Daily Activities in European Children and Adolescents During COVID-19 School Closure: A Longitudinal Study Exploring Physical Activity, Use of Screens, and Sleep Patterns.

This longitudinal study aimed to analyze the evolution of patterns of daily activities (physical activity time, screen usage time, and sleep hours) in European youth during school closure due to the COVID-19 health crisis. Participants were 624 caregivers of children and adolescents aged 3-18 from Italy, Spain, and Portugal. Evaluations were online, and four time-points were considered: retrospective measurement of daily activities before confinement (T1), and two (T2), five (T3), and eight (T4) weeks after starting the lockdown. Generally accepted international guidelines on physical activity time, screen usage time, and hours of sleep by age group were used to determine whether the pattern might increase the risk for ill health or not. To estimate the evolution of daily activities, generalized estimating equations (GEE) were used. The percentage of children who practiced less than 60 min of daily exercise increased significantly from before home confinement (47.8%) to T2 (86.4%); it slightly decreased at T3 (79.8%), and remained stable at T4 (76.1%). The percentage of children who made excessive use of screens (according to their age group) significantly increased from T1 to T2 and remained stable and high in the rest of the evaluations. The percentage of children who slept fewer or more hours than recommended for their age group remained stable between T1 and T4, although there was a significant increase at T3. In general, results found unhealthier behaviors as confinement was extended. Results are discussed in order to find strategies for promoting healthy daily activities for future pandemics.

Stressful Life Events in Children Aged 3 to 15 Years During the COVID-19 Pandemic: A Latent Class Analysis.

BACKGROUND: Although several studies have reported an increase in psychological problems during the COVID-19 pandemic, the impact of stressful life events on Spanish children and adolescents using a person-oriented statistical approach and the relationships between the profiles and emotional and behavioral symptoms have not yet been examined. The present study aims to identify profiles of Spanish children and adolescents, considering life-threatening stressful events during the COVID-19 pandemic. METHOD: Participants were 252 parents of children aged 3 to 15 years old who completed an online structured questionnaire that collected information about stressful life events related to the pandemic and its impact on their children's welfare. RESULTS: Through Latent Class Analysis (LCA), four profiles of children and adolescents were found according to the stressful events experienced: "COVID infection, social confinement", "economic loss", "reduced social contact" and "parental stress", with no significant age or gender differences. Reduction in social contact was the most prevalent stressor. Comparisons of psychological symptoms across latent classes were analyzed. CONCLUSIONS: The findings increase our understanding of how stressful life events during the COVID-19 situation impacted young people's psychological welfare and highlight the need to promote strategies to prevent emotional problems during a pandemic considering the identified profiles.

Examining academic self-concept as a mediator of the relationship between anxiety and depression: A longitudinal study.

BACKGROUND: Self-concept plays a role as a mediator in the development and maintenance of internalizing symptoms but mechanisms through which the early presence of anxiety symptoms is associated with the subsequent development of depression is unknown. The aim of this longitudinal study was to analyze the mediating role of different areas of self-concept in the relationship between the early development of anxiety symptoms and the later appearance of depressive symptoms. METHODS: A longitudinal study with 3 time-points was conducted, including baseline, 2 months and 12 months from the baseline assessment. A total of 217 children aged 8-12 years participated. Mediation analyses were conducted using PROCESS Macro for SPSS. RESULTS: Academic self-concept (Time 2) mediated the relationship between Anxiety (Time 1) and Depression (Time 3) when controlling for children's sex and, age, baseline value of the mediator, anxiety (at Times 2 and 3), and depression (at Times 1 and 2). Children with self-reports of higher anxiety symptoms (Time 1) presented lower Academic self-concept (Time 2). Children who reported lower levels of Academic self-concept and Family self-concept (Time 2) were more likely to develop depressive symptoms (Time 3). CONCLUSIONS: Feeling competent in the school environment may be considered a protective factor against the development of depression in childhood. The identification of risk factors facilitates the development and implementation of preventive programs.

Spanish Validation of the Short Mood and Feelings Questionnaire (SMFQ) in Children Aged 8-12.

BACKGROUND: The Short Mood and Feelings Questionnaire (SMFQ) is one of the few well-established available measures designed to assess childhood depression. The objective of the present study was to assess the psychometric properties and explore the differential item functioning (DIF) of the SMFQ in a community sample of Spanish children. Gender and age differences in SMFQ scores were also analyzed. METHOD: The sample included 824 students aged 8-12 years (Mage = 9.64, SD = 1.2) recruited from four public and private schools in urban areas in the southeast of Spain. RESULTS: Findings from factor analysis and Polytomous Rasch analysis supported a unidimensional interpretation of the SMFQ, thereby replicating findings across cultures and languages. The SMFQ had good reliability, and test-retest analysis indicated fair to good temporal stability. Evidence of construct validity was provided by a path diagram of the SMFQ and SDQ subscales. No age or gender differences in the SMFQ scores were observed. However, two items (3 and 11) exhibited gender-related DIF. CONCLUSIONS: The use of SMFQ sum-scores as a continuous measure of the severity of depressive symptoms can be supported. The measure shows promise as brief, reliable, valid instrument for the assessment of depressive symptoms in Spanish children.

Early detection of anxiety problems in childhood: Spanish validation of the brief Spence Children's Anxiety Scale for parents.

The small percentage of children with anxiety problems who receive psychological treatment, and the negative psychological consequences associated with these problems highlight the need for early detection. Although assessment instruments with appropriate measurement properties exist, they tend to be extensive, making it difficult to apply them in clinical settings, schools, or primary care practices. This study aimed to adapt the Spanish brief version for parents of the Spence Children's Anxiety Scale (SCAS-P-8). For this purpose, information on 215 children between 8 and 12 years of age was reported by 163 parents. The Spanish version of the SCAS-P-8 adequately fit a one-factor structure, χ2 = 44.25; df = 19; comparative fit index = .97; Tucker-Lewis index = .96; root mean square error of approximation: .07 (.04, .09); standardized root mean squared residual = .08. Evidence of internal consistency of the total SCAS-P-8 score was good (α = 0.82), and the direct correlations obtained between the SCAS-P-8 and internalizing problems showed evidence of convergent validity. Moreover, the appropriate measurement properties of the SCAS-P-8 were shown to be independent of gender. Differences in sociodemographic variables and SDQ-P between children with anxiety symptoms and those without anxiety symptoms were also discussed. Information reported by parents can help the clinician carry out an accurate diagnosis. A brief assessment scale can be easily applied in schools or primary care settings.

Validation of the Children's Separation Anxiety Scale - Parent Version (CSAS-P).

The main objective of this research was to validate the parents' version of the Children's Separation Anxiety Scale (CSAS-P), which assesses separation anxiety symptoms in pre-adolescence, the stage with the highest incidence of anxiety disorder due to separation. In Study 1, 1,089 parents, those children aged between 8 and 11 (M = 9.59, SD = 1.11), 51.7% girls, were selected by random cluster sampling, who completed the CSAS-P to obtain the factorial structure. Exploratory factor analysis identified four related factors: Worry, Opposition, Calm, and Distress, which explained 42.93% of the variance. In Study 2, 3,801 parents, those children aged between 8 and 11 (M = 9.50, SD = 1.10), 50.2% girls, completed the CSAS-P, and their children completed the Children's Separation Anxiety Scale (CSAS). The four related-factor model from Study 1 was validated by confirmatory factor analysis. The CSAS-P had adequate internal consistency (α = 0.84), temporal stability (r = 0.72), and invariance across children's age and gender and the parent who completed the scale. Age and gender differences were small: older children scored higher on Worry and younger children on Distress; the girls scored higher on all factors. Small differences were also found depending on the parent who completed the scale without finding a clear pattern. Parents scored significantly lower than the child on all four factors of the scale. The results support the reliability and validity of the CSAS-P, an instrument that complements the child's self-report in the framework of the multi-source assessment.

Effects of a Sexual Risk-Reduction Intervention for Teenagers: A Cluster-Randomized Control Trial.

This study evaluated the efficacy of the COMPAS program in the short term and 6 months after its application. For the initial sample, 2047 teenagers aged 14-19 years from 14 schools in 11 Colombian cities participated; eight schools were randomly assigned to the experimental condition and six to the control group. The participants completed self-report assessments that evaluated several variables theoretically associated with protective sexual behaviors. In the short term, the experimental group showed increased knowledge about HIV and other STIs, sexual assertiveness, self-efficacy, greater behavioral intention toward condom use, and more favorable attitudes toward HIV and condom use than the control group. After 6 months, most psychological and health variables also showed a significant positive change. In conclusion, the COMPAS program is the first school-based sexuality education program that has been shown to be effective in reducing mediating and behavioral variables associated with sexual risk reduction in Colombia.

RESUMEN: Este estudio evaluó la eficacia del programa COMPAS a corto plazo y a 6 meses después de la aplicación. Para la muestra inicial participaron 2.047 adolescentes de 14 a 19 años provenientes de 12 escuelas en 11 ciudades colombianas; 8 escuelas fueron aleatoriamente asignadas a la condición experimental y 6 al grupo control. Los participantes completaron autoinformes sobre variables teóricamente asociadas con comportamientos sexuales de protección. A corto plazo, el grupo experimental mostró un mayor conocimiento sobre ITS, asertividad sexual, autoeficacia e intención conductual hacia el uso del condón y actitudes más favorables hacia el VIH que el grupo de control. Después de seis meses, la mayoría de las variables psicológicas y de salud también mostraron un cambio positivo. En conclusión, el programa COMPAS es el primer programa de educación sexual que ha demostrado ser efectivo para reducir las variables mediadoras y conductuales asociadas con la reducción del riesgo sexual en Colombia.

Psychological Symptoms in Italian, Spanish and Portuguese Youth During the COVID-19 Health Crisis: A Longitudinal Study.

Aiming to slow down the spread of the COVID-19, a lockdown was declared in the first term of 2020 in many European countries, applying different restrictions measures. Although the psychological effects of home confinement in children have been described, there is a lack of longitudinal research examining the impact of the confinement over time. The present study analyzes the evolution of the psychological wellbeing of children and adolescents from three European countries with different restrictions. Parents of 624 Italian, Spanish, and Portuguese children and adolescents aged 3 to 18 years old completed the "Impact Scale of COVID-19 and Home Confinement on Children and Adolescents" two, five, and eight weeks after the lockdown. Results show a different pattern for each country. Children from Italy, the first European country that applied a lockdown, were better adapted than Spanish and Portuguese children the first two weeks after confinement but they were more psychologically impacted by home confinement at the eight-week assessment. Portuguese children, who followed a general duty of home confinement, were the best adapted to the situation, with no significant differences over time. A significant change was found in anxiety symptoms in Spanish children, with a decrease at the last assessment. Findings suggest that long confinements and hard restrictions affect children, so prevention measures should be applied during confinements to prevent psychological problems in children.

Validation of the brief version of the Spence Children's Anxiety Scale for Spanish children (SCAS-C-8).

OBJECTIVE: This study aimed to validate the self-reported brief version of the Spence Children's Anxiety Scale-Children (SCAS-C-8) in pre-adolescent Spanish children. METHOD: Participants were 824 children aged 8-12 from a community sample. The results revealed a good fit to the one-factor structure, adequate internal consistency (α = 0.75), and evidence of test-retest reliability (α = 0.77). RESULTS: The strong relationship between the SCAS-C-8 and emotional problems provided evidence of convergent validity. Also, the results showed factorial gender invariance. CONCLUSION: The SCAS-C-8 is a suitable instrument for pre-adolescent Spanish children. The brevity and simplicity of this scale may facilitate early detection and help to narrow the existent gap between the presence of anxiety problems and psychological assistance-seeking.

Validation and Adaptation of the Brief Self-Control Scale With Spanish Adolescents: Factorial Structure and Evidences of Reliability, Validity, and Factor Invariance Across Gender and Age.

During adolescence, the difficulty to control impulses is especially notable. The Brief Self-Control Scale has been used in different countries for years to study associations between self-control and other variables. However, its factor structure is not completely clear, and it is necessary to have a scale with psychometric assurances that evaluates self-control in adolescents. The aim of this study was to examine the factorial structure of the Brief Self-Control Scale and to provide evidences of reliability, validity, and factor invariance across gender and age in a sample of Spanish adolescents. Participants were 693 adolescents from Southeastern Spain, aged 13 to 18 years. Data supported an excellent fit to a two-dimensional model and evidences of reliability, validity and factor invariance across gender and age were obtained. This study provides new data on the two-dimensionality of self-control. The need of this tool becomes increasingly relevant to the susceptibility of new emerging addictions, such as mobile phones or internet.

Effects as a function of implementation fidelity of a transdiagnostic prevention program in young school-aged children.

Super Skills for Life (SSL) is a transdiagnostic prevention program for school-aged children with internalizing problems. The current study aimed to examine the short- and long-term (12-month follow-up) effectiveness of SSL, depending on implementation fidelity. Participants were 123 Spanish-speaking children aged 6-8 years with internalizing symptoms and their parents. High (n = 41) and low fidelity (n = 26) groups were established and compared with a control group (CG) (n = 56). Compared to CG, the high-fidelity group (HFG) achieved better outcomes than the low-fidelity group (LFG) at short and long term, including symptoms of anxiety, depression, and internalizing problems, and also externalizing problems at long-term. The LFG improved key symptoms at short term (depression) and long term (anxiety and depression). Findings suggest that SSL is beneficial even if not delivered at maximum fidelity, although considering the influence of implementation fidelity is critical because the high-fidelity implementation yielded the greatest effects when compared to the CG. This research provides valuable data, analyzing for the first time the influence of fidelity on SSL outcomes in young school-aged children exhibiting internalizing symptoms, while there is still a lack of studies of these characteristics concerning transdiagnostic prevention programs targeting childhood anxiety and depression.

A Cross-Cultural Study on Attachment and Adjustment Difficulties in Adolescence: The Mediating Role of Self-Control in Italy, Spain, China, and Poland.

From a socio-ecological perspective, individuals are influenced by the interplay of individual, relational, and societal factors operating as a broader system. Thereby, to support youth adjustment during the critical adolescence period, the interplay between these factors should be investigated. This study aimed to investigate cross-cultural differences in adolescents' maternal and paternal attachment, adolescents' adjustment difficulties and self-control, and in their association. N = 1000 adolescents (mean (M) age = 16.94, SD = 0.48; 45.90% males) from China, Italy, Spain, and Poland participated by completing self-report measures. Results showed cross-country similarities and differences among the considered variables and their associative pattern. Moreover, conditional process analysis evaluating the association between maternal vs. paternal attachment and adjustment difficulties, mediated by self-control, and moderated by country, was performed. Maternal attachment directly, and indirectly through greater self-control, influenced adjustment difficulties in all four countries. This association was stronger among Spaniards. Paternal attachment influenced directly, and indirectly through self-control, on adolescents' adjustment difficulties only in Italy, Spain, and Poland, and was stronger among Polish adolescents. For Chinese adolescents, paternal attachment solely associated with adjustment difficulties when mediated by self-control. Thus, results highlighted both similarities and differences across countries in the interplay between maternal vs. paternal attachment and self-control on adolescents' adjustment difficulties. Implications are discussed.

Spanish version of Super Skills for Life in individual modality: Improvement of children's emotional well-being from a transdiagnostic approach.

OBJECTIVE(S): This study analyzed the short-term effects of the Super Skills for Life (SSL) program in its individual format from the parents' perspective. METHODS: Parents of 70 Spanish children aged 8-11 years (M = 9.31; SD = 1.16) completed assessment instruments about their children's emotional state at the baseline and postintervention. RESULTS: Analyses revealed significantly lower scores in depression (The Mood and Feelings Questionnaire), anxiety, and specific disorders (The Spence Children's Anxiety Scale) (i.e., panic attack/agoraphobia, separation anxiety, social phobia, and generalized anxiety). Significant improvements were also found in anxiety life interference at home (The Child Anxiety Life Interference Scale), total difficulties, internalized and externalized problems, emotional symptoms, peer problems, and hyperactivity/inattention (The Strengths and Difficulties Questionnaire) at posttest. SSL was effective in reducing psychopathological symptoms similarly in both girls and boys. CONCLUSIONS: These promising results provide preliminary support for the usefulness of the SSL program in individual format for the indicated prevention of children's emotional problems. This study provides a valuable resource for research and clinical practice.

Effectiveness of Group vs. Individual Therapy to Decrease Peer Problems and Increase Prosociality in Children.

Emotional difficulties in children are often shown to be associated with peer problems and low prosocial behaviors. Super Skills for Life (SSL) is a transdiagnostic protocol for the prevention of emotional problems in children and has also obtained improvements of other comorbid symptoms. This study aimed at comparing the effects of SSL in reducing peer problems and increasing prosocial behaviors in children aged 8 to 12 years between the group and the individual modalities. For this purpose, 140 children (35% girls) received the program, 70 in group format and 70 in individual format, and were evaluated at the baseline, posttest, and after one year. Both modalities were effective in enhancing social relationships in children, although the individual modality showed more promising results. Children belonging to the individual modality group presented fewer peer problems (less social isolation and rejection, greater social acceptance, more friends) and greater prosocial behaviors (helping, empathy, kindness, and sharing) compared to children receiving the therapy in group modality, both in the short and in the long term. In conclusion, this study provides evidence of SSL protocol efficacy for improving children's peer relationships and prosocial behaviors and encourages the implementation of transdiagnostic interventions in both clinical and educational settings.

Psychological Treatments for Depression in Adolescents: More Than Three Decades Later.

Depression is a common and impairing disorder which is a serious public health problem. For some individuals, depression has a chronic course and is recurrent, particularly when its onset is during adolescence. The purpose of the current paper was to review the clinical trials conducted between 1980 and 2020 in adolescents with a primary diagnosis of a depressive disorder, excluding indicated prevention trials for depressive symptomatology. Cognitive behavioral therapy (CBT) is the pre-eminent treatment and is well established from an evidence-based treatment perspective. The body of research on the remaining treatments is smaller and the status of these treatments is varied: interpersonal therapy (IPT) is well established; family therapy (FT) is possibly effective; and short-term psychoanalytic therapy (PT) is experimental treatment. Implementation of the two treatments that work well-CBT and IPT-has more support when provided individually as compared to in groups. Research on depression treatments has been expanding through using transdiagnostic and modular protocols, implementation through information and communication technologies, and indicated prevention programs. Despite significant progress, however, questions remain regarding the rate of non-response to treatment, the fading of specific treatment effects over time, and the contribution of parental involvement in therapy.

The Nighttime Fears Scale: Development and psychometric evidence of a standardized self-report scale to assess nighttime fears in children.

Nighttime fears are highly prevalent in children and are linked to children's distress and internalizing problems, especially childhood anxiety. Although its assessment may be critical, there is a lack of available standardized self-reports. This study aimed to describe the development and psychometric evaluation of the Nighttime Fears Scale (NFS), a new standardized self-report for assessing nighttime fears in school-aged children. The construction of the scale was based on prior relevant research and involvement of researchers and clinicians, experts in childhood anxiety, and fears. A total of 794 Spanish-speaking children (51.1 % girls) aged 8-12 years completed the NFS along with measures of anxiety, sleep problems, internalizing and externalizing problems, and positive behaviors. Exploratory and confirmatory factor analyses supported a four-factor structure of the NFS, consisting of 21 items measuring a range of potentially fear-provoking stimuli at nighttime. Strong internal consistency (alphas ranging from .87 to .94), adequate test-retest reliability, and evidence of convergent, divergent and incremental validity was found. This study provides initial support for the use of the NFS by clinicians and researchers, suggesting that it is a promising tool for a rapid and easily-administered assessment to identify the presence and intensity levels of a set of common children's nighttime fears.

Anxiety and Depressive Symptoms in Children and Adolescents during COVID-19 Pandemic: A Transcultural Approach.

BACKGROUND: Despite being necessary to delay the spread of COVID-19, home confinement could have affected the emotional well-being of children and adolescents. Knowing which variables are involved in anxiety and depressive symptoms could help to prevent young people's psychological problems related to lockdown as early as possible. This cross-sectional study aims to examine anxiety and depressive symptomatology in Italian, Spanish, and Portuguese children and adolescents in order to determine which variables are related to poorer well-being during the pandemic. METHOD: The parents of 515 children, aged 3-18 years old, completed an online survey. Children's anxiety symptoms were assessed using the Spence Children's Anxiety Scale-Parent Version, and depressive symptoms were measured with the Short Mood and Feelings Questionnaire-Parent Version. RESULTS: We found differences in anxiety and depression between countries, with higher anxiety scores in Spanish children, and higher depression scores in Spanish and Italian children compared to the Portuguese. Anxiety and depressive symptoms were more likely in children whose parents reported higher levels of stress. CONCLUSIONS: These findings are discussed in the light of detecting and supporting affected children as early as possible.

Rumination, Catastrophizing, and Other-Blame: The Cognitive-Emotional Regulation Strategies Involved in Anxiety-Related Life Interference in Anxious Children.

Childhood anxiety problems have a great impact on the daily functioning of children and their families. The first objective of this study was to compare whether the use of cognitive-emotional regulation strategies differs in children with and without anxious symptomatology. A second objective was to analyze the possible mediating role of regulation strategies in the relationship between the presence of anxious symptomatology and its subsequent interference in children's lives. In total, 315 children (53.7% boys) between 8 and 12 years old participated. Mann-Whitney-Wilcoxon U-test was used to analyze differences in the use of cognitive-emotional regulation strategies between children with and without anxious symptomatology. In order to identify the cognitive-emotional regulation strategies which mediate the relation between anxiety and the consequent interference in children's lives, mediation analyses were carried out. As expected, children with anxious symptomatology used more maladaptive regulatory strategies than those without such symptomatology. Multiple mediation models in parallel showed that catastrophizing, rumination, and other-blame mediated the relationship between anxiety problems and their consequent interference. The identification of functional or dysfunctional patterns of cognitive-emotion regulation may favor the inclusion of new components in the evidence-based interventions currently available, in an attempt to increase rates of remission of anxiety.

Internalizing and externalizing symptoms in Spanish children aged 6-8: Results of a latent profile analysis.

BACKGROUND: Internalizing and externalizing problems are widely addressed in research. However, most studies use variable-centred approaches and ignore the possible co-occurrence of both types of symptoms. This study aimed to identify homogeneous groups of children with similar psychological difficulties and strengths, using latent profile analysis as a person-centred approach. METHODS: The parents of 107 Spanish children aged 6 to 8 years completed the Strengths and Difficulties Questionnaire (SDQ). RESULTS: The results revealed the existence of four latent groups. The children who belonged to the high difficulties group showed the most severe symptoms in emotional problems, peer problems and hyperactivity. The children classified in the externalizing group showed high levels of hyperactivity, behavioral problems, and emotional problems. On another hand, the internalizing profile grouped children with emotional and peer problems. Finally, the well-adjusted group showed an adequate psychological adjustment in all evaluated variables. High difficulties were associated with lower educational attainment of their parents. LIMITATIONS: Data were reported from a single source of information, father or mother. Also, the socio-demographic variables that were related to each one of the four profiles only considered the age and educational level of the main informant. CONCLUSIONS: These data suggest that co-occurrence of symptoms is very high in young Spanish children. It is essential to carry out clinical assessments that include both types of symptoms. Considering externalization and internalization as independent and exclusive phenomena can compromise the effectiveness of psychological treatments and preventive programs.