Parental unemployment and educational outcomes in late adolescence: the importance of family cohesion, parental education, and family income in a Norwegian study.

AIMS: The study aimed to investigate the association between parental unemployment and grade point average and school completion in adolescence, and the importance of family cohesion, parental education, and family income in explaining these associations. METHODS: Data stem from the Norwegian cross-sectional 2012 youth@hordaland-survey including 8437 adolescents (53.4% girls). Information on grade point average, school completion, parental education, and family income were retrieved from the National Education Database. Parental work status and family cohesion were assessed by adolescent self-report. RESULTS: Adolescents with at least one unemployed parent had lower grade point averages (3.49 compared with 3.92, P<0.001) and rates of school completion (71.9% compared with 86.6%, P<0.001) compared with adolescents with two working parents. The associations between parental unemployment and both grade point average (b = -0.22, 95% confidence interval -0.32, -0.12) and school completion (odds ratio 0.59, 95% confidence interval 0.46, 0.76) partly attenuated but remained significant when taking family cohesion, parental education, and family income into account. There was a significant interaction between parental unemployment and family cohesion on grade point average, in which the positive association between family cohesion and grade point average was weaker for adolescents with unemployed parents. CONCLUSIONS: Adolescents with parents outside of the workforce are at higher risk of poorer educational outcomes than peers with working parents. Combined with the positive associations between parental education, family cohesion, family income, and educational outcomes, this underscores the importance of parents for adolescent educational outcomes, and suggests that parents and the family situation should be considered when providing academic support for adolescents who struggle in upper secondary school.

Diabetes Care and Mental Health During the COVID-19 Pandemic: Perspectives of Adolescents with Diabetes, Parents, and Providers.

This study explored ways in which the COVID-19 pandemic impacted adolescents' diabetes management and psychosocial functioning, and how adolescents, parents, and providers viewed telemedicine. We present data from three studies: (1) a comparison of psychosocial functioning and glycemic levels before and after pandemic onset (n = 120 adolescents; 89% with type 1 diabetes), (2) an online survey of parents about pandemic-related stressors (n = 141), and (3) qualitative interviews with adolescents, parents, and medical providers about the pandemic's impacts on adolescents' diabetes care and mental health (n = 13 parent-adolescent dyads; 7 medical providers). Results suggested some adverse effects, including disrupting routines related to health behaviors and psychosocial functioning and impairing adolescents' quality of life. Despite these challenges, most participants did not endorse significant impacts. Some even noted benefits, such as increased parental supervision of diabetes management that can be leveraged beyond the pandemic. Furthermore, telemedicine offers benefits to continuity of diabetes care but presents challenges to care quality. These findings underscore the varied and unique impacts of the COVID-19 pandemic on adolescents with diabetes.

Patient and Provider Views on Psychosocial Screening in a Comprehensive Diabetes Center.

Guidelines recommend routinely screening adults with diabetes for psychological concerns, but few diabetes clinics have adopted screening procedures. This study assessed patient and provider perspectives regarding the role of mental health in diabetes care, psychosocial screening procedures, and patients' support needs. Patients with diabetes (n = 15; 73.3% type 2) and their medical providers (n = 11) participated in qualitative interviews. Thematic content analysis was used to categorize results. Participants believed that mental health was important to address within comprehensive diabetes care. Patients expressed positive or neutral opinions about psychosocial screening. Providers had mixed reactions; many thought that screening would be too time-consuming. Both groups emphasized that screening must include referral procedures to direct patients to mental health services. Patients and providers interviewed in this study viewed psychosocial screening as compatible with diabetes care. Including a mental health professional on the treatment team could reduce potential burden on other team members.

Psychosocial screening in a pediatric diabetes clinic: Adolescents' and mothers' perspectives.

OBJECTIVE: Adolescents with type 1 diabetes (T1D) frequently experience psychosocial concerns, and mental health screening is becoming increasingly common in routine diabetes care. However, little is known about what adolescents or their caregivers think about the role of mental health screening and intervention within the context of comprehensive diabetes care, or how their diabetes care providers should be involved in navigating mental health concerns. This study used qualitative methods to obtain the perspectives of adolescents with T1D and their caregivers regarding these issues. METHODS: Participants were 13 adolescents with T1D (ages 12-19 years; M = 15.1 years; 53.8% female; 61.5% Hispanic/Latinx White) and 13 mothers, recruited from an outpatient pediatric endocrinology clinic in South Florida, who participated in semi-structured interviews via video teleconference. Thematic content analysis was used to evaluate participants' responses. RESULTS: Adolescents and their mothers reported positive experiences with the clinic's psychosocial screening procedures and appreciated meeting with the psychology team during visits. They wanted the clinic to offer more opportunities for peer support. Mothers highlighted barriers to seeking mental health care outside of the clinic and the importance of mental health professionals understanding diabetes. Mothers also wanted the clinic to offer more on-site therapeutic services. DISCUSSION: Study participants valued psychosocial screening and supported addressing mental health as a routine part of diabetes comprehensive care.

Treating Children and Adolescents with Posttraumatic Stress Disorder: Moderators of Treatment Response.

Youth exposed to a wide range of potentially traumatic events, such as natural disasters, acts of violence, terrorism, motor vehicle accidents, and life-threatening illnesses, are at risk for developing posttraumatic stress disorder (PTSD) or significant posttraumatic stress symptoms (PTSS). Recent reviews of the existing evidence-base for the treatment of PTSD in children and adolescents identified trauma-focused cognitive behavioral therapy (TF-CBT) and cognitive behavioral therapy (CBT) as well-established treatments. However, studies that evaluated treatment moderators have been scant. Research on treatment moderators is important for guiding clinical decision-making around selecting treatments that might be most effective given the characteristics and circumstances of a particular child or adolescent. Thus, this article provides an updated review of potential moderators evaluated in recent (i.e., past 5 years) meta-analyses and systematic reviews of psychological treatments for PTSD in youth. The moderators examined were in the areas of youth characteristics (age, gender, ethnicity, domicile), parent/caregiver factors (involvement, functioning), trauma type, and treatment factors (dose, individual/group, provider, exposure elements, sudden gains). Some support was identified for age, gender, domicile, parent/caregiver involvement, maternal depressive symptoms, treatment dose, individual/group, and sudden gains as possible treatment moderators, although the strength of the evidence varied and more research is needed to clarify findings. Further study of moderators will be essential to advance the knowledge base in the treatment of PTSD in youth.

The role of empathy and social anxiety in Latinx adolescents' indirect peer aggression during the transition to high school.

The primary purpose of this study was to evaluate the relationship between decreased empathy (i.e., cognitive and affective) and indirect and cyber peer aggression among Latinx adolescents during their transition to high school. Further, we examined the degree to which social anxiety moderated this relationship. Participants were 469 Latinx ninth graders, ages 13-17 years (M = 14.52, SD = 0.58; 58% girls). Adolescents completed the Revised Peer Experiences Questionnaire, Cyber Peer Experiences Questionnaire, Basic Empathy Scale, and Social Anxiety Scale for Adolescents at two different time points, 3 months apart. Hierarchical linear regression analyses revealed concurrent and prospective relationships between lower cognitive empathy and the perpetration of both indirect and cyber aggression. In addition, social anxiety moderated the concurrent associations between both types of empathy and both types of aggression perpetration. Results suggest that interventions that facilitate cognitive empathy and decrease social anxiety may help to reduce adolescents' indirect and cyber aggression toward peers throughout the high school transition.

Stressors, Repetitive Negative Thinking, and Insomnia Symptoms in Adolescents Beginning High School.

OBJECTIVE: Although the first year of high school may represent a particularly stressful time for adolescents, no research addresses how stressors are related to insomnia symptoms during this time. Thus, we examined how stress relates to concurrent and prospective insomnia symptoms in adolescents beginning high school (Aim 1). Additionally, we assessed repetitive negative thinking (RNT) as a mediator (Aim 2). We also evaluated whether the pattern of associations differed for boys and girls (Aim 3). METHODS: Adolescents (N = 502; M age = 14.22 years; 58.2% girls; 91.2% Hispanic/Latinx) completed questionnaires about stressors related to beginning high school (e.g., school performance, peer pressure), family support, RNT, and insomnia symptoms at the beginning and end of their first year of high school. Multiple group structural equation models assessed relationships between these variables and evaluated differences between boys and girls. RESULTS: School/leisure conflict and low family support were directly associated with insomnia symptoms at both times, and RNT mediated these relationships in both boys and girls. In girls, peer pressure and low family support were indirectly associated with Time 1 and Time 2 insomnia symptoms via RNT. In boys, school performance was indirectly associated with Time 1 and Time 2 insomnia symptoms via RNT. CONCLUSIONS: Stressful experiences at the beginning of high school negatively affect sleep in adolescents both in the short and long term. Pediatric psychologists should educate adolescents and their parents about the risk of sleep problems during this time period and provide strategies for stress management and for proper sleep hygiene.

Sleep Problems and Posttraumatic Stress: Children Exposed to a Natural Disaster.

OBJECTIVE: Sleep plays a critical role in children's growth and development. This study examined the frequency and persistence of children's sleep problems following a natural disaster, risk factors for children's sleep problems, and the bidirectional relationship between children's sleep problems and posttraumatic stress symptoms (PTSS) over time. METHODS: This study assessed 269 children (53% female, M = 8.70 years, SD = 0.95) exposed to Hurricane Ike at 8 months (Time 1) and 15 months (Time 2) post-disaster. Children completed measures of hurricane exposure and related stressors, stressful life events, sleep problems, and PTSS. RESULTS: Children's sleep problems were significantly correlated from Time 1 to Time 2 (r = .28, p < .001). Risk factors for sleep problems at Time 2 were younger age, sleep problems at Time 1, and PTSS, not including sleep items, at Time 1. Examinations of the bidirectional relationship between sleep problems and PTSS indicated that PTSS significantly predicted later sleep problems, but sleep problems did not significantly predict later PTSS. CONCLUSIONS: Findings demonstrate that PTSS may contribute to the development and course of children's sleep problems post-disaster.

Historical Analysis: Editors' Reflections on 50 Years of the Journal of Pediatric Psychology.

OBJECTIVE: This article provides an historical perspective on the Journal of Pediatric Psychology (JPP) on the occasion of its 50th anniversary. METHODS: Former and current editors of JPP participated in a symposium at the 2019 Society of Pediatric Psychology Annual Conference (SPPAC), each highlighting prominent types of articles published during their terms, the influence of these papers over time, and their reflections on the next 50 years of the journal. Their presentations were summarized and integrated for this article. Additional data on editorial teams, special issues, and publication metrics over time are included. RESULTS: The data demonstrate changes over time in the growth, scope, and impact of JPP. The article also shows the consistency in areas of emphasis over time. Anticipated topics for the future were quite consistent across editors and included increased use of technology, broader attention to teams and approaches, and methodological advances as the field will continue to grow. CONCLUSIONS: This article provides an unusual collaboration among editors of JPP, providing an historical perspective on the journal's growth over time and anticipation of continued impact into the future.

Cyber victimization, cyber aggression, and adolescent alcohol use: Short-term prospective and reciprocal associations.

INTRODUCTION: Cyber victimization is a significant public health concern. We examined prospective and reciprocal associations between cyber victimization, cyber aggression, and adolescents' drinking and binge drinking. Gender, Hispanic ethnicity, and age were examined as moderators. METHODS: Adolescents (N = 1140; 58% girls; 13-19 years; 80% Hispanic) from two US high schools completed the Cyber Peer Experiences Questionnaire and alcohol use items from the Youth Risk Behavior Survey at two time points, three months apart. Perceived social support was assessed at Time 1 and controlled for. Cross-lagged panel analyses using structural equation modeling were conducted, using zero-inflated negative binomial regressions for alcohol use outcomes. RESULTS: Adolescents who experienced more cyber victimization were more likely to abstain from drinking over time; however, they reported more frequent drinking if they were a drinker, a relationship that was stronger for older adolescents. Cyber victimization was unrelated to binge drinking, and alcohol use was unrelated to cyber victimization over time. Adolescents who engaged in more cyber aggression were more likely to use alcohol over time; conversely, adolescents who used alcohol more frequently engaged in more cyber aggression over time. Gender and ethnicity did not moderate these associations. CONCLUSIONS: A complex relationship between cyber victimization and alcohol use emerged; findings support the self-medication hypothesis among drinkers only and especially older adolescents. Reciprocal associations between cyber aggression and alcohol use fit with problem behavior theory Adolescent alcohol use prevention programs might play an important role in addressing cyber aggression. Drinking behaviors may be important to target in anti-cyberbullying interventions.

Social Anxiety Scale for Adolescents and School Anxiety Inventory: Psychometric properties in French adolescents.

School and social anxiety are common problems and have a significant impact on youths' development. Nevertheless, the questionnaires to assess these anxious symptoms in French adolescents have limitations. The aim of this study is to provide a French version of the Social Anxiety Scale for Adolescents (SAS-A) and the School Anxiety Inventory (SAI), analysing their psychometric properties by the factor structure, internal consistency, and convergent validity. The SAS-A and the SAI were collectively administered in a sample of 1011 French adolescents (48.5% boys) ranging in age from 11 to 18 years. Confirmatory factor analyses replicated the previously identified correlated three-factor structure of the SAS-A and the correlated four-factor structure of the SAI. Acceptable internal consistency indexes were found for SAS-A and SAI scores. Correlations supported the convergent validity of the questionnaires' subscales. Overall, results supported the internal consistency and validity of the French versions of the SAS-A and SAI.

Lessons Learned About Barriers to Implementing School-Based Interventions for Adolescents: Ideas for Enhancing Future Research and Clinical Projects.

The majority of youth with mental health problems do not receive treatment, highlighting the critical need to transport evidence-based interventions into community settings, such as schools. Despite being able to reach a large number of adolescents and minority youth, the process of implementing evidence-based interventions to schools is challenging. This paper discusses some expected and unexpected challenges experienced during the implementation of an open trial and a pilot randomized controlled trial examining the acceptability and effectiveness of a school-based preventive intervention for adolescents at risk for internalizing disorders. First, we highlight key programs and findings on preventive interventions for adolescents at risk for depression and anxiety. Next, we provide a brief overview of the preventive intervention we implemented in schools. This provides a context for the section that describes implementation issues and highlights specific challenges and potential solutions for intervention implementation. Finally, the paper offers recommendations for researchers and clinicians interested in implementing school-based mental health services for adolescents.

Posttraumatic Stress Symptom Trajectories Among Children After Disaster Exposure: A Review.

Natural disasters, such as hurricanes and floods, are increasing in frequency and scope. Youth exposed to disasters are at risk for developing posttraumatic stress symptoms (PTSS). However, not all youth who report initially elevated PTSS report persistent PTSS that last beyond the first three to six months postdisaster. Thus, it is crucial to understand how and why youth differ in their patterns of PTSS. This study reviewed the literature on children's postdisaster PTSS, evaluating the typical number and types of patterns for children's PTSS trajectories, as well as risk and protective factors predicting trajectory membership. This review identified eight empirical studies on youth PTSS trajectories following natural disasters; these studies included 8,306 children aged 3 to 18 years. All studies identified resilience, recovery, and chronic trajectories. Evidence for a delayed trajectory was mixed. Proportions of children falling into each trajectory varied widely across studies, but overall, resilience was the most prevalent trajectory. These findings were consistent across study factors (i.e., analytic strategy, assessment timing, and study selection criteria). Female gender, disaster exposure, negative coping, and lack of social support were significant risk factors for chronic trajectories across several studies. Future research should combine individual level participant data across studies of children's responses to disasters to better understand PTSS trajectories.

DSM-IV, DSM-5, and ICD-11: Identifying children with posttraumatic stress disorder after disasters.

BACKGROUND: Different criteria for diagnosing posttraumatic stress disorder (PTSD) have been recommended by the 5th edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) and the proposed 11th edition of the International Classification of Diseases (ICD-11). Although children are vulnerable to PTSD following disasters, little is known about whether these revised criteria are appropriate for preadolescents, as diagnostic revisions have been based primarily on adult research. This study investigated rates of PTSD using DSM-IV, DSM-5, and ICD-11 diagnostic criteria, and their associations with symptom severity, impairment, and PTSD risk factors. METHODS: Children (7-11 years) exposed to Hurricanes Ike (n = 327) or Charley (n = 383) completed measures 8-9 months postdisaster. Using diagnostic algorithms for DSM-IV, DSM-5, and ICD-11, rates of 'probable' PTSD were calculated. RESULTS: Across samples, rates of PTSD were similar. However, there was low agreement across the diagnostic systems, with about a third overlap in identified cases. Children identified only by ICD-11 had higher 'core' symptom severity but lower impairment than children identified only by DSM-IV or DSM-5. ICD-11 was associated with more established risk factors for PTSD than was DSM-5. CONCLUSIONS: Findings revealed differences in PTSD diagnosis across major diagnostic systems for preadolescent children, with no clear advantage to any one system. Further research on developmentally sensitive PTSD criteria for preadolescent children is needed.

Adolescent Peer Victimization and Physical Health Problems.

OBJECTIVE: Peer victimization (PV) is a key interpersonal stressor that can be traumatizing for youth. This study evaluated the relationships between overt, relational, reputational, and cyber PV and adolescents' somatic complaints and sleep problems. Symptoms of depression and social anxiety were examined as potential mediators. METHOD: Adolescents (N = 1,162; M age = 15.80 years; 57% female; 80% Hispanic) were assessed at three time points, 6 weeks apart, using standardized measures of PV, depression, social anxiety, sleep problems, and somatic complaints. Structural equation modeling evaluated key study aims. RESULTS: Relational, reputational, and cyber PV, but not overt PV, were directly or indirectly associated with subsequent somatic complaints and/or sleep problems. Depression and social anxiety mediated relationships between relational PV and health outcomes, whereas reputational PV was indirectly associated with somatic complaints via depression only. DISCUSSION: The stress of PV may contribute to adolescents' sleep problems and somatic complaints and has implications for pediatric psychologists.

Trauma and Child Health: An Introduction to the Special Issue.

Potentially traumatic events are common occurrences that can lead to significant psychological distress, and yet, there has been remarkably little attention to the associations between traumatic events and youth's physical health. The articles contained in this Special Issue of the Journal of Pediatric Psychology represent a significant step forward in the establishment of "Trauma and Child Health" as a major area of study within the field of pediatric psychology. In this introductory article, we briefly describe several contextual issues that may help to set the stage for the articles contained in this Special Issue. These contextual issues include the most common types of traumatic events that are studied, as well as the features of traumatic events that may affect physical and mental health outcomes, such as whether casualties or interpersonal violence is involved.

Social Phobia and Educational and Interpersonal Impairments in Adolescence: A Prospective Study.

We examined longitudinal associations between social phobia (SP) and educational and interpersonal impairments among Finnish adolescents. Participants were 3278 adolescents (9th grade; M age = 15.5 years) who completed measures of SP and depressive symptoms; 2070 participated in follow-up two years later. Indicators for educational and interpersonal functioning were assessed for each sex separately. Multivariate analyses, controlling for depression and relevant socioeconomic covariates, indicated that for boys, age 15 SP predicted slow academic progression, being without a close friend or not having a romantic relationship, and poor support from friends and significant others at age 17. However, for girls, age 15 SP only predicted not having been involved in a romantic relationship by age 17. In conclusion, we found striking sex differences for adolescent SP as a predictor for subsequent educational and interpersonal impairments in late adolescence. SP may have a more devastating effect on boys' social and academic functioning relative to that of girls.

Psychological distress in young adults exposed to war-related trauma in childhood.

We tested a conceptual model of the effect of war-trauma exposure in childhood on psychological distress in young adulthood. Participants included 151 urban Kuwaiti children (51% female; M age = 10.62 years) exposed to the 1990-1991 Gulf crisis (assessed in 1993); participants also included 140 parents (81% female; M age mothers = 36.50 years; M age fathers = 41 years). In 2003, 120 participants were reassessed as young adults (50% female; M age = 21.19 years). The conceptual model was evaluated with structural equations. War-trauma exposure was associated with psychological distress in children and parents, but parents reported larger effects than children. Parents' psychological distress did not contribute to children's psychological distress. Children's psychological distress did not dissipate over time. Social support may function as a potential mediator of the effect of war-trauma exposure on psychological distress. Findings support the importance of early detection and treatment of children exposed to war trauma. Findings also implicate social support as a factor to consider in clinical interventions for children exposed to war trauma.

Cyber victimization by peers: Prospective associations with adolescent social anxiety and depressive symptoms.

Peer victimization that occurs via electronic media, also termed cybervictimization, is a growing area of concern for adolescents. The current study evaluated the short-term prospective relationship between cybervictimization and adolescents' symptoms of social anxiety and depression over a six-week period. Participants were 839 high-school aged adolescents (14-18 years; 58% female; 73% Hispanic White), who completed measures of traditional peer victimization, cybervictimization, depression, and social anxiety at two time points. Findings supported the distinctiveness of cybervictimization as a unique form of peer victimization. Furthermore, only cybervictimization was associated with increased levels of depressive symptoms over time, and only relational victimization was associated with increased social anxiety over time, after controlling for the comorbidity of social anxiety and depression among youth. Cybervictimization appears to be a unique form of victimization that contributes to adolescents' depressive symptoms and may be important to target in clinical and preventive interventions for adolescent depression.

Perceived life threat in children during the COVID-19 pandemic: associations with posttraumatic stress, anxiety, and depressive symptoms.

Defining children's "trauma exposure" in the context of the COVID-19 pandemic has been a source of debate. Children were exposed to threatening messaging about COVID-19 but might interpret this information differently than adults. Perceived life threat (PLT), the belief that one's life is in danger, has been identified as a robust predictor of posttraumatic stress symptoms (PTSS), and may be a better predictor of PTSS than actual life threat (ALT). This study investigated parent reports of children's self-PLT (belief that they might die from COVID-19) and family-PLT (belief that a family member might die from COVID-19). The aims were to compare PLT to ALT, evaluate their associations with children's psychological functioning, and identify risk factors associated with PLT. We hypothesized an association between PLT and children's psychological functioning in the context of the COVID-19 pandemic. Parents (N = 140) reported on their child's (M age = 9.81 years, 47% female) pandemic experiences, psychological functioning, and both self-PLT and family-PLT. Results revealed self-PLT for 10% of the children and family-PLT for 43% of the children, yet only 6% experienced ALT (i.e., they or their parent tested positive for COVID-19). Children with reported self- or family-PLT had higher PTSS, depressive symptoms, anxiety symptoms, and functional impairment compared to children without these reported beliefs. PLT, but not ALT, was associated with psychological outcomes. Children with only PLT had greater PTSS and impairment than children with ALT. There were differences in parental functioning and pandemic-related information/media exposure between children with and without PLT. Children's perceptions, rather than objective experiences, may be more central to their psychological functioning. This has implications for screening for pandemic-related symptomatology in children as traditional trauma exposure measures may not adequately identify distressed children.