Siblings’ Perceptions of Differential Treatment,Fairness, and Jealousy and Adolescent Adjustment: A Moderated Indirect Effects Model

Youth’s perception of parents’ differential treatment (PDT) are associated with maladjustment during adolescence. Although the direct relations between PDT and youth’s maladjustment have been well established, the mechanisms underlying these associations remain unclear. We addressed this gap by examining whether sibling jealousy accounted for the links between PDT and youth’s depressive symptoms, self-worth, and risky behaviors. Additionally, we examined whether youth’s perceptions of fairness regarding their treatment as well as the gender constellation of the dyad moderated these indirect relations (i.e., moderated-indirect effects). Participants were first- and second-born adolescent siblings (M = 15.96, SD = .72 years for older siblings, M = 13.48, SD = 1.02 years for younger siblings) and their parents from 197 working and middle class European American families. Data were collected via home interviews. A series of Conditional Process Analyses revealed significant indirect effects of PDT through sibling jealousy to all three adjustment outcomes. Furthermore, perceptions of fairness moderated the relations between PDT and jealousy, such that the indirect effects were only significant at low (?1 SD) and average levels of fairness. At high levels of fairness (+1 SD) there was no association between PDT, jealousy, and youth adjustment. Taken together, results indicate that youth and parents would benefit from engaging in clear communication regarding the reasoning for the occurrence of differential treatment, likely maximizing youth and parent perceptions of that treatment as being fair and in turn mitigating sibling jealousy and maladjustment.     

Sleep Problems and Separation Anxiety in Preschool-Aged Children: A Path Analysis

Sleep problems occur frequently in young children, possibly causing detrimental effects on their development. Parental marital difficulties are known to put a burden on children’s sleep and adjustment. However, research concerning the relation between the parental relationship quality and children’s sleep difficulties is rare for preschool-aged children. This study aims to fill in the gap. Initially, caregivers of 94 preschoolers (41 girls and 53 boys, aged 2–6 years) filled in questionnaires providing information on their children’s sleep and anxiety as well as on their own sleep and relationship quality. A path model approach was used to examine two competing theoretical models linking these factors. The conducted path analysis indicated that children’s separation anxiety, β = ?.134, p = .017, as well as their anxiety in general, β = ?.177, p = .024, partially mediated the relation between the parental relationship quality and children’s sleep problems. Parental sleep problems correlated with the relationship quality, r = ?.371, p = .030, but had no significant influence on children’s sleep. The results of our study suggest that children growing up with parents who state a low relationship quality might thus be concerned about the stability of their family system. As a result children’s sleep quality might be compromised due to irritation and feelings of insecurity. The study highlights the importance of the parental relationship as an influence factor in children’s sleep quality.     

Emotional Competence and Anxiety in Childhood and Adolescence: A Meta-Analytic Review

Anxiety is conceptualized as a state of negative emotional arousal that is accompanied by concern about future threat. The purpose of this meta-analytic review was to evaluate the evidence of associations between emotional competence and anxiety by examining how specific emotional competence domains (emotion recognition, emotion expression, emotion awareness, emotion understanding, acceptance of emotion, emotional self-efficacy, sympathetic/empathic responses to others’ emotions, recognition of how emotion communication and self-presentation affect relationships, and emotion regulatory processes) relate to anxiety in childhood and adolescence. A total of 185 studies were included in a series of meta-analyses (N’s ranged from 573 to 25,711). Results showed that anxious youth are less effective at expressing (r = ?0.15) and understanding emotions (r = ?0.20), less aware of (r = ?0.28) and less accepting of their own emotions (r = ?0.49), and report less emotional self-efficacy (r = ?0.36). More anxious children use more support-seeking coping strategies (r = 0.07) and are more likely to use less adaptive coping strategies including avoidant coping (r = 0.18), externalizing (r = 0.18), and maladaptive cognitive coping (r = 0.34). Emotion acceptance and awareness, emotional self-efficacy, and maladaptive cognitive coping yielded the largest effect sizes. Some effects varied with children’s age. The findings inform intervention and treatment programs of anxiety in youth and identify several areas for future research.     

Stress-Related Growth in Japanese Adolescents Experiencing High School Entrance Examinations

High school entrance examinations and preparation for them have become a highly stressful experience for many Japanese adolescents. This study examined the relationship between stress-related growth (SRG) and distress resulting from these exams from the perspective of positive meaning-making. Ninth graders (N = 183, 87 females, aged 14–15 years) of a public school in Tokyo participated in the study by responding to a questionnaire survey. Results indicated that meaning-making was positively correlated with SRG (r = .58, p < .001), whereas it was negatively correlated with distress (r = ?.20, p = .006). Moreover, SRG was negatively correlated with distress (r = ?.34, p < .001). Mediation analysis demonstrated that SRG positively mediates the relationship between meaning-making and distress, while distress negatively mediates the relationship between meaning-making and SRG. These results have implications for understanding the causal relationships between SRG and distress, from the perspective of positive meaning-making regarding high school entrance examinations in Japan.     

The Effect of Religious Belief and Forgiveness on Coping with Diabetes

We aimed to investigate the relationship of religious beliefs and forgiveness in diabetic patients with various sociodemographic characteristics, emotional problems and glycaemic control. The study comprises 100 patients diagnosed with type 2 DM. We used a data collection form, the Scale of Forgiveness and Religiosity (SFR), Problem Areas in Diabetes Scale (PAID), Beck Depression Inventory (BDI), State-Trait Anxiety Inventory (STAI) and the Audit of Diabetes-Dependent Quality of Life (ADDQoL). We also recorded blood glucose and HbA1c test results. A statistically significant relationship was determined only between the scores of the STAI-I and the religious belief scales (r = 0.198, p = 0.049). A statistically significant negative relationship was determined between the forgiveness scale points and the BDI (r = 0.326, p = 0.001), the STAI-II (r = 0.308, p = 0.002) and PAID (r = 0.313, p = 0.001) and a positive correlation with ADDQoL (r = 0.284, p = 0.004). To conclude, forgiveness by patient himself or others reduced the emotional problems which were experienced related to diabetes by reducing stress levels and could increase quality of life.     

Self-Competence and Depressive Symptom Trajectories during Adolescence

The purpose of this study was to examine the relationship between self-competence and subsequent depressive symptom trajectories, by gender, in a community sample of adolescents (N = 753; 53% female; 65% non-Hispanic White). Data were collected annually for three years beginning when adolescents were in the 10th and 11th grades (Age: M = 16.09, SD = 0.72 years). Adolescents provided self-reports of self-competence at baseline and depressive symptoms every year. In latent growth curve models examining the overall trajectory of depressive symptoms, higher global self-worth and self-competence in close friendships were significantly associated with greater decreases in depressive symptoms (ps < 0.05). In contrast, higher academic self-competence was associated with more attenuated decreases in depressive symptoms (p = 0.001). When examining subgroups of latent depressive symptom trajectories within the context of growth mixture modeling, higher self-competence in physical appearance was associated with a decreased likelihood of membership in trajectory classes characterized by high initial, then decreasing depressive symptoms or and low initial, then increasing depressive symptoms (ps < 0.01). Among girls, higher global self-worth and self-competence in close friendship and academic domains were associated with membership in a trajectory class distinguished by high stable depressive symptoms (ps < 0.01); these associations were not observed among boys (ps > 0.05). Findings suggest that the competence-based model of depression is valid and applicable during middle-to-late adolescence, and emphasize the importance of considering gender and individual differences in the developmental course of depressive symptoms to gain a more nuanced understanding of the role of self-competence in depressive symptom trajectories.     

Psychoeducational Psychotherapy and Omega-3 Supplementation Improve Co-Occurring Behavioral Problems in Youth with Depression: Results from a Pilot RCT

This pilot randomized controlled trial (RCT) investigated benefits of omega-3 fatty acid supplementation and Individual-Family Psychoeducational Psychotherapy (PEP; a family-focused, cognitive-behavioral therapy) for behavior problems among youth with depression. Participants aged 7–14 with DSM-IV-TR depressive disorders (N = 72; 56.9 % male) were randomized to 1 of 4 treatment conditions: PEP + omega-3, PEP monotherapy (with pill placebo), omega-3 monotherapy, or placebo (without active intervention). At screen, baseline, and 2, 4, 6, 9, and 12 weeks post-baseline, parents completed the SNAP-IV, which assesses attention-deficit/hyperactivity disorder symptoms, oppositional defiant disorder symptoms, and overall behavior problems. At screen, baseline (randomization), 6 and 12 weeks, parents completed the Eyberg Child Behavior Inventory (ECBI), which includes Intensity and Problem scales for child behavior problems. Youth who had a completed SNAP-IV or ECBI for at least two assessments during treatment (n = 48 and 38, respectively) were included in analyses of the respective outcome. ClinicalTrials.gov.:NCT01341925. Linear mixed effects models indicated a significant effect of combined PEP + omega-3 on SNAP-IV Total (p = 0.022, d = 0.80) and Hyperactivity/Impulsivity trajectories (p = 0.008, d = 0.80), such that youth in the combined group saw greater behavioral improvement than those receiving only placebo. Similarly, youth in combined treatment had more favorable ECBI Intensity trajectories than youth who received no active treatment (p = 0.012, d = 1.07). Results from this pilot RCT suggest that combined PEP + omega-3 is a promising treatment for co-occurring behavior symptoms in youth with depression.     

Sleep Problems in Childhood and Borderline Personality Disorder Symptoms in Early Adolescence

Sleep disorders, such as insomnia and nightmares, are commonly associated with Borderline Personality Disorder (BPD) in adulthood. Whether nightmares and sleep-onset and maintenance problems predate BPD symptoms earlier in development is unknown. We addressed this gap in the literature using data from the Avon Longitudinal Study of Parents and Children (ALSPAC). Participants included 6050 adolescents (51.4 % female) who completed the UK Childhood Interview for DSM-IV BPD at 11 to 12 years of age. Nightmares and sleep onset and maintenance problems were prospectively assessed via mother report when children were 2.5, 3.5, 4.8 and 6.8 years of age. Psychopathological (i.e., emotional temperament; psychiatric diagnoses; and emotional and behavioural problems) and psychosocial (i.e., abuse, maladaptive parenting, and family adversity) confounders were assessed via mother report. In logistic regressions, persistent nightmares (i.e., regular nightmares at 3 or more time-points) were significantly associated with BPD symptoms following adjustment for sleep onset and maintenance problems and all confounders (Adjusted Odds Ratio = 1.62; 95 % Confidence Interval = 1.12 to 2.32). Persistent sleep onset and maintenance problems were not significantly associated with BPD symptoms. In path analysis controlling for all associations between confounders, persistent nightmares independently predicted BPD symptoms (Probit co-efficient [β] = 0.08, p = 0.013). Emotional and behavioural problems significantly mediated the association between nightmares and BPD (β =0.016, p < 0.001), while nightmares significantly mediated associations between emotional temperament (β = 0.001, p = 0.018), abuse (β = 0.015, p = 0.018), maladaptive parenting (β = 0.002, p = 0.021) and subsequent BPD. These findings tentatively support that childhood nightmares may potentially increase the risk of BPD symptoms in early adolescence via a number of aetiological pathways. If replicated, the current findings could have important implications for early intervention, and assist clinicians in the identification of children at risk of developing BPD.     

Alliance and Treatment Outcome in Family-Involved Treatment for Youth Problems: A Three-Level Meta-analysis

Alliance has been shown to predict treatment outcome in family-involved treatment for youth problems in several studies. However, meta-analytic research on alliance in family-involved treatment is scarce, and to date, no meta-analytic study on the alliance–outcome association in this field has paid attention to moderating variables. We included 28 studies reporting on the alliance–outcome association in 21 independent study samples of families receiving family-involved treatment for youth problems (N = 2126 families, M age youth ranging from 10.6 to 16.1). We performed three multilevel meta-analyses of the associations between three types of alliance processes and treatment outcome, and of several moderator variables. The quality of the alliance was significantly associated with treatment outcome (r = .183, p < .001). Correlations were significantly stronger when alliance scores of different measurement moments were averaged or added, when families were help-seeking rather than receiving mandated care and when studies included younger children. The correlation between alliance improvement and treatment outcome just failed to reached significance (r = .281, p = .067), and no significant correlation was found between split alliances and treatment outcome (r = .106, p = .343). However, the number of included studies reporting on alliance change scores or split alliances was small. Our findings demonstrate that alliance plays a small but significant role in the effectiveness of family-involved treatment. Future research should focus on investigating the more complex systemic aspects of alliance to gain fuller understanding of the dynamic role of alliance in working with families.     

Relationship between Disabilities and Adoption Outcomes in African American Children

Although many children adopted from the public child welfare system have special needs, little is known about the experiences of African American adopted children with disabilities and their families. The purpose of this study is to explore different categories of disabilities, including chronic health issues; emotional, mental, or behavioral (EMB) disorders; and intellectual or developmental disabilities (IDDs) on adoption outcomes in a sample of African American children. Data were from the Post-Permanency Round II Survey collected in 2008. A random sample of 412 adoptive parents or legal guardians self-reported their children’s disability diagnoses and family caregiving experiences. Hierarchical regression modelling was used to investigate the relationship between child disability and child and parental outcomes. Results indicated that chronic health issues (β?=?.10, p?<?.05), EMB disorders (β?=?.16, p?<?.01), and IDDs (β?=?.12, p?<?.05) were positively associated with parental burden. In addition, asthma (β?=?.10, p?<?.05), from the larger physical health issue category, was also associated with parental burden. However, none of the disability categories was significantly related with caregiver commitment or adoption dissolution. Future research should disentangle the definitions of special needs or disabilities.     

Irrational Beliefs and Attention Bias Towards Symptoms-Related Stimuli in Maintaining Gastrointestinal Symptoms: Results from a Pilot Study

Recent etiopathogenic theories of gastrointestinal conditions state that information processing biases can be a possible major factor involved in the aetiology and maintenance of these conditions. This exploratory study investigated the role of attention biases (AB) towards symptoms-related cues in gastrointestinal patients with respect to symptom maintenance, simultaneously taking into consideration the role of irrational beliefs. We included 32 patients diagnosed with gastrointestinal conditions. Patients completed a battery of psychological tests and an experimental task aimed to measure the preferential attention processing of linguistic stimuli related to gastrointestinal symptoms when they compete for attention resources with neutral stimuli. AB was positively related to irrational beliefs [r(31) = .376, p = .037] and analgesics use [r(32) = .518, p = .002], but not to self-report gastrointestinal symptoms [r(30) = ?.165, p = .382]. Irrational beliefs correlated with pain catastrophizing [r(31) = .373, p = .039], but not to gastrointestinal symptoms, pain intensity, visceral sensitivity or negative emotions; however, pain catastrophizing correlated with all of these. Taken together, our results suggest that core irrational beliefs action as general vulnerability factors that trigger specific implicit and explicit cognitive mechanisms (i.e., AB, pain catastrophizing) involved in the onset and maintenance of symptoms. Future experimental studies should test the robustness of these results in larger samples and aim to further advance our understanding of how cognitive factors interact and potentiate each other in generating and maintaining debilitating suffering.     

The links between self-determined motivations and behavioral automaticity in a variety of real-life behaviors

The different motivations postulated by the Self-Determination Theory have proved to be meaningful to predict the level of engagement in a wide variety of life domains. The present research examines the relation between the different forms of self-determined motivation and behavioral automaticity of 12 behaviors associated with different life domains. Following 1743 measurements of self-determination (using a short version of the situational motivational scale, SIMS8), behavioral automaticity (using the self-reported behavioral automaticity index, SRBAI), and behavioral frequency (self-reported number of executions in a unit of time) for 12 various common behaviors collected on 315 young adults (M_age = 20.60?±?2.87 years) through an online survey, the results of crossed linear mixed models indicated that self-determined motivations are more associated with behavioral automaticity than non-self-determined motivations (intrinsic motivation: β?=?0.13, p?<?.001, identified extrinsic motivation: β?=?0.13, p?<?.001; external extrinsic motivation : β?=?0.08, p?<?.001; amotivation: β?=?0.02, p?=?.433). Furthermore, self-determination played a moderating role between the repetition of behaviors and behavioral automaticity (β?=?0.06, p?<?.002) suggesting that self-determination facilitated automatization, as high level of behavioral automaticity was achieved with less frequent behaviors when behaviors were performed for highly self-determined (β?=?0.41, p?<?.001) than weakly self-determined reasons (β?=?0.29, p?<?.001). The applications of these findings for learning and habit formation are discussed.     

The Effectiveness of Psychosocial Interventions Delivered by Teachers in Schools: A Systematic Review and Meta-Analysis

The growing mental health needs of students within schools have resulted in teachers increasing their involvement in the delivery of school-based, psychosocial interventions. Current research reports mixed findings concerning the effectiveness of psychosocial interventions delivered by teachers for mental health outcomes. This article presents a systematic review and meta-analysis that examined the effectiveness of school-based psychosocial interventions delivered by teachers on internalizing and externalizing outcomes and the moderating factors that influence treatment effects on these outcomes. Nine electronic databases, major journals, and gray literature (e.g., websites, conference abstract) were searched and field experts were contacted to locate additional studies. Twenty-four studies that met the study inclusion criteria were coded into internalizing or externalizing outcomes and further analyzed using robust variance estimation in meta-regression. Both publication and risk of bias of studies were further assessed. The results showed statistically significant reductions in students’ internalizing outcomes (d = .133, 95% CI [.002, .263]) and no statistical significant effect for externalizing outcomes (d = .15, 95% CI [?.037, .066]). Moderator analysis with meta-regression revealed that gender (%male, b = ?.017, p < .05), race (% Caucasian, b = .002, p < .05), and the tier of intervention (b = .299, p = .06) affected intervention effectiveness. This study builds on existing literature that shows that teacher-delivered Tier 1 interventions are effective interventions but also adds to this literature by showing that interventions are more effective with internalizing outcomes than on the externalizing outcomes. Moderator analysis also revealed treatments were more effective with female students for internalizing outcomes and more effective with Caucasian students for externalizing outcomes.     

Antisocial Process Screening Device Subscales Predict Recidivism in an Australian Juvenile Offender Sample

The present study is the first to examine the psychometric properties of the self-report Antisocial Process Screening Device (APSD-SR), and the predictive utility of its subscales for reoffending, among Australian juvenile offenders (N?= 308, M age = 17.00, SD?=?1.49). Exploratory factor analysis supported a modified three-factor structure in which four items loaded differently to prior studies. Total APSD-SR and modified subscale scores were positively associated with criminal history and mental health problems (e.g., internalizing and externalizing problems, alcohol and substance abuse/dependence). Survival analyses indicated that youth scoring high on the APSD-SR total score were faster to reoffend nonviolently (Hazard Ratio [HR]?= 1.31, p?=?.0003) and violently (HR?=?1.42, p?=?.0003) than those scoring low. Whereas the modified grandiose-manipulative subscale predicted faster time to nonviolent recidivism (HR?=?1.18, p?=?.026) as a single predictor, when all subscales were simultaneously entered into the model only callous-unemotional (CU) traits and impulsivity predicted nonviolent recidivism (HR?=?1.19, p?=?.026 and 1.22, p?=?.015, respectively), and only impulsivity predicted violent recidivism (HR?=?1.26, p?=?.014). Findings inform current understanding of the relative contribution of adolescent psychopathy dimensions to designating a particularly high-risk group of Australian youth in custody.     

Comparing the CASI-4R and the PGBI-10 M for Differentiating Bipolar Spectrum Disorders from Other Outpatient Diagnoses in Youth

We compared 2 rating scales with different manic symptom items on diagnostic accuracy for detecting pediatric bipolar spectrum disorder (BPSDs) in outpatient mental health clinics. Participants were 681 parents/guardians of eligible children (465 male, mean age = 9.34) who completed the Parent General Behavior Inventory-10-item Mania (PGBI-10 M) and mania subscale of the Child and Adolescent Symptom Inventory-Revised (CASI-4R). Diagnoses were based on KSADS interviews with parent and youth. Receiver operating characteristic (ROC) analyses and diagnostic likelihood ratios (DLRs) determined discriminative validity and provided clinical utility, respectively. Logistic regressions tested for incremental validity in the CASI-4R mania subscale and PGBI-10 M in predicting youth BPSD status above and beyond demographic and common diagnostic comorbidities. Both CASI-4R and PGBI-10 M scales significantly distinguished BPSD (N = 160) from other disorders (CASI-4R: Area under curve (AUC) = .80, p < 0.0005; PGBI-10 M: AUC = 0.79, p < 0.0005) even though scale items differed. Both scales performed equally well in differentiating BPSDs (Venkatraman test p > 0.05). Diagnostic likelihood ratios indicated low scores on either scale (CASI: 0–5; PGBI-10 M: 0–6) cut BPSD odds to 1/5 of those with high scores (CASI DLR- = 0.17; PGBI-10 M DLR- = 0.18). High scores on either scale (CASI: 14+; PGBI-10 M: 20+) increased BPSD odds about fourfold (CASI DLR+ = 4.53; PGBI-10 M DLR+ = 3.97). Logistic regressions indicated the CASI-4R mania subscale and PGBI-10 M each provided incremental validity in predicting youth BPSD status. The CASI-4R is at least as valid as the PGBI-10 M to help identify BPSDs, and can be considered as part of an assessment battery to screen for pediatric BPSDs.     

Neurocognitive Functioning in Depressed Young People: A Systematic Review and Meta-Analysis

Background: Depression is among the most common mental health problems for young people. In adults, depression is associated with neurocognitive deficits that reduce the effectiveness of treatment and impair educational and vocational functioning. Compared to adults, less is known about the neurocognitive functioning of young people with depression, and existing research has reported inconsistent findings. Method: This systematic review and meta-analysis synthesized the literature on neurocognitive functioning in currently depressed youth aged 12–25 years in comparison to healthy controls. Results: Following a systematic review of the literature, 23 studies were included in the meta-analysis. Poorer performance in the domains of attention (SMD: .50, 95% CI: .18–.83, p?=?.002), verbal memory (SMD: .78, 95% CI: .50–1.0, p?<?.001), visual memory (SMD: .65, 95% CI: .30–.99, p?<?.001), verbal reasoning/knowledge (SMD: .46; 95% CI: .14–.79; p?<?0.001) and IQ (SMD: .32; 95% CI: .08–.56; p?=?0.01) were identified in depressed youth. Relative weaknesses in processing speed/reaction time and verbal learning were also evident, however, these findings disappeared when the quality of studies was controlled for. Moderator analysis showed a tendency for poorer set-shifting ability in younger depressed participants relative to controls (although non-significant; p?=?.05). Moderator analysis of medication status showed taking medication was associated with poorer attentional functioning compared to those not taking medication. Conclusion: The findings suggest that currently depressed young people display a range of neurocognitive weaknesses which may impact treatment engagement and outcome. The findings support the need to consider neurocognitive functioning when treating youth with depression.     

Predictors of Diabetes Fatalism Among Arabs: A Cross-Sectional Study of Lebanese Adults with Type 2 Diabetes

Fatalism is a grounded cultural belief that is common among Arabs and is known to hinder self-care in chronic diseases including diabetes (Nabolsi and Carson in Scand J Caring Sci 25(4):716–724, 2011). The purpose of this study is to identify predictors of diabetes fatalism in this population. Data on 280 Lebanese patients with type 2 diabetes (mean age 58.24 ± 13.48 years; mean HbA1c 7.90 ± 1.90%; 53.76% females) recruited from one hospital in greater Beirut, Lebanon, and from the community using snowballing technique were examined. Multiple linear regression was used to assess the independent association between diabetes fatalism and demographic and patient characteristics. Age (β = ?.14, 95% CI ?.27, ?.002), BMI (β = .35, 95% CI .15; .54), level of education (β = ?3.98, 95% CI ?7.64; ?.32) and number of diabetes problems (β = ?5.03, 95% CI ?9.89; ?.18) were significantly associated with diabetes fatalism in the regression model. The combination of demographic and patient characteristics accounted for 14.5% of the variance in diabetes fatalism scores’ change. Patients with type 2 diabetes who exhibited more fatalistic attitudes were younger, of lower education levels, had higher BMI and had fewer diabetes comorbidities. Such findings are crucial for healthcare practitioners to identify fatalistic patients and to tailor culturally appropriate strategies in diabetes management. Further studies are warranted to explore other potential determinants of diabetes fatalism with larger sample and non-Lebanese Arabic population.     

Interplay between Attachment to Peers and Parents in Korean Adolescents’ Behavior Problems

The present study investigated the relative contribution of style of peer attachment (secure, anxious, avoidant) and quality of attachment to parents on behavior problems in Korean adolescents. In addition, we examined the role of paternal and maternal attachment separately as a potential moderator in the relationship between style of peer attachment and internalizing and externalizing behavior problems. Middle school students (245 males, 209 females) completed the Korean version of the Adolescent Friendship Attachment Scale, Inventory of Parental and Peer Attachment-Revised, and Youth Self-Report. Attachment to peers and parents as predictors of behavior problems were tested via hierarchical multiple regression analyses. Results revealed that anxious peer attachment remained the strongest predictor of behavior problems among adolescents (internalizing behavior problems β?=?.18, p?<?.01; externalizing behavior problems β?=?.21, p? <?.001), indicating the relative importance of peer relationship compared to attachment to parents. Paternal attachment significantly moderated the relationship between avoidant peer attachment and externalizing behavior problems (β?=?.15, p?<?.05), even when the main effect of avoidant peer attachment on externalizing behavior problems was not significant. Results highlight the role of both attachments to peers and parents on adolescents’ psychological adjustment.     

The Children’s Attention-Deficit Hyperactivity Disorder Telemental Health Treatment Study: Caregiver Outcomes

The Children’s Attention-deficit Hyperactivity Disorder (ADHD) Telemental Health Treatment Study (CATTS) tested the hypotheses that children and caregivers who received guideline-based treatment delivered through a hybrid telehealth service delivery model would experience greater improvements in outcomes than children and caregivers receiving treatment via a comparison delivery model. Here, we present caregiver outcomes. 88 primary care providers (PCPs) in seven geographically underserved communities referred 223 children (ages 5.5 ? 12.9 years) to the randomized controlled trial. Over 22 weeks, children randomized to the CATTS service delivery model received six sessions of telepsychiatry and six sessions of caregiver behavior management training provided in person by community therapists who were trained and supervised remotely. Children randomized to the comparison Augmented Primary Care (APC) service model received management in primary care augmented by a single telepsychiatry consultation. Caregiver outcomes included changes in distress, as measured by the Patient Health Questionnaire (PHQ-9), Parenting Stress Index (PSI), Caregiver Strain Questionnaire (CSQ) and Family Empowerment Scale (FES). Caregivers completed five assessments. Multilevel mixed effects regression modeling tested for differences between the two service delivery models in caregiver outcomes from baseline to 25 weeks. Compared to caregivers of children in the APC model, caregivers of children in the CATTS service model showed statistically significantly greater improvements on the PHQ-9 (β?=?-1.41, 95 % CI?=?[?2.74, ?0.08], p?<?.05), PSI (β?=??4.59, 95 % CI?=?[?7.87, ? 1.31], p?<?.001), CSQ (β?=??5.41, 95 % CI?=?[? 8.58, ?2.24], p?<?.001) and FES (β?=?6.69, 95 % CI?=?[2.32, 11.06], p?<?.01). Improvement in child ADHD symptoms mediated improved caregiver scores on the PSI and CSQ. Improvement in child ODD behaviors mediated caregiver CSQ scores. The CATTS trial supports the effectiveness of a hybrid telehealth service delivery model for reducing distress in caregivers of children with ADHD and suggests a mechanism through which the service model affected caregiver distress.