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BackgroundBipolar disorder is a serious mental illness that results in significant morbidity and mortality. Pharmacotherapy is the primary treatment for bipolar disorder; however, adjunctive psychotherapy can help individuals use self-management strategies to improve outcomes. Yet access to this therapy is limited. Smartphones and other technologies have the potential to increase access to therapeutic strategies that enhance self-management while simultaneously providing real-time user feedback and provider alerts to augment care. ObjectiveThis paper describes the user-centered development of LiveWell, a smartphone-based self-management intervention for bipolar disorder, to contribute to and support the ongoing improvement and dissemination of technology-based mental health interventions. MethodsIndividuals with bipolar disorder first participated in a field trial of a simple smartphone app for self-monitoring of behavioral targets. To develop a complete technology-based intervention for bipolar disorder, this field trial was followed by design sessions, usability testing, and a pilot study of a smartphone-based self-management intervention for bipolar disorder. Throughout all phases of development, intervention revisions were made based on user feedback. ResultsThe core of the LiveWell intervention consists of a daily self-monitoring tool, the Daily Check-in. This self-monitoring tool underwent multiple revisions during the user-centered development process. Daily Check-in mood and thought rating scales were collapsed into a single wellness rating scale to accommodate user development of personalized scale anchors. These anchors are meant to assist users in identifying early warning signs and symptoms of impending episodes to take action based on personalized plans. When users identified personal anchors for the wellness scale, the anchors most commonly reflected behavioral signs and symptoms (40%), followed by cognitive (25%), mood (15%), physical (10%), and motivational (7%) signs and symptoms. Changes to the Daily Check-in were also made to help users distinguish between getting adequate sleep and keeping a regular routine. At the end of the pilot study, users reported that the Daily Check-in made them more aware of early warning signs and symptoms and how much they were sleeping. Users also reported that they liked personalizing their anchors and plans and felt this process was useful. Users experienced some difficulties with developing, tracking, and achieving target goals. Users also did not consistently follow up with app recommendations to contact providers when Daily Check-in data suggested they needed additional assistance. As a result, the human support roles for the technology were expanded beyond app use support to include support for self-management and clinical care communication. The development of these human support roles was aided by feedback on the technology's usability from the users and the coaches who provided the human support. ConclusionsUser input guided the development of intervention content, technology, and coaching support for LiveWell. Users valued the provision of monitoring tools and the ability to personalize plans for staying well, supporting the role of monitoring and personalization as important features of digital mental health technologies. Users also valued human support of the technology in the form of a coach, and user difficulties with aspects of self-management and care-provider communication led to an expansion of the coach's support roles. Obtaining feedback from both users and coaches played an important role in the development of both the LiveWell technology and human support. Attention to all stakeholders involved in the use of mental health technologies is essential for optimizing intervention development.

Objective: Irritability symptoms are closely associated with, and may reflect, temperament traits, particularly negative affectivity (NA). However, there are few empirical data on the relationships between child temperament and irritability symptoms. Method: We investigated cross-sectional and longitudinal relationships between irritability symptoms and temperament traits from age 3–15 in a community sample of 609 children and their parents. Irritability symptoms were assessed through structured interviews with parents at ages 3/ 6, and inventories completed by parents and youth at ages 12/15. Temperament traits were assessed using parent reports at ages 3/6, and parent and child reports at ages 12/15. Path analysis and structural equation modeling were used to explore longitudinal associations from ages 3–6 and 12–15, respectively. Results: Higher levels of irritability symptoms at ages 3/6 were concurrently associated with higher levels of NA and lower levels of effortful control (EC). In adolescence, higher irritability symptoms were concurrently associated with higher negative temperament and disinhibition. In longitudinal analyses from age 3–6 and 12–15, irritability symptoms showed modest but significant stability after adjusting for the stability of temperament traits. However, there were significant differences in the stability paths at age 3–6, reflecting lower stability of irritability symptoms. Finally, EC at age 3 predicted increased irritability symptoms at age 6, while irritability symptoms at age 3 predicted increased NA at age 6. Conclusion: Irritability symptoms are robustly associated with both temperamental NA and difficulty regulating attention and behavior. These findings help situate irritability symptoms within widely accepted temperament/personality taxonomies. [ABSTRACT FROM AUTHOR]

The article offers information on a randomized controlled trial (RCT) of intranasal oxytocin for young people with severe irritability, aiming to estimate the causal effect of oxytocin on emotional processing using functional MRI. Topics include the mechanism of oxytocin, its role in social interactions, and its potential for treating disorders with impaired social interactions.

Objective: Irritability is a common and clinically important problem in children and adolescents and a risk factor for later psychopathology and impairment. Irritability can manifest in both tonic (e.g., irritable, touchy mood) and phasic (e.g., temper outburst) forms, and recent studies of adolescents suggest that they predict different outcomes. However, no studies have examined whether tonic and phasic irritability are empirically distinguishable in 6‐year‐old children and whether they have distinct correlates and outcomes. Method: We utilized data from a longitudinal study of an unselected community sample of four hundred fifty‐two 6‐year‐olds followed at 3‐year intervals to age 15. We conducted confirmatory factor analysis (CFA) using relevant items from a diagnostic interview and several parent‐report inventories. Results: The CFA identified dimensions that were consistent with tonic and phasic irritability. Tonic irritability was independently associated with concurrent parent‐reported temperamental negative affectivity and internalizing and externalizing disorders at age 6 and predicted higher rates of internalizing psychopathology, and suicidal ideation, in adolescence. Phasic irritability was independently associated with concurrent parent‐reported temperamental negative affectivity, surgency, and low effortful control, maladaptive parenting styles and practices, and externalizing disorders at age 6, and predicted higher rates of externalizing psychopathology in adolescence. Conclusions: Tonic and phasic irritability in 6‐year‐old children appear to be distinguishable constructs with different temperament and parenting correlates and psychopathological outcomes. Distinguishing these components has implications for research on the etiology and pathophysiology of irritability and developing effective treatments. [ABSTRACT FROM AUTHOR]

Background: The rates of suicide in youth have increased dramatically, leading to increased interest in routinely screening youth for suicidality. However, data on suicidal ideation (SI) in younger children are sparse, especially with brief self‐report measures that can easily be used for screening non‐referred samples. Methods: We evaluated a community sample of 497 6‐year‐old children and their parents and followed them into adolescence. SI was assessed via child self‐report at ages 6 and 9 using an item from the Children's Depression Inventory, and via parent‐report at age 6 using an item from the Early Childhood Inventory. Child psychopathology and functioning were assessed via semi‐structured interviews every 3 years from age 6 through 15. Results: Child endorsement of SI at age 6 did not predict later psychopathology or functioning. Child endorsement of SI at age 9 was associated with attention deficit hyperactivity disorder (ADHD) and disruptive behavior disorders (DBD) diagnoses across the adolescent follow‐up assessments. Parent endorsement of child SI predicted an increased likelihood of later SI and non‐suicidal self‐injury, a higher rate of DBD and externalizing symptoms, and poorer global functioning in adolescence. Conclusions: Our results support recommendations against administering SI screening measures to children under the age of 10. [ABSTRACT FROM AUTHOR]

Attachment theory suggests that parent responsiveness to infant distress predicts secure parent–child attachment and subsequent healthy child development. While much is known about microsystem factors that interfere with responsive caregiving, there is a paucity of research investigating how exosystem factors, such as neighborhood crime, affect parenting. In a sample of 200 diverse caregivers and their 5- to 21-month-old infants (M = 11.82; 49% male), we leveraged data from a randomized clinical trial of Attachment and Biobehavioral Catch-up (ABC), an attachment-based intervention, to assess whether individual level burden (indicated by single-parent status, low income, residential instability, young parenthood, parental psychopathology, and own history of early adversity) and neighborhood crime density (geocoded within a 500 ft radius of parent's residence) were associated with their beliefs about infant crying, an indicator of responsive parenting. Consistent with Bronfenbrenner's ecological systems' theory of development, both greater exposure to individual burden indicators and greater neighborhood crime density predicted greater maladaptive beliefs about infant crying, suggesting that contextual factors outside the household are associated with parenting cognitions. Further, when accounting for the effect of crime and individual burden on parental beliefs about infant crying, participation in the ABC intervention was effective in reducing maladaptive parenting beliefs. We consider implications for multi-level intervention approaches that target family processes, neighborhood-level factors, and policy initiatives to promote community wellbeing and positive child development. [ABSTRACT FROM AUTHOR]

Background: In recent years, epidemiological and clinical studies have revealed that depressive disorders can present in early childhood. To clarify the validity and prognostic significance of early childhood‐onset depression, we investigated diagnostic and functional outcomes in later childhood and adolescence. Methods: A community sample (N = 516) was assessed for psychopathology at ages 3 and 6 using the Preschool Age Psychiatric Assessment. When participants were 9, 12, and 15 years old, children and parents completed the Kiddie Schedule for Affective Disorders and Schizophrenia and measures of symptoms and functioning. Results: In models adjusting for covariates, depressed 3/6‐year‐old children were more likely to experience subsequent episodes of depressive disorders and exhibited significantly higher rates of later anxiety disorder, attention deficit hyperactivity disorder, and suicidality compared to children without depressive disorders at age 3/6. Early childhood depression was also associated with higher levels of mother, but not child, reported depressive symptoms at age 15 compared to children without depressive disorders at age 3/6. Finally, depression at age 3/6 predicted lower levels of global and interpersonal functioning and higher rates of treatment at age 15 compared to children without depressive disorders at age 3/6. Conclusions: Results support the clinical significance of depression in 3/6‐year‐old children, although further studies with larger samples are needed. [ABSTRACT FROM AUTHOR]

There are large differences in expulsions and suspensions on the basis of race starting in preschool and divergent explanations for their cause. The current study explores how developmental methodology can shed light on this vexing issue. We leverage two measures: (1) childcare provider complaints about children's behavior and their recommended disciplinary action (measured by parent report); and (2) observed disruptive behavior measured by a laboratory‐based standardized observation tool, the Disruptive Behavior Diagnostic Observation Schedule (DB‐DOS), among a large, sociodemographically diverse sample of children (n =$\text{=}$ 430; mean age =$\text{=}$ 4.79 years). We identified three latent class profiles on the basis of race/socioeconomic status (SES) and found disparities in childcare provider complaints based on profile membership. More specifically, children classified in the Black/Hispanic, poor and Black, nonpoor profiles both had significantly higher childcare provider complaints compared with children in the White/Hispanic, nonpoor profile. By contrast, there were no differences in observed disruptive behavior based on race/SES profiles. Finally, childcare provider complaints in preschool were associated with lower cognitive performance in elementary school, above and beyond observed disruptive behavior in preschool and race/SES profiles. Implications for classroom practice and contributions to the national debate on school disciplinary policies are discussed. [ABSTRACT FROM AUTHOR]

Background: Irritability is a transdiagnostic risk factor for psychopathology and interpersonal problems in youth. However, there is little research on the role of life stress in irritability. The association between stress and irritability may be bidirectional, with irritability leading to stress exposure and stress aggravating irritability. Moreover, it is conceivable that there are sex differences in these relationships. Therefore, we examined the prospective, bidirectional relationships between irritability and stressful life events in a sample of adolescents while considering the role of biological sex., Methods: We tested multi-group path models investigating bidirectional associations of irritability with dependent and independent episodic stressors in a community sample of 520 adolescents (52.1 % male) across ages 12, 15, and 18., Results: All models had acceptable fit. For males, dependent stress at age 12 predicted irritability at age 15, which in turn predicted more stress at age 18. For females, irritability at age 12 predicted dependent stress at age 15, which in turn predicted more irritability at age 18. For independent events in males, irritability at age 15 predicted stress at age 18. For females, independent stress at age 12 predicted irritability at age 15, which in turn predicted more stress at age 18., Conclusion: There are significant bidirectional relationships between irritability and episodic stressors, although the relationships varied depending on youth's age, sex, and role in contributing to stressor occurrence., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2024 Elsevier B.V. All rights reserved.)