Helpful or Not? A Qualitative Study on Female Adolescents' Experience of TikTok When Recovering From Anorexia Nervosa.

OBJECTIVE: The scientific literature reports on how social media potentially influences eating disorders, although there is a large gap in the specific case of TikToks influence of adolescent's recovery from anorexia nervosa (AN). Our study uses in-depth interviews with female adolescents primarily suffering from AN to explore how they perceive the social media platform TikTok in relation to their recovery. METHOD: A total of 14 interviews with female adolescents recovering from AN were conducted and analyzed with reflexive thematic analysis. RESULTS: We developed four distinct main themes: social connectivity, algorithmic engagement, regulation and adaptation, and personal agency and recovery pathways. Our findings indicate both potential benefits and harm by TikTok use when in recovery from AN, depending on a complex interplay of individual and contextual factors. DISCUSSION: The study adds nuance to the on-going scientific debate on the role that TikTok plays in recovery from AN in general from the perspective provided by female adolescents. Suggestions are made for clinical implications at adolescent AN outpatient care including parental or professional support in TikTok adaptations and advice on how to discern when use may be triggering or supportive. Future research would benefit from longitudinal designs and inclusion of how individual differences, such as gender and personality, influence the effects on recovery and TikTok use.

Gambling Habits and Attitudes among Athlete and Non-Athlete High School Students in Skåne Region, Sweden.

Previous literature has reported increased rates of gambling problems in athletes compared to non-athletes. More liberal gambling-related attitudes have been suggested as a reason, although this rarely has been researched. The present study aimed to examine gambling experience, gambling problems, and gambling-related attitudes and parental gambling experience in high school students, comparing student-athletes to students at conventional schools. This is a cross-sectional web survey study in high school students (N = 473, 53% at sports high schools, 57% male) at eleven schools in the Skåne region, Sweden, who answered a web survey addressed gambling experiences, parental gambling and gambling-related attitudes, and included validated screening instruments for gambling problems and psychological distress. A history of any gambling was common and increased with age. Problem gambling was detected in 10% (13% of males and 5% of females, p < .001), and was associated with paternal and maternal gambling but not with psychological distress. Sports high school students were not more likely (9%) than other students (10%) to endorse gambling problems and history of each gambling type. However, paternal (but not maternal) gambling was more commonly reported in athletes, who also had more positive attitudes to gambling's effects on society and gambling availability. In contrast to other studies, this study did not demonstrate higher prevalence of gambling or gambling problems among young athletes than among other students, but liberal attitudes towards gambling, and experience of parental gambling on the father's side, were more common among athletes than among non-athletes. Gambling attitudes in adolescents may need to be targeted in future preventive efforts in young athletes and others.

Effects of stochastic vestibular stimulation on cognitive performance in children with ADHD.

Previous work has shown that exposure to auditory white noise (WN) can improve cognitive performance in children with ADHD, but it is unknown whether this improvement generalizes to other sensory modalities. To address this knowledge gap, we tested the effect of Stochastic Vestibular Stimulation (SVS) on cognitive performance and reaction time (RT) variability in two groups: children with ADHD and typically developing children (TDC). Children with ADHD (N=42) and TDC (N=28) performed three cognitive tasks (Spanboard, Word Recall and N-back tasks) at two different occasions, with and without exposure to SVS, in a double blinded design. The results showed no main effects of SVS on neither performance nor RT variability for children in any of the groups, and no interactions between SVS and group. Based on these results we conclude that, using our stimulation protocol, the positive effects of WN exposure on cognition in children with ADHD do not generalize to Stochastic Vestibular Stimulation.

Removing Biases in Communication of Severity Assessments of Intimate Partner Violence: Model Development and Evaluation.

BACKGROUND: To support a victim of violence and establish the correct penalty for the perpetrator, it is crucial to correctly evaluate and communicate the severity of the violence. Recent data have shown these communications to be biased. However, computational language models provide opportunities for automated evaluation of the severity to mitigate the biases. OBJECTIVE: We investigated whether these biases can be removed with computational algorithms trained to measure the severity of violence described. METHODS: In phase 1 (P1), participants (N=71) were instructed to write some text and type 5 keywords describing an event where they experienced physical violence and 1 keyword describing an event where they experienced psychological violence in an intimate partner relationship. They were also asked to rate the severity. In phase 2 (P2), another set of participants (N=40) read the texts and rated them for severity of violence on the same scale as in P1. We also quantified the text data to word embeddings. Machine learning was used to train a model to predict the severity ratings. RESULTS: For physical violence, there was a greater accuracy bias for humans (r2=0.22) compared to the computational model (r2=0.31; t38=-2.37, P=.023). For psychological violence, the accuracy bias was greater for humans (r2=0.058) than for the computational model (r2=0.35; t38=-14.58, P<.001). Participants in P1 experienced psychological violence as more severe (mean 6.46, SD 1.69) than participants rating the same events in P2 (mean 5.84, SD 2.80; t86=-2.22, P=.029<.05), whereas no calibration bias was found for the computational model (t134=1.30, P=.195). However, no calibration bias was found for physical violence for humans between P1 (mean 6.59, SD 1.81) and P2 (mean 7.54, SD 2.62; t86=1.32, P=.19) or for the computational model (t134=0.62, P=.534). There was no difference in the severity ratings between psychological and physical violence in P1. However, the bias (ie, the ratings in P2 minus the ratings in P1) was highly negatively correlated with the severity ratings in P1 (r2=0.29) and in P2 (r2=0.37), whereas the ratings in P1 and P2 were somewhat less correlated (r2=0.11) using the psychological and physical data combined. CONCLUSIONS: The results show that the computational model mitigates accuracy bias and removes calibration biases. These results suggest that computational models can be used for debiasing the severity evaluations of violence. These findings may have application in a legal context, prioritizing resources in society and how violent events are presented in the media.

Symptoms of depression and anxiety among elite high school student-athletes in Sweden during the COVID-19 pandemic: A repeated cross-sectional study.

The COVID-19 pandemic precipitated numerous changes in daily life, including the cancellation and restriction of sports globally. Because sports participation contributes positively to the development of student-athletes, restricting these activities may have led to long-term mental health changes in this population. Using a repeated cross-sectional study design, we measured rates of depression using the Patient Health Questionnaire-2 and anxiety using the Generalized Anxiety Disorder-2 scale in student-athletes attending elite sport high schools in Sweden during the second wave of the pandemic (February 2021; n = 7021) and after all restrictions were lifted (February 2022; n = 6228). Depression among student-athletes decreased from 19.8% in 2021 to 17.8% in 2022 (p = .008, V = .026), while anxiety screening did not change significantly (17.4% to 18.4%, p > .05). Comparisons between classes across years revealed older students exhibited decreases in depressive symptoms, while younger cohorts experienced increases in symptoms of anxiety from 2021 to 2022. Logistic regressions revealed that being female, reporting poorer mental health due to COVID-19, and excessive worry over one's career in sports were significant predictors of both depression and anxiety screenings in 2022. Compared to times when sports participation was limited, the lifting of restrictions was associated with overall reduced levels of depression, but not anxiety.

Involvement of fear, incompleteness, and disgust during symptoms of pediatric obsessive-compulsive disorder.

Fear has been assigned a central role in models of obsessive-compulsive disorder (OCD), but empirical investigations into the emotions that underpin OCD symptoms are few, especially in pediatric samples. Using validated, clinician-led structured interviews, 124 youth with OCD reported on the presence and severity of symptoms across the main symptom dimensions of OCD (aggressive, symmetry, contamination) and the degree to which fear, incompleteness, and disgust accompanied these symptoms. For comparison purposes, the degree of fear, incompleteness, and disgust during symptoms was obtained also from youth with social anxiety disorder (SAD; n = 27) and generalized anxiety disorder (GAD; n = 28). Participants with OCD reported that all three emotions were involved in their symptoms; however, fear was most strongly linked to aggressive symptoms, incompleteness to symmetry symptoms, and disgust to contamination symptoms. Incompleteness differentiated youth with OCD from those with SAD and GAD. No differences for these emotions were found for youth with OCD with versus without the tic-disorder subtype or comorbid autism. A positive association between incompleteness and self-reported hoarding emerged among youth with OCD. Further studies of the emotional architecture of pediatric OCD, and its relationship to etiology and treatment, are warranted.

Personality traits explain the relationship between psychedelic use and less depression in a comparative study.

Interest in psychedelics is increasing due to the potential for improved mental health and quality of life. However, adverse effects on mental health are still a concern. Personality traits have been suggested to both influence the psychedelic experience and mental health, and even be changed by psychedelic use. The present study describes for the first time a national sample of Swedish psychedelic users (n = 400) compared to a sex and age-matched control-group of non-users (n = 400) regarding mental health variables (depression, insomnia, problematic alcohol and drug use, and dissociation) and personality (Big Five). Data was collected in an online survey including individuals from 16 years of age who had at least one psychedelic experience. The main results reported psychedelic users as less depressed (Patient Health Questionnaire-9; PHQ-9) (d = - 0.29) and having more use of drugs (Drug Use Disorders Identification Test; DUDIT) (d = 1.27). In the Big Five personality traits, openness differed notably (d = 1.72), and the between-group effects in PHQ-9 were explained by lower neuroticism. Our findings reveal that psychedelic users report less depression and higher drug use, and this is partly due to personality traits. These results have implications on how we view psychedelic users and the use of psychedelic drugs.

The relationship between game genre, monetization strategy and symptoms of gaming disorder in a clinical sample of adolescents.

Background: Gaming disorder (GD) has been introduced as a new diagnosis in the International Classification of Disease 11 (ICD-11). Currently, there's limited understanding of how various video games may differentially contribute to the risk of developing GD. The main aim of this study was to examine the relationship between individuals' game genre preferences, their preferred games' monetization strategies, and GD Symptoms. Methods: A total of 85 patients undergoing treatment for GD at a child and youth psychiatric clinic were included in the study. Their preferred games were classified into five novel genres based on gameplay similarities and objectives, and further categorized based on their monetization strategy. Results: Symptom burden of GD, measured with Game Addiction Scale for Adolescents (GASA), was highest for those playing Free-to-Play (F2P) games and lowest for Pay-to-Play (P2P) players. Players of Competitive Games endorsed higher GD symptom burden, whereas players of Story-driven games reported lower GD symptom burden. Symptoms of GD were associated with attention-deficit hyperactivity disorder (ADHD) diagnosis in males. Conclusions: This study reveals that game genre preference is influenced by sex, age, and certain psychiatric diagnoses. The categorizing of games into genres is increasingly complex and our research introduces a novel categorization in a developing research field. The result of this study suggests that the monetization model is important to consider while trying to understand the relationship between game characteristics and GD symptoms.

Concussion history associated with adolescent psychological distress but not hazardous gambling: a cross-sectional study.

BACKGROUND: Sustaining multiple concussions over one's lifetime may be associated with behavioral and mood changes beyond the acute phase of injury. The present cross-sectional study examined the relationship between concussion history, the incidence of current moderate-severe psychological distress, and lifetime adolescent hazardous gambling in high school students. METHODS: Four-hundred fifty-nine high school students from southern Sweden (age: 16.81 ± 0.83, 58.2% male) completed a survey assessing concussion history (0,1,2…>8), psychological distress using the Kessler-6 scale, and lifetime hazardous gambling using the NODS-CLiP scale. RESULTS: Participants who self-reported three or more concussions were more likely to endorse moderate-severe symptoms of psychological distress than those with no concussion history while controlling for covariates, OR = 2.71, 95% CI [1.19, 6.18]. In contrast, concussion history was not associated with hazardous gambling after controlling for confounding variables. CONCLUSIONS: Self-reporting three or more concussions was associated with increased current psychological distress beyond the acute phase of injury among high school students. Adolescents who have sustained multiple concussions should undergo mental health evaluations beyond the acute phase of injury to identify and treat psychological distress, but probing for hazardous gambling may not be clinically relevant in this previously concussed adolescent population.

When the Relationship Is at Stake: Parents' Perception of the Relationship with a Child with Problematic Gaming and Their Perceived Need for Support.

Intrapersonal parental factors play a significant role in the development of problematic gaming in children. However, few studies have explored parental perspectives on their relationship with a child engaged in problematic gaming, as well as the need for support parents perceive in relation to the child's gaming. We conducted semi-structured interviews with 12 parents (83.3% women) of 11 children (81.8% boys, Mage = 15 ± 2) to examine how parents of children with problematic gaming behavior perceive the parent-child relationship and their need for additional support. We analyzed qualitative accounts using thematic analysis to identify themes and subthemes while drawing on the theoretical frameworks of Aaron Antonovsky's theory of sense of coherence (SOC) and Jürgen Habermas' theory of logic. Participants described difficulties regarding all three components of SOC (meaningfulness, comprehensibility, and manageability) in relation to their child's gaming, with the most significant challenge being manageability. Parents primarily sought assistance from institutions and organizations, such as mental health services, to enhance manageability. The findings emphasize parents' need for relational and practical support tailored to their unique context, as well as their wish to be more involved in the treatment of their children.

Effectiveness and Acceptability of Cognitive Behavioral Therapy and Family Therapy for Gaming Disorder: Protocol for a Nonrandomized Intervention Study of a Novel Psychological Treatment.

BACKGROUND: Gaming disorder (GD) is a new official diagnosis in the International Classification of Diseases, 11th Revision, and with its recognition, the need to offer treatment for the condition has become apparent. More knowledge is needed about the type of treatment needed for this group of patients. OBJECTIVE: This study aims to evaluate the effectiveness and acceptability of a novel module-based psychological treatment for GD based on cognitive behavioral therapy and family therapy. METHODS: This study is a nonrandomized intervention study, with a pretest, posttest, and 3-month follow-up design. It will assess changes in GD symptoms, psychological distress, and gaming time, alongside treatment satisfaction, working alliance, and a qualitative exploration of patients' and relatives' experiences of the treatment. RESULTS: This study started in March 2022 and the recruitment is expected to close in August 2024. CONCLUSIONS: This study evaluates the effectiveness and acceptability of a psychological treatment for patients with problematic gaming behavior and GD. It is an effectiveness trial and will be conducted in routine care. This study will have high external validity and ensure that the results are relevant for a diverse clinical population with psychiatric comorbidity. TRIAL REGISTRATION: ClinicalTrials.gov NCT06018922; https://clinicaltrials.gov/study/NCT06018922. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/56315.

Effects of Auditory and Visual White Noise on Oculomotor Inhibition in Children With Attention-Deficit/Hyperactivity Disorder: Protocol for a Crossover Study.

BACKGROUND: In attention-deficit/hyperactivity disorder (ADHD), poor inhibitory control is one of the main characteristics, with oculomotor inhibition impairments being considered a potential biomarker of the disorder. While auditory white noise has demonstrated the ability to enhance working memory in this group, visual white noise is still unexplored and so are the effects of both types of white noise stimulation on oculomotor inhibition. OBJECTIVE: This crossover study aims to explore the impact of auditory and visual white noise on oculomotor inhibition in children with ADHD and typically developing (TD) children. The study will investigate the impact of different noise levels (25% and 50% visual, 78 dB auditory), and performance will be evaluated both with and without noise stimulation. We hypothesize that exposure to white noise will improve performance in children with ADHD and impair the performance for TD children. METHODS: Memory-guided saccades and prolonged fixations, known for their sensitivity in detecting oculomotor disinhibition in ADHD, will be used to assess performance. Children diagnosed with ADHD, withdrawing from medication for 24 hours, and TD children without psychiatric disorders were recruited for the study. RESULTS: Data collection was initiated in October 2023 and ended in February 2024. A total of 97 participants were enrolled, and the first results are expected between September and November 2024. CONCLUSIONS: This study will examine whether cross-modal sensory stimulation can enhance executive function, specifically eye movement control, in children with ADHD. In addition, the study will explore potential differences between auditory and visual noise effects in both groups. Our goal is to identify implications for understanding how noise can be used to improve cognitive performance. TRIAL REGISTRATION: ClinicalTrials.gov NCT06057441; https://clinicaltrials.gov/study/NCT06057441. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/56388.

The influence of methylphenidate on auditory brainstem response patients with attention deficit hyperactivity disorder; an exploratory study.

Background: Attention-deficit hyperactivity disorder (ADHD), characterized by periods of inattention, overactivity, and impulsiveness, is the most prevalent neurodevelopmental disorder among children. Auditory Brainstem Response (ABR) is a technique in which clickshaped sounds elicit potentials that are recorded from electrodes placed on a patient's skull. Extant research indicates that ABR is frequently affected in neurodevelopmental disorders such as ADHD. Methylphenidate (MPH), a psychostimulant, is often prescribed to children with ADHD as a first-line pharmacological treatment. The aim of this study was to explore the effects of Methylphenidate treatment on previously observed amplitude alterations in the ABR of patients with ADHD. Methods: We recruited 32 drug-naïve children and adolescents (19 males and 13 females; mean age 11 years) diagnosed with ADHD and 35 health controls (15 males and 20 females; mean age 12 years). The ADHD group was treated with Methylphenidate, and ABR was recorded before treatment and at a steady state of medical treatment. Results: Medicated ADHD patients exhibited increased activity in the right side ABR in Wave VI. Conclusions: A significant increase in activity was found in a part of the ABR thought to correspond to the thalamic area in medicated ADHD patients compared to the same area of non-medicated ADHD patients. The results add to the growing body of research suggesting that specific ABR peaks correlate to certain psychiatric symptoms.

Adolescents' Perceptions of a Relapse Prevention Treatment for Problematic Gaming-A Qualitative Study.

Given the increasing prevalence of problematic gaming, in 2013, the diagnosis "Internet gaming disorder (IGD)" was included in the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5) as a potential diagnosis. With a new diagnosis, it is important to determine treatment options. The importance of the parent-child relationship has been emphasised in problematic gaming and its treatment. This study aims to provide more knowledge about adolescents' perceptions of a treatment for problematic gaming and understand whether such treatment may have a bearing on the parent-child relationship. We conducted individual interviews with nine adolescents who completed a treatment for problematic gaming. The interviews were analysed using thematic analysis. The analysis revealed three themes. Theme 1: adolescents' experiences of the new treatment; Theme 2: adolescents' perceptions of the effect of the treatment on their gaming behaviour; and Theme 3: adolescents' perceptions of changes in their parent-child relationships. The adolescents viewed the treatment as a way of gaining control of their gaming, a process in which a therapist played an integral part. For the majority of the adolescents in our study, the main effects of treatment were gaining insight into how their gaming and gaming-related behaviours affected other parts of their lives. The participants felt that the treatment improved their relationship with their parents through reducing everyday conflicts. This new knowledge can be used for the development of future interventions involving children and adolescents.

Relapse Prevention Therapy for Problem Gaming or Internet Gaming Disorder in Swedish Child and Youth Psychiatric Clinics: Protocol for a Randomized Controlled Trial.

BACKGROUND: Although gaming is a common arena where children socialize, an increasing number of children are exhibiting signs of problem gaming or internet gaming disorder. An important factor to the development of problem gaming is parent-child relationships. A cognitive behavioral therapy-based form of treatment, labeled relapse prevention, has been developed as a treatment for child and adolescent problem gaming or internet gaming disorder. However, no study has evaluated the effect of this treatment among Swedish children and youth nor the role of the parent-child relationships in this treatment. OBJECTIVE: This study aims (1) to evaluate a relapse prevention treatment for patients showing signs of problem gaming or internet gaming disorder recruited from child and youth psychiatric clinics and (2) to test whether the quality of parent-child relationships plays a role in the effect of relapse prevention treatment and vice versa-whether the relapse prevention treatment has a spillover effect on the quality of parent-child relationships. Moreover, we explore the carer's attitudes about parent-child relationships and child gaming, as well as experiences of the treatment among the children, their carers, and the clinicians who carried out the treatment. METHODS: This study is a 2-arm, parallel-group, early-stage randomized controlled trial with embedded qualitative components. Children aged 12-18 years who meet the criteria for problem gaming or internet gaming disorder will be randomized in a 1:1 ratio to either intervention (relapse prevention treatment) or control (treatment as usual), with a total of 160 (80 + 80) participants. The primary outcomes are measures of gaming and gambling behavior before and after intervention, and the secondary outcomes include child ratings of parent-child communication and family functioning. The study is supplemented with a qualitative component with semistructured interviews to capture participants' and clinicians' experiences of the relapse prevention, as well as attitudes about parent-child relationships and parenting needs in carers whose children completed the treatment. RESULTS: The trial started in January 2022 and is expected to end in December 2023. The first results are expected in March 2023. CONCLUSIONS: This study will be the first randomized controlled trial evaluating relapse prevention as a treatment for child and adolescent problem gaming and internet gaming disorder in Sweden. Since problem behaviors in children interact with the family context, investigating parent-child relationships adjacent to the treatment of child problem gaming and internet gaming disorder is an important strength of the study. Further, different parties, ie, children, carers, and clinicians, will be directly or indirectly involved in the evaluation of the treatment, providing more knowledge of the treatment and its effect. Limitations include comorbidity in children with problem gaming and internet gaming disorder and challenges with the recruitment of participants. TRIAL REGISTRATION: ClinicalTrials.gov NCT05506384 (retrospectively registered); https://clinicaltrials.gov/ct2/show/NCT05506384. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/44318.

Relapse prevention therapy for internet gaming disorder in Swedish child and adolescent psychiatric clinics: a randomized controlled trial.

Objectives: To evaluate the effectiveness of relapse prevention (RP) as a treatment for internet gaming disorder (IGD). Design: Randomized controlled trial. Setting: Three child and adolescent psychiatry (CAP) units in Region Skåne, Sweden. Participants: Children aged 13-18 years, coming for their first visit to CAP during 2022, were screened for gaming behavior. Those who met the proposed DSM-5 criteria for IGD were offered participation in the trial, if they had the capacity to provide written informed consent and if they spoke Swedish. A total of 111 CAP patients agreed to participate. Out of those, 11 patients were excluded due to incorrect inclusion such as young age (n = 1), or due to the absence of responses to follow-up measures (n = 9). After exclusion, 102 participants remained (intervention = 47, control = 55). Interventions: The intervention, RP, is based on cognitive behavioral treatment (CBT) and was provided individually, comprising of five to seven 45-min sessions over a period of 5 to 7 weeks versus treatment as usual. Outcome measures: Participants were assessed with Game Addiction Scale for Adolescents pre-treatment (GASA) (baseline), post-treatment (treatment group only), and 3 months after baseline (follow-up). Results: The repeated measures ANOVA showed a significant interaction effect between treatment and time. Both the control group and treatment group lowered their mean GASA score from baseline to follow-up significantly, but the improvement was greater in the treatment group (mean difference in control group -5.1, p < 0.001, 95% CI = - 3.390 to -6.755, mean difference in treatment group -9.9, p < 0.001, 95% CI = -11.746 to -8.105). Conclusion: RP was found to be superior to treatment as usual in terms of reduction of IGD symptoms. Future research should address which aspects within a given treatment are effective, who benefits from treatment, in what aspects, and why. Trial registration number: ClinicalTrials.gov, NCT05506384 https://clinicaltrials.gov/ct2/show/NCT05506384.

Effect of Internet-Delivered Emotion Regulation Individual Therapy for Adolescents With Nonsuicidal Self-Injury Disorder: A Randomized Clinical Trial.

Importance: Nonsuicidal self-injury is prevalent in adolescence and associated with adverse clinical outcomes. Effective interventions that are brief, transportable, and scalable are lacking. Objective: To test the hypotheses that an internet-delivered emotion regulation individual therapy for adolescents delivered adjunctive to treatment as usual is superior to treatment as usual only in reducing nonsuicidal self-injury and that improvements in emotion regulation mediate these treatment effects. Design, Setting, and Participants: This 3-site, single-masked, randomized superiority trial enrolled participants from November 20, 2017, to April 9, 2020. Eligible participants were aged between 13 and 17 years and met diagnostic criteria for nonsuicidal self-injury disorder; they were enrolled as a mixed cohort of consecutive patients and volunteers. Parents participated in parallel to their children. The primary end point was at 1 month after treatment. Participants were followed up at 3 months posttreatment. Data collection ended in January 2021. Interventions: Twelve weeks of therapist-guided, internet-delivered emotion regulation individual therapy delivered adjunctive to treatment as usual vs treatment as usual only. Main Outcomes and Measures: Primary outcome was the youth version of the Deliberate Self-harm Inventory, both self-reported by participants prior to treatment, once every week during treatment, and for 4 weeks posttreatment, and clinician-rated by masked assessors prior to treatment and at 1 and 3 months posttreatment. Results: A total of 166 adolescents (mean [SD] age, 15.0 [1.2] years; 154 [92.8%] female) were randomized to internet-delivered emotion regulation therapy plus treatment as usual (84 participants) or treatment as usual only (82 participants). The experimental intervention was superior to the control condition in reducing clinician-rated nonsuicidal self-injury (82% vs 47% reduction; incidence rate ratio, 0.34; 95% CI, 0.20-0.57) from pretreatment to 1-month posttreatment. These results were maintained at 3-month posttreatment. Improvements in emotion dysregulation mediated improvements in self-injury during treatment. Conclusions and Relevance: In this randomized clinical trial, a 12-week, therapist-guided, internet-delivered emotion regulation therapy delivered adjunctive to treatment as usual was efficacious in reducing self-injury, and mediation analysis supported the theorized role of emotion regulation as the mechanism of change in this treatment. This treatment may increase availability of evidence-based psychological treatments for adolescents with nonsuicidal self-injury. Trial Registration: ClinicalTrials.gov Identifier: NCT03353961.

Gaming Activity and Possible Changes in Gaming Behavior Among Young People During the COVID-19 Pandemic: Cross-sectional Online Survey Study.

BACKGROUND: Young people's daily lives and social interactions changed remarkably during the COVID-19 pandemic as schools and cinemas closed, leisure activities were cancelled, and gatherings were regulated. Questions have been raised by the media, schools, policy makers, and research communities about the effect on young people's online behaviors. OBJECTIVE: This cross-sectional study aimed to study self-reported changes in gaming, focusing on a younger section of the population during the COVID-19 pandemic in Sweden. We also wanted to look at potential risk factors behind problematic gaming during the pandemic, including gaming patterns, gambling behavior, psychological distress, certain sociodemographic characteristics, health factors, and school situation. METHODS: This was an anonymous online survey study of web panel participants in Sweden (n=1501) to study changes in gaming behaviors during the COVID-19 pandemic. Self-reported increases in gaming were analyzed in logistic regression analyses against sociodemographic and health factors. RESULTS: Within the study population that reported changes in gaming activity, we found significant differences in age, employment status, disposable income, whether they ever played on loot boxes, time spent at home, school attendance, psychological distress, and gambling and gaming problems, as well as significant differences in changes in alcohol consumption and exercise habits. When examining the 16-24-year-old age group who reported changes in gaming activity, we found significant differences within the group in disposable income, time at home, and school attendance. When examining the 25-39-year-old age group who reported changes in gaming activity, we found significant differences within the group in employment status, disposable income, time spent at home, whether the respondents were studying, school attendance level, psychological distress, and gaming problems, as well as significant differences in changes in alcohol consumption and exercise habits. Psychological distress (all age groups analyzed together; 25-39-year-old age group), drinking less alcohol (all age groups analyzed together), spending more time at home (all age groups analyzed together), gaming problems, and exercising less (25-39-year-old age group) were positively correlated with a self-reported increase in gaming activity. Being employed (25-39-year-old age group) and being over 40 years of age (all age groups analyzed together) were negatively correlated with increased gaming. We found no significant correlations in the 16-24-year-old age group. CONCLUSIONS: Those who reported increased gaming during the COVID-19 pandemic were more likely to be 16 years to 39 years old. In the age group of 25 years to 39 years old, the increase was associated with psychological distress, reporting less exercise, and being unemployed. COVID-19 may present as a risk factor of increased online gaming in a small but vulnerable group. More research and preferably longitudinal studies are needed in the field of gaming and effects of the COVID-19 pandemic.

An auditory processing advantage enables communication in less complex social settings: Signs of an extreme female brain in children and adolescents being assessed for Autism Spectrum Disorders.

Background: The underlying factors of the male predominance in Autism Spectrum Disorders (ASD) are largely unknown, although a female advantage in social communication has been pointed out as a potential factor. Recently, attention has been given to ASD as a sensory processing disorder, focusing on the audio-visual temporal processing paramount for the development of communication. In ASD, a deviant audio-visual processing has been noted, resulting in difficulties interpreting multisensory information. Typically Developed (TD) females have shown an enhanced language processing in unisensory situations compared to multisensory situations. We aim to find out whether such an advantage also can be seen in girls within the ASD population, and if so, is it related to social communication skills? Method: Forty children (IQ > 85), 20 females (mean age = 13.90 years, SD = 2.34) and 20 males (mean age = 12.15 years, SD = 2.83) triaged for an ASD assessment were recruited from a child and youth psychiatric clinic in Sweden. Using The Social Responsiveness Scale (SRS) we looked at associations with child performance on the Integrated Visual and Auditory Continuous Performance Test (IVA-2). Results: An auditory advantage in the female group was associated with less rated problems in social communications in unisensory processing whereas in multisensory processing an auditory dominance was associated with more rated problems in Social Awareness. In the male group, a visual dominance was associated with more rated problems in Social Rigidity. Conclusion: A female unisensory processing advantage in ASD could very well be explaining the male domination in ASD. However, the social difficulties related to multisensory processing indicate that ASD females might be struggling as hard as males in more complex settings. Implications on the assessment procedure are discussed.

Reduced thalamic activity in ADHD under ABR forward masking conditions.

Attention-deficit hyperactivity disorder (ADHD) is a common chronic neurodevelopmental disorder characterized by symptoms of inattention, overactivity, and/or impulsiveness. The prevalence of ADHD varies in different settings and there have been voices raised to call for more objective measures in order to avoid over- and underdiagnosing of ADHD. Auditory Brainstem Response (ABR) is a method where click shaped sounds evoke potentials that are recorder from electrodes on the skull of a patient. The aim of this study was to explore possible alterations in the ABR of 29 patients with ADHD compared to 39 healthy controls. We used a forward masked sound. We found differences in ABR that correspond to the thalamic area. The thalamus seems to play an active role in regulation of activity level in ADHD. More research is needed to draw any further conclusions on using ABR as an objective measurement to detect ADHD.