Feasibility and potential efficacy of a guided internet- and mobile-based CBT for adolescents and young adults with chronic medical conditions and comorbid depression or anxiety symptoms (youthCOACHCD): a randomized controlled pilot trial.

BACKGROUND: Adolescents and young adults (AYA) with a chronic medical condition show an increased risk for developing mental comorbidities compared to their healthy peers. Internet- and mobile-based cognitive behavioral therapy (iCBT) might be a low-threshold treatment to support affected AYA. In this randomized controlled pilot trial, the feasibility and potential efficacy of youthCOACHCD, an iCBT targeting symptoms of anxiety and depression in AYA with chronic medical conditions, was evaluated. METHODS: A total of 30 AYA (Mage 16.13; SD= 2.34; 73% female), aged 12-21 years either suffering from cystic fibrosis, juvenile idiopathic arthritis or type 1 diabetes, were randomly assigned to either a guided version of the iCBT youthCOACHCD (IG, n=15) or to a waitlist control group (CG, n=15), receiving an unguided version of the iCBT six months post-randomization. Participants of the IG and the CG were assessed before (t0), twelve weeks after (t1) and six months after (t2) randomization. Primary outcome was the feasibility of the iCBT. Different parameters of feasibility e.g. acceptance, client satisfaction or potential side effects were evaluated. First indications of the possible efficacy with regard to the primary efficacy outcome, the Patient Health Questionnaire Anxiety and Depression Scale, and further outcome variables were evaluated using linear regression models, adjusting for baseline values. RESULTS: Regarding feasibility, intervention completion was 60%; intervention satisfaction (M = 25.42, SD = 5.85) and perceived therapeutic alliance (M = 2.83, SD = 1.25) were moderate and comparable to other iCBTs. No patterns emerged regarding subjective and objective negative side effects due to participation in youthCOACHCD. Estimates of potential efficacy showed between group differences, with a potential medium-term benefit of youthCOACHCD (ß = -0.55, 95%CI: -1.17; 0.07), but probably not short-term (ß = 0.20, 95%CI: -0.47; 0.88). CONCLUSIONS: Our results point to the feasibility of youthCOACHCD and the implementation of a future definitive randomized controlled trial addressing its effectiveness and cost-effectiveness. Due to the small sample size, conclusions are premature, however, further strategies to foster treatment adherence should be considered. TRIAL REGISTRATION: The trial was registered at the WHO International Clinical Trials Registry Platform via the German Clinical Trials Register (ID: DRKS00016714 , 25/03/2019).

[Preventing Obesity in Children: Which Factors Impede and Which Facilitate the Parental Access to Prevention Programmes?]. / Prävention kindlicher Adipositas: Was verhindert und erleichtert Eltern den Zugang zu Präventionsangeboten?

Preschool children of deprived obese parents are a risk group for the development of childhood obesity. The risk sensitiveness, perceived courses of action and barriers as well as motivational aspects of these patients for the participation in a prevention programme were analysed using focused interviews and questionnaires. Based upon the results, a target group-specific parent training was designed. A pilot evaluation study showed promising results.

[Sociocultural Factors and Eating Disorders in Adolescence: Evaluation of a School-Based Programme]. / Soziokulturelle Faktoren und Essstörungen im Jugendalter: Evaluation eines schulbasierten Präventionsprogramms.

Eating disorders are serious, hard to treat and widely spread. Hence it was the goal of the present project to develop and evaluate a universal preventive concept (Potsdam Prevention at Schools). The POPS programme focuses in an interactive manner on topics such as coping with social pressure, strengthening the media and problem-solving competence and healthy eating. Results from the ITT analysis support its efficacy, even over the course of one year in terms of reduction of body dissatisfaction, perceived media pressure, internalising of the media beauty ideal and disordered eating.

A longitudinal investigation of sports-related risk factors for disordered eating in aesthetic sports.

Previous studies have indicated a higher risk of disordered eating in certain types of elite sports such as aesthetic sports (e.g., rhythmical gymnastics, figure skating). But even though some studies on risk factors for disordered eating in sports exist, most research on this topic is based on cross-sectional data with limitations on causal inferences. We examined sports-related risk factors for disordered eating in a 1-year longitudinal study with two assessment points. The participants were 65 adolescent athletes from aesthetic sports (mean age 14.0 ±.2.2 years) who completed measures of disordered eating, social pressure from the sports environment, sports-related body dissatisfaction, desire to be leaner to improve sports performance, and emotional distress resulting from missed exercise sessions. All variables were relatively stable in the mean. Individual changes in the desire to be leaner to improve sports performance were associated with individual changes in disordered eating. Furthermore, a cross-lagged partial correlation analysis showed that the desire to be leaner to improve sports performance was predictive of disordered eating and not vice versa. The results of our study indicate that athletes are more at risk for disordered eating if they believe it is possible to enhance their sports performance through weight regulation.

[Cognitive flexibility in adolescent patients with unipolar affective disorders-gender differences]. / [Kognitive Flexibilität bei jugendlichen Patienten mit unipolaren Affektiven Störungen unter Berücksichtigung geschlechtsbezogener Unterschiede].

OBJECTIVE: Several studies have revealed impairments in cognitive functions among patients with affective disorders (AD). However, to date there are few neuropsychological studies on cognitive flexibility among adolescent patients with AD, especially on gender differences in AD. Here, we investigate cognitive functions, especially cognitive flexibility, in adolescent patients with unipolar AD (UAD) compared to a healthy control group (CG). METHOD: The study population consists of 17 male patients (Mage = 15.4 ± 1.3) and 22 female patients with UAD (Mage = 15.6 ± 1.4) as well as 20 male (Mage = 16.0 ± 1.0) and 30 female (Mage = 15.7 ± 0.9) healthy adolescents. A neuropsychological test battery was conducted, and depressive symptoms, psychological stress, and intelligence were also assessed. RESULTS: The analyses revealed no significant group differences regarding cognitive flexibility or visual processing speed, albeit slight better performance in motor processing speed for the CG. Furthermore, no gender differences were observed regarding cognitive flexibility, though female subjects general displayed better performance in processing speed. CONCLUSIONS: Overall, there are no indications for serious deficits and specific gender differences in cognitive flexibility or processing speed in adolescent patients with UAD. Independent of psychological distress, female subjects seem to have some advantages in processing speed.

Further evaluation of the psychometric properties of the German version of the Body Appreciation Scale-2 (BAS-2): Cross-validation, measurement invariance, and population-based norms.

Using a representative sample of the German general population (N = 2509, 16-74 years), this work aimed to cross-validate the modified one-factor model recently reported for the German Body Appreciation Scale 2 (BAS-2). We also examined measurement invariance across gender, tested differential item functioning across age and BMI, systematically evaluated subgroup differences, and provided norms according to subgroups. Overall, the BAS-2 demonstrates good internal consistency. Cross-validation supported the generalizability of the modified one-factor model. Multi-group confirmatory factor analyses supported full scalar invariance across gender; comparisons revealed higher scores among men compared to women with a small effect size. Age (only women) and BMI (both genders) significantly predicted latent BAS-2 scores. Of note, differential item functioning for age and BMI was observed. Concerning manifest group differences, we found a significant main effect of weight status: Individuals with obesity reported the lowest body appreciation levels, while individuals with underweight/ normal weight reported highest levels. Our findings suggest that the German BAS-2 has good psychometric properties and is suitable for examining body appreciation across gender among German women and men. Moreover, norm values enable future usage of the scale in health and clinical research by providing reference data for interpretation.

Self-regulation as a resource for coping with developmental challenges during middle childhood and adolescence: the prospective longitudinal PIERYOUTH-study.

BACKGROUND: Self-regulation (SR) as the ability to regulate one's own physical state, emotions, cognitions, and behavior, is considered to play a pivotal role in the concurrent and subsequent mental and physical health of an individual. Although SR skills encompass numerous sub-facets, previous research has often focused on only one or a few of these sub-facets, and only rarely on adolescence. Therefore, little is known about the development of the sub-facets, their interplay, and their specific contributions to future developmental outcomes, particularly in adolescence. To fill these research gaps, this study aims to prospectively examine (1) the development of SR and (2) their influence on adolescent-specific developmental outcomes in a large community sample. METHODS/DESIGN: Based on previously collected data from the Potsdam Intrapersonal Developmental Risk (PIER) study with three measurement points, the present prospective, longitudinal study aims to add a fourth measurement point (PIERYOUTH). We aim to retain at least 1074 participants now between 16 and 23 years of the initially 1657 participants (6-11 years of age at the first measurement point in 2012/2013; 52.2% female). The study will continue to follow a multi-method (questionnaires, physiological assessments, performance-based computer tasks), multi-facet (assessing various domains of SR), and multi-rater (self-, parent-, and teacher-report) approach. In addition, a broad range of adolescent-specific developmental outcomes is considered. In doing so, we will cover the development of SR and relevant outcomes over the period of 10 years. In addition, we intend to conduct a fifth measurement point (given prolonged funding) to investigate development up to young adulthood. DISCUSSION: With its broad and multimethodological approach, PIERYOUTH aims to contribute to a deeper understanding of the development and role of various SR sub-facets from middle childhood to adolescence. The large sample size and low drop-out rates in the first three measurements points form a sound database for our present prospective research. Trial registration German Clinical Trials Register, registration number DRKS00030847.

[Psychological aspects of obesity. Consquences for content, indication, and success of therapy]. / Psychologische Aspekte der Adipositas. Konsequenzen für Therapieinhalte, Therapieindikation und Therapieerfolg.

To simply reduce obesity to the medical set of problems falls short due to the complexity of the disorder. The focus of the affected children and adolescents is less on acute and future somatic health impairments but on the psychosocial aspects of obesity. The high degree of stigmatization especially accounts for the psychosocial burdens of the persons concerned. Constraints in the quality of life and a higher prevalence of mental disorders are reported by overweight and obese children and adolescents. In the sense of a vicious psychosocial circle, these variables in turn influence our eating and exercise behavior and hence central influences of weight control actions. Therefore, complex multimodal programs, which take into account these relationships, have long since been established in therapy. Numerous studies have underscored the efficacy of such lifestyle interventions resulting in moderate weight loss effects. Parent involvement and including behavioral strategies is associated with better results. Future studies should focus more on various psychosocial outcomes and addressing the question of psychosocial predictors of short- and long-term treatment success.

The unhappy obese child.

OBJECTIVE: One of the most painful aspects of obesity may be the emotional suffering it causes. The paper discusses the psychological and social effects of obesity. METHOD: Current studies examining the psychosocial strains of obese children and adolescents are reported. The report especially focuses on stigmatization, mental health disorders, school performance and health-related quality of life. DISCUSSION: Research is showing that obesity is associated with poorer psychosocial functioning even compared with other chronic diseases. Future studies should further explicate the risk and protective factors for developing severe psychosocial strain.

[Measuring the quality of life of children and adolescents with asthma--The Pediatric Asthma Quality of Life Questionnaire]. / Messung der Lebensqualität von asthmaerkrankten Kindern und Jugendlichen--Der Paediatric Asthma Quality of Life Questionnaire.

Quality of life becomes more and more important in evaluating the effects of treatments. At the moment, different questionnaires to measure quality of life in children and adolescents with asthma are available. The Paediatric Asthma Quality of Life Questionnaire (PAQL) was developed by Juniper and co-workers in Canada and has already been translated into German. It is a self- or interviewer-administered instrument for children and adolescents between age 7 and 17. The PAQL contains 23 items in three domains: activity limitation, symptoms, and emotional function. The empirical results suggest that the PAQL is reliable and sensitive to clinical change. Problems associated with the administration are discussed.

Psychological adjustment in parents of young children with atopic dermatitis: which factors predict parental quality of life?

BACKGROUND: Bringing up children with atopic dermatitis (AD) is widely perceived as being stressful because parenting demands considerable time and energy. There have been only a few studies to assess the extent of problems experienced by the parents. OBJECTIVE: To assess the psychosocial well-being of parents caring for a young child with AD and to examine the relationship between parental quality of life and disease-related and sociodemographic variables. METHODS: One hundred and eighty-seven parents of young children with AD attending an inpatient rehabilitation clinic participated in the study. At admission, parents completed a set of questionnaires (assessing health-related quality of life, coping with the disease, family functioning). Dermatologists assessed disease severity using the severity scoring of AD index (SCORAD). RESULTS: In general, parents cope well with their situation. Compared with normal values, high rates of psychological distress were observed in a subsample of parents of children with AD. Parents of children with a higher severity of disease reported a significantly higher impact on family functioning, a greater financial burden and a higher level of disease management. Parental disease management could be predicted by the familial situation, their personal well-being and the severity of disease of their child. Differences attributed to their child's gender or age were not observed. CONCLUSIONS: Childhood AD has a profound impact on the emotional and social well-being of many of the parents. The results underline the importance of psychological treatment approaches designed to increase parental well-being and ability to cope with stress and social strain.

Conceptualisation and evaluation of a cognitive-behavioural training programme for children and adolescents with obesity.

OBJECTIVE: Obesity is common in children and adolescents with incidence rates increasing both nationally and internationally. Its causes are complex and multifaceted, and obesity is associated with high morbidity and mortality as well as psychological distress. Multidimensional programmes are necessary in the treatment of this chronic disease in order to change eating and physical activity habits. A cognitive-behavioural training programme was developed and evaluated. In combination with diet and exercise, this special group programme that includes well established behavioural methods, was expected to result in long-term weight reduction and decrease of psychological distress in connection with obesity. DESIGN: As part of the six week in-patient rehabilitation for children and adolescents at Viktoriastift in Bad Kreuznach, the three-part programme (experimental group, EG) was compared with a programme that differed only in the psychological intervention component (instead of the specific training programme they undertook muscle relaxation training, comparison group, CG). SUBJECTS: In total, 197 children and adolescents between 9 and 19 y-of-age were recruited into the study. MEASUREMENTS: Somatic (eg weight status), behavioural (eg eating behaviour) and psychological (eg quality of life) outcomes were assessed at five points in time: two weeks before the intervention, at the beginning and end of the programme, as well as six months and one year post-intervention. The study started in spring 1997. Main outcomes will be presented. RESULTS: Pre- vs post-intervention-tests showed significant improvements in self-reported eating behaviours for the EG compared with the CG (F=6.38, P<0.05); these changes were independent of age and sex. The weight status measured as the percentage of overweight dependent on height was reduced in both groups immediately after the intervention and at follow-up (F=16.51, P<0.01). Reduction in the prevalence of obesity tended to be higher in the EG than in the CG (15% vs 10%). Self-reported quality of life increased from before the intervention to follow-up more in the EG than in the CG (F=3.27, P=0.08). In all, the acceptance of the behavioural patient education programme was good. CONCLUSION: In summary, evaluation results indicate that the cognitive-behavioural training programme is a promising approach to alter obesity-related habits and to reduce somatic and psychosocial consequences. Long-term effects after two years are expected to underscore these results.