Assessment and Management of Suicide Risk in Children and Adolescents

This article presents a pragmatic approach to assessing and managing suicide risk in children and adolescents. We first present general recommendations for conducting risk assessments with children and adolescents, followed by an algorithm for designating risk. Risk assessment and designation should be based on both distal (i.e., a prior history of self-harm behaviors) and proximal (i.e., suicide ideation, plans, intent, and preparations) predictors of suicide attempt. We then discuss safety planning as an easy-to-implement approach for intervening and managing suicide risk when working with children and adolescents. We end with a case example illustrating the implementation of risk assessment, risk designation, and safety planning with an adolescent client and her mother.     

The Koala Fear Questionnaire: Its Relationship with Fear of Storms and Hurricanes in 4- to 14-Year-Old Antillean Children

The present study further investigated the reliability and validity of the recently developed Koala Fear Questionnaire (KFQ) in a large sample of 4- to 14-year-old school children (N = 378) who lived on Sint-Maarten, The Netherlands Antilles. The results confirmed that the KFQ is a reliable scale with good internal consistency. Furthermore, evidence was obtained for the concurrent validity of the scale. That is, KFQ scores were substantially correlated with a highly relevant fear of the children on Sint-Maarten, namely fear of storms and hurricanes. Finally, psychometric properties in the younger children of our sample were highly similar to those obtained in older children. Altogether, these findings provide further support for the notion that the KFQ is a reliable and valid scale for assessing fears and fearfulness in children aged 4 years and above.     

The Structure of Negative Self-Statements in Children and Adolescents: A Confirmatory Factor-Analytic Approach

The aim of this study was to examine the nature and organization of a range of negative self-statements in children and adolescents, using a structural equations/confirmatory factor-analytic approach. A community sample of 978 children aged 7-16 years completed a questionnaire about the frequency with which they experienced a broad range of negative automatic thoughts. The outcome of comparative modeling provided strongest support for a model in which 4 distinct cognitive factors were all related to a single higher order factor. The 4 lower order factors related to cognitions on social threat, physical threat, personal failure, and hostility. The pattern of results was consistent across age and gender. Results were consistent with assumptions of cognitive specificity models of psychopathology, on the latent structure of automatic thoughts in children and adolescents.     

The Relationship Between Peer Status and Depressive Symptoms in Children and Adolescents

The purpose of this study was to examine the relationship between specific symptoms of depression and particular styles of peer difficulties. Participants were 1687 students in fourth, sixth, seventh, eighth, ninth, and eleventh grades from a midsized Midwestern city. Based on previous studies, it was hypothesized that rejected and neglected youths would report greater depressive symptomatology than other peers. In addition, aggressive-rejected youth were predicted to report more Interpersonal Problems while submissive-rejected youths were expected to report more Anhedonia. There were no sociometric group differences on global scores of depression as measured by the Children's Depression Inventory; however, the aggressive- and submissive-rejected youths did report specific differences. Aggressive-rejected youths reported more Interpersonal Problems and feelings of Ineffectiveness, while the neglected and submissive-rejected youths reported more Anhedonia. Taken together, such differences provide support for differentiating among types of rejected students and suggest that different interventions may be necessary to address the needs of these youths.     

Assessment of Disgust Sensitivity in Children With an Age-Downward Version of the Disgust Emotion Scale

The present study examined the psychometric properties of the Disgust Emotion Scale for Children (DES-C). Principal components analysis of the DES-C data revealed five factors reflecting disgust toward (a) rotting foods, (b) injection and blood, (c) odors, (d) mutilation and death, and (e) animals, which were largely in keeping with the intended subscales. The DES-C showed good reliability, excellent convergent validity (as established by correlations with an alternative self-report index of disgust), fairly good predictive validity (as assessed by correlations with measures of fear/anxiety and a behavioral index of disgust), and acceptable parent–child agreement (in particular with the mothers). Importantly, the DES-C proved to perform better on some psychometric indicators than an age-downward version of the Disgust Scale. These findings indicate that the DES-C should be regarded as the preferred scale for measuring disgust sensitivity and its role in the etiology and maintenance of anxiety problems in children.     

Mild Head Injury in Children and Adolescents

Although mild head injury is the most prevalent type of head injury in children and adolescents, only a relatively small number of studies on this kind of head injury have been reported. This article summarizes a review of studies examining cognitive, academic, and psychosocial outcomes in children who sustained mild head injuries. Despite earlier claims of mild head injury being a "silent epidemic," the studies, which were published from 1970 to 1998, provide no compelling evidence to support this view.     

儿童青少年认知能力发展与脑发育

自发展认知神经科学兴起以来, 研究者就开始借助MRI等脑成像技术探讨儿童青少年认知能力发展与大脑结构发育和功能特点等之间的关系, 这为揭示行为发展与生理成熟之间的关系、儿童认知发展的神经活动规律、正常和障碍群体的独特大脑神经结构及活动特点等提供了重要启示。通过对有关儿童青少年智力、工作记忆、反应抑制等认知能力发展与大脑结构发育、大脑功能发育之间关系, 以及认知能力训练与大脑可塑性等研究的介绍, 指出发展认知神经科学的未来研究应重视采用纵向设计, 关注自然成熟和经验对正常或障碍儿童青少年认知发展与脑发育关系的交互影响, 同时从练习和训练的角度对大脑可塑性的特点进行探讨。     

儿童青少年优秀品质的基本特点与模式*

采用优势行动价值问卷儿童青少年版（VIA-Youth）对947名城市儿童青少年进行调查,以探究儿童青少年优秀品质的基本特点,包括各种优秀品质的性别及年龄特点,以及儿童青少年优秀品质的组合模式等。研究得出以下结论：在24种优秀品质中,儿童青少年得分最高的5种分别是领导力、信仰、审慎、谦虚和正直,得分最低的5种为幽默、善良慷慨、感恩、宽容和好奇心。男生的好奇心得分显著高于女生,女生的情感智力和自我控制得分显著高于男生,在其他优秀品质上不存在显著性别差异;除创造力、信仰等5种优秀品质以外,八年级青少年的优秀品质得分均显著高于五年级儿童。潜剖面分析表明,儿童青少年优秀品质表现为高优秀品质组、中等略低优秀品质组和低优秀品质组3种不同的组合模式,3种组合模式的分布不存在显著的性别和年级差异。     

Allergies and Anxiety in Children and Adolescents: A Review of the Literature

  There is an increasing prevalence of anxiety disorders and allergic conditions in children and adolescents, with previous research showing that these illnesses are often comorbid. Knowledge of the association between anxiety and allergies in children and adolescents is important because these comorbid disorders may negatively impact functioning and development. This research is necessary for identification of at risk children and to develop intervention and prevention programs. A review of studies examining comorbid anxiety and allergies in children and adolescents demonstrated a consistent association between these disorders despite differences in methodology. Several methodological limitations are presented, followed by a discussion of theories which may explain the association between these conditions. Implications of this work and suggestions for future research are provided.     

Assessment of Tripartite Factors of Emotion in Children and Adolescents II: Concurrent Validity of the Affect and Arousal Scales for Children

The authors assessed the reliability and validity of the Affect and Arousal Scale for Children (AFARS; Chorpita, Daleiden, Moffitt, Yim, & Umemoto, 2000). The AFARS is a new measure of children's positive affect (PA), negative affect (NA), and physiological hyperarousal (PH). In the first study, 176 school children, 7 to 17 years of age, were administered measures of childhood worry, anxiety sensitivity, and autonomic arousal and their parents completed a child behavior problem checklist. In a second study, two groups of 100 and 114 school children, 8 to 18 years of age, were administered measures of childhood depression and anxiety, respectively, Also, 120 of these children took part in a 1-week retest administration of the AFARS. These studies provided preliminary evidence of acceptable 1-week test–retest reliability, convergent validity, and discriminant validity for the AFARS PA, NA, and PH scales. However, the predicted pattern of convergent and discriminant relations with parent-reported criterion only emerged for children over 11 years of age. Further, a consistent positive relation emerged between NA and PH, yet each of these scales accounted for unique variance in the prediction of criterion measures.     

Characteristics of Children and Adolescents Admitted to a Residential Treatment Center

Studies of youths in residential treatment that utilize systematic assessments and validated measures are rare. We examined psychopathology, family characteristics, occurrence of physical or sexual abuse, types of aggressive behavior, hyperactive/impulsive behavior, medical and neurological problems, and self-reported drug and alcohol use in 397 youth who were assessed using reliable measures and consecutively treated in a residential treatment center. Results indicate high rates of internalizing and externalizing psychopathology, aggressive behavior, and consistent gender differences, with girls having higher levels of internalizing and externalizing psychopathology and aggressive behavior. The sample was characterized by high rates of medical problems including asthma, seizures, and obesity, as well as evidence of extensive family dysfunction, including high rates of parental alcohol use, violence, and physical or sexual abuse. Residential treatment needs to progress beyond the one size fits all approach and develop more specific and empirically proven treatments for the specific needs of this population.     

Posttraumatic Stress Disorder in Children and Adolescents: A Review and Analysis

Only recently has the mental health community recognized the applicability of diagnostic criteria for posttraumatic stress disorder (PTSD) in children and adolescents, including a consideration of specific age-related features. This paper provides a current review of the literature on PTSD pertaining to children and adolescents. Following a discussion of issues on diagnostic criteria and assessment of this affective disorder in this population, there is an overview of the existing literature on prevalence, comorbidity, risk factors, parental and family factors, and issues of gender and age of onset. The remainder of the paper focuses on the range of traumatic stressors in children and adolescents that can result in PTSD, including natural or human disasters, war and violence, chronic or life-threatening medical conditions, community violence and the witnessing of traumatic events, and physical and/or sexual abuse and other forms of interpersonal violence. Throughout the paper, there is an emphasis on the importance of considering developmental factors. Finally, implications of the existing literature for future areas of research are addressed.     

儿童青少年自尊发展理论建构与实证研究

自尊是包含能力和价值的重要心理资源,是个体心理健康的核心。多年来,我们围绕自尊开展了一系列理论建构及其相关的实证研究。其中,理论建构包括对自尊内涵和本质的探寻、"倒立的金字塔"自尊结构模型的建构。同时,运用多种方法对个体自尊的发展进行了实证研究,包括婴幼儿早期自尊的观察研究、小学生自尊发展与学校适应的关系研究、青少年自尊发展特点横向和纵向比较、特殊群体自尊与心理健康的关系研究。最后,运用实验方法分析了诱发失败情境下自尊对不良情绪的缓冲作用,不同自尊类型被试的记忆偏向和情感反应。这些研究为丰富国内自尊领域的研究成果做出了贡献。     

Psychiatric Symptomatology and Family Functioning in Children and Adolescents with Spina Bifida

The purpose of this study was to (a) examine the occurrence of psychiatric symptomatology in children and adolescents with spina bifida, (b) investigate the relationship between psychiatric features and aspects of disability, and (c) explore the impact of spina bifida and psychiatric status on family functioning. Fifty-four children and adolescents ages 6 to 18 years (M = 12.94, SD = 3.59) were examined. Parents completed the Child Symptom Inventory (CSI) and the Family Assessment Device (FAD). Using the CSI, a psychiatric diagnostic screen, 43% of the sample obtained one, and 13% obtained two or more screening cutoff scores reflective of psychiatric diagnoses. The two most prevalent diagnostic categories were Attention-Deficit/Hyperactivity Disorder (33%) and Oppositional Defiant Disorder (13%). The sample as a whole exhibited elevated levels of clinical symptoms, with internalizing symptoms more prominent than externalizing symptoms. No differences in diagnostic categories or overall symptomatology were found based on age, gender, ambulation status, or lesion level. Overall symptom counts were positively correlated with scales on the FAD reflecting problematic family functioning (.42–.65). Results suggest that psychiatric symptomatology occurs at a high rate in children and youth with spina bifida. Although ADHD was the modal diagnostic category, the sample as a whole exhibited extensive psychiatric symptoms independent of specific diagnostic categories. Psychiatric symptoms were also associated with increased problematic functioning in families.     

认知行为疗法治疗儿童青少年强迫症的应用研究

强迫症已经被认为是儿童青少年常见的心理障碍之一。强迫症的认知行为模型在成人研究中得到了大量的实证支持,但这个模型在儿童青少年群体中研究相对较少。认知行为疗法被广泛认为是治疗儿童青少年强迫症的有效心理治疗方案,但对于认知行为治疗儿童青少年强迫症的实证研究还有待进一步深入。     

Anxiety and Depression in Children and Adolescents: A Factor-Analytic Examination of the Tripartite Model

The tripartite model of Clark and Watson (1981) suggests that the oft-observed covariation between anxiety and depression can best be understood by examining three related yet distinct constructs: negative affectivity, positive affectivity, and elevated physiological arousal. In the present study, 510 boys and girls in the 4th, 7th, and 10th grades completed the Children's Depression Inventory and the Revised Children's Manifest Anxiety Scale. Confirmatory factor analyses were conducted to determine the goodness of fit of single-factor (i.e., negative affectivity), two-factor (i.e., anxiety and depression), and three-factor models (i.e., negative affectivity, positive affectivity, and physiological arousal). Analyses were conducted by examining each of the models in the whole sample first and then separately for boys and girls and for fourth, seventh, and tenth grade youths. Results failed to support the tripartite theory; rather, the findings supported a two-factor model in all cases. These factors represented the general constructs of anxiety and depression, and these factors remained significantly interrelated. Consistent with previous findings, the strength of these relations was stronger for boys than girls and for children than adolescents.     

Assessment of Psychotic Disorders in Inpatient Children and Adolescents: Use of the Devereux Scales of Mental Disorders

The Devereux Scales of Mental Disorders (DSMD), with its 3-factor model of measurement (i.e., Internalizing, Externalizing, and Critical Pathology), may be useful in screening for psychotic disorders in children. This study assessed the ability of the DSMD to differentiate between inpatient children and adolescents with psychotic disorders (n = 18) and those with other clinical syndromes (n = 71). Results of ANCOVAs indicated that the psychotic group scored significantly higher on most DSMD scales and composites than the nonpsychotic clinical group. However estimates of effect size were particularly large for the Critical Pathology Composite and the Autism and Acute Problems Scales. Diagnostic efficiency statistics revealed that the DSMD's Critical Pathology Composite was highly accurate in differentiating between the 2 clinical groups. These findings support the utility of the DSMD in identifying children and adolescents with psychotic disorders.     

Interventions to Address the Academic Impairment of Children and Adolescents with ADHD

There exists a strong link between ADHD and academic underachievement. Both the core behavioral symptoms of ADHD and associated executive functioning deficits likely contribute to academic impairment. Current evidence-based approaches to the treatment of ADHD (i.e., stimulant medication, clinical behavior therapy and classroom behavioral interventions) have demonstrated a robust impact on behavioral variables such as attention and disruptive behavior within classroom analogue settings; however, their efficacy in improving academic outcomes is much less clear. Although surprisingly few treatment outcome studies of ADHD have attempted to incorporate interventions that specifically target academic outcomes, the studies that are available suggest that these interventions may be beneficial. The state of the treatment literature for addressing academic impairment in children and adolescents with ADHD will be reviewed herein, as well as limitations of current research, and directions for future research.     

Emotional and Behavioural Problems Among Refugee Children and Adolescents Living in South Australia

While there is a growing body of literature on the mental health status of adult refugees, children have been relatively neglected in research, particularly in Australia. This study investigated the prevalence of emotional and behavioural problems and patterns of service utilisation among 530 refugee children and adolescents aged 4–17 years living in South Australia. Parents and teachers of children aged 4–17 years and adolescents aged 13–17 years completed the appropriate versions of the Strengths and Difficulties Questionnaire. Of the 11.0% of children and adolescents found to have borderline or abnormal emotional and behavioural problems, only 13.0% accessed professional help. The study has practical implications for policy and practice.     

Assessment of Tripartite Factors of Emotion in Children and Adolescents I: Structural Validity and Normative Data of an Affect and Arousal Scale

The authors developed and evaluated a self-report measure for children designed to assess factors of the tripartite model of emotion (Clark & Watson, 1991). Factor analytic results from a large, multi-ethnic sample (n = 1,289) supported the structural validity of the scale, with the additional suggestion that negative affect appeared to contain two lower order dimensions in the item pool. Confirmatory factor analysis in an independent sample of 300 children and adolescents suggested favorable structure. Consistent with prediction, positive and negative affect emerged as relatively orthogonal dimensions. Physiological hyperarousal was found to be positively correlated with negative affect. Normative data are presented, and tests for differences by sex, grade level, and ethnicity demonstrated nonsignificant or minimal differences between groups. The implications for the assessment of tripartite factors and their relation to psychopathology in youth are discussed.