Associations between executive functions, intelligence and adaptive behaviour in children and adolescents with mild intellectual disability.

Background: The purpose of this study was to explore the role of everyday executive functions in relation to intelligence and adaptive behaviour in children and adolescents with mild intellectual disability. Method: A group of children and adolescents, previously diagnosed with mild intellectual disability were assessed according to intelligence, everyday executive functions and adaptive behaviour. The association between everyday executive functions and intelligence was examined, and it was explored whether intelligence or everyday executive functions would best predict adaptive behaviour. Results: Adaptive behaviour was significantly predicted by executive functions, but not by intelligence. Nor was intelligence significantly related to everyday executive functions in this group. Conclusions: Although fundamental in diagnosing intellectual disability, intelligence cannot predict adaptive behaviour. Assessing everyday executive functions and adaptive behaviour, as well as acknowledging the strong association between them, provides valuable information in the process of optimizing developmental support for children and adolescents with mild intellectual disability.

A randomized controlled trial of individual cognitive therapy, group cognitive behaviour therapy and attentional placebo for adolescent social phobia.

BACKGROUND: Very few studies have investigated the effects of individual disorder-specific treatment of social phobia (SP) in adolescents. The objective of this study was to compare the effects of individual cognitive therapy for SP, group cognitive behavioural therapy (CBTG) and attentional placebo (AP) among adolescents with a primary diagnosis of SP. METHODS: A randomized controlled design was used, and a total of 279 adolescents were assessed. Fifty-seven adolescents, between 13 and 16 years old, were allocated to individual cognitive therapy, CBTG or AP. The participants were assessed before treatment, at the end of treatment and at a 12-month follow-up using both self-report and a semi-structured interview. RESULTS: The individual cognitive therapy showed significant reductions in symptoms, impairment and diagnostic criteria both at the end of treatment and at the 12-month follow-up. Compared with CBTG and AP, the individual cognitive therapy group demonstrated significantly greater effects on both symptom reduction and impairment. There were no significant differences between CBTG and AP. CONCLUSIONS: In a direct comparison between the most commonly used treatments for adolescent SP, we found that individual therapy was the most effective, yielding better effects than both CBTG and AP.

Investigating the psychometric properties of PaRCADS-Parenting to Reduce Child Anxiety and Depression Scale in a Norwegian sample.

OBJECTIVES: Parents play a pivotal role in child development and several parental factors have been identified as risk or protective factors for childhood anxiety and depression. To assess and target these parental factors in interventions, there is a need for a comprehensive, easy-to-use instrument. METHOD: This study aimed to investigate the psychometric properties of an adapted version of the Parenting to Reduce Child Anxiety and Depression Scale, PaRCADS(N) in a Norwegian community sample (N = 163) of parents of children aged 8-12 years. RESULTS: Our findings indicate that PaRCADS(N) has acceptable psychometric properties. These results are comparable to those of the original study of the PaRCADS in Australia. CONCLUSION: Based on these results, we recommend that PaRCADS(N) can be utilized by health care workers as a tool for assessment and identification of parental practices related to child anxiety and/or depression to target relevant risk and protective factors in treatment and prevention.

Behavioral Inhibition and Social Anxiety Disorder as Predictors of Long-Term Outcomes of Cognitive Behavioral Therapy for Youth Anxiety Disorders.

The temperamental trait behavioral inhibition (BI) is related to the development and maintenance of anxiety, particularly much so to social anxiety disorder. We investigated if BI and social anxiety disorder predicted cognitive behavioral therapy (CBT) outcomes for youth anxiety. Youth (N = 179; Mage = 11.6 years) were assessed 4 years following a randomized controlled CBT effectiveness trial. BI was measured by the parent-reported Behavioral Inhibition Questionnaire at baseline. The outcomes were diagnostic recovery, youth- and parent-reported anxiety symptoms, and clinical severity at post-treatment, 1-year, and 4-year follow-up. Having social anxiety disorder negatively predicted diagnostic recovery and predicted higher clinical severity at all assessment points and was the only significant predictor of outcomes at 4-year follow-up. Higher BI negatively predicted diagnostic recovery and predicted higher clinical severity and parent-reported symptom levels at post-treatment and 1-year follow-up, and predicted higher youth-reported anxiety levels at 1-year follow-up. Higher BI was the only predictor of youth- and parent-reported anxiety symptoms. BI and social anxiety disorder seem to be unique predictors of CBT outcomes among youth with anxiety disorders. CBT adaptations may be indicated for youth with high BI and social anxiety disorder.

Optimizing indicated cognitive behavioral therapy to prevent child anxiety and depression: A cluster-randomized factorial trial.

Identifying effective components can lead to interventions that are less resource-intensive and better suited for real-world needs. In this 2×2×2 cluster-randomized factorial trial (clinicaltrials.gov NCT04263558), we investigated the effects of three components of an indicated, transdiagnostic CBT intervention for children: 1) Intervention Delivery Format (child group format versus a blended format with group sessions and automated web-based sessions), 2) Parental Involvement in the intervention (group-based versus psychoeducational brochure), and 3) a Measurement Feedback System (MFS; on versus off). The intervention was delivered at schools in a group-based format. The participants (N = 701 children) were school children (age 8-12 years) with elevated symptoms of anxiety or depression, and their parents. The main outcomes were self-reported (N = 633) and parent-reported (N = 725) symptoms of child anxiety and depression post-intervention. The secondary outcome was children's user satisfaction with the intervention. We did not find significant main or interaction effects of Delivery Format, Parental Involvement, or MFS on children's symptom levels. There were no significant effects on children's user satisfaction. Results were compatible with retaining the least resource intensive combination (i.e., blended format, parental brochure, no MFS) in an optimized intervention.

Anxiety as a risk factor for school absenteeism: what differentiates anxious school attenders from non-attenders?

BACKGROUND: Anxiety is a major risk factor for problematic school absenteeism. However, most anxious students attend school. What differentiates anxious attenders from non-attenders? METHOD: High school students (N = 865) were assigned to groups based on anxiety and absenteeism scores. These groups were then tested for differences in risk factor profiles using discriminant analysis. RESULTS: Anxious school attenders were less affected by negative personality traits, total number of risk factors, social anxiety, panic, and behavioural and family problems. They also displayed greater resilience. CONCLUSIONS: This study indicates that the risk for problematic school absenteeism increases as the number of risk factors aggregate and that treatment for anxious school refusal should be based on a profile of the individual's risk factors.

School children's mental health during the COVID-19 pandemic.

Introduction: The COVID-19 pandemic significantly impacted the daily routines of children, with social distancing and quarantine leading to reduced social interactions and potential increased conflicts within families. These factors can increase the risk for anxiety and depression while reducing overall quality of life. Methods: Our study included 1843 school children aged 8 to 12 from 56 schools over a 2.5-year period before and during the pandemic. This multi-wave cross-sectional study utilized baseline data from an optimization trial of an indicated preventive intervention. The main outcomes were self-reported symptoms of anxiety and depression, and quality of life was the secondary outcome measure. Furthermore, responses to COVID-relevant questions were measured using a self-composed scale. Our objectives were to compare anxiety and depression symptom levels between cohorts of children who participated in the study before and during the pandemic, to examine if anxiety or depression predicted the COVID response, and whether anxiety and depression and subtypes of anxiety had an impact on quality of life during the pandemic. Linear regression and interaction models were used to examine relevant associations. Results: Levels of anxiety and depression were higher in all waves compared to pre-pandemic levels. Quality of life was lower during the pandemic than before the pandemic, particularly among children with generalized anxiety symptoms. Quality of life was negatively associated with loneliness. Discussion: Our study revealed that children reported higher anxious and depressive symptoms during the pandemic compared to pre-pandemic levels, as well as reduced quality of life. Lockdowns and restrictions may have contributed to this burden. Additionally, self-reported loneliness was a significant possible consequence of the restrictive measures imposed on children during the pandemic. Additional research is needed to investigate the long-term effects of the pandemic on children, particularly regarding the stability of elevated levels of anxiety and depression. Such studies could examine whether these conditions are indicative of a trajectory toward more severe internalizing disorders.Clinical trial registration: NCT04263558.

Sex and age-related anxiety in a community sample of Norwegian adolescents.

The first aim of this study was to estimate the prevalence of anxiety and DSM-related anxiety symptom-clusters among adolescents (13-19 years of age) in middle Norway. A second aim was to examine the developmental trajectories of anxiety symptoms for boys and girls during adolescence. In a cross-sectional study, 1,802 students in junior high schools and high schools in the Mid-Norway Health Region filled out a questionnaire (a response-rate of 77%) including the SCARED self-report form (Birmaher et al., 1997) during one school hour. In line with findings of previous studies, girls reported higher anxiety-levels than did boys. A large gender-specific increase in anxiety in 14-15-year-old girls was also found. Apart from this age-specific effect, the results indicated a general reduction in anxiety during adolescence for all symptom groups except generalized anxiety and school phobia. The high anxiety levels in girls aged 13 to 14 years implicate a need for caution by clinicians because such high anxiety levels may be mistaken for the existence of an anxiety disorder. The rapid increase in anxiety symptoms among girls in early adolescence may reflect a heightened sensitivity in this age group, and may have implications for when to implement secondary prevention programs.

Adolescent school absenteeism: modelling social and individual risk factors.

BACKGROUND: School absenteeism is a complex problem that includes risk factors associated with individual traits, socio-economic conditions, family structure, the school and society. The consequences of extensive school absenteeism can be detrimental for the youth. METHOD: In this exploratory study we aimed to investigate the relative importance of different risk factors on school absenteeism. We assessed 865 Norwegian high school students testing a model of school absenteeism using Exploratory Structural Equation Modelling (ESEM). RESULTS: Analysis show that on the individual level most of the measured risk factors were significantly associated with absenteeism. School absenteeism was predicted by externalising behaviour, family work and health, and school environment directly. CONCLUSION: The implications of the findings on school absenteeism are that it will be important to focus more on the context and co-occurrence of these problems in order to fully understand them.

Making high-quality measures available in diverse contexts-The psychometric properties of the Revised Child Anxiety and Depression Scale in a Norwegian sample.

OBJECTIVES: Recent initiatives have recommended the Revised Child Anxiety and Depression Scale (RCADS) for use in research and as patient-reported outcome in health care globally. We aimed to investigate, for the first time, whether the psychometric properties of the anxiety and depression youth self-report measures, RCADS-47 and RCADS-25, generalize to a Norwegian setting. METHODS: We examined gender and age differences in symptomatology among 592 children (mean age 10.7 years), and conducted a psychometric investigation of the internal reliability, structural validity, measurement invariance and convergent validity of the RCADS-47 and RCADS-25 youth versions. RESULTS: Girls reported higher levels of anxious and depressive symptoms than boys, but no age differences were observed. Reliability coefficients for the RCADS-47 and RCADS-25 scales indicated good internal consistency. Structural validity for RCADS-47 and RCADS-25 was supported by confirmatory factor analyses results. For both measures, strong gender-based measurement invariance was present. Convergent validity of the RCADS-47 and RCADS-25 with other well-established self-report measures for anxiety (Multidimensional Anxiety Scale for Children) and depression (The Short Mood and Feelings Questionnaire) was supported. CONCLUSION: The RCADS-47 and RCADS-25 youth versions are valid and reliable instruments for measuring symptoms of anxiety and depression in a Norwegian setting. The results add to the evidence supporting RCADS's cross-cultural validity.

Divergent decennial trends in mental health according to age reveal poorer mental health for young people: repeated cross-sectional population-based surveys from the HUNT Study, Norway.

OBJECTIVES: Public health trends are formed by political, economic, historical and cultural factors in society. The aim of this paper was to describe overall changes in mental health among adolescents and adults in a Norwegian population over the three last decades and discuss some potential explanations for these changes. DESIGN: Repeated population-based health surveys to monitor decennial changes. SETTING: Data from three cross-sectional surveys in 1995-1997, 2006-2008 and 2017-2019 in the population-based HUNT Study in Norway were used. PARTICIPANTS: The general population in a Norwegian county covering participants aged 13-79 years, ranging from 48 000 to 62 000 000 in each survey. MAIN OUTCOME MEASURES: Prevalence estimates of subjective anxiety and depression symptoms stratified by age and gender were assessed using the Hopkins Symptom Checklist-5 for adolescents and the Hospital Anxiety and Depression Scale for adults. RESULTS: Adolescents' and young adults' mental distress increased sharply, especially between 2006-2008 and 2017-2019. However, depressive symptoms instead declined among adults aged 60 and over and anxiety symptoms remained largely unchanged in these groups. CONCLUSIONS: Our trend data from the HUNT Study in Norway indicate poorer mental health among adolescents and young adults that we suggest are related to relevant changes in young people's living conditions and behaviour, including the increased influence of screen-based media.

Inside the Clockwork of the ECHO Factorial Trial: A Conceptual Model With Proposed Mediators for Prevention of Emotional Problems in Children.

Having interventions that are not only evidence-based and effective but also cost-effective and efficient is important for the prevention and treatment of child and adolescent emotional problems. A randomized clinical trial (RCT) tests the total interventions effect but does not address specific components of the intervention. In this article the hypothesis and a conceptual model of the ECHO study are presented and discussed. The ECHO intervention consists of three different components each containing two levels of intervention. By using a cluster randomized factorial design, children aged 8-12 at 40 schools across Norway will be randomized to eight different experimental conditions investigating the optimal balance between effect, cost-effectiveness, and efficiency. The article presents the design and the different components being tested and discusses how optimalization can be reached through this innovative design. The article also discusses how interventions can be improved by investigating and understanding the mechanisms of change within psychological interventions. For each of the three components in the study we consider the mediators that could be active within the intervention and how the study investigates such mediation. The results will contribute to a better understanding of how psychological interventions work and how we intend to optimize the EMOTION intervention.

Study protocol of a factorial trial ECHO: optimizing a group-based school intervention for children with emotional problems.

BACKGROUND: Youth mental health problems are a major public health concern. Anxiety and depression are among the most common psychological difficulties. The aim of this study is to evaluate an optimized version of a promising indicated group intervention for emotional problems. The program (EMOTION Coping Kids Managing Anxiety and Depression) targets school children 8-12 years with anxious and depressive symptoms and examines three factors. Factor 1 compares the standard EMOTION intervention delivered in 16 group-based sessions (Group), versus a partially-digital EMOTION intervention (DIGGI) delivered as eight group sessions and eight digital sessions. Both versions use virtual reality technology (VR) to improve behavioral experiments. Factor 2 compares parent participation in a 5-session parent group (high involvement) versus sharing information with parents via a brochure (low involvement). Factor 3 compares the use of a measurement and feedback system (MFS) designed to help group leaders tailor the intervention using feedback from children with no MFS. METHODS: Using a cluster-randomized factorial design, 40 schools across Norway will be randomized to eight different experimental conditions based on three, two-level factors. To assess internalizing symptoms in children, children and their parents will be given self-report questionnaires pre-, post-, and one year after intervention. Parents also report on demographics, user satisfaction, personal symptoms and perception of family related factors. Teachers report on child symptoms and school functioning. Group leaders and the head of the municipal services report on implementation issues. The primary outcomes are changes in depressive and anxious symptoms. Some secondary outcomes are changes in self-esteem, quality of life, and user satisfaction. Questions regarding the consequences of the COVID-19 pandemic are included. Treatment fidelity is based on checklists from group leaders, and on user data from the participating children. DISCUSSION: This study is a collaboration between three regional centers for child and adolescent mental health in Norway. It will provide knowledge about: (1) the effect of school-based preventive interventions on anxiety and depression in children; (2) the effect of feedback informed health systems, (3) the effect and cost of digital health interventions for children, and (4) the effect of parental involvement.

Does maternal psychopathology discriminate between children with DSM-IV generalised anxiety disorder or oppositional defiant disorder? The predictive validity of maternal axis I and axis II psychopathology.

What dimensions of maternal psychopathology predict internalising or externalising disorder in children? We conducted a study of maternal axis I and axis II psychopathology in a group of children 8-12 years of age with Generalised Anxiety Disorder (GAD), Oppositional Defiant Disorder (ODD) and non-patient controls (NC). By using Multigroup Discriminant Analyses (MDA) on three groups of children (N = 85) and measures of axis I and axis II psychopathology of their mothers, we attempted to discriminate between these groups on a data driven basis. Two separate MDA were computed, one based on maternal axis I disorders, and one based on maternal axis II disorders. The results demonstrated that maternal symptomatic and personality psychopathology was differentially related to childhood anxiety or behavioural disorders. Mothers of children with ODD were characterised by more negative emotions and detached personality styles, whereas mothers of children with GAD seemed to be more somatic preoccupied, controlling and over-protective.