to believe that their child's misbehaviour was caused by factors intrinsic to their child and more likely to believe that their child's ASD-related behaviour may change in the future. Parental attributions before the intervention significantly predicted change in the dysfunctional parenting styles over-reactivity and verbosity throughout the intervention. The implications of these findings are discussed in the context of developing a model for the role of parental attributions in predicting treatment outcome. (Contains 1 figure and 5 tables.)

This study was conducted in conjunction with a randomised controlled trial of the parenting program Stepping Stones Triple P for parents of children with Autism Spectrum Disorders. The current study concerned examination of the qualitative data arising from the RCT as well as evaluation of the particular parenting strategies that the parents found helpful. The results showed that parents were satisfied with the program, including the partial group format. Further, the majority of participants found the parenting strategies within Stepping Stones Triple P to be helpful, including timeout, physical guidance and blocking. In addition, many of the parents also used the additional strategies of Comic Strip Conversations and Social Stories and the majority of the parents who attempted these strategies found them to be helpful. The clinical implications of the findings are discussed. (Contains 2 figures and 3 tables.)

A cluster, stratified randomized design was used to evaluate the impact of universal, indicated, and combined universal plus indicated cognitive- behavioral approaches to the prevention of depression among 13- to 15-year-olds initially reporting elevated symptoms of depression. None of the intervention approaches differed significantly from a no-intervention condition or from each other on changes in depressive symptoms, anxiety, externalizing problems, coping skills, and social adjustment. All high-symptom students, irrespective of condition, showed a significant decline in depressive symptoms and improvement in emotional well-being over time although they still demonstrated elevated levels of psychopathology compared with the general population of peers at 12-month follow-up. There were also no significant intervention effects for the universal intervention in comparison with no intervention for the total sample of students in those conditions.

In this study, the authors examined the 2-, 3-, and 4-year outcomes of a school-based, universal approach to the prevention of adolescent depression. Despite initial short-term positive effects, these benefits were not maintained over time. Adolescents who completed the teacher-administered cognitive-behavioral intervention did not differ significantly from adolescents in the monitoring-control condition in terms of changes in depressive symptoms, problem solving, attributional style, or other indicators of psychopathology from preintervention to 4-year follow-up. Results were equivalent irrespective of initial level of depressive symptoms.

Although a relatively high percentage of Australian adolescents experience mental health problems, many disturbed adolescents do not receive the help they require, and only a small proportion of adolescents seek professional psychological help. The present study examined adolescents' willingness to seek help and investigated factors that promote and prevent adolescents from seeking help for a mental illness from both formal and informal sources. Secondary school students (254 in number) from schools in Brisbane, Australia completed a questionnaire that examined the relationship between demographic and psychological variables, attitudes toward mental illness, and willingness to seek help for a mental illness. Results suggest that adolescents with greater adaptive functioning, fewer perceived barriers to help seeking, and higher psychological distress were more willing to seek help from formal and informal sources for a mental illness. Greater social support also predicted willingness to seek help from informal sources. Although attitudes toward mental illness did not influence willingness to seek help, less stigmatising attitudes were related to higher knowledge of mental illness, being female, and higher levels of social support. Implications for the present study focus on enhancing the ability of mental health interventions to increase adolescents' willingness to seek psychological help.KEY WORDS: adolescents; help seeking; barriers; mental health literacy.

Researchers and theorists (e.g., Shneidman, Stengel, Kovacs, and Beck) hyothesized that suicidal people engage in an internal debate, or struggle, over whether to live or die, but few studies have tested its tenability. This study introduces direct assessment of a suicidal debate, revealing new aspects of suicidal ideation. Results, from an online survey (N= 1,016), showed nearly all suicide-risk respondents engaged in the debate. In addition, debate frequency accounted for 54% of the variance in suicidality scores, and showed significant associations with other indicators of suicide risk. Likely factors of the debate, reasons for living and dying, showed significant differences by suicidality, and most suicide-risk participants reported going online for such purposes, demonstrating a behavioral component of the debate.