How to make mental health services more youth-friendly? A Delphi study involving young adults, parents and professionals.

INTRODUCTION: Although youth-friendly service characteristics have been previously identified, consensus among a representative group of stakeholders about which of these characteristics are truly relevant to the youth-friendliness of services is currently lacking. In our study, young adults, parents and professionals were consulted on this topic to reveal existing (dis)agreement. In addition, (dis)agreement on feasibility for implementation in clinical practice was also assessed. METHODS: A mixed-method Delphi approach was used with three online questionnaire rounds and a physical meeting. Young adults (18-26 years) and parents were part of a public panel and professionals were allocated to the professional panel. In the rounds, participants were asked to rate the importance and feasibility of each item. Subsequently, the percentage agreement (% of participants giving a score of 7 or above on a 9-point Likert scale) within and across panels was calculated. Consensus was assumed to have been reached when at least 70% agreement was achieved. A thematic analysis of the qualitative data, obtained in the rounds and the physical meeting, was performed to identify overarching themes and characteristics of relevance to the youth-friendliness of services. RESULTS: For 65% of the items included in the Delphi questionnaire, consensus on importance was reached within both panels. Participants showed more insecurity about the feasibility of these items, however. Our thematic analysis revealed reasons for disagreement between and within the panels. CONCLUSIONS: Our study revealed substantial between- and within-panel agreement on youth-friendly service characteristics. We recommend that the items for which consensus was reached should be used as a checklist in terms of youth mental health service development, design and delivery. The characteristics for which there was disagreement between and within the panels should inspire an ongoing trialogue between young adults, parents and professionals both on the individual level and the service level. PATIENT OR PUBLIC CONTRIBUTION: In this study, (parents of) young adults with lived experience were included as experts, including one of the coauthors. This coauthor contributed to the manuscript by having a final say about the included quotes.

Parental experiences of homeschooling during the COVID-19 pandemic: differences between seven European countries and between children with and without mental health conditions.

The aim of the present study was to examine parental experiences of homeschooling during the COVID-19 pandemic in families with or without a child with a mental health condition across Europe. The study included 6720 parents recruited through schools, patient organizations and social media platforms (2002 parents with a child with a mental health condition and 4718 without) from seven European countries: the UK (n = 508), Sweden (n = 1436), Spain (n = 1491), Belgium (n = 508), the Netherlands (n = 324), Germany (n = 1662) and Italy (n = 794). Many parents reported negative effects of homeschooling for themselves and their child, and many found homeschooling to be of poor quality, with insufficient support from schools. In most countries, contact with teachers was limited, leaving parents with primary responsibility for managing homeschooling. Parents also reported increased levels of stress, worry, social isolation, and domestic conflict. A small number of parents reported increased parental alcohol/drug use. Some differences were found between countries and some negative experiences were more common in families with a child with a mental health condition. However, differences between countries and between families with and without a mental health condition were generally small, indicating that many parents across countries reported negative experiences. Some parents also reported positive experiences of homeschooling. The adverse effects of homeschooling will likely have a long-term impact and contribute to increased inequalities. Given that school closures may be less effective than other interventions, policymakers need to carefully consider the negative consequences of homeschooling during additional waves of the COVID-19 pandemic and future pandemics.

"Hold Me Tight So I Can Go It Alone": Developmental Themes for Young Adults With Autism Spectrum Disorder.

Although research shows that young adults with autism spectrum disorder (ASD) struggle with higher rates of depression, anxiety, and other co-occurring psychiatric disorders, their psychological development through emerging adulthood remains understudied. To explore relevant developmental themes for young adults with ASD while subscribing to a social-constructionist epistemology, we interviewed young adults with ASD and their mental health care professionals individually, and organized focus groups with their parents in a multiperspective design. Developmental themes were identified using interpretative phenomenological analysis. Despite a substantial body of research considering lack of social motivation, a central ASD characteristic, narratives were remarkably socially oriented. This article discusses the overarching themes of (a) searching for balance and negotiating ASD and (b) searching for suitable surroundings in different areas of life, as well as their implications for clinical practice.

Truthfulness as the basis for ethical safeguards in deceptive research: An interview study with researchers.

Ethical safeguards such as debriefing are often recommended or required for research studies in which participants are deceived. However, existing guidance on these safeguards seems insufficiently coherent and precise, which may be associated with their suboptimal implementation in practice. This study aimed to contribute to a more coherent and precise framework of ethical safeguards in deceptive studies through semi-structured interviews with a diverse sample of 24 researchers who had significant experience with deception. Interviewees discussed which ethical safeguards they implemented and how, as well as their relation to the notion of truthfulness (i.e., the intentional communication of true information). Moreover, interviewees provided a variety of reasons for and against implementing these safeguards, as well as how these reasons varied with the particular context of a study. Overall, the current study contributes to a more coherent and precise understanding of ethical safeguards in deceptive research that could be useful for guiding researchers and ethics reviewers in their ethical decision-making, although certain imprecisions and incoherent aspects remain in need of further investigation and normative reflection.

Informed Consent and Debriefing When Deceiving Participants: A Systematic Review of Research Ethics Guidelines.

Informed consent and debriefing of research participants in studies that use deception are ethical safeguards for which existing scholarly work on their implementation remains variable and insufficiently clear. A systematic review of research ethics guidelines was conducted to sketch a picture of whether, why and how informed consent and debriefing are recommended when using deception. Documents roughly agreed on several general principles, but varied significantly in the specifics of why and whether these safeguards are necessary, in which conditions and how they should be implemented. Various aspects that appear in the literature could not be found in the guidelines. In our review, guidance was integrated and showed a variation of implementation strategies that could help in contextualizing these safeguards.

The association between working memory, teacher-student relationship, and academic performance in primary school children.

Introduction: Early relationships with teachers play an important role in children's development and significantly influence students' cognitive and academic performance. Studies suggest that working memory (WM) is a strong predictor of academic achievement, especially of reading and arithmetic outcomes. The associations between teacher-student relationship (TSR) quality, children's WM skills and their academic performance have been reported in numerous observational studies. However, the potentially bidirectional and temporal nature of the relationships between these constructs is understudied. Methods: The purpose of this study was to investigate the relationships between primary school children's WM and TSR by applying a cross-lagged design and measuring these constructs at three time points throughout the academic year. More exploratively, this study investigated how WM and TSR bidirectionally relate to children's academic performance. Results: The findings of this study revealed a temporal relationship between WM and TSR: between WM-related problems in the classroom at baseline and conflict at 3-month follow-up, and between closeness at 3-month follow-up and WM-related problems in the classroom at 5-month follow-up. Moreover, the findings showed a bidirectional relationship between arithmetic performance and WM-related problematic behaviour. Discussion: This study highlights that relationships between the teacher and students play an important role in supporting students' cognitive and academic development. Importantly, this study suggests that children with WM problems may benefit from interventions that focus on improving their relationships with teachers. Additionally, the findings propose that interventions targeting WM may also have positive effects on children's academic performance.

Sleep and Sleep Hygiene of Adolescents With and Without ADHD During COVID-19.

OBJECTIVE: This study examined the effect of COVID-19 restrictions on the sleep and sleep hygiene of adolescents with ADHD and comorbid sleep problems and neurotypical adolescents (NT). METHOD: Four groups (two ADHD and two NT) of in total 100 adolescents (50 ADHD and 50 NT) were included. One ADHD and NT group were tested during many COVID-19 restrictions, the other during few. MANCOVAs were implemented with ADHD diagnosis and level of COVID-19 restrictions as independent and sleep outcomes (subjective and objective total sleep time (TST) and sleep onset latency (SOL), sleep and sleep hygiene problems) as dependent variables. RESULTS: Both groups had a shorter objective TST during the week during many COVID-19 restrictions. Furthermore, adolescents with ADHD had a shorter subjective SOL during the weekend when there were many COVID-19 restrictions, while the SOL of the NT group stayed the same. CONCLUSION: COVID-19 restrictions are related to the sleep of adolescents with and without ADHD. However, causality and underlying mechanisms need further investigation.

Sleep IntervEntion as Symptom Treatment for ADHD (SIESTA)-Blended CBT sleep intervention to improve sleep, ADHD symptoms and related problems in adolescents with ADHD: Protocol for a randomised controlled trial.

INTRODUCTION: Adolescents with attention deficit hyperactivity disorder (ADHD) experience a more disrupted sleep and more sleep problems compared with typically developing adolescents. This is particularly concerning, because disrupted sleep is related to worsened clinical, neurocognitive and functional outcomes and leads to increased ADHD symptom impairment. Due to the specific difficulties adolescents with ADHD experience, a tailored sleep treatment is needed. Therefore, our lab developed a cognitive behavioural treatment-Sleep IntervEntion as Sympom Treatment for ADHD (SIESTA)-that integrates sleep training with motivational interviewing, and planning/organisational skills training with the aim of improving sleep problems in adolescents with ADHD. METHODS AND ANALYSIS: A randomised, controlled, investigator-blinded monocentre trial is used to test whether SIESTA in combination with treatment as usual (TAU) for ADHD results in greater improvement in sleep problems than TAU only. Adolescents (aged 13-17 years) with ADHD and sleep problems are included. They complete measurements before treatment (pre-test), approximately 7 weeks after the pre-test (post-test), and approximately 3 months after the post-test (follow-up). The assessment includes questionnaires filled out by adolescents, parents and teachers. Additionally, sleep is assessed by actigraphy and sleep diaries at all time-points. Primary outcomes include objectively and subjectively measured sleep architecture (specified as total sleep time, sleep onset latency, sleep efficiency and number of awakenings), subjectively measured sleep problems and sleep hygiene. Secondary outcomes include ADHD symptoms, comorbidities and functional outcomes. To analyse the data, a linear mixed effects model will be used with an intent-to-treat approach. ETHICS AND DISSEMINATION: The study activities, informed consent and assent forms have been approved by the Ethical Committee Research UZ/KU Leuven (study ID S64197). If proven effective, the intervention will be implemented throughout Flanders. Therefore, an advisory board consisting of societal partners in healthcare is appointed at the start of the project, giving advice throughout the project and assistance with implementation afterwards. TRIAL REGISTRATION NUMBER: NCT04723719.

Cultural universality and specificity of teacher-student relationship: a qualitative study in Belgian, Chinese, and Italian primary school teachers.

Extensive evidence highlights the significant influence of dyadic, emotional teacher-student relationship (TSR) on students' cognitive functioning, socio-emotional development, and overall well-being. However, it remains unclear whether the TSR construct and its manifestations can be generalized across cultures. This qualitative study investigated TSR among 60 primary school teachers in Belgium, China, and Italy (i.e., countries with varying positions on the collectivistic-individualistic continuum of culture). Through semi-structured interviews and metatheme analysis, the study examined the similarities and differences in TSR across these countries, revealing a nuanced and diverse picture in various cultural contexts. The findings align with the existing TSR model by including dimensions of closeness, conflict, and dependency, while also extending the model to identify additional dimensions such as authority, balance, distance, fairness, increasing student motivation, patience, and strictness. Regarding cultural perspective, teachers from these three countries exhibited similar conceptualizations of closeness, conflict, fairness, increasing student motivation, patience, and strictness, whereas the conceptualization of dependency, authority, balance, and distance may be influenced by (collectivistic versus individualistic) culture. Moreover, the manifestations of TSR varied across countries, highlighting the influence of cultural factors such as cultural norms, collectivistic versus individualistic values, and the perceived legitimacy of teacher authority. These findings shed light on the complexities of TSR across countries and emphasize the significance of culturally sensitive approaches in fostering positive TSR in education.

Sleep parameters and problems in adolescents with and without ADHD: A systematic review and meta-analysis.

Background: Adolescence is characterized by an increase in the rate of sleep problems, which might be even more pronounced in adolescents with ADHD. This systematic review with meta-analysis aimed to compare sleep in adolescents with and without ADHD, including sleep parameters, both subjectively and objectively measured, sleep problems and sleep hygiene. Methods: Medline, CINAHL, PsycINFO, EMBASE, ERIC, Web of Science, and PubMed databases were searched for studies with case-control designs (published between 1980 and 2022) directly comparing sleep in adolescents (12-25 years) with ADHD to typically developing controls. Standardized mean differences were calculated and a random-effects model was implemented using RevMan. Results: Overall, 6974 titles/abstracts and 205 full texts were screened, resulting in 13 eligible studies. The sample sizes range from 35 to 9846 with in total 2465 adolescents with ADHD and 18,417 controls. The data suggests that adolescents with ADHD report significantly more disturbed subjective sleep parameters (e.g., total sleep time; n = 7, SMD = 0.47, p < .001) and experience more sleep problems compared to typically developing peers (e.g., daytime sleepiness; n = 5, SMD = 0.54, p = .01). Only few studies objectively measured sleep and no significant differences were found between both groups (n = 3) in any parameter. Differences in sleep hygiene could not be examined due to a limited number of studies. Conclusions: Adolescents with ADHD report significantly worsened subjectively sleep parameters and more sleep problems compared to controls. These findings are still preliminary as a limited number of studies was identified. Nevertheless, it is advised to routinely include sleep assessment in the ADHD diagnostic process. More research is needed with a focus on objective measurement and sleep hygiene in ADHD.

Temporal discounting of monetary rewards in children and adolescents with ADHD and autism spectrum disorders.

It has been difficult to differentiate attention-deficit/hyperactivity disorder (ADHD) and autism spectrum disorder (ASD) in terms of some aspects of their cognitive profile. While both show deficits in executive functions, it has been suggested that they may differ in their response to monetary reward. For instance, children with ADHD prefer small immediate over large delayed rewards more than typically developing controls. One explanation for this is that they discount the value of rewards to a higher degree as they are moved into the future. The current study investigated whether children with ADHD can be differentiated from those with ASD in terms of reward discounting. Thirty-nine children (8-16 y) with ADHD, 34 children with ASD and 46 typically developing controls performed a hypothetical monetary temporal discounting task. Participants were instructed to make repeated choices between small variable rewards (0, 5, 10, 20, 30€) delivered immediately and large rewards delivered after a variable delay. Children with ADHD but not ASD discounted future rewards at a higher rate than typically developing controls. These data confirm steeper discounting of future rewards in ADHD and add to a small but growing literature showing that the psychological profile of ADHD can be distinguished from that of ASD in terms of disrupted motivational processes.

Assessing the acceptability of individual studies that use deception: A systematic review of normative guidance documents.

Research participants are often deceived for methodological reasons. However, assessing the ethical acceptability of an individual study that uses deception is not straightforward. The academic literature is scattered on the subject and several aspects of the acceptability assessment are only scarcely addressed, which parallels reports of inconsistent ethics review. Therefore, we aimed to investigate where normative guidance documents agree and disagree about this assessment. A PRISMA-Ethics-guided systematic review of normative guidance documents that discuss deception of research participants was conducted. Our search strategy resulted in 55 documents that were subsequently analyzed through abductive thematic analysis. While guidance documents mention little about specific risks and opportunities of deception, our analysis describes a rich picture of the thresholds for acceptability of the risks and benefits of deception and their integration, the comparison with the risk-benefit analysis of alternative non-deceptive methods, and the bodies of people who are positioned to do the review. Our review reveals an agreement on the general process of assessing the acceptability of studies that use deception, although significant variability remains in the details and several topics are largely or completely unaddressed in guidance documents.

Distance learning during the COVID-19 pandemic for children with ADHD and/or ASD: a European multi-center study examining the role of executive function deficits and age.

BACKGROUND: One of the COVID-19 pandemic consequences that has affected families the most is school lockdowns. Some studies have shown that distance learning has been especially challenging for families with a child with neurodevelopmental disorders such as ADHD or ASD. However, previous studies have not taken the heterogeneity of these disorders into account. The aim of the present study was therefore to investigate differences between families with a child with ADHD, ASD, or both conditions, and to examine the role of underlying deficits in executive functioning (EF) in both children and parents in relation to negative and positive effects of distance learning. METHODS: Survey data assessing both negative and positive experiences of distance learning were collected from parents with a child aged 5-19 years in seven Western European countries: the UK, Germany, Spain, Sweden, the Netherlands, Italy, and Belgium. Altogether, the study included 1010 families with a child with ADHD and/or ASD and an equally large comparison group of families with a child without mental health problems. We included measures of three different types of negative effects (i.e., effects on the child, effects on the parent, and lack of support from school) and positive effects on the family. RESULTS: Results confirmed that families with a child with ADHD, ASD or a combination of ADHD and ASD showed higher levels of both negative and positive effects of distance learning than the comparison group. However, few differences were found between the clinical groups. Group differences were more pronounced for older compared to younger children. Regarding the role of both ADHD/ASD diagnosis and EF deficits, primarily children's EF deficits contributed to high levels of negative effects. Parent EF deficits did not contribute significantly beyond the influence of child EF deficits. Families of children with ADHD/ASD without EF deficits experienced the highest levels of positive effects. CONCLUSIONS: School closings during COVID-19 have a major impact on children with EF problems, including children with neurodevelopmental disorders. The present study emphasizes that schools should not focus primarily on whether a student has a neurodevelopmental disorder, but rather provide support based on the student's individual profile of underlying neuropsychological deficits.

Psychological and psychiatric issues in urinary and fecal incontinence.

PURPOSE: We provide an overview of the psychological and psychiatric aspects of nocturnal enuresis, urinary and fecal incontinence. Clinical behavioral disorders and subclinical psychological symptoms are reviewed. Aspects of screening, assessment, counseling and in severe cases treatment are outlined, and recommendations are formulated. MATERIALS AND METHODS: Relevant publications on psychological and psychiatric aspects are reviewed. The recommendations passed several rounds of consensus finding, and were circulated among International Children's Continence Society members and external experts. RESULTS: In addition to subclinical effects on self-esteem, quality of life and distress, the rate of comorbid clinical behavioral disorders is increased. In fact, 20% to 30% of children with nocturnal enuresis, 20% to 40% with daytime urinary incontinence and 30% to 50% with fecal incontinence fulfill the criteria for ICD-10 or Diagnostic and Statistical Manual of Mental Disorders IV psychiatric disorders. These concomitant disturbances require assessment and counseling, and in severe cases treatment. They have a negative effect on compliance and outcome if not addressed and left untreated. CONCLUSIONS: Because the comorbidity rate is high, screening for psychological symptoms is recommended for all children in all settings with enuresis and/or daytime urinary and/or fecal incontinence. Standardized, validated questionnaires are recommended. In addition to clinical observation and history, a short screening questionnaire can be used as a first step. If problem behaviors are present a longer broadband questionnaire is recommended. If problem items in the clinical range are noted, a full child psychiatric or psychological assessment is recommended.

Common alterations in sensitivity to type but not amount of reward in ADHD and autism spectrum disorders.

BACKGROUND: Children with attention deficit/hyperactivity disorder (ADHD) display abnormalities in reward processing. Most reward studies have focused on the effects of material or monetary rewards. Studies with autism spectrum disorder (ASD) have focused on social rewards. In this study we compared the effects of amount and type of reward in children with ADHD and those with ASD. METHODS: Two adapted versions of the Monetary Incentive Delay Task were used to study the effects of monetary and social reward anticipation on performance in 40 typically developing (TD) children and adolescents (8-16y), 35 children and adolescents with ADHD and 31 children and adolescents with ASD. RESULTS: Monetary and social reward improved accuracy and response time (RT) in all groups. The higher the anticipated reward, the more accurate and faster were responses. Independent of these effects, there was a differential effect of reward type. Both clinical groups, but not TD, responded faster for monetary than social rewards. CONCLUSIONS: The results, while not supporting hyposensitivity to changes in reward amount in ADHD and ASD, do suggest that both groups are generally less motivated in settings where social as opposed to monetary rewards can be earned.

Strengthening Executive Function and Self-Regulation Through Teacher-Student Interaction in Preschool and Primary School Children: A Systematic Review.

Executive functions (EF) and self-regulation (SR) are fundamental for children's learning, school functioning and academic achievement. EF/SR fail to develop to its full potential if contextual stimulation is not adequately presented. This is evident in the training programmes directly and exclusively targeting EF/SR stimulation, which lack durable and transferable effects. Therefore, recent research has shifted the attention towards malleable environmental factors; more specifically, to the role of school and classroom environment as an important developmental context for promoting children's EF/SR skills and, in turn, their cognition and behaviour. Numerous observational studies have shown a correlation between the quality of teacher-student relationship (TSR) at the dyadic level or teacher-student interaction (TSI) at the classroom level and children's EF/SR skills. To explore the direction of this association, the objective of this systematic literature review was to examine the causal effect of experiments and interventions that aim to improve children's EF/SR by manipulating the TSI. Overall, the results from 18 included studies indicated that children in treatment groups show higher gains, albeit small-sized, in EF/SR performance compared to controls. Furthermore, TSI manipulation seemed to affect children's SR skills more strongly than children's EF skills. More importantly, the findings revealed the largest effects of these manipulations in children considered vulnerable or disadvantaged, suggesting that the cognitive deficits can be minimised if these children are supported appropriately. Given high study heterogeneity, this review highlights the need for more research (and interventions) explicitly investigating TSI and TSR and their potential impact on EF and SR in children. This study aims to provide information as to which specific aspects need to be examined more closely, instructing further development and implementation of efficient and effective interventions in education.

Features of Flemish Emerging Adults and their Association with Demographic Markers.

As the Inventory of Dimensions of Emerging Adulthood (IDEA) was developed to assess features of emerging adulthood, international differences have been observed between emerging adults over the world. To assess the IDEA's applicability to emerging adults in Flanders, a Dutch translation was administered to 489 participants between 17 and 26 years old, and exploratory and confirmatory factor analyses were performed. Important latent factors in the version used in the United States of America, such as focus on others, were not observed. Four subscales were created to reflect psychological features of our sample, combining elements of both Arnett's theory of emerging adulthood and neo-Eriksonian theories of identity development. A new subscale, reflecting commitment and responsibility, was more present in older participants and employed participants, and associated with well-being. Finally, results suggested that employment, as well as place of residency, and romantic relationships significantly influence psychological development during young adulthood.

Problem behavior, parental stress and enuresis.

PURPOSE: We determined maternal and paternal ratings of problem behavior in 5 to 13-year-old children with (non)monosymptomatic enuresis and investigated parental stress and the association between parental ratings of child behavior and parental stress. MATERIALS AND METHODS: We compared problem behavior in 78 children with (non)monosymptomatic enuresis vs that in 110 without enuresis using the Child Behavior Checklist and the Disruptive Behavior Disorders Rating Scale. Parental stress was measured using the Parenting Stress Index. RESULTS: Maternal results replicated previous findings of significantly higher Child Behavior Checklist scores for externalizing and total problems compared with those in the control group, whereas no significant differences were found for paternal ratings. Mothers and fathers of enuretic children reported significantly higher scores on the Disruptive Behavior Disorders Rating Scale inattention, hyperactivity/impulsivity and oppositional defiant disorder subscales than parents of children without enuresis. The Parenting Stress Index revealed significantly higher overall stress in mothers and fathers of children with (non)monosymptomatic enuresis compared with that in parents of controls. Especially parental stress related to child characteristics was associated with a greater report of child behavior problems. CONCLUSIONS: Each parent but especially mothers reported more problem behavior in children with (non)monosymptomatic enuresis than in controls. They also reported more stress, which correlates highly with parental ratings of problem behavior in children with (non)monosymptomatic enuresis.

The Implementation of Extended Examination Duration for Students With ADHD in Higher Education.

OBJECTIVE: Recently, research indicated that extended examination duration was perceived as effective by students with ADHD. However, the objective effectiveness of this accommodation has not been researched extensively. This study addresses this gap in literature. METHOD: A total of 30 students with ADHD and 30 matched typically developing controls (TDC) participated in a simulation of a real-life examination. They filled in three parallel versions of a paper-and-pencil test in three time conditions: 1 hr (+0%), 1 hr 20 min (+33%), and 1 hr 30 min (+50%). RESULTS: When granted extended examination duration, students with ADHD and TDC use extra time but their performance does not increase. In addition, test-taking strategies were altered to a limited extent, and strategies that are perceived as effective (e.g., marking key words) were rarely used by the students. CONCLUSION: It is concluded that extended examination duration is not objectively effective in an experimental design. Limitations and guidelines for future research are formulated.