Parental accommodation is a well-established anxiogenic parenting practice that is ubiquitous among parents of youth with obsessive-compulsive symptoms (OCS). Accommodation is associated with heightened symptom severity (i.e., high levels of accommodation reinforce and maintain OCS). The present study sought to evaluate whether child age and gender moderated the relationship between parental accommodation and symptom severity. Participants included parents of children with a broad range of psychiatric disorders, as well as some youth with no psychiatric disorder (N = 61, children ages 7-17). Parents completed questionnaires related to their accommodation practices and their child's obsessive-compulsive symptoms. Age significantly moderated the relationship between accommodation and symptom severity, such that the relationship was stronger among older children. Gender significantly moderated the relationship between accommodation and symptom severity, such that the relationship was stronger among boys. Additional research is needed to further delineate the impact of age and gender on parental accommodation and OCS.

There are few evaluations of early intervention for the prevention of anxiety disorders in East Asia, and those that exist generally evaluate outcomes to a maximum of 6-12 months. The current study evaluated the long-term effect (5 years) of an anxiety prevention program presented to preschool children and their parents in Japan. Participants for the study were 10 inhibited children 5-6 years old and their parents. The parent's and children's program comprised group sessions of a cognitive-behavioural program. Parents and teachers completed the anxious/depressed, withdrawn and behavioural inhibition at pre-post-intervention and 3-month follow-up. Five years after starting the intervention, participants were invited to a diagnostic interview, Anxiety Disorders Interview Schedule (ADIS) to examine a long-term preventive effect of the intervention. The majority of children showed a reduction in anxious/depressed, behavioral inhibition, and approximately half showed reliable change according to parents' and teachers' reports. Moreover, the results indicated that 9 of the 10 children did not met the diagnostic criteria for anxiety disorders. These results suggested that the early intervention had preventive effects because the diagnostic criteria for anxiety disorders were not met in the follow-up assessment conducted five years later.

Childhood mental health problems are common, impairing, and can become chronic if left untreated. Children are not reliable reporters of their emotional and behavioral health, and caregivers often unintentionally under- or over-report child symptoms, making assessment challenging. Objective physiological and behavioral measures of emotional and behavioral health are emerging. However, these methods typically require specialized equipment and expertise in data and sensor engineering to administer and analyze. To address this challenge, we have developed the ChAMP (Childhood Assessment and Management of digital Phenotypes) System, which includes a mobile application for collecting movement and audio data during a battery of mood induction tasks and an open-source platform for extracting digital biomarkers. As proof of principle, we present ChAMP System data from 101 children 4-8 years old, with and without diagnosed mental health disorders. Machine learning models trained on these data detect the presence of specific disorders with 70-73% balanced accuracy, with similar results to clinical thresholds on established parent-report measures (63-82% balanced accuracy). Features favored in model architectures are described using Shapley Additive Explanations (SHAP). Canonical Correlation Analysis reveals moderate to strong associations between predictors of each disorder and associated symptom severity (r = .51-.83). The open-source ChAMP System provides clinically-relevant digital biomarkers that may later complement parent-report measures of emotional and behavioral health for detecting kids with underlying mental health conditions and lowers the barrier to entry for researchers interested in exploring digital phenotyping of childhood mental health.

Childhood mental health problems are common, impairing, and can become chronic if left untreated. Children are not reliable reporters of their emotional and behavioral health, and caregivers often unintentionally under- or over-report child symptoms, making assessment challenging. Objective physiological and behavioral measures of emotional and behavioral health are emerging. However, these methods typically require specialized equipment and expertise in data and sensor engineering to administer and analyze. To address this challenge, we have developed the ChAMP (Childhood Assessment and Management of digital Phenotypes) System, which includes a mobile application for collecting movement and audio data during a battery of mood induction tasks and an open-source platform for extracting digital biomarkers. As proof of principle, we present ChAMP System data from 101 children 4-8 years old, with and without diagnosed mental health disorders. Machine learning models trained on these data detect the presence of specific disorders with 70-73% balanced accuracy, with similar results to clinical thresholds on established parent-report measures (63-82% balanced accuracy). Features favored in model architectures are described using Shapley Additive Explanations (SHAP). Canonical Correlation Analysis reveals moderate to strong associations between predictors of each disorder and associated symptom severity (r = .51-.83). The open-source ChAMP System provides clinically-relevant digital biomarkers that may later complement parent-report measures of emotional and behavioral health for detecting kids with underlying mental health conditions and lowers the barrier to entry for researchers interested in exploring digital phenotyping of childhood mental health.

In a growing body of literature, poor sleep quality has been associated with externalizing problems. In adults, anxiety was found to mediate the relationship, and callous-unemotional (CU) traits were found to moderate it. We sought to examine these relationships in a child population. We examined these relationships in 239 clinic-referred youth (age 6-17) in Singapore with externalizing behavior problems. Parent- but not child-rated sleep problems were associated with increased parent-rated externalizing problems. This association was partially mediated by anxiety. Unlike in adults, CU traits did not moderate the relationship. Sleep problems were associated with externalizing problems regardless of the level of CU traits. It is possible externalizing behaviors may lead children to internalize experiences, leading to anxiety about their behaviors. Another possibility is externalizing behaviors may lead to more stressful life experiences due to negative reactions children with externalizing behaviors receive from parents, teachers, or peers. Regardless, the partial mediation found indicates anxiety may be an important factor to consider in future interventions focused on improving sleep as a means to reduce externalizing problems.

The 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).

There 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.

The 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.

These 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.

There is a great variety of measurement instruments to assess similar constructs in clinical research and practice. This complicates the interpretation of test results and hampers the implementation of measurement-based care.

For reporting and discussing test results with patients, we suggest converting test results into universally applicable common metrics. Two well-established metrics are reviewed: T scores and percentile ranks. Their calculation is explained, their merits and drawbacks are discussed, and recommendations for the most convenient reference group are provided.

We propose to express test results as T scores with the general population as reference group. To elucidate test results to patients, T scores may be supplemented with percentile ranks, based on data from a clinical sample. The practical benefits are demonstrated using the published data of four frequently used instruments for measuring depression: the CES-D, PHQ-9, BDI-II and the PROMIS depression measure.

Recent initiatives have proposed to mandate a limited set of outcome measures to harmonize clinical measurement. However, the selected instruments are not without flaws and, potentially, this directive may hamper future instrument development. We recommend using common metrics as an alternative approach to harmonize test results in clinical practice, as this will facilitate the integration of measures in day-to-day practice.

Comorbidity is the co-occurrence of two or more disorders in the same person.

This study investigated the frequency of comorbid conditions, in children and adolescents, with autism spectrum disorder (ASD), cerebral palsy (CP), and a comorbid diagnosis of ASD and CP.

Ninety-six children and adolescents with ASD, CP, and both ASD and CP aged between 4 and 18 years participated in this study. Parents completed the Gastrointestinal Symptom Inventory, Children's Sleep Habits Questionnaire, Child Behavior Checklist, Social Communication Questionnaire, and the Vineland Adaptive Behavior Scales.

Results of ANOVA analyses revealed significant group differences in sleep problems, social communication difficulties, and adaptive behavior. Regression analysis found that the presence of an intellectual disability significantly predicted levels of adaptive behavior.

This research demonstrated the importance of studying comorbidities in children and adolescents with CP alone, ASD alone, and combined ASD and CP.

It is well established that anxiety can contribute to social functioning difficulties during childhood and adolescence. It is less clear which anxious youth are most likely to struggle socially, and what types of difficulties they are likely to experience, limiting the extent of identification and intervention efforts. In this study, we aim to improve specification of the linkages between youth anxiety severity and social functioning by examining several potential moderators of these associations. Specifically, we examine whether family accommodation of youth anxiety, in addition to youth age, sex, and the presence of a social anxiety disorder diagnosis, influence associations between anxiety severity and social functioning among youth with anxiety disorders. Youth (N = 158, M_age = 9.99 years, SD = 2.74) and their mothers completed diagnostic interviews and questionnaires assessing anxiety and depression symptoms, family accommodation, and a range of social functioning variables. In a series of hierarchical linear regressions, we found that youth anxiety severity was most strongly associated with social impairment at high levels of family accommodation for adolescents and for youth without social anxiety disorder (mother-report). We also found several direct effects of anxiety severity, family accommodation, and youth age, sex, and diagnosis on different facets of youth social functioning (youth- and/or mother-report). We discuss clinical implications and future research directions focused on specifying the nature of associations between youth anxiety and their social functioning.

Myriad parenting behaviors have been linked to the development of internalizing disorders in children. Intrusive parenting, characterized by autonomy-limiting behaviors that hold the parent's agenda above that of the child, may uniquely contribute to the development of child internalizing symptoms. The current study investigates bidirectional effects between maternal intrusiveness and internalizing symptomology from infancy to middle childhood.

Participants were a community sample of 218 infant-mother dyads assessed at 7 time points (5 and 10 months; 2, 3, 4, 6, and 9 years). Maternal intrusiveness was behaviorally coded at all timepoints; mothers completed the CBCL for their child at ages 3, 4, 6, and 9 years. The empirically derived Internalizing subscale was used to assess child internalizing symptoms.

About 1/3 to ½ of mothers displayed maternal intrusiveness across infancy and childhood, with the exception of ages 2-3 years, when an increase in the number of mothers displaying intrusiveness was observed. A cross-lagged panel model showed that intrusiveness and internalizing symptoms were concurrently related at 3 years, but this relationship disappeared when we controlled for maternal education. There was no evidence of prospective relationships between our constructs.

Mothers in a community-based sample may increase intrusiveness in the toddler and early preschool years as children strive for more autonomy. Intrusiveness may play more of a maintenance role in child internalizing symptoms, and associations between maternal intrusiveness and child internalizing symptomatology may be weaker than hypothesized, varying by maternal education. Suggestions for assessing intrusive parenting in future studies are discussed.

Children who experience obsessive-compulsive symptoms (OCS) may be at risk for developing Obsessive-Compulsive Disorder (OCD). The current study aimed to investigate developmental trajectories of OCS, as well as possible predictors, within a community-based sample of children. Children (N = 1147) from the longitudinal NICHD Study of Early Child Care and Youth Development (SECCYD) were assessed for OCS, via the Child Behavioral Checklist - Obsessive-Compulsive Scale (OCS-8), eight times between Pre-Kindergarten (54 months; Pre-K) and High School (15 years of age; HS.) Participants were recruited within the United States and included only maternal caregivers. Preliminary analyses indicated that approximately 3% of the sample was above the diagnostic cutoff score on the OCS-8 at the High School time-point. Latent growth models tested symptom trajectories. Findings demonstrated three groups of OCS trajectories. Most children fell within a low symptomatology group (the No Peak group) with low OCS across all time points. Two additional OCS trajectories were also demonstrated: Pre-K Peak (high to low OCS across time) and HS Peak (low to high OCS across time). Both higher attention problems and greater depression/anxiety symptoms at the Pre-K time point predicted children's membership in the Pre-K Peak or HS Peak groups compared to the No Peak group. Membership within the HS Peak group predicted a high likelihood of children's OCS being above previously established cutoff scores for an OCD diagnosis at age 15 years. Membership within either the Pre-K Peak or No Peak groups predicted a low likelihood. This study provides new evidence for the existence of different developmental trajectories for youth with OCS. From a clinical perspective, these results may have important implications when considering the identification and early intervention of childhood OCS and OCD within the community.

The association between sports participation and mental health has not been studied in primary care samples of school-age children, nor in underrepresented minority children. We assessed the relationship between number of sports played and psychiatric symptoms in children ages 6-11 at well-child visits in an urban clinic.

Guardians of 206 children (85% Latinx) ages 6-11 completed Child Behavior Checklists (CBCL) in Spanish (66.5%) or English at well-child visits at an urban community health center. We performed linear regression between number of sports played and individual CBCL syndrome scores, and multiple logistic regression with normal (T-score <60) vs. elevated (T-score ≥60) CBCL syndrome scale score as the outcome. We conducted bivariate, multiple logistic regression, and linear regression analyses between low (1 or fewer) vs. high (2 or more) sports participators and subscales of interest.

Fewer sports played was associated with higher Withdrawn/Depressed CBCL syndrome scale T-scores (p = 0.019), but not with other CBCL syndrome scale scores nor number of syndrome scale elevations (p = 0.638). Low participators had higher odds of an elevated Withdrawn/Depressed T-score (p = 0.033) than high participators.

Our dataset did not contain certain details about sports played, nor information about income and insurance, and our results may not generalize to other populations.

Playing fewer sports is associated with higher withdrawn/depressed symptoms in urban, predominantly Latinx, school-age children. Therefore, urban school-age children with low sports participation may be at risk for depression, and sports participation might protect against depressive symptoms in childhood.

The Coping Questionnaire (CQ)-child and parent version-is an idiographic measure of youth's perceived ability to cope in anxiety provoking situations. Participants (N = 442; aged 7-17) met DSM-IV criteria for separation anxiety disorder, generalized anxiety disorder, or social anxiety disorder. The internal consistency of the CQ was supported, and retest reliability and parent/child agreement were, as expected, modest. The CQ scores were significantly correlated in the expected direction with measures of anxiety symptoms and functioning, providing evidence of convergent and divergent validity. The criterion validity of the CQ also was supported: the CQ scores were significantly correlated with the clinical severity rating of the youth's principal diagnosis on ADIS. There was a significant correlation between change in CQ scores and in anxiety severity and symptoms following treatment. Results support the CQ as a measure to assess coping efficacy in anxious youths as part of evidence-based assessment.

Objective: This feasibility study examined the effects of a particular Traditional Chinese Medicine (TCM) herbal formula on attention-deficit/hyperactivity disorder (ADHD) and related problem behaviors. Design: A total of 79 participants aging 6-12 years consumed a granulated TCM herbal formula twice daily over a period of 3 months and underwent assessments at months 0, 3, and 6. Changes in ADHD symptoms and related behaviors were measured using the ADHD rating scale-IV (ADHD-RS-IV), child behavior checklist (CBCL), children's global sssessment scale (CGAS), as well as the clinical global impressions-severity (CGI-S) and improvement (CGI-I) scales. Results: Repeated measures mixed model analyses revealed significant differences in scores across time on all ADHD-RS-IV and CBCL subscales as well as on the CGAS, CGI-S, and CGI-I scales. Pairwise comparisons between months 0 and 3 as well as months 0 and 6 indicated significant improvements in scores. Scores also did not differ significantly between months 3 and 6. The results may suggest that this particular TCM formula possesses potential therapeutic qualities in the treatment of ADHD. Furthermore, changes in ADHD symptoms generally appear to be stable 3 months after discontinuation. However, these findings could also be attributed to placebo effects as well as reporting biases. Conclusion: This particular TCM formula may prove to be a useful adjunctive treatment for children with ADHD, and randomized controlled trials need to be conducted to evaluate its efficacy.

The dysregulation of the inflammatory response, including pro-inflammatory molecules, produces neuropsychiatric symptoms and depression-like behavior, including withdrawal from the physical and social environment. Genetic variants that enhance immune reactivity may thus increase inflammatory and withdrawn reactions to stress. Here we investigated a functional polymorphism of Interferon Gamma gene (IFNG +874 T > A, rs2430561) as moderator of the relationship between mothers' distress exposure and children's withdrawn behavior at preschool age. Participants were 198 Portuguese preschool children (mean age = 57.98 months). Exposure to mother's distress was assessed using the Brief Symptom Inventory, and withdrawn behavior with the Caregiver Teacher Report Form. All children provided saliva samples for genotyping. Contrary to expecations based on prior work, the rs2430561 AA genotype-not the T variant-interacted with (high levels of) mothers' distress exposure, to increase children's withdrawn behavior. No significant main effects were detected. The polymorphism in Interferon Gamma gene showed specific environmental stressor-dependent effects on withdrawn behavior during childhood, ones which are interpreted in light of the "behavioral immune system" hypothesis, and which proved inconsistent with diathesis-stress thinking.

The Child Behavior Checklist (CBCL) is widely used to assess behavioral and emotional problems in youth. The CBCL Diagnostic and Statistical Manual (DSM)-Oriented Anxiety Problems subscale (CBCL-AP) was developed for the identification of DSM-IV anxiety disorders. Using data from 298 youth aged 6- to 18, the CBCL-AP scale was examined to determine its ability to differentially predict, via Receiver Operating Characteristics (ROC) analysis, the presence of (a) generalized anxiety disorder (GAD), (b) separation anxiety disorder (SAD), (c) specific phobia (SPPH), or (d) the presence of any of these disorders. Independent Evaluators (IEs) administered the Anxiety Disorders Interview Schedule for Children (ADIS-C/P) to determine the presence of an anxiety disorder. The ability of the CBCL-AP to predict to anxiety disorders was compared to the ability of the CBCL Anxious/Depressed (CBCL-A/D) scale and the seven empirically derived CBCL syndrome subscales and five DSM-Oriented subscales to predict anxiety disorder diagnoses. Results revealed that CBCL-AP scores significantly predicted all diagnoses. CBCL-A/D scores significantly predicted SAD (AUC = 0.67), GAD (AUC = 0.69), and the presence of any of the three disorders (AUC = 0.72), but not the presence of SPPH (AUC = 0.52). Although the CBCL-AP scale may not be a substitute for extensive diagnostics, it has demonstrated utility as an instrument for assessing anxiety and can serve to identify anxious youth in need of mental health services.

Childhood anxiety and depression often go undiagnosed. If left untreated these conditions, collectively known as internalizing disorders, are associated with long-term negative outcomes including substance abuse and increased risk for suicide. This paper presents a new approach for identifying young children with internalizing disorders using a 3-min speech task. We show that machine learning analysis of audio data from the task can be used to identify children with an internalizing disorder with 80% accuracy (54% sensitivity, 93% specificity). The speech features most discriminative of internalizing disorder are analyzed in detail, showing that affected children exhibit especially low-pitch voices, with repeatable speech inflections and content, and high-pitched response to surprising stimuli relative to controls. This new tool is shown to outperform clinical thresholds on parent-reported child symptoms, which identify children with an internalizing disorder with lower accuracy (67-77% versus 80%), and similar specificity (85-100% versus 93%), and sensitivity (0-58% versus 54%) in this sample. These results point toward the future use of this approach for screening children for internalizing disorders so that interventions can be deployed when they have the highest chance for long-term success.

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.

There is a critical need for fast, inexpensive, objective, and accurate screening tools for childhood psychopathology. Perhaps most compelling is in the case of internalizing disorders, like anxiety and depression, where unobservable symptoms cause children to go unassessed-suffering in silence because they never exhibiting the disruptive behaviors that would lead to a referral for diagnostic assessment. If left untreated these disorders are associated with long-term negative outcomes including substance abuse and increased risk for suicide. This paper presents a new approach for identifying children with internalizing disorders using an instrumented 90-second mood induction task. Participant motion during the task is monitored using a commercially available wearable sensor. We show that machine learning can be used to differentiate children with an internalizing diagnosis from controls with 81% accuracy (67% sensitivity, 88% specificity). We provide a detailed description of the modeling methodology used to arrive at these results and explore further the predictive ability of each temporal phase of the mood induction task. Kinematical measures most discriminative of internalizing diagnosis are analyzed in detail, showing affected children exhibit significantly more avoidance of ambiguous threat. Performance of the proposed approach is compared to clinical thresholds on parent-reported child symptoms which differentiate children with an internalizing diagnosis from controls with slightly lower accuracy (.68-.75 vs. .81), slightly higher specificity (.88-1.00 vs. .88), and lower sensitivity (.00-.42 vs. .67) than the proposed, instrumented method. These results point toward the future use of this approach for screening children for internalizing disorders so that interventions can be deployed when they have the highest chance for long-term success.

Child welfare involvement has been linked to child behavioral health issues, including increased likelihood of internalizing mental health problems such as depression and anxiety, and externalizing behavioral problems such as oppositional behaviors and substance use problems. One predictor of child behavioral health is caregiver mental health. Although, there remains a specific gap associated with identification of factors among caregivers that are associated with longitudinal child behavioral health trajectories. Using LONGSCAN, we explore the effects of caregiver depression on the behavioral health of children over time. Multilevel mixed-effects linear regression models showed that children with a caregiver who reported depression showed significantly higher internalizing behavioral problems over time, and significantly larger decreases in externalizing behavioral problems over time, compared to children with a caregiver who reported no depression. These findings emphasize that early interventions geared towards jointly assessing and treating parent and child mental health issues in the child welfare system may be successful at improving future behavioral health outcomes.

Withdrawn/depressed behavior (WD) as defined by the Child Behavior Checklist (CBCL) relates to various outcomes in developmental psychopathology such as depression, pervasive developmental disorders, and suicide. We sought to examine the temperamental characteristics of children who concurrently endorse symptoms of WD. Junior Temperament and Characteristic Inventory (JTCI) and CBCL data were collected from 397 children's parents in a family study in the northeastern United States. Linear mixed models were used to test the relations between WD and temperament dimensions (Novelty Seeking, Harm Avoidance, Reward Dependence, Persistence) on the JTCI, while controlling for age, sex, item overlap, and co-occurring aggression and attention problems. When controlling for definitional artifact and CBCL aggressive behavior and attention scores, high harm avoidance and low reward dependence were both significant predictors of childhood withdrawn behavior. This study marks the first characterization of a temperamental profile associated with WD in children and adolescents.

Although most people will experience a traumatic event at some point in their life, only some will develop significant psychological symptoms in the aftermath. In the current study, we use a preexisting longitudinal study located in Long Island to examine the impact of Hurricane Sandy on internalizing symptoms in a large sample of children. We focused on temperamental fear and a biomarker of risk for anxiety, the error-related negativity (ERN). The ERN is a negative deflection in the event-related potential (ERP) occurring when individuals make mistakes and is increased in anxious individuals.

The final sample consisted of 223 children who had undergone an observational assessment of fear at age 3 years and an electroencephalogram assessment of the ERN at age 6 years. At the age 9 year assessment, internalizing symptoms were assessed, and then again after the hurricane (∼65 weeks later).

A significant three-way interaction among fearfulness, hurricane stressors, and the ERN in predicting posthurricane increases in internalizing symptoms suggested that children who were high in fear at age 3 years and experienced elevated hurricane stressors were characterized by subsequent increases in internalizing symptoms, but only when they were also characterized by an increased ERN at age 6 years.

These findings support a diathesis-stress model, suggesting that early temperament and prestressor biological markers confer risk for increased psychological symptoms following environmental stressors.

To examine the psychosocial outcomes and impact of attention problems in survivors of pediatric brain tumor.

The survivors' cognitive functioning was measured using the Wechsler Intelligence Scale for Children. The Child Behavior Checklist-Attention Problems scale was used to screen for attention problems, and participants were classified as having attention problems (n=15) or normal attention (n=36). Psychosocial functioning was examined with the Korean Personality Rating scale for Children (K-PRC) at precraniospinal radiation and at 2-year follow-up.

The attention problem group showed significantly higher depression and externalizing symptoms (delinquency, hyperactivity) and more significant impairment in family relationships than did the normal attention group at baseline. At follow-up, the attention problem group demonstrated significantly more delinquency and impaired family and social relationships. With the K-PRC scores, except for the somatization, social relationship subscale, there were significant differences between groups, but not in terms of treatment by time interaction or within time. At follow-up, multiple linear regressions showed that age at diagnosis significantly predicted K-PRC somatization (B=-1.7, P=0.004) and social relationships (B=-1.7, P=0.004), baseline full-scale intelligence quotient predicted K-PRC depression (B=-0.4, P=0.032) and somatization (B=-0.3, P=0.015), and attention problems at baseline predicted K-PRC depression (B=-15.2, P=0.036) and social relationships (B=-11.6, P=0.016).

Pediatric brain tumor survivors, in particular, patients with attention problems, had worse psychosocial functioning at baseline and follow-up. Attention problems at baseline need to be carefully evaluated in assessing psychosocial functioning of pediatric brain tumor survivors.

This study investigated the diagnostic and clinical utility of the parent-rated Screen for Child Anxiety Related Emotional Disorders (SCARED-P) for detecting youth anxiety disorders. Youth ages 6 to 12 years, 11 months were recruited from 9 outpatient mental health clinics (N = 707). Consensus diagnoses were based on semistructured interviews (Schedule for Affective Disorders and Schizophrenia for School-Age Children) with youth and caregivers; 31% were diagnosed with at least one anxiety disorder. Caregivers completed the SCARED-P to describe youth anxiety levels. SCARED-P scores were not considered during the consensus diagnoses. Areas under the curve (AUCs) from receiver operating characteristic analyses and diagnostic likelihood ratios (DLRs) quantified performance of the SCARED-P total score and subscale scores (generalized anxiety disorder and separation anxiety disorder). SCARED-P total scores had variable efficiency (AUCs = .69-.88), and Generalized Anxiety Disorder and Separation Anxiety subscale scores were excellent (AUCs = .86-.89) for identifying specific anxiety disorders. Optimal subscale cutoff scores were computed to help rule in (DLRs = 2.7-5.4) or rule out (DLRs < 1.0) anxiety disorders among youth. Results suggest that the Generalized Anxiety Disorder and Separation Anxiety SCARED-P subscales accurately identify their respective matched diagnoses. DLRs may aid clinicians in screening for youth anxiety disorders and improve accuracy of diagnosis.

Sleep-related problems (SRPs) are common and problematic among anxious youth but have not been investigated in anxious youth with autism spectrum disorder (ASD). Participants were 102 youth (ages 7-16 years) with ASD and comorbid anxiety. Youth and their primary caregiver were administered the Pediatric Anxiety Rating Scale. Parents completed the Multidimensional Anxiety Scale for Children-Parent (MASC-P) Report, Social Responsiveness Scale, and the Child Behavior Checklist (CBCL). A measure of SRPs was created from items from the CBCL and MASC-P. Results suggest SRPs were relatively common among youth with ASD and comorbid anxiety. The number of SRPs endorsed directly associated with parent ratings of social deficits, internalizing and externalizing symptoms, and anxiety symptoms, as well as with clinician-rated anxiety symptoms. Parent-rated internalizing symptoms predicted frequency of SRPs over and above social deficits, externalizing symptoms, and parent- and clinician-rated anxiety symptoms. A subset of 40 participants who completed family-based cognitive-behavioral therapy (CBT) experienced reduced SRPs following treatment. Implications, study limitations, and recommendations for future research are discussed.

The current study presents an approach for empirically identifying tailoring variables at midtreatment of cognitive behavioral therapy (CBT) protocols for youth with anxiety disorders that can be used to guide moves to second-stage treatments. Using 2 independent data sets (Study 1 N = 240, M age = 9.86 years; Study 2 N = 341; M age = 9.53 years), we examined treatment response patterns after 8 sessions of CBT (i.e., CBT midtreatment). We identified and replicated 3 classes of response patterns at CBT midtreatment: Early Responders, Partial Responders, and Nonresponders. Class membership at CBT midtreatment was predictive of outcome at CBT posttreatment. Receiver operating characteristics curves were used to derive guidelines to optimize accuracy of assignment to classes at CBT midtreatment. These findings support the promise of treatment response at CBT midtreatment to identify tailoring variables for use in abbreviating first-stage treatments and facilitating moves to second-stage treatments.

The Child Behavior Checklist (CBCL) is a widely used parent-report of child and adolescent behavior. We examined the ability of the CBCL-A scale, a previously published subset of CBCL items, to predict the presence of generalized anxiety disorder (GAD), separation anxiety disorder (SAD), and social phobia (SoP), as well as anxiety severity, among 488 youth randomized in the Child Anxiety Multimodal Study (CAMS). We predicted that the CBCL-A's unique inclusion of items related to somatic symptoms would better identify anxiety disorder and severity than other CBCL scales, given that somatic complaints are often key features of anxiety among youth. Results support the use of the anxiety-based CBCL subscales as first-line screeners for generally elevated symptoms of anxiety, rather than tools to identify specific anxiety disorders. Although somatic symptoms are often reported and included in diagnostic criteria for certain anxiety disorders (e.g., SAD, GAD), the unique combination of somatic and non-somatic symptoms for the CBCL-A subscale did not increase its ability to consistently predict the presence of specific anxiety disorders.

Despite high rates of clinically elevated anxiety difficulties in children and adolescents with autism spectrum disorders (ASDs), very few studies have systematically examined the usefulness of commonly used caregiver report anxiety screening tools with this population. This study investigated the use of the Spence Children's Anxiety Scale-Parent version (SCAS-P) as a screening tool for anxiety disorders when compared to a standardized DSM-IV-TR-based clinical interview, the Kiddie-Schedule for Schizophrenia and Affective Disorders-Present and Lifetime version (K-SADS-PL). Thirty-two caregivers of youth with a clinical diagnosis of ASD (mean age 10.3 years) attending a specialist autism school participated in this study. They first completed the SCAS-P, a measure of adaptive functioning and a checklist of other emotional and behavioral difficulties. They were then interviewed with the K-SADS-PL. Internal consistency for the SCAS Total score was .88, but Cronbach's alphas were <.70 in three of the six SCAS-P subscales. The sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of the SCAS-P against K-SADS diagnosis were .75, .71, .27, and .95, respectively. All values were >.70, except for the PPV. Evidence of convergent validity between the SCAS-P, K-SADS-PL and DBC anxiety subscale was also found. The high false positive rates notwithstanding, the preliminary data of acceptable to excellent sensitivity, specificity and NPV values tentatively suggest that the SCAS-P may be useful for screening non-help seeking young people with ASD for elevated anxiety symptoms. Further replication in larger studies is needed and ways in which the SCAS-P could be further developed and investigated for use with youth with ASD are discussed.

Anxiety disorders are common among children but can be difficult to diagnose. An actuarial approach to the diagnosis of anxiety may improve the efficiency and accuracy of the process. The objectives of this study were to determine the clinical utility of the Achenbach Child Behavior Checklist (CBCL) and Youth Self Report (YSR), two widely used assessment tools, for diagnosing anxiety disorders in youth and to aid clinicians in incorporating scale scores into an actuarial approach to diagnosis through a clinical vignette. Demographically diverse youth, 5 to 18 years of age, were drawn from two samples; one (N = 1,084) was recruited from a research center, and the second (N = 651) was recruited from an urban community mental health center. Consensus diagnoses integrated information from semistructured interview, family history, treatment history, and clinical judgment. The CBCL and YSR internalizing problems T scores discriminated cases with any anxiety disorder or with generalized anxiety disorder from all other diagnoses in both samples (ps < .0005); the two scales had equivalent discriminative validity (ps > .05 for tests of difference). No other scales, nor any combination of scales, significantly improved on the performance of the Internalizing scale. In the highest risk group, Internalizing scores greater than 69 (CBCL) or greater than 63 (YSR) resulted in a Diagnostic Likelihood Ratio of 1.5; low scores reduced the likelihood of anxiety disorders by a factor of 4. Combined with other risk factor information in an actuarial approach to assessment and diagnosis, the CBCL and YSR Internalizing scales provide valuable information about whether a youth is likely suffering from an anxiety disorder.

Theories of organizational culture and climate (OCC) applied to child welfare systems hypothesize that strategic dimensions of organizational culture influence organizational climate and that OCC explains system variance in youth outcomes. This study provides the first structural test of the direct and indirect effects of culture and climate on youth outcomes in a national sample of child welfare systems and isolates specific culture and climate dimensions most associated with youth outcomes. The study applies multilevel path analysis (ML-PA) to a U.S. nationwide sample of 2,380 youth in 73 child welfare systems participating in the second National Survey of Child and Adolescent Well-being. Youths were selected in a national, two-stage, stratified random sample design. Youths' psychosocial functioning was assessed by caregivers' responses to the Child Behavior Checklist at intake and at 18-month follow-up. OCC was assessed by front-line caseworkers' (N=1,740) aggregated responses to the Organizational Social Context measure. Comparison of the a priori and subsequent trimmed models confirmed a reduced model that excluded rigid organizational culture and explained 70% of the system variance in youth outcomes. Controlling for youth- and system-level covariates, systems with more proficient and less resistant organizational cultures exhibited more functional, more engaged, and less stressful climates. Systems with more proficient cultures and more engaged, more functional, and more stressful climates exhibited superior youth outcomes. Findings suggest child welfare administrators can support service effectiveness with interventions that improve specific dimensions of culture and climate.

Evidence is emerging to support the promise of Attention Bias Modification Treatment (ABMT), a computer-based attention training program, in reducing anxiety in children. ABMT has not been tested as an adjuvant for children with anxiety disorders who do not respond to Cognitive-Behavioral Therapy (CBT). This case series presents findings from an open trial of ABMT among six children (four girls; M age = 11.2 years) who completed a CBT protocol and continued to meet diagnostic criteria for an anxiety disorder. All children completed the ABMT protocol with no canceled or missed sessions. Child self-ratings on anxiety symptoms and depressive symptoms significantly decreased from pretreatment to posttreatment, as did parent ratings on child anxiety-related impairment. Parent ratings on child anxiety and internalizing symptoms displayed non-significant decreases from pretreatment to posttreatment. These findings support the potential promise of ABMT as a feasible adjuvant treatment that reduces anxiety and impairment among child anxiety CBT nonresponders.

The goals of the present study were to: (i) examine similarities and differences in behavioral/emotional problems manifested by children with autism spectrum disorder (ASD) and those with anxiety disorder (ANX); (ii) test the ability of each of the eight child behavioral checklist (CBCL) and teacher report form (TRF) syndrome scales to differentiate the ASD group from the ANX group; and (iii) test the ability of an ASD scale derived by Ooi et al. to differentiate the ASD group from the ANX group.

Archival CBCL and TRF data from 180 children between 4 and 18 years of age (119 males, 61 females) diagnosed with ASD (n = 86) or ANX (n = 94) at an outpatient child psychiatric clinic in Singapore were analyzed.

The ASD group scored significantly higher on Social Problems and Attention Problems but significantly lower on Anxious/Depressed and Somatic Complaints than the ANX group. The groups did not show significant differences on Withdrawn/Depressed and Thought Problems. Both the CBCL and TRF ASD scales were significant predictors of the ASD group, with moderate to high sensitivity and specificity.

Our findings for an Asian sample support the diagnostic overlap between ASD and ANX reported for Western samples and underscore the importance of treating ASD as both a unitary disease and as a web of overlapping configurations of underlying problem dimensions.

The current study examined the relationship between child-reported parenting behaviors and children's anxiety, depressive, and externalizing symptoms. Youth ages 7 - 14 (N = 175; 52.6% male) and their parents seeking treatment for child anxiety were evaluated. The parenting behaviors that were measured separately included father's and mother's acceptance, psychological control, and firm/behavioral control. Children's symptoms were assessed using diagnostic interviews, self-reports, parent-reports, and teacher-reports. Independent t-tests revealed that children diagnosed with a primary anxiety disorder perceived higher parental control than children without an anxiety disorder. Results from regression analyses indicated that child-reported maternal acceptance was associated with lower symptoms of child anxiety, depression, and externalizing behavior, whereas psychological control predicted higher symptoms. Further, child-reported depressive symptoms moderated the relationship between maternal psychological control and children's anxiety, such that the relationship was weaker for anxious children with more depressive symptoms. The current findings support that children's perception of parenting behavior is associated with anxiety, and children's depressive symptoms moderate this relationship.

Social withdrawal is a core neuropsychiatric phenomenon in developmental psychopathology. Its presence predicts psychopathology across many domains, including depression, psychosis, autism, anxiety, and suicide. Withdrawn behavior is highly heritable, persistent, and characteristically worsens without intervention. To date, few studies have successfully identified genetic associations with withdrawn behavior, despite the abundance of evidence of its heritability. This may be due to reliance of categorical over dimensional measures of the behaviorally inhibited phenotype. The aim of this study is to identify associations between known psychiatric candidate genes and a dimensionally derived measure of withdrawn behavior.

Genetic information was collected on 20 single-nucleotide polymorphisms (SNPs) from a custom-designed SNP chip and TAQMAN arrays of 4 variable number of tandem repeat (VNTR) genes for 551 individuals from 187 families. Linear mixed modeling was employed to examine the relationship between genotypes of interest and Child Behavior Checklist (CBCL) Withdrawn Behavior Subscale Score (WBS) while controlling for gender and age through multiple linear regressions.

Withdrawn behavior was highly associated with polymorphism rs6314 of the serotonin receptor 2A (HTR2A) [p = .009, estimate = 0.310 (bootstrap 95% CI 0.155-0.448), bootstrap p = .001] and rs1800544 of the alpha 2-adrenergic (ADRA2A) [p = .001, estimate = -0.310 (bootstrap 95% CI -0.479 to -0.126), bootstrap p = .001] genes after correction for gender and age. The association between withdrawn behavior and ADRA2A was stronger for younger children.

HTR2A and ADRA2A genes are associated with withdrawn behavior. This reinforces the role of catecholaminergic genes in the heritability of withdrawn behavior.

High caseworker turnover has been identified as a factor in the poor outcomes of child welfare services. However, almost no empirical research has examined the relationship between caseworker turnover and youth outcomes in child welfare systems and there is an important knowledge gap regarding whether, and how, caseworker turnover relates to outcomes for youth. We hypothesized that the effects of caseworker turnover are moderated by organizational culture such that reduced caseworker turnover is only associated with improved youth outcomes in organizations with proficient cultures.

The study applied hierarchical linear models (HLM) analysis to the second National Survey of Child and Adolescent Well-being (NSCAW II) with a U.S. nationwide sample of 2,346 youth aged 1.5- to 18-years-old and 1,544 caseworkers in 73 child welfare agencies. Proficient organizational culture was measured by caseworkers' responses to the Organizational Social Context (OSC) measure; staff turnover was reported by the agencies' directors; and youth outcomes were measured as total problems in psychosocial functioning with the Child Behavior Checklist (CBCL) completed by the youths' caregivers at intake and at 18 month follow-up.

The association between caseworker turnover and youth outcomes was moderated by organizational culture. Youth outcomes were improved with lower staff turnover in proficient organizational cultures and the best outcomes occurred in organizations with low turnover and high proficiency.

To be successful, efforts to improve child welfare services by lowering staff turnover must also create proficient cultures that expect caseworkers to be competent and responsive to the needs of the youth and families they serve.

Withdrawn behavior (WB) relates to many developmental outcomes, including pervasive developmental disorders, anxiety, depression, psychosis, personality disorders and suicide. No study has compared the latent profiles of different informants' reports on WB. This study uses multi-informant latent class analyses (LCA) of the child behavior checklist (CBCL), teacher report form (TRF) and youth self-report (YSR) to examine phenotypic variance in WB. LCA was applied to the CBCL, TRF and YSR of 2,031 youth (ages 6-18); of which 276 children were clinically-referred. A 4-class solution for the CBCL and 3-class solutions for the YSR and TRF were optimal. The CBCL yielded low symptoms, predominantly shy or secretive moderate symptoms, and all symptoms classes. The TRF lacked the moderate--secretive class, and the YSR lacked the moderate--shy class. Agreement was low. LCA shows similar structure of withdrawn behavior across informants but characterizations of moderate WB vary.

This study evaluated the psychometric properties of the treatment-emergent activation and suicidality assessment profile (TEASAP) in a clinical sample of 56 youth aged 7-17 with obsessive-compulsive disorder (OCD) who participated in a double-blind randomized controlled trial. The 38-item TEASAP demonstrated good internal consistency for its total score (α=0.93) and adequate to good performance for its five subscale scores (α=0.65-0.92). One-week test-retest stability (N=18) was adequate (Intraclass correlation coefficient [ICC]=0.68-0.80) except for Self-Injury (ICC=0.46). Construct validity was supported by total and subscale TEASAP score relationships with related constructs, including irritability, hyperactivity, externalizing behaviors, manic symptoms, and suicidal ideation, and the absence of relationships with unrelated constructs. Predictive validity was established for the Disinhibition subscale through significant associations with subsequent activation events. Furthermore, TEASAP sensitivity to change in activation scores over time was supported by longitudinal associations of TEASAP scores with clinician ratings of activation over the course of treatment. Findings indicate that the TEASAP has acceptable psychometric properties in a clinical sample of youth with OCD and merits further study in larger samples for additional refinement of its measurement approaches.

The Children's Moods, Fears and Worries Questionnaire (CMFWQ) is a recently developed parent-report measure for detecting young children's internalising difficulties. This study evaluated construct and criterion-related validity with a clinical sample.

The measure was completed by 30 mothers of children aged between 18 months and 7 years referred to hospital clinical psychology services.

The CMFWQ demonstrated sound convergent and discriminant validity and a clinical cut-point was established, which optimally discriminated between children with internalising problems and those within the normal range.

The CMFWQ has potential value for identifying young children in need of intervention for internalising problems.

Since the mid-90s, the university environment has challenged the motivation of academic staff to engage in pastoral care. A literature review revealed five themes that aligned with analysis of interview data from a previous study (Laws and Fiedler, 2010). The key themes were i) staff were often disturbed by unplanned intrusions of students who exhibited behavioural problems or sought emotional support, ii) the management of emotions in face-to-face encounters was stressful, iii) staff felt under-equipped for dealing with Mental Health (MH) issues, iv) standards and control needed updating and v) counselling and disability services did not meet academics' need to know about 'at risk' students.

Having identified the incidence of mental health issues among Australian University students, this study aims to locate literature that describes how well current university policies/protocols are supported by Evidence Based Practice in the management of MH problems in the student population.

Findings from a content analysis of the literature were triangulated with verbatim comments recorded during a previous study that utilised semi structured interviews with 34 academics at the School of Nursing and Midwifery and the School of Commerce at the University of South Australia (Laws and Fiedler, 2010).

Lack of clarity on role boundaries around promotion of students' well-being was not clearly defined. The Higher Education (HE) institutions' slowness in responding to mental health needs of students combined with the increasing expectations of academics' performance monitoring has lead staff to avoid deep investment in their students' well-being. The literature indicates that students are in need of psychological support, but pastoral care remains ill-defined despite enduring expectations held by university administrators. Teacher motivation is diminished by time spent with students in need of emotional support which is not acknowledged in workloads. Staff stress is increased by 'emotion work' requiring a greater integration of resources that guide them toward more appropriate and timely student support.

Staff require ongoing professional development on the nature of MH problems among students. There is a need for specific orientation programs that better define pastoral care and identify support services for staff and students. Universities need to focus on what is needed to create a well-being environment. Workload allocations must include 'emotion work', and mental health professionals must be employed to improve intervention and support not only for students but also for University staff. With better defined pastoral care roles, academics can more effectively balance their intrinsic and extrinsic motivations toward both personal and corporate objectives. Further research into the efficacy of university resourcing of programs and services is needed.

Childhood exposure to trauma has been associated with increased rates of somatic symptoms (SS), which may contribute to diminished daily functioning. One hundred and sixty-one children residing at a residential treatment home who had experienced neglect and/or abuse were administered the Trauma Symptom Checklist for Children (TSCC), the Multidimensional Anxiety Scale for Children, and the Children's Depression Inventory (CDI). Primary caregivers completed the Child Behavior Checklist. Two composite measures of SS were formed to represent both child- and caregiver-rated SS. Over 95% of children endorsed at least one SS on the child-rated measure. Children who had experienced sexual abuse had higher rates of SS relative to children who had not. Child-rated SS were highly correlated with the CDI total score and the TSCC subscales of anxiety, depression, posttraumatic stress, dissociation, and anger. The TSCC anxiety subscale mediated the relationship between sexual abuse and child-rated SS.

Genetic variation of the A118G polymorphism of the μ-opioid receptor gene (OPRM1) predicts individual sensitivity to social rejection and fMRI activation during simulated social rejection in adults, while data on these relationships during childhood are lacking. We investigated whether this polymorphism predicts childhood withdrawal - a predictor of sensitivity to social rejection -, and the face-specific N170 event-related waveform in response to facial expressions. Among facial expressions, 'anger' was expected to be particularly evocative, as it communicates social rejection. Forty-nine children aged 8-10 years were characterised for their OPRM1 genotype, their score at the Withdrawn Scale of the Child Behavior Checklist (CBCL), and for N170 latencies and amplitudes recorded during a task of implicit processing of happy, neutral, and angry expressions of other children. Children carrying the OPRM1-G allele had higher CBCL Withdrawn scores and enhanced N170 amplitudes in response to facial expressions. Multiple linear regressions showed that the Withdrawn scale score predicts larger N170 amplitudes at the Pz and C4 electrodes, only for the anger expression. Children who carry one or two copies of the OPRM1 G-allele are more likely to manifest withdrawn behaviours, and differ for electrophysiological responses to the early phases of processing affective stimuli.

Previous studies analyzed the clinical validity of the Child Behavior Checklist (CBCL) for screening primary depressive disorders (major depression and dysthymia). Other psychiatric disorders with depressive symptomatology (e.g. adjustment disorders with depressive reaction) have not been a research focus to date. This study aims to examine the utility of the CBCL scales Anxious/Depressed and Affective Problems in screening both primary depressive disorders and other disorders with depressive symptomatology.

The two samples consisted of 1445 outpatients and 698 inpatients aged 11-18 who were referred for child and adolescent psychiatric services. The predictive power of the CBCL scales was examined using ROC-analysis.

Both CBCL scales showed small to medium predictive power when screening for primary and other depressive disorders in clinically referred outpatients (AUCs=.694-.780). Within the inpatient sample, only primary depressive disorders were detected with small predictive power different from chance level (AUCs=.625-.673). Both CBCL scales did not differ significantly with regards to predicting depressive disorders.

A limitation of this study is the lack of reliability checks for consensus classification process of the ICD-10 diagnoses. However, comparable prior work using structured interviews resulted in similar AUC values, supporting our findings.

In outpatient samples, the CBCL is suitable for screening other depressive disorders in addition to primary depressive disorders. This is not the case for inpatients due to a misclassification number of 40%; thus using CBCL scales screen for depressive disorders in such populations warrants caution.

The Child Behavior Checklist's (CBCL) is often used as a screening instrument at first contact in standard child and adolescent psychiatric settings adding valuable information to the diagnostic process. However, its correspondence to clinical, in particular anxiety, diagnoses has not always been clear. Using parent reports from 2763 outpatients and 888 inpatients referred for psychiatric services, CBCL-anxiety scales were examined regarding their predictive validity and potential use as screening devices for anxiety disorders. Symptom scores across four diagnostic groups (anxiety disorder, emotional disorder, other psychiatric disorder and no psychiatric disorder) were calculated and compared; in addition ROC-analyses for the anxiety-disordered group were performed. Support for the validity of the "Anxiety Problems" scale (Achenbach et al., 2003) was found. However, AUC-values were only in the medium range (.71-.72) with substantial misclassification numbers proposing a limited utility of the scale as a screening instrument in our samples. Adding valuable information to the diagnostic process, the CBCL's associations with clinical anxiety diagnoses seem only moderate suggesting the additional use of other anxiety-specific instruments in clinical routine.