The role of anxiety and callous-unemotional traits in the relationship between externalizing behaviors and sleep problems in clinic-referred youth.

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

Predicting How Well Adolescents Get Along with Peers and Teachers: A Machine Learning Approach.

How well adolescents get along with others such as peers and teachers is an important aspect of adolescent development. Current research on adolescent relationship with peers and teachers is limited by classical methods that lack explicit test of predictive performance and cannot efficiently discover complex associations with potential non-linearity and higher-order interactions among a large set of predictors. Here, a transparently reported machine learning approach is utilized to overcome these limitations in concurrently predicting how well adolescents perceive themselves to get along with peers and teachers. The predictors were 99 items from four instruments examining internalizing and externalizing psychopathology, sensation-seeking, peer pressure, and parent-child conflict. The sample consisted of 3232 adolescents (M = 14.0 years, SD = 1.0 year, 49% female). Nonlinear machine learning classifiers predicted with high performance adolescent relationship with peers and teachers unlike classical methods. Using model explainability analyses at the item level, results identified influential predictors related to somatic complaints and attention problems that interacted in nonlinear ways with internalizing behaviors. In many cases, these intrapersonal predictors outcompeted in predictive power many interpersonal predictors. Overall, the results suggest the need to cast a much wider net of variables for understanding and predicting adolescent relationships, and highlight the power of a data-driven machine learning approach with implications on a predictive science of adolescence research.

Feasibility trial of virtual reality exposure therapy for selective mutism.

Virtual reality exposure therapy (VRET) has been commonly utilised as an extension of cognitive behavioural therapy (CBT). However, most studies examined its effectiveness among adults, with no study focusing on children with selective mutism (SM). We aimed to examine its feasibility and acceptability among children with SM. Twenty children aged 6-12 with SM diagnosis were recruited and completed six therapist-guided VRET sessions. Parents and clinicians completed measures at pre-VRET, post-VRET, 1-month and 3-month follow-up visits. At post-VRET, parent and child participants completed the acceptability questionnaires. Findings suggested the feasibility of VRET as all participants completed the programme with no attrition. Parents and child participants also reported VRET to be an acceptable and effective treatment for SM. Significant improvement in overall functioning were found at post-treatment and follow-up measures, but there were no significant changes in parent-rated speech frequency and anxiety measures. These support the acceptability of VRET as an adjunct modality (and not substitute) of CBT in SM treatment. Future studies, with more robust experimental designs and larger sample sizes, can be conducted to confirm its efficacy. As technology becomes more sophisticated, tools such as virtual environments can be explored to enhance evidence-based care for children and their families.

Structure of Dark Triad Dirty Dozen Across Eight World Regions.

The Dark Triad (i.e., narcissism, psychopathy, Machiavellianism) has garnered intense attention over the past 15 years. We examined the structure of these traits' measure-the Dark Triad Dirty Dozen (DTDD)-in a sample of 11,488 participants from three W.E.I.R.D. (i.e., North America, Oceania, Western Europe) and five non-W.E.I.R.D. (i.e., Asia, Middle East, non-Western Europe, South America, sub-Saharan Africa) world regions. The results confirmed the measurement invariance of the DTDD across participants' sex in all world regions, with men scoring higher than women on all traits (except for psychopathy in Asia, where the difference was not significant). We found evidence for metric (and partial scalar) measurement invariance within and between W.E.I.R.D. and non-W.E.I.R.D. world regions. The results generally support the structure of the DTDD.

Student Version of the Teacher-Student Relationship Inventory (S-TSRI): Development, Validation and Invariance.

There is limited knowledge concerning children's relationships with their teachers, and specifically, we lack a suitable, culturally appropriate measurement instrument for assessing the teacher-student relationship from the student's perspective in Asia. This study used attachment theory as a theoretical framework to understand teacher-student relationships. Using a dataset from the Ministry of Education (MOE) of Singapore, the authors developed and validated a student version of the Teacher-Student Relationship Inventory (S-TSRI), with good psychometric properties for Singaporean children. The three-factor S-TSRI model comprising the factors satisfaction, instrumental help, and conflict was first established by exploratory factor analysis (EFA) and confirmed by confirmatory factor analysis (CFA). Through subsequent multigroup CFAs, we found that the factorial invariance was supported across gender, grade levels, and students of different academic levels, represented by the pass and fail groups. The structural model was tested in the total, pass, and fail groups. For the total and pass groups, the factors satisfaction and instrumental help showed significant positive relationships with a sense of school belonging, and negative or non-significant relationships with aggression. The conflict factor showed a weaker negative or non-significant relationship with a sense of school belonging, and a positive relationship with aggression. For the fail group, identical results were obtained with one exception; this was discussed in light of the fail group having a different needs profile. Findings from this study show that the 14-item S-TSRI measure has robust psychometric properties and yields scores that are reliable and valid in this large sample of primary school students from Singapore.

Profiles of Antisocial Behavior in School-Based and At-Risk Adolescents in Singapore: A Latent Class Analysis.

This study used latent class analysis to examine whether multiple subgroups can be identified based on rule-breaking and aggressive behavior in school-based and at-risk adolescent samples. These groups were tested for differences in behavioral, emotional, personality and interpersonal correlates. Rule breaking and aggressive behavior co-occurred across all classes. School-based adolescents were classified as having minimal, minor or moderate antisocial problems. At-risk adolescents were classified as having mild, medium or severe antisocial problems. Generally, at-risk adolescents had higher levels of antisocial behavior, and greater severity of antisocial behavior was associated with more problems in various domains. Results differed however, for the school-based and at-risk samples with respect to emotional problems, sensation-seeking and peer conformity pressure. There is a need to jointly consider both non-aggressive rule-breaking behavior and aggressive behavior in prevention and intervention work, as it is insufficient to address isolated symptoms and problems in children and adolescents.

An Interactive Mobile App Game to Address Aggression (RegnaTales): Pilot Quantitative Study.

BACKGROUND: The rapid advancement in media technology has radically changed the way we learn and interact with one another. Games, with their engaging and interactive approach, hold promise in the delivery of knowledge and building of skills. This has potential in child and adolescent mental health work, where the lack of insight and motivation for therapy are major barriers to treatment. However, research on the use of serious games in mental health interventions for children and adolescents is still in its infancy. OBJECTIVE: This study adds to the research on serious games in mental health interventions through the development and evaluation of RegnaTales, a series of 6 mobile apps designed to help children and adolescents manage anger. We examined the usability and playability of RegnaTales, as well as children's aggression levels before and after the game play. METHODS: A total of 72 children aged between 6 and 12 years were recruited for the study. Thirty-five participants had a clinical diagnosis of disruptive behavior disorders (DBD), whereas 37 were typically developing (TD) children. Each child played 1 of the 6 RegnaTales apps for approximately 50 min before completing the Playability and Usability Questionnaire. The Reactive-Proactive Aggression Questionnaire was completed before and after the game play. RESULTS: The overall results showed high levels of enjoyment and playability. TD children and children with DBD had similar experienced fun and perceived playability scores on all 6 mobile apps. All 6 mobile apps garnered comparable experienced fun and perceived playability scores. Furthermore, 42% (5/12) to 67% (8/12) of the children indicated that they would like to play the games again. Importantly, children felt that they acquired skills in anger management, were motivated to use them in their daily lives, and felt confident that the skills would help them better manage their anger. Children reported significantly lower reactive aggression after playing the mobile apps Rage Raver (P=.001), Abaddon (P=.008), and RegnaTools (P=.03). These apps focused on the psychoeducation of the link between thoughts and emotions, as well as equipping the participants with various emotion regulation strategies such as relaxation and cognitive restructuring. CONCLUSIONS: This study presents evidence to support RegnaTales as a feasible serious game. The preliminary findings associated with reduction in reactive aggression, coupled with future research to further establish its efficacy, could warrant RegnaTales as a potential intervention for anger issues among clinical and community populations.

Omega-3 (ω-3) and social skills interventions for reactive aggression and childhood externalizing behavior problems: a randomized, stratified, double-blind, placebo-controlled, factorial trial.

BACKGROUND: While studies suggest that nutritional supplementation may reduce aggressive behavior in children, few have examined their effects on specific forms of aggression. This study tests the primary hypothesis that omega-3 (ω-3), both alone and in conjunction with social skills training, will have particular post-treatment efficacy for reducing childhood reactive aggression relative to baseline. METHODS: In this randomized, double-blind, stratified, placebo-controlled, factorial trial, a clinical sample of 282 children with externalizing behavior aged 7-16 years was randomized into ω-3 only, social skills only, ω-3 + social skills, and placebo control groups. Treatment duration was 6 months. The primary outcome measure was reactive aggression collected at 0, 3, 6, 9, and 12 months, with antisocial behavior as a secondary outcome. RESULTS: Children in the ω-3-only group showed a short-term reduction (at 3 and 6 months) in self-report reactive aggression, and also a short-term reduction in overall antisocial behavior. Sensitivity analyses and a robustness check replicated significant interaction effects. Effect sizes (d) were small, ranging from 0.17 to 0.31. CONCLUSIONS: Findings provide some initial support for the efficacy of ω-3 in reducing reactive aggression over and above standard care (medication and parent training), but yield only preliminary and limited support for the efficacy of ω-3 in reducing overall externalizing behavior in children. Future studies could test further whether ω-3 shows promise in reducing more reactive, impulsive forms of aggression.

Student perceptions of self-efficacy and teacher support for learning in fostering youth competencies: Roles of affective and cognitive engagement.

INTRODUCTION: This exploratory study extends research on student engagement by examining the relationships between its different facets, students' perception of teacher support for learning and self-efficacy, and adaptive youth competencies. Guided by Reschly and Christenson's (2012) student engagement framework, affective and cognitive engagement were posited to mediate the relationships between students' perceived beliefs, adaptive competencies and behavior engagement. METHOD: 3776 Singapore Grade 7 and 8 students completed a self report survey questionnaire. RESULTS: Self-efficacy and teacher support demonstrated different indirect relationships with student competencies and via different engagement pathways. Cognitive engagement mediated the effects of teacher support and self-efficacy on the four student competencies, while affective engagement's mediated effects was only evident on academic buoyancy. CONCLUSION: This study holds important implications for educational and psychological research on student engagement, demonstrating that the construct, though theorized in a western context, has empirical utility and relevance in an East Asian context.

Callous unemotional traits and the relationship between aggressive parenting practices and conduct problems in Singaporean families.

Research into parenting influences on child conduct problems in Asian countries has been limited compared to that conducted in Western countries, especially with regard to interplay between parenting and callous unemotional (CU) traits (e.g., lack of guilt and empathy). This study examined associations between dimensions of aggressive parenting practices (psychological aggression, mild and severe physical aggression), dimensions of child aggression (proactive, reactive), and child CU traits, in Singapore. Participants were children and adolescents with clinic-referred externalizing problems (N = 282; 87.6% boys), aged 7-16 years. Mild and severe parental physical aggression was found to be uniquely associated with children's proactive aggression, whereas parental psychological aggression was uniquely associated with both proactive and reactive aggression. Consistent with previous evidence regarding CU traits as moderators of the relationship between negative parenting and child conduct problems, physically aggressive parenting was found to be more strongly associated with children's proactive aggression among children with low levels of CU traits, than those with high CU traits. These findings support the need for ongoing research into CU traits in Asian cultures, focused on heterogeneous risk pathways to antisocial behavior and individual differences in response to family-based interventions.

Functions of Aggression and Delinquency: The Moderating Role of Parent Criminality and Friends' Gang Membership.

This study examined the relationships between two functions of aggression (i.e., reactive and proactive) and delinquency, including the moderating effects of parent criminality and friends' gang membership, in a sample of 1,027 Singaporean adolescents from Grade 7 to Grade 9, with age ranging from 12 to 19 years ( M = 14.10, SD = 1.15). Findings suggested that both reactive aggression and proactive aggression significantly and positively predicted delinquency (after controlling for proactive aggression and reactive aggression, respectively), with proactive aggression being a stronger predictor. Friends' gang membership was found to moderate the relationship between reactive aggression and delinquency, and proactive aggression and delinquency, with stronger moderator effects for the latter. Those who were aggressive proactively and who had friends in a gang appear to be impacted most negatively with respect to delinquency. Parent criminality did not moderate these relationships. These findings highlight the need to effectively address the issues of child and adolescent aggression. Also, developing positive peer relations early is crucial for delinquency prevention.

Neurocognitive characteristics of youth with noncomorbid and comorbid forms of conduct disorder and attention deficit hyperactivity disorder.

OBJECTIVE: Studies investigating neurocognitive deficits in youth with conduct disorder (CD) and attention deficit hyperactivity disorder (ADHD) are often confounded by the high rates of comorbidity between the two. METHOD: Neurocognitive functioning was examined in three diagnostic groups (ADHD only, CD only, comorbid ADHD and CD) matched by age, sex, IQ, and medication status (n=28-32 per group). RESULTS: No significant differences emerged between the diagnostic groups on measures of risk-taking or response inhibition. Children with CD performed better on a measure of spatial planning than those with comorbid ADHD and CD, and dimensional analyses in the full sample (n=265) revealed a small association between ADHD symptoms and poorer spatial planning. CONCLUSION: These results suggest that deficits in spatial planning may be more pronounced in individuals with ADHD, but that the neurocognitive functioning of youth with noncomorbid and comorbid CD and ADHD are largely similar.

Agreement Between Parent- and Self-Reports of Psychopathic Traits and Externalizing Behaviors in a Clinical Sample.

A number of studies have identified discrepancies in informant ratings of externalizing behaviors in youth, but it is unclear whether similar discrepancies exist between informants when rating psychopathic traits. In this study, we examined parent-child agreement on ratings of both psychopathic traits and externalizing behaviors, and examined the factors that influence agreement in both of these domains. A total of 282 children between 7 and 16 years (M = 10.60 years, SD = 1.91) from an outpatient child psychiatric clinic participated in this study. Our findings revealed low levels of parent-child agreement on these measures (ICC values ranging from .02 to .30 for psychopathic traits; ICC values ranging from .09 to .30 for externalizing behaviors). In addition, our findings did not support the moderating effects of child's age, gender, clinical diagnosis, informant, and parental conflict on the relationship between parent- and child-ratings of psychopathic traits and externalizing behaviors. Further research is needed to better understand how parents and child reports of child's externalizing behaviors and psychopathic traits are similar and/or different from one another and factors that influence these agreements.

Multiple trauma exposure and psychosocial functioning in Singaporean children in out-of-home care.

OBJECTIVE: Children in out-of-home care are often exposed to chronic, interpersonal traumas such as abuse and domestic violence. Exposure to more than 1 interpersonal trauma is associated with functional impairments, mental health symptoms, and risk behaviors. Despite the importance of studying trauma in this vulnerable population, very few studies have investigated trauma exposure among children and youth in out-of-home care in Asia. This is the first study to examine the effects of multiple interpersonal trauma exposure in a large sample of children in out-of-home care in Singapore. METHOD: A cross-sectional study of 721 children between the ages of 5 and 17 years residing in foster care and voluntary children's homes in Singapore was conducted to determine the proportion of children with interpersonal trauma exposure and the effect of trauma exposure on psychosocial functioning. RESULTS: Results indicated that 63% of the sample experienced at least 1 interpersonal trauma, with neglect (34%) and physical abuse (31%) the most prevalent. Girls were more likely to be emotionally and sexually abused than boys. Children with multiple interpersonal trauma exposure (35% of the sample) were significantly older, more likely to be female, and had a higher number of life functioning, behavioral, and emotional, as well as risk behavior needs compared with children with no previous trauma. CONCLUSION: Findings highlight the importance of conducting comprehensive assessments of children in out-of-home care to provide specialized interventions for children with interpersonal trauma exposure. (PsycINFO Database Record

Factor Structure and Invariance of the Reactive and Proactive Aggression Questionnaire in a Large Sample of Young Adolescents in Singapore.

The present study investigated the factor structure, gender invariance, and convergent validity of the scores associated with the Reactive-Proactive Aggression Questionnaire (RPQ) in a Singapore sample of 1027 school-going adolescents. Results demonstrated that the 2-factor reactive-proactive aggression model had a superior fit compared with the 1-factor general aggression model, providing evidence that while reactive and proactive aggression were correlated, they were nevertheless distinct and separable. Current findings also provided empirical support for the invariance of the 2-factor model of the RPQ across gender. Furthermore, convergent validity was examined; while both reactive and proactive aggression were shown to be positively and significantly related to delinquency and narcissism, it was proactive aggression rather than reactive aggression that showed relatively stronger associations with delinquency and narcissism. Collectively, these findings provided evidence that there are meaningful differences between reactive and proactive aggression, and contributed to the cross-cultural generalizability of the RPQ.

Re-Examining of Moffitt's Theory of Delinquency through Agent Based Modeling.

Moffitt's theory of delinquency suggests that at-risk youths can be divided into two groups, the adolescence- limited group and the life-course-persistent group, predetermined at a young age, and social interactions between these two groups become important during the adolescent years. We built an agent-based model based on the microscopic interactions Moffitt described: (i) a maturity gap that dictates (ii) the cost and reward of antisocial behavior, and (iii) agents imitating the antisocial behaviors of others more successful than themselves, to find indeed the two groups emerging in our simulations. Moreover, through an intervention simulation where we moved selected agents from one social network to another, we also found that the social network plays an important role in shaping the life course outcome.

An analysis of blinding success in a randomised controlled trial of fish oil omega-3 fatty acids.

INTRODUCTION: Incidental reports collected in clinical trials suggest that amongst participants, omega-3 fatty acids derived from fish oil ('omega-3') may be difficult to blind. MATERIALS AND METHODS: We conducted a systematic evaluation of blinding success in a 24-week trial of omega-3 versus an oil-based placebo. Within 1 week of supplement commencement (Week 1), a blinding questionnaire was completed by 131 children enrolled in a trial of omega-3 for the treatment of disruptive behaviour disorders. A version of the questionnaire was also completed by their parents at Week 1, and by the children at the end of supplement administration (Week 24). RESULTS: Participants were unable to differentiate omega-3 from placebo, and accuracy did not improve as a function of: the confidence of guesses, reason for guesses, notice of any change, beliefs about what should change, or time. Child and parent guesses also showed high concordance. CONCLUSION: Taken together, these data provide strong evidence that the identity of omega-3 can be blinded to participants.

The role of delinquency, proactive aggression, psychopathy and behavioral school engagement in reported youth gang membership.

Given the robust positive association between gangs and crime, a better understanding of factors related to reported youth gang membership is critical and especially since youth in gangs are a universal concern. The present study investigated the role of delinquency, proactive aggression, psychopathy and behavioral school engagement in reported youth gang membership using a large sample of 1027 Singapore adolescents. Results from logistic regression showed that delinquency, proactive aggression, and behavioral school engagement were statistically significant risk factors for reported youth gang membership, and that psychopathy was not related to reported gang membership. Implications for prevention and intervention work with respect to youth gang membership were discussed. In particular, strengthening students' engagement with school and meaningful school-related activities and developing supportive teacher-student relationships are particularly important in working with young people with respect to prevention work. Additionally, the present study's theoretical and empirical contributions were also discussed.

The impact of shyness on problematic internet use: the role of loneliness.

In recent years, research indicated that the problematic effects of Internet use must be examined together with individual differences present in its users with which such effects are contingent. This study examined loneliness in adolescents as a mediator of the relationship between shyness and their generalized problematic Internet use (PIU). A total of 1469 adolescents (48.5% male, 51.5% female) from Grade 8 and Grade 9 classes participated in this study. Using the Social Reticence Scale (SRS), the revised UCLA Loneliness scale and the Generalized Problematic Internet Use scale, initial findings indicated significant correlations among the three variables. Results from the study further revealed that loneliness completely mediated the relationship between shyness and generalized problematic Internet use. Implications for intervention work addressing both loneliness and shyness issues facing adolescents who are problematic users of the Internet were discussed.

An outcome evaluation of the implementation of the Outward Bound Singapore five-day "intercept" program.

The present study evaluated an Outward Bound Singapore five-day "intercept" program for 136 adolescent participants, aimed at addressing frequent deliberate truancy and absenteeism from school and within-school extracurricular activities using a quasi-experimental design with a matched no-treatment comparison group. Findings suggested that there is some preliminary evidence that such a program could yield positive outcomes in terms of adolescents being more behaviorally engaged in school as demonstrated by improved attendance of both academic and non-academic activities up to 3 months after the conclusion of the intervention program. Goal setting had a short-term positive effect with intervention participants improving significantly more so than comparison participants at 1-month post intervention but not at 3-month follow up. For problem solving, although the intervention group participants improved more than comparison participants at both 1-month post intervention and at 3-month follow up, these effects were not statistically significant. Research and practice implications were discussed.