Executive functioning and psychological adjustment in children and youth with spina bifida

Children and adolescents with spina bifida are at risk for poor neuropsychological functioning and psychological outcomes. The relationship between executive functioning and psychological adjustment is an area worthy of investigation in this population. The current study assessed executive functioning and psychological outcomes in a group of children and adolescents with spina bifida (SBM) (n = 51) and nondisabled controls (n = 45). A mediation model was hypothesized, such that Metacognition, as measured by the Behavior Rating Inventory of Executive Function (BRIEF), mediated the relationship between group status (spina bifida versus nondisabled controls) and psychological outcomes. Results indicated that metacognitive skills fully explained the relationship between group and internalizing and depressive symptoms as reported by mothers. In particular, specific components of the BRIEF Metacognition composite were most responsible for this relationship, including Initiate, Working Memory, and Plan/Organize. The study limitations include its cross-sectional nature that precludes drawing conclusions about causality. The results have implications for treatment interventions for children and adolescents with spina bifida and typically developing individuals.     

The Role of Children��s Appraisals on Adjustment Following Psychological Maltreatment: A Pilot Study

Little is known about the cognitive mechanisms involved in the development of psychopathology following psychological maltreatment in children. This study therefore examined the role of thinking styles on children's outcomes following this subtype of maltreatment. Children who had experienced past maltreatment (n?=?24) and a control group (n?=?26) were assessed using self-report questionnaires. Maltreatment history, cognitive styles and psychological outcomes, such as depression, posttraumatic stress disorder (PTSD) and self-esteem were assessed. Parents/caregivers also completed a measure of child internalizing and externalizing behaviours. Psychological maltreatment made a significant contribution to children's self-reported depression and low self-esteem, and parent reported internalizing and externalizing problems, even after controlling for other abusive experiences. This was not the case for PTSD symptoms. Further, children's cognitive styles were associated with self-reported depression, self-esteem and PTSD. They did not, however, predict parent-rated emotional and behavioural problems. This study provides preliminary support for a cognitive model of adjustment following psychological maltreatment. The results indicate the need for enhanced community awareness about the impact of psychological maltreatment, and suggest a direction for therapeutic intervention.     

Subtyping children and adolescents with loss of control eating by negative affect and dietary restraint

OBJECTIVE: Research suggests that subtyping adults with binge eating disorders by dietary restraint and negative affect predicts comorbid psychopathology, binge eating severity, and treatment outcome. Little research has explored the validity and clinical utility of subtyping youth along these dimensions. METHOD: Children (aged 8-18 years) reporting loss of control eating (n=159) were characterized based upon measures of dietary restraint and negative affect using cluster analysis, and then compared regarding disordered eating attitudes and behaviors, and parent-reported behavior problems. RESULTS: Robust subtypes characterized by dietary restraint (n=114; 71.7%) and dietary restraint/high negative affect (n=45; 28.3%) emerged. Compared to the former group, the dietary restraint/high negative affect subtype evidenced increased shape and weight concerns, more frequent binge eating episodes, and higher rates of parent-reported problems (all ps<0.05). CONCLUSION: Similar to findings from the adult literature, the presence of negative affect may mark a more severe variant of loss of control eating in youth. Future research should explore the impact of dietary restraint/negative affect subtypes on psychiatric functioning, body weight, and treatment outcome.     

Psychological adjustment of pediatric lung transplantation candidates and their parents

Investigated psychological functioning of 45 children and adolescents (ages 5 to 17 years) and their parents presenting at a major medical center for evaluation for lung transplantation. Patients completed self-reports, and parents completed measures on their children's behavior problems and emotional distress as well as on their own symptoms of distress. In general, children and their parents reported normal functioning on standard psychological measures. Few children fell in the clinically significant range, whereas 21% of mothers and 14% of fathers reported clinically significant levels of distress. Older children reported lower levels of depressive symptoms than younger children, and patients with cystic fibrosis manifested lower levels of internalizing symptoms than those with other pulmonary diseases. Findings demonstrate the resiliency of children and their parents facing a stressful point in the child's medical status and document the usefulness of psychological screening of patients and parents to identify those in need of clinical intervention.     

Maternal Psychosocial Maladjustment and Child Internalizing Symptoms: Investigating the Modulating Role of Maternal Sensitivity

In light of evidence suggesting that maternal adaptation may impact early child emotional development, this study investigated the interactive effects of maternal psychosocial maladjustment and maternal sensitivity on child internalizing symptoms, with the aim of investigating the potentially protective function of maternal sensitivity. Families (N?=?71 to 106 across measures, with gender spread almost evenly: number of boys?=?31 to 51 across measures) took part in four assessments between child ages 1 and 3 years. Mothers completed measures of parental stress, psychological distress, and marital satisfaction when their children were between 12 and 15 months. A composite score of maternal psychosocial maladjustment was derived from these measures. Maternal sensitivity was rated by trained observers at 12 months following a home visit. Child internalizing symptoms were assessed by both parents when the child was 2 and 3 years old. Hierarchical regressions revealed that increased maternal psychosocial maladjustment was related to more internalizing symptoms in children, however only among children of less sensitive mothers. In contrast, children of more sensitive mothers appeared to be protected. This was observed with maternal reports at 2 years, and both maternal and paternal reports at 3 years. These results suggest that young children may be differentially affected by their parents’ emotional adjustment, while highlighting the pivotal protective role of maternal sensitivity in this process.     

Adolescents with attention deficit hyperactivity disorder: Mother-adolescent interactions,family beliefs and conflicts,and maternal psychopathology

A group of 83 adolescents with attention deficit hyperactivity disorder (ADHD) were subdivided into those with ADHD alone (n = 27) and those with ADHD and oppositional defiant disorder (ADHD/ODD, n = 56). They were compared to each other and a community control group (n = 77) on measures of family conflicts, family beliefs, maternal adjustment, and observations of mother-adolescent interactions during both a neutral and conflict discussion. Both ADHD groups had more topics on which there was conflict and more angry conflicts at home than control adolescents on parent reports. Only the ADHD/ODD adolescents reported more such conflicts, endorsed more extreme and unreasonable beliefs about their parent-teen relations, and demonstrated greater negative interactions during a neutral discussion than the control teenagers. Similarly, only mothers of the ADHD/ODD teens displayed greater negative interactions during a neutral discussion, more extreme and unreasonable beliefs about their parent-teen relations, greater personal distress, and less satisfaction in their marriages than the mothers in the control group. Most findings for the ADHD only group were between the control group and the group with mixed ADHD/ODD but did not differ from either group. Results imply that it is the combination of ODD symptoms with those of ADHD that is associated with the greater-than-normal conflicts, anger, poor communications, unreasonable beliefs, and negative interactive styles seen in ADHD adolescents. These same characteristics typify their mothers' interactions as well such that both the adolescents' ODD symptoms and maternal psychological distress (hostility) make unique contributions to the degree of conflict and anger in the parent-teen relations of ADHD adolescents.     

Three Subtypes of Internalizing and Externalizing Behaviors in Chinese Adolescents: Results of a Latent Class Analysis

Using latent class analyses (LCA), the present study aimed to test whether meaningful subtypes of internalizing and externalizing behaviors could be found among Chinese community-based adolescents. A total of 5244 adolescents, ages 11–18 years (M?=?15.11, SD?=?1.79) recruited from 16 Chinese middle schools completed the Chinese version of the Strengths and Difficulties Questionnaire (SDQ-C). We examined the data using Latent Class Analysis to identify subtypes of internalizing and externalizing behaviors among the adolescents. Multivariate Logistic regression was subsequently implemented to ascertain the relationships between latent classes and demographic covariates. Three distinct subtypes were uncovered: a high-risk group, a middle-risk group and a low-risk group; the three subtypes accounted for 19.8, 31.1, and 49.1 % of the total sample variance respectively. Youth with elevations in one behavior type were likely to have elevations in the other behavior type. Further analyses revealed that compared to the low-risk group, the adolescents from the high-risk group and middle-risk groups were female and older. Significant heterogeneity in internalizing and externalizing behaviors was revealed in this Chinese adolescent’s sample. Profiling behavior problems patterns is potentially useful as a first step in developing tailored prevention and intervention programs. Suggestions for future research, including cross-national studies, and implications for mental health professionals were discussed.     

Memory in Early Onset Bipolar Disorder and Attention-Deficit/Hyperactivity Disorder: Similarities and Differences

Differentiating between early-onset bipolar disorder (BD) and attention-deficit/hyperactivity disorder (ADHD) can be difficult. Memory problems are commonly reported in BD, and forgetfulness is among the diagnostic criteria for ADHD. We compared children and adolescents with BD (n?=?23), ADHD combined type (ADHD-C; n?=?26), BD?+?ADHD-C (n?=?15), and 68 healthy controls on memory tests (Digit span, Children's Verbal Learning Test-II). Further analyses were performed on subgroups of BD (BD-I, BD-II/BD-NOS, with and without previous psychotic symptoms). All clinical groups demonstrated some problems with free recall, but the BD subgroup with a history of psychotic symptoms had a more pervasive problem that also included recognition and semantic clustering. The ADHD-C groups demonstrated the lowest performance on working memory. These data suggest that children and adolescents with BD and previously psychotic symptoms may have inefficient encoding of verbal material, whereas memory problems in ADHD-C appear more characterized by impaired free recall.     

The association between social withdrawal and internalizing problems of children

Children identified as low-frequency interactors or socially withdrawn were compared to outgoing children to evaluate whether socially withdrawn children display concurrent internalizing problems. From a sample of 640 children in grades 2-5, 48 children were identified by teachers as low-frequency interactors and 72 children were selected as outgoing or sociable. When these two groups were compared on a battery of teacher, peer, and self-report measures that assessed internalizing difficulties, the low-frequency interactors were found to display concurrent problems in adjustment. Children who rarely interacted with peers were less well liked by their peers, displayed poorer self-concepts, and were more depressed and anxious than sociable children. In contrast to these findings regarding internalizing problems, the two groups did not differ on measures of externalizing problems. The results lend support to the concurrent validity of the low-interaction method of identifying socially withdrawn children.     

Internalizing problems of adolescents: The role of the informant in identifying family and individual difficulties

The purpose of this study was to examine the family environment and school functioning of adolescents who differed on level of internalizing problems as reported by the adolescent and her/his mother. Thirty-six adolescents, their mothers, and their social studies teacher served as participants. Three groups were formed based on the report of level of internalizing problems: high mother and adolescent report (high concordant); low mother/high adolescent report (discordant); and low mother/low adolescent report (low concordant). The results indicated that the high concordant group, but not the discordant group, differed significantly from the low discordant group in that adolescents from the former group were from home environments with more difficulties (more interparental conflict, maternal depression, & maternal anxiety) and had more internalizing problems and lower grades in school. The results point to the importance of parent-report data when clinically assessing adolescents or conducting research on internalizing problems of adolescents.     

The Efficacy of Systemic Therapy for Internalizing and Other Disorders of Childhood and Adolescence: A Systematic Review of 38 Randomized Trials

Systemic therapy (ST) is one of the most widely applied psychotherapeutic approaches in the treatment of children and adolescents, yet few systematic reviews exist on the efficacy of ST with this age group. Parallel to a similar study on adults, a systematic review was performed to analyze the efficacy of ST in the treatment of children and adolescents. All randomized or matched controlled trials (RCT) evaluating ST in any setting with child and adolescent index patients were identified by database searches and cross‐references, as well as in existing meta‐analyses and reviews. Inclusion criteria were: index patient diagnosed with a DSM‐IV or ICD‐10 listed psychological disorder, or suffering from other clinically relevant conditions, and trial published by December 2011. Studies were analyzed according to their sample, research methodology, interventions applied, and results at end‐of‐treatment and at follow‐up. This article presents findings for internalizing and mixed disorders. Thirty‐eight trials were identified, with 33 showing ST to be efficacious for the treatment of internalizing disorders (including mood disorders, eating disorders, and psychological factors in somatic illness). There is some evidence for ST being also efficacious in mixed disorders, anxiety disorders, Asperger disorder, and in cases of child neglect. Results were stable across follow‐up periods of up to 5 years. Trials on the efficacy of ST for externalizing disorders are presented in a second article. There is a sound evidence base for the efficacy of ST as a treatment for internalizing disorders of child and adolescent patients.     

共情与青少年内外化问题的关系及影响机制

内外化问题是青少年最常见的心理行为问题,共情与青少年内外化问题具有重要联系,但以往研究青少年内外化问题的时候不注重共情不同成分的区分;即使区分了共情的不同成分,认知共情和情绪共情作为共情的不同成分和内外化问题的关系仍旧存在一定争议,且共情对内外化问题影响的机制鲜有探讨。本文首先综述了认知共情和情绪共情与青少年内外化问题的关系,并借助共情的发生过程（自我-他人模型）理论、发展过程（风险性发展模型）理论和相关神经生理因素,为理解共情对青少年内外化问题的影响机制提供了解释。未来研究可明确共情的定义,发展更生态化的测评方式,并进一步探索影响因素及机制,结合和关注个体特点、特殊群体及文化背景,以便为揭示共情与青少年内外化问题构建更系统的理论。     

儿童青少年内外化心理病理问题“共发”现象研究现状与展望

儿童青少年内外化心理病理问题存在共发现象,已受到发展心理学和心理病理学研究者的广泛关注。本文对当前关于儿童青少年内外化问题的描述性研究和解释性研究进行了梳理,对儿童青少年共发现象发生率、发展特点、预测因素和发展结果等方面的重要研究发现进行系统性介绍。最后,基于发展级联和个体与环境因素交互作用视角,对未来本领域的研究进行展望,以期系统、完整地揭示内外化问题共发的原因。     

The Role of Parental and Adolescent Attributions in Adjustment of Adolescents with Chronic Illness

Previous literature has demonstrated the separate contributions of parental attributions and adolescent attributions to psychosocial adjustment of adolescents with chronic illness. However, it is unknown whether parental attributions affect adolescents' mental health directly or indirectly by influencing the youths' attributional style. This study evaluated the direct and indirect (through adolescent attributions) effects of parental attributions on internalizing and externalizing problems of adolescents with chronic illness. Adolescents (N?=?128; M?=?14.7?years) diagnosed with cystic fibrosis or diabetes and their caregivers completed measures of attributional style and adolescent adjustment. Parents' optimistic attributions were associated with fewer adolescent internalizing and externalizing problems. These effects were partly mediated by adolescent attributions. These results suggest that targeting both adolescent and parent attributions may be important for improving adolescents' adjustment to a chronic illness.     

Psychological consequences of rheumatic diseases in children and adolescents: A first exploratory study

The objective of our study was to make a first exploratory study about the psychological status of children and adolescents with rheumatic diseases exploring, also, the significant differences between girls and boys. A total of 123 children (81 girls and 42 boys) with rheumatic diseases, between the ages of 1 and 19 years old were assessed using different measures for evaluating behavioral and emotional problems. The results showed a picture of a mild or moderate degree of psychological problems in the different measures of anxiety, depression, general distress and behavioral problems. Girls, compared to boys, scored higher in most of the measures used, showing more internalizing than externalizing kinds of symptoms. The results suggest the importance of making a more detailed study of these children, comparing them with matched controls and making prospective, longitudinal studies in order to detect psychological problems, and to explore the influence of predictive variables.     

The relationships among parental psychological control/autonomy support,self‐trouble,and internalizing problems across adolescent genders

This study aimed to explore the relationships among early adolescents’ perceived parental psychological control/autonomy support, self‐trouble, and internalizing problems as well as the potential gender differences in these relationships. Multiple‐group path analysis was performed on the data collected from 1,089 adolescents in Beijing junior high schools. Results revealed that parental psychological control (autonomy support) was associated with adolescents’ more (fewer) internalizing problems, and self‐trouble acted as a mediator in these two relationships. Moreover, only the indirect relationship between parental autonomy support and internalizing problems via self‐trouble was moderated by gender, with girls showing a little stronger indirect effect than boys, and specifically, it was the relationship between autonomy support and self‐trouble that existed gender differences, with girls showing higher coefficient than boys. The relationship between parental psychological control/autonomy support and early adolescents’ internalizing problems was discussed with regard to self‐trouble and gender differences.     

School-Based Cognitive Mindfulness Intervention for Internalizing Problems: Pilot Study with Hong Kong Elementary Students

Childhood internalizing problems such as anxiety and depression can have serious personal, familial and societal repercussions, including drug and alcohol abuse, delinquency, unplanned pregnancy, and even suicide. There is little research on mindfulness interventions for children with clinical levels of internalizing problems, and school-based mindfulness research with children has focused on non-clinical groups. We employed a two-stage screening and intervention procedure to evaluate an in-school mindfulness-based cognitive intervention for Hong Kong children with subclinical internalizing difficulties. Ninety-three fourth to sixth graders were screened, and twenty students (age 9–13, median age 10) highest among their peers on internalizing problems, but lowest on externalizing problems, participated in a 9-week group mindfulness-based intervention. We employed a two-phase open trial design, with random assignment to an immediate intervention group or wait-list control group. In single-trial analysis, one-tailed dependent sample t-tests showed significant decreases in both worry and in symptoms of panic disorder, obsessive compulsive disorder, generalized anxiety and overall internalizing problems. In a randomized controlled trial analysis, the immediate intervention group evidenced larger but nonsignificant reductions on almost all measures. Eighty-five percent of the participants rated the program as helpful, and 65–80 % reported improvement in handling emotions and interpersonal relationships at post-treatment, with some treatment gains maintained at 3-month follow-up. These preliminary findings have encouraging implications for implementing time-limited school-based mindfulness interventions targeting elevated childhood internalizing difficulties.     

Emotional memory for central and peripheral details in children with callous-unemotional traits

A limited number of studies have shown that adults and adolescents with psychopathic traits suffer from emotional memory impairment. The present study examined whether this finding could be replicated in a sample of children between 8 and 12?years of age with callous-unemotional (CU) traits. Children with high CU traits (n?=?24) were compared with children with low CU traits (n?=?18) with regard to performance on a peripheral memory recognition test that examined memory for central and peripheral components of neutral and negative pictures. Results showed that overall recognition rates did not differ between the high- and low-CU groups. For negative pictures, both groups demonstrated better recognition of the central component at the expense of the peripheral component, while for neutral pictures, the peripheral component was better recognized than the central component. This study is the first to demonstrate that children with high CU traits do not suffer from an impaired emotional memory. Copyright ? 2012 John Wiley & Sons, Ltd.     

Psychometric properties of eating disorder instruments in Black and White young women: internal consistency, temporal stability, and validity

Most of the major instruments in the eating disorder field have documented psychometric support only in predominantly White samples. The current study examined the internal consistency, temporal stability, and convergent and discriminant validity of a variety of eating disorder measures in Black (n = 97) and White (n = 179) female undergraduates. Internal consistency coefficients were good (>.76) for all measures for both groups. Temporal stability across 5 months was also adequate in both groups, but with evidence for dietary restraint and subjective binge eating being less stable in Black women (e.g., for the Restraint subscale of the Three-Factor Eating Questionnaire [TFEQ], r = .63 for Black women and r = .82 for White women). Scores on the bulimic symptoms and dietary restraint instruments converged and diverged in a theoretically consistent pattern. Findings suggest these eating disorder measures are reliable (internally consistent; temporally stable over 5 months) and that the bulimic symptom measures of the Bulimia Test-Revised, the Bulimia subscale of the Eating Disorder Inventory, and the dietary restraint measures from the Eating Disorder Examination-Questionnaire and TFEQ demonstrate convergent and discriminant validity in Black college women.