Parent and child experience of skin conditions: relevance for the provision of mindfulness-based interventions.

BACKGROUND: Managing a skin condition can be difficult, and there is a lack of psychological support for children and their families. OBJECTIVES: To identify issues surrounding caring for a child with a skin condition, investigate experiences of current psychological support to gain a sense of what is needed, and determine the relevance of offering mindfulness-based interventions for children and families. MATERIALS AND METHODS: This study employed a mixed inductive and deductive form of qualitative inquiry to understand the experiences and needs of children and families. Twenty-three participants (12 parents/carers: 11 females, 1 male; 11 children: 6 females, 5 males, aged 8-11 years) were recruited with an advert posted on social media. In-depth data were collected from semi-structured interviews. Interviews were recorded, transcribed and analysed with a descriptive form of thematic analysis. RESULTS: Systematic analysis of the data led to five themes being developed: (i) caregiver burden of childhood skin conditions; (ii) skin condition overshadowing childhood; (iii) battling for recognition and lack of support; (iv) naturalistic use and understanding of mindfulness in everyday coping: and (v) openness and relevance of offering mindfulness-based interventions. CONCLUSIONS: Living with a skin condition was reported as being associated with mood disturbance, with impacts on schooling, sleep and daily life. Parents and children expressed a desire for short/accessible interventions that could fit with daily routines and might provide the opportunity to connect with other families. The findings indicate that mindfulness-based interventions may be likely to be accepted, as many participants had experience of using mindful techniques in school, and described that they were naturalistically using 'mindfulness' to manage itch and stress. However, the findings indicate that a number of misconceptions exist about the fundamental nature and aims of mindfulness. Addressing misconceptions related to mindfulness needs to be considered when planning both future studies and service delivery.

Living With Physical Health Conditions: A Systematic Review of Mindfulness-Based Interventions for Children, Adolescents, and Their Parents.

OBJECTIVES: This systematic review aimed to identify and appraise studies investigating the efficacy of mindfulness-based interventions (MBIs) for improving depression, anxiety and parental stress in families affected by childhood physical illnesses, as well as feasibility and acceptability. METHODS: Embase, PsycINFO, Scopus, Medline, and PubMed were searched between February 2 and 17, 2021, and updated on August 5, 2022. Studies investigating MBIs with children and adolescents (<18 years) with physical health conditions were included, and results are presented with narrative synthesis. RESULTS: Eighteen studies met eligibility criteria. Studies included children and adolescents with chronic pain, headaches, cancer, heart conditions, esophageal atresia, inflammatory bowel disease, and polycystic ovary syndrome. Most studies reported mindfulness was feasible and acceptable, although findings for different health conditions were mixed. Some studies encountered difficulties with attrition, resulting in findings being underpowered. CONCLUSIONS: MBIs show promise for improving anxiety and depression in children with physical health conditions, but there is limited support for reducing stress in the family unit. A potential direction for future research might be the inclusion of parents. However, because of the heterogeneity of studies included in this review, findings must be cautiously interpreted.

Adoptive parents' finances and employment status: a 5-year longitudinal study.

We investigated risk and facilitating factors related to families' change in finances and employment over 5 years following adoption of a child from local authority care in a prospective, longitudinal study of children placed for adoption between 2014 and 2015 (N = 96). Parents completed questionnaires at approximately 5, 21, 36, 48 and 60 months post-placement. We used time series analysis to examine the impact of child (e.g. pre-placement experiences, mental health), family structure (e.g. number of siblings, parent relationship status), and parent (e.g. mental health) factors on change in household income and parent employment status after adoption. We also examined the tendency for parents to comment on employment and finances and the emotional valence of their comments to gauge their concern about their circumstances. Children's mental health problems were associated with primary caregivers reducing their time spent in employment and parents' tendency to comment on their financial and work circumstances. Children who experienced more moves in care were more likely to have a primary caregiver not in full-time work, as were children with higher prosocial behaviour scores. Being in full-time work was associated with parents' symptoms of anxiety. We also detected associations between structural features of the family and changes in income and employment. This study represents one of the first empirical investigations of factors associated with the socioeconomic features of adoptive families' lives and informs ongoing discussion regarding the support needs of families and the timing, nature, and delivery of post-adoption professional services.

Facial emotion recognition in adopted children.

Children adopted from public care are more likely to experience emotional and behavioural problems. We investigated two aspects of emotion recognition that may be associated with these outcomes, including discrimination accuracy of emotions and response bias, in a mixed-method, multi-informant study of 4-to-8-year old children adopted from local authority care in the UK (N = 42). We compared adopted children's emotion recognition performance to that of a comparison group of children living with their birth families, who were matched by age, sex, and teacher-rated total difficulties on the Strengths and Difficulties Questionnaire (SDQ, N = 42). We also examined relationships between adopted children's emotion recognition skills and their pre-adoptive histories of early adversity (indexed by cumulative adverse childhood experiences), their parent- and teacher-rated emotional and behavioural problems, and their parents' coded warmth during a Five Minute Speech Sample. Adopted children showed significantly worse facial emotion discrimination accuracy of sad and angry faces than non-adopted children. Adopted children's discrimination accuracy of scared and neutral faces was negatively associated with parent-reported behavioural problems, and discrimination accuracy of angry and scared faces was associated with parent- and teacher-reported emotional problems. Contrary to expectations, children who experienced more recorded pre-adoptive early adversity were more accurate in identifying negative emotions. Warm adoptive parenting was associated with fewer behavioural problems, and a lower tendency for children to incorrectly identify faces as angry. Study limitations and implications for intervention strategies to support adopted children's emotion recognition and psychological adjustment are discussed.

Negative parental emotional environment increases the association between childhood behavioral problems and impaired recognition of negative facial expressions.

Impaired facial emotion recognition is a transdiagnostic risk factor for a range of psychiatric disorders. Childhood behavioral difficulties and parental emotional environment have been independently associated with impaired emotion recognition; however, no study has examined the contribution of these factors in conjunction. We measured recognition of negative (sad, fear, anger), neutral, and happy facial expressions in 135 children aged 5-7 years referred by their teachers for behavioral problems. Parental emotional environment was assessed for parental expressed emotion (EE) - characterized by negative comments, reduced positive comments, low warmth, and negativity towards their child - using the 5-minute speech sample. Child behavioral problems were measured using the teacher-informant Strengths and Difficulties Questionnaire (SDQ). Child behavioral problems and parental EE were independently associated with impaired recognition of negative facial expressions specifically. An interactive effect revealed that the combination of both factors was associated with the greatest risk for impaired recognition of negative faces, and in particular sad facial expressions. No relationships emerged for the identification of happy facial expressions. This study furthers our understanding of multidimensional processes associated with the development of facial emotion recognition and supports the importance of early interventions that target this domain.

Charting the trajectories of adopted children's emotional and behavioral problems: The impact of early adversity and postadoptive parental warmth.

Children who are adopted from care are more likely to experience enduring emotional and behavioral problems across development; however, adoptees' trajectories of mental health problems and factors that impact their trajectories are poorly understood. Therefore, we used multilevel growth analyses to chart adoptees' internalizing and externalizing problems across childhood, and examined the associations between preadoptive risk and postadoptive protective factors on their trajectories. This was investigated in a prospective longitudinal study of case file records (N = 374) and questionnaire-based follow-ups (N = 96) at approximately 5, 21, and 36 months postadoptive placement. Preadoptive adversity (indexed by age at placement, days in care, and number of adverse childhood experiences) was associated with higher internalizing and externalizing scores; the decrease in internalizing scores over childhood was accelerated for those exposed to lower levels of preadoptive risk. Warm adoptive parenting was associated with a marked reduction in children's internalizing and externalizing problems over time. Although potentially limited by shared methods variance and lack of variability in parental warmth scores, these findings demonstrate the deleterious impact of preadoptive risk and the positive role of exceptionally warm adoptive parenting on children's trajectories of mental health problems and have relevance for prevention and intervention strategies.

Early adversity predicts adoptees' enduring emotional and behavioral problems in childhood.

Children adopted from the public care system are likely to experience a cluster of inter-related risk factors that may place them on a trajectory of mental health problems that persist across the life course. However, the specific effects of putative risk factors on children's mental health post-placement are not well understood. We conducted a prospective, longitudinal study of children placed for adoption between 2014 and 2015 (N = 96). Adoptive parents completed questionnaires at approximately 5, 21, 36, and 48 months post-placement. We used time series analysis to examine the impact of pre-adoptive risk factors [adverse childhood experiences [ACEs], number of moves, days with birth parents and in care] on children's internalizing and externalizing problems, and prosocial behavior over 4 years post-placement. Adoptees' internalizing and externalizing problems remained consistently high over the 4-year study period, but more ACEs predicted increases in internalizing and externalizing problems. Contrary to expectations, more pre-placement moves and time in care predicted fewer problems over time, but exploratory analyses of interactive effects revealed this was only the case in rare circumstances. We identify pre- and post-removal factors that may incur benefits or have a deleterious impact on adoptees' outcomes in post-adoptive family life. Our findings provide knowledge for front-line professionals in the support of adoptive families and underscore the vital need for effective early intervention.

Maternal depressive symptoms and adolescent academic attainment: Testing pathways via parenting and self-control.

Maternal depression is associated with reduced academic attainment in children, however, it is not clear how this association comes about. Depressive symptoms are associated with impairment in social roles including parenting. Children's self-control is an important contributor to academic attainment and is influenced by parenting. We therefore hypothesised that impaired parenting and children's self-control may mediate links between maternal depression and children's academic attainment. Data were from a brief longitudinal study (3 waves) of UK children aged 11-12 years and their mothers. Higher maternal depressive symptoms at baseline were associated with lower academic attainment in children assessed one year later. There was evidence to support an indirect effect of maternal depressive symptoms on children's academic attainment through the mother-child and the father-child relationship which, in turn, reduced children's self-control. These influences were independent of socio-economic deprivation. A direct effect of maternal depression on children's academic attainment was also observed.

An investigation of changes in children's mental health in Wales between 2007/2008 and 2012/2013.

Improving children's mental wellbeing is a recognised public health priority, but evidence on recent trends is lacking. This study updates evidence on differences in child mental health since 2008 by comparing two nationally representative cohorts in Wales, UK. Parents of 4- to 12-year-old children completed the Strengths and Difficulties Questionnaire (SDQ). No significant differences were seen for younger girls between 2007/2008 and 2012/2013. There was a decrease in conduct, hyperactivity and total difficulties symptom scores and an increase in prosocial scores for boys and older girls. These findings suggest that rates of child mental health problems are stable or falling.

Profiling depression in childhood and adolescence: the role of conduct problems.

BACKGROUND: Depression is typically more common in females and rates rise around puberty. However, studies of children and adolescents suggest that depression accompanied by conduct problems may represent a different subtype not characterised by a female preponderance, with differing risk factors and genetic architecture compared to pure-depression. This study aimed to identify aetiologically distinct profiles of depressive symptoms, distinguished by the presence or absence of co-occurring conduct problems. METHODS: Latent profile analysis was conducted on a school sample of 1648 children (11-12 years) and replicated in a sample of 2006 twins (8-17 years). RESULTS: In both samples pure-depressive and conduct-depressive profiles were identified. The pure-depressive profile was associated with female gender, while the conduct-depressive profile was associated with lower cognitive ability but not with gender. Twin analyses indicated possible differences in genetic aetiology. CONCLUSIONS: There was evidence for aetiologically heterogeneous depression symptom profiles based on the presence or absence of co-occurring conduct problems.

Understanding the unfolding of stress regulation in infants.

Early identification of problems with psychosocial stress regulation is important for supporting mental and physical health. However, we currently lack knowledge about when reliable individual differences in stress-responsive physiology emerge and which aspects of maternal behavior determine the unfolding of infants' stress responses. Knowledge of these processes is further limited by analytic approaches that do not account for multiple levels of within- and between-family effects. In a low-risk sample (n = 100 dyads), we observed infant cortisol and mother/infant behavior during regular play and stress sessions longitudinally from age 1 to 3, and used a three-level model to separately examine variability in infant cortisol trajectories within sessions, across years, and across infants. Stable individual differences in hypothalamus-pituitary-adrenal axis regulation were observed in the first 3 years of life. Infants of less sensitive and more intrusive mothers manifested stress sensitization, that is, elevated cortisol levels during and following stress exposure, a profile related to behavioral distress. These findings have important practical implications, suggesting that children at risk for long-term stress dysregulation may be identified in the earliest years of life.

Higher cognitive ability buffers stress-related depressive symptoms in adolescent girls.

Stress has been shown to have a causal effect on risk for depression. We investigated the role of cognitive ability as a moderator of the effect of stressful life events on depressive symptoms and whether this varied by gender. Data were analyzed in two adolescent data sets: one representative community sample aged 11-12 years (n = 460) and one at increased familial risk of depression aged 9-17 years (n = 335). In both data sets, a three-way interaction was found whereby for girls, but not boys, higher cognitive ability buffered the association between stress and greater depressive symptoms. The interaction was replicated when the outcome was a diagnosis of major depressive disorder. This buffering effect in girls was not attributable to coping efficacy. However, a small proportion of the variance was accounted for by sensitivity to environmental stressors. Results suggest that this moderating effect of cognitive ability in girls is largely attributable to greater available resources for cognitive operations that offer protection against stress-induced reductions in cognitive processing and cognitive control which in turn reduces the likelihood of depressive symptomatology.

A longitudinal study of self-control at the transition to secondary school: Considering the role of pubertal status and parenting.

Higher self-control in children and adolescents is associated with a range of positive outcomes in adulthood. However, little is known about the naturalistic development of self-control during early adolescence and the factors that affect this. We examined the role of puberty and parenting style as theoretically important influences on stability and change in self-control. A longitudinal (3 waves), multiple-informant dataset of children entering early adolescence (M = 11 years) was used to explore longitudinal change in self-control using latent growth curve modelling. Children's self-control declined during the one-year study period and declines were associated with children's behavioural and social functioning. Associations with self-control were found for pubertal status and parental warmth and hostility, but not for parental discipline. The findings suggest that during early adolescence, when children make the transition to secondary school, self-control declines. This is particularly the case for those experiencing puberty earlier than their peers. Parent warmth influences the trajectory of self-control during this period.

Psychopathology among young homeless people: longitudinal mental health outcomes for different subgroups.

BACKGROUND: Homeless young people are recognized as a very vulnerable group in terms of mental health; however, few studies in the UK have examined this. Furthermore, homeless young people represent a heterogeneous group in terms of their mental health and greater characterization could improve intervention work. OBJECTIVES: The aims of this study were to examine prevalence and subtypes of psychopathology among a British sample of young homeless people and to investigate potential associations between identified typologies and a priori specified current and past experiences. In addition, the study intended to explore physical health, mental health, and housing outcomes for the different mental health subgroups. DESIGN: A prospective longitudinal design was used. METHODS: Structured interviews including a mental health assessment were conducted with 90 young homeless people aged 16-23 years. Follow-up interviews were conducted approximately 10 and 20 months later. Cluster analysis at baseline was used to identify groups based on lifetime mental health problems. RESULTS: The current and lifetime incidence of mental health problems was high (88% and 93%, respectively). Three subgroups of homeless young people were identified: (1) minimal mental health issues; (2) mood, substance, and conduct disorder; and (3) post-traumatic stress disorder, mood, and anxiety issues. These groups differed with respect to follow-up indicators of change and stability of mental health status, service use, and suicide risk, but not housing outcome. Other characteristics (gender ratio, past experiences) also distinguished the subgroups. CONCLUSIONS: Typologies of young homeless people based on psychopathology reveal differences in lifetime and future experiences including mental health at follow-up. Identified groups could be used to tailor interventions towards differing needs. PRACTITIONER POINTS: Low mood, anxiety, post-traumatic stress disorder, and psychosis are common mental health issues among young homeless people in the UK. Subgroups of young homeless people with differing needs can be identified, and these groups can be used to predict outcomes. Tailoring support provision towards specific needs has the potential to improve mental health and other outcomes for vulnerable young homeless people. Young homeless people often do not access the support to which they are entitled. Services need to be adapted to improve access for this group.

The Developmental Relationship Between Depressive Symptoms in Adolescence and Harmful Drinking in Emerging Adulthood: The Role of Peers and Parents.

Depressive symptoms have been linked to the development of harmful drinking in adolescence but it remains unclear to what extent this effect continues into emerging adulthood. Deviant peers represent a risk factor while parental monitoring is a protective factor for harmful drinking. The study explored the relationship between depressive symptoms and harmful drinking between early adolescence and emerging adulthood. We also assessed to what extent this relationship is mediated by the influence of deviant peers and whether parental monitoring weakens this process. The sample consisted of 2964 adolescents (64 % females) from the Avon Longitudinal Study of Parents and Children study assessed between the ages of 14 and 19. Using structural equation modelling, we found that affiliation with deviant peers mediated the association between depressive symptoms and harmful drinking after adjustment for socio-demographic variables, parental drinking and depression, teenager's sex, conduct problems as well as drinking and depressive symptoms in early adolescence. We also found that parental control and solicitation reduced the influence of deviant peers on harmful drinking. The results indicate that prevention programs should offer adolescents training for peer resistance training and monitoring skills training for parents may have a long-term effect at weakening peer influences on harmful drinking.

Prospective associations between the family environment, family cohesion, and psychiatric symptoms among adolescent girls.

The present study used a longitudinal design to investigate whether parental values, interests, and the perceived level of expressiveness, cohesiveness and control in the family were associated with changes in psychiatric symptoms during early adolescence. We used data gathered at ages 12, 14 and 17 from 1,600 adolescent girls in the National Heart, Lung and Blood Institute Growth and Health Study. Using a novel approach we found significant informant effects of family cohesion on psychiatric symptoms, with stronger associations for adolescent ratings than parental ratings. Multivariate modelling adjusting for family cohesion (from parents and adolescents perspective), and parents' depressive and eating disorder symptoms indicated parental ratings on the intellectual and cultural orientation of the family predicted small but significant increases in eating disorder symptoms, anxiety and a reduction in self-worth 2-years later. Parental control also predicted a reduction in anxiety and family expressiveness was related to increases in self-worth.

Healthcare professionals' views on psychological support for children and families affected by skin conditions in the UK: A qualitative study.

Background: Skin conditions can have a psychological impact on a child and their caregivers, however, support is not equally distributed between geographical regions in the United Kingdom (UK). Objectives: This study aimed to investigate the experience of National Health Service (NHS) healthcare professionals (HCPs) of addressing the psychological needs of children with skin conditions and their families, and gain expert opinion as to how services need to further develop. Design: HCPs were recruited to a qualitative study with an advert posted on social media. Methods: Fifteen HCPs took part in interviews, including dermatologists (n = 4), dermatology nurse consultants/specialists (n = 4), clinical psychologists (n = 4), liaison psychiatrists (n = 2), and a children's psychological well-being practitioner (n = 1). Results: Thematic analysis revealed children often presented with anxiety, depression, self-harm and suicidal ideation. The impact on caregivers was equally profound. There were differences in service provision across the UK and all HCPs recognised the urgent need for psychological support to be integrated into standard care. Participants described how a range of interventions are typically required including cognitive behavioural therapy (CBT), and systemic approaches, as well as mindfulness/third-wave approaches. Barriers to the delivery of psychological services were associated with a lack of funding and training opportunities for core and specialist staff alike. However, in some instances, participants had overcome these challenges to be able to deliver unique services. Conclusions: There exist several barriers to providing paediatric psychological interventions, and many locations across the UK remain vulnerable as a result of continuing lack of national guidelines for the provision of psychological services.

Low skin conductance activity in infancy predicts aggression in toddlers 2 years later.

Low autonomic nervous system activity is claimed to be a biomarker for aggressive and antisocial behavior. Although there is evidence that low skin conductance activity (SCA) accounts for variation in the severity of antisocial behavior and predicts the onset of aggression in children and adults, it is unknown whether SCA measured in infancy can predict the development of aggression. We measured SCA in 70 typically developing 1-year-old infants at baseline, during an orienting habituation paradigm, and during a fear challenge. We also observed the infants' fear behavior, and each mother rated her infant's temperament and her attachment to her child. At follow-up, mothers rated the children at 3 years old for aggressive and nonaggressive behavior problems. Low infant SCA predicted aggressive behavior, but there was no association between SCA and nonaggressive behavior problems. Mothers' ratings of the infants' temperament and their maternal attachment and the infants' observed fearlessness did not predict later aggression. These results suggest that SCA is a specific biomarker for aggression in low-risk samples of infants.

Psychopathology in young people experiencing homelessness: a systematic review.

Understanding mental health issues faced by young homeless persons is instrumental to the development of successful targeted interventions. No systematic review of recent published literature on psychopathology in this group has been completed. We conducted a systematic review of published research examining the prevalence of psychiatric problems among young homeless people. We examined the temporal relationship between homelessness and psychopathology. We collated 46 articles according to the PRISMA Statement. All studies that used a full psychiatric assessment consistently reported a prevalence of any psychiatric disorder from 48% to 98%. Although there was a lack of longitudinal studies of the temporal relationship between psychiatric disorders and homelessness, findings suggested a reciprocal link. Supporting young people at risk for homelessness could reduce homelessness incidence and improve mental health.

A longitudinal study of psychological functioning and academic attainment at the transition to secondary school.

This longitudinal study of adolescents in the first year of secondary school, examined the relationship between psychological functioning at the beginning of year 7 (mean age 11.25 years) with attainment at the end of year 7 (mean age 11.78 years). Depressive symptoms, school liking and conduct problems predicted lower attainment across time having controlled for the temporal stability in psychological functioning and attainment. School concerns predicted lower attainment for boys only, and the effects of depressive symptoms on later attainment were significantly stronger for boys compared to girls. School liking - and school concerns for boys - remained significant predictors of attainment when controlling for conduct problems. The transition to secondary school may represent a window of opportunity for developing interventions aimed at improving both pupil psychological functioning and attainment.