Physical activity of older children and adolescents in Germany - Results of the HBSC study 2022 and trends since 2009/10.

Background: Physical activity is central to health, beginning in childhood and adolescence, and regular monitoring provides important information for strategic decisions on promoting physical activity in Germany. Methods: The current survey cycle of the Health Behaviour in School-aged Children (HBSC) study gives an insight into the prevalence of the indicators daily recommended physical activity, high and low physical activity, and sporting activity among students aged between 11 and 15 for 2022. In addition, the data is compared to the survey cycles of the 2009/10, 2013/14, and 2017/18 school years and analysed over time. Results: The results of the current survey cycle show that 10.8 % of girls, 20.9 % of boys, and 12.4 % of gender diverse adolescents fulfil the daily physical activity recommendation. There are also major gender-specific differences for the other indicators. The group of gender diverse adolescents needs to be analysed further. The changes over time between 2009/10 and 2022 are relatively small. While girls' physical activity habits decreased slightly for the various indicators between 2009/10 and 2022, boys' prevalence remained relatively stable over the same period. Conclusions: Overall, in part due to the effects of the various COVID-19 lockdowns, the need for effective and population-based measures to promote physical activity in childhood and adolescence remains high.

Concept and methodology of the Health Behaviour in School-aged Children (HBSC) study - Insights into the current 2022 survey and trends in Germany.

Background: Health Behaviour in School-aged Children (HBSC) is one of the largest international studies on child and adolescent health and cooperates with the World Health Organization (WHO). In Germany, adolescents aged 11, 13 and 15 are surveyed every four years about their health, health behaviour and social conditions. This article describes the HBSC study and in particular the methodology of the current 2022 survey and prior surveys conducted between 2009/10 and 2017/18. Method: 174 schools with a total of 6,475 students participated in the 2022 survey. The survey was conducted using questionnaires and covered a wide range of topics (including mental health, physical activity, bullying experiences, social determinants of health and experiences related to COVID-19). The 2022 survey was complemented by a school principal survey (N = 160). In addition to the current sample, the samples of the three previous surveys with representative data for Germany are presented: 2009/10 (N = 5,005), 2013/14 (N = 5,961) and 2017/18 (N = 4,347). Discussion: The health of children and adolescents is of great public health importance. The HBSC study makes a substantial contribution by providing internationally comparable results, analysing trends, and providing stakeholders with comprehensive and representative health monitoring data.

Subjective health and psychosomatic complaints of children and adolescents in Germany: Results of the HBSC study 2009/10 - 2022.

Background: Subjective health and well-being are important health indicators in childhood and adolescence. This article shows current results and trends over time between 2009/10 and 2022. Methods: The Health Behaviour in School-aged Children (HBSC) study examined subjective health, life satisfaction and psychosomatic complaints of N = 21,788 students aged 11 to 15 years in the school years 2009/10, 2013/14, 2017/18 and in the calendar year 2022. Multivariate regression analyses show the associations between sociodemographic characteristics and well-being in 2022, as well as trends since 2009/10. Results: The majority of children and adolescents indicate a good subjective health and high life satisfaction. About half of the girls and one third of the boys report multiple psychosomatic health complaints, with a clear increase over time. Older adolescents, girls and gender diverse adolescents are at an increased risk of poor well-being. Subjective health and life satisfaction varied between 2009/10 and 2022, with a significant deterioration between 2017/18 and 2022. Conclusions: The high proportion of children and adolescents with psychosomatic complaints, as well as the observed gender and age differences, underline the need for target group-specific prevention, health promotion and continuous health monitoring.

Gender and Age Differences in ADHD Symptoms and Co-occurring Depression and Anxiety Symptoms Among Children and Adolescents in the BELLA Study.

Attention-deficit/hyperactivity disorder (ADHD) is one of the most diagnosed neurodevelopmental disorders of childhood. Current studies addressing gender and age differences in ADHD are lacking. The present study aims to fill this research gap by dimensionally evaluating gender and age differences in ADHD symptoms, as measured by a DSM-5-based parent rating scale, in children and adolescents who participated in the two-year follow-up of the community-based BELLA study (n = 1326). Associations between ADHD symptoms and depression symptoms and anxiety symptoms were also examined. Multiple linear regressions revealed significant associations between gender and all ADHD symptoms. Age was significantly associated with hyperactive/impulsive symptoms. Additional multiple linear regressions demonstrated significant positive associations between depression and anxiety symptoms and ADHD symptoms. Further, female gender was found to be positively associated with both depression and anxiety symptoms. These findings may suggest a need for more gender-specific approaches to ADHD diagnosis and treatment, as well as more research into the intersections of ADHD and depression and anxiety symptoms in children and adolescents.

Socioeconomic Status, Protective Factors, and Mental Health Problems in Transition from Adolescence to Emerging Adulthood: Results of the Longitudinal BELLA Study.

Lower familial socioeconomic status (SES) is associated with more mental health problems in adolescence. The aim of this study was to identify factors that may protect adolescents from families with lower SES from developing mental health problems in emerging adulthood. Data of the population-based longitudinal BELLA study included n = 426 participants aged 13 to 17 years at t0 (2009-2012) and 18 to 24 years at t1 (2014-2017). Hierarchical multiple linear regressions with interaction terms were conducted, examining three selected protective factors (self-efficacy, family climate, and social support). Self-efficacy had a small protective effect for adolescents from families with lower SES for mental health problems in emerging adulthood. However, social support had a small protective effect for adolescents from families with higher SES. No moderating effect was found for family climate. Instead, better family climate in adolescents predicted fewer mental health problems in emerging adulthood with a small effect regardless the SES in adolescence. Results indicate the need for prevention measures for adolescents from families with lower SES for becoming mentally healthy emerging adults.

The youth mental health crisis: Quasi-experimental evidence on the role of school closures.

During the COVID-19 pandemic, the youth mental health crisis has reached unprecedented levels. To which extent school closures, one of the most heavily debated pandemic measures, have contributed to or even caused this crisis is largely unknown. We seek to narrow this blind spot, by combining quasi-experimental variation in school closure and reopening strategies across the German federal states at the onset of the pandemic with nationwide, population-based survey data on youth mental health and high-frequency data from the largest crisis helpline. We show that prolonged school closures led to a substantial deterioration in youth health-related quality of life, precipitating early signs of mental health problems. The effects were most severe among boys, younger adolescents, and families with limited living space. We further provide evidence that family problems are a major issue that adolescents were struggling with when denied access to school. Overall, school closures largely explain the deterioration of youth mental health over the first pandemic wave.

Three years into the pandemic: results of the longitudinal German COPSY study on youth mental health and health-related quality of life.

Purpose: For the past three years, the German longitudinal COPSY (COVID-19 and PSYchological Health) study has monitored changes in health-related quality of life (HRQoL) and the mental health of children and adolescents during the COVID-19 pandemic. Methods: A nationwide, population-based survey was conducted in May-June 2020 (W1), December 2020-January 2021 (W2), September-October 2021 (W3), February 2022 (W4), and September-October 2022 (W5). In total, n = 2,471 children and adolescents aged 7-17 years (n = 1,673 aged 11-17 years with self-reports) were assessed using internationally established and validated measures of HRQoL (KIDSCREEN-10), mental health problems (SDQ), anxiety (SCARED), depressive symptoms (CES-DC, PHQ-2), psychosomatic complaints (HBSC-SCL), and fear about the future (DFS-K). Findings were compared to prepandemic population-based data. Results: While the prevalence of low HRQoL increased from 15% prepandemic to 48% at W2, it improved to 27% at W5. Similarly, overall mental health problems rose from 18% prepandemic to W1 through W2 (30-31%), and since then slowly declined (W3: 27%, W4: 29%, W5: 23%). Anxiety doubled from 15% prepandemic to 30% in W2 and declined to 25% (W5) since then. Depressive symptoms increased from 15%/10% (CES-DC/PHQ-2) prepandemic to 24%/15% in W2, and slowly decreased to 14%/9% in W5. Psychosomatic complaints are across all waves still on the rise. 32-44% of the youth expressed fears related to other current crises. Conclusion: Mental health of the youth improved in year 3 of the pandemic, but is still lower than before the pandemic.

Eating disorder symptoms among children and adolescents in Germany before and after the onset of the COVID-19 pandemic.

Background: Disordered eating is highly prevalent among children and adolescents. Since the outbreak of the COVID-19 pandemic, hospitalizations due to eating disorders have peaked and overweight has risen. The aim of this study was to determine differences in the prevalence of eating disorder symptoms among children and adolescents in Germany before and after the onset of the COVID-19 pandemic and to identify associated factors. Materials and methods: Eating disorder symptoms and associated factors were examined in a sample of n = 1,001 participants of the nationwide population-based COPSY study in autumn 2021. Standardized and validated instruments were used to survey 11-17-year-olds along with a respective parent. To identify differences in prevalence rates, logistic regression was used to compare results with data from n = 997 participants of the prepandemic BELLA study. Multiple logistic regression analyses were performed to examine associations with relevant factors in the pandemic COPSY sample. Results: Eating disorder symptoms were reported by 17.18% of females and 15.08% of males in the COPSY study. Prevalence rates were lower overall in the COPSY sample compared to before the pandemic. Male gender, anxiety, and depressive symptoms were associated with increased odds for eating disorder symptoms in the pandemic. Conclusion: The pandemic underscores the importance of further research, but also prevention and intervention programs that address disordered eating in children and adolescents, with a focus on age - and gender-specific differences and developments. In addition, screening instruments for eating disorder symptoms in youths need to be adapted and validated.

[Children's mental health: the role of screen time, parenting behavior, and parenting stress-a secondary data analysis of KiGGS and BELLA data]. / Mental Health im Kindesalter: der Einfluss von Mediennutzung, Erziehungsverhalten und elterlichem Stresserleben ­ eine Sekundärdatenanalyse von KiGGS- und BELLA-Daten.

BACKGROUND: Previous studies established a link between high screen time and mental health problems in childhood. The role of possible influencing factors is currently unclear. This study aims at testing correlations among mental health problems, high screen time, parenting stress, and inconsistent and positive parenting behavior. METHODS: This study is based on data from the KiGGS and BELLA studies. For the present study, data from preschool children (age: 3-5 years, N = 417) and school children (age: 7-13 years, N = 239) were analyzed. Binary-logistic regressions were carried out to test for correlations between high screen time and children's mental health problems in cross-sectional and longitudinal analyses. Socioeconomic status, the child's gender, the parent's gender, parenting stress, and inconsistent and positive parenting behavior were used as control variables. RESULTS: In the cross-sectional analysis, mental health problems in preschool children were associated with high screen time (OR = 3.02; p = 0.003), parenting stress (OR = 17.00; p < 0.001), and positive parenting behavior (OR = 0.24; p < 0.001). In the longitudinal analysis, mental health problems in school children were associated with parenting stress (OR = 4.04; p < 0.001). Socioeconomic status and the child's and parent's gender were at no point associated with mental health problems. DISCUSSION: The sole existence of high screen time cannot explain mental health problems in children. Parental variables seem to be critical for children's mental health and should be considered in a holistic apporach on children's mental health in terms of strengthening parental competencies.

[The COVID-19 pandemic-How did it affect the mental health of children?] / Die COVID-19-Pandemie ­ Wie hat sie die Kinderpsyche beeinflusst?

Background: The COVID-19 pandemic has had a substantial impact on the daily life of children and adolescents due to lockdowns, contact restrictions, closings of childcare, schools and leisure facilities. Objective: This article examines the impact of the pandemic on the mental health of children and adolescents in Germany. Material and methods: In the population-based longitudinal COPSY study (COVID-19 and Psychological Health) 1600 parents of children aged 7-17 years old and 1000 children and adolescents aged 11-17 years old completed established questionnaires at 5 online survey points (t1: May and June 2020 to t5: September and October 2022). For comparison, pre-pandemic data were obtained from the representative BELLA study. Results: During the pandemic the portion of children and adolescents, who reported a low health-related quality of life, increased from pre-pandemic 15% to 48% in the first year of the pandemic and improved in year 3 to 27%. This is still substantially above pre-pandemic levels. Similar trajectories were found for mental health problems which rose from 18% (pre-pandemic) to 31% and improved in year 3 to 23%. For anxiety and depression, the changes were similar except that depressive symptoms returned to pre-pandemic levels in year 3. The physical activity of almost one third of the youth was still very low in year 3. Conclusion: The mental health of children and adolescents was ignored during the pandemic for a long time. Now support and allocation of funding is urgently needed to mitigate the negative mental health effects and prevent further impairment by new crises.

[Epidemiology of mental well-being in childhood and adolescence. Results from three epidemiological studies before and during the COVID-19 pandemic]. / Epidemiologie seelischen Wohlbefindens von Kindern und Jugendlichen in Deutschland. Ergebnisse aus 3 Studien vor und während der COVID-19-Pandemie.

BACKGROUND: Continuous nationwide health monitoring is important to track the well-being of children and adolescents and to map developmental trajectories. Based on the results of three selected epidemiological studies, developments in child well-being over the past 20 years are presented. METHODS: Data are based on (1) the mental health module of the German National Health Interview and Examination Survey among Children and Adolescents (BELLA study, 2003-2017, N = 1500 to 3000), which is a module of the KiGGS study; (2) the COvid-19 and PSYchological Health Study (COPSY, 2020-2022, N = 1600-1700), which is based on the BELLA Study; and (3) the International Health-Behaviour in School-aged Children Study (HBSC, 2002-2018, N = 4300-7300). Well-being was assessed in 7­ to 17-year-olds using indicators of health-related quality of life (KIDSCREEN-10), life satisfaction (Cantril Ladder), and mental health problems (Strenghts and Difficulties Questionnaire (SDQ), Screen for Child Anxiety Related Emotional Disorders (SCARED), and Center for Epidemiological Studies Depression Scale for Children (CES-DC)). RESULTS: Overall, children and adolescents show consistently high health-related quality of life and high overall life satisfaction pre-pandemic (2002-2018), which initially worsened with the onset of the 2020 COVID-19-pandemic. Two years later, improvements are evident but have not yet reached baseline levels. Psychological problems, as well as symptoms of anxiety and depression, increased by up to 12 percentage points at the beginning of the pandemic and are still higher two years after the onset of the pandemic compared to pre-pandemic studies. CONCLUSION: The epidemiology of child well-being provides a necessary data basis to assess the support needs of children and adolescents and to use this as a basis for developing measures of health promotion, prevention, and intervention.

Lessons Learned-The Impact of the Third Wave of the COVID-19 Pandemic on German Waldorf Parents' Support Needs and Their Rating of Children's Health-Related Quality of Life: A Cross-Sectional Online Survey.

BACKGROUND: COVID-19-related lockdowns and homeschooling have imposed a substantial burden on school-aged children and parents. Waldorf education is a reform-educational concept. Little is known about the situation of German Waldorf families under pandemic conditions. METHODS: A cross-sectional, online, parent-proxy survey was conducted regarding the third pandemic wave. The primary outcome was parents' support needs, assessed with questions from the German COPSY (COVID-19 and PSYchological Health) study; the secondary outcome was children's HRQoL (KIDSCREEN-10, proxy version). RESULTS: We analyzed questionnaires from 431 parents of 511 Waldorf students aged 7 to 17 years. While 70.8% of Waldorf parents (WPs) reported a general need for support in dealing with their children, 59.9% of COPSY parents (CPs) indicated this need. WPs' support needs in dealing with their children's academic demands were similar to CPs' needs but relatively higher in terms of dealing with emotions and moods, behavior, and relationships within the family. WPs sought support mainly from school and teachers (65.6%). Support needs were high, although WPs rated their children's HRQoL higher than CPs. CONCLUSIONS: Our results underline the substantial pandemic-related burden on families across school types. WPs participating in this survey gave evidence that supports should focus on academic demands as well as psychosocial issues.

[Prevention perspective: mental health of schoolchildren in Germany]. / Perspektive Prävention: Psychische Gesundheit von Schülerinnen und Schülern in Deutschland.

BACKGROUND: The COVID-19 pandemic has impacted the learning and health of children and adolescents. The aim of this paper is to examine school students' mental health problems, family burden, and support needs during the pandemic depending on the type of school. Approaches to school-based prevention and health promotion are discussed. METHODS: Findings are based on data from the population-based COPSY study (T1: 05/2020 - T4: 02/2022) and the BELLA study (T0, pre-pandemic comparison). Approximately 1600 families with children aged 7 to 19 years were surveyed at each measurement point (T). Mental health problems were assessed using the SDQ, while family burden and support needs were captured with individual items in the parent report. RESULTS: Mental health problems increased among students in all school types at the beginning of the pandemic and have stabilized at a high level. Elementary school students are particularly affected (increase from 16.9% pre-pandemic to 40.0% at T2), especially in behavioral problems (11.7% to 24.6%) and hyperactivity (13.9% to 34.0%). Secondary school students also show higher levels of mental health problems (21.4% to 30.4%). Pandemic-related burden is consistently high, as is the need for family support received from schools/teachers and experts. DISCUSSION: There is a high need for mental health promotion and prevention measures in the school setting. These should start at primary school age in the sense of a "whole school approach" at different levels and include external stakeholders. In addition, binding legal requirements are needed in all federal states to create framework conditions and structures for school-based health promotion and prevention, including access to necessary resources.

Effects of a Pretend Play Intervention on Health-Related Quality of Life in Children With Cancer: A Swedish-German Study.

Background: Cancer diagnosis can lead to massive physical, emotional, and social burdens on children and their families. Although children have the right to be informed and participate in their care, research shows that children's views are often not considered in care situations. Thus, it is essential to strengthen children's communication and self-efficacy (SE) to convey desires and needs. The present study explores whether a play intervention is associated with improved health-related quality of life (HrQoL) and SE for communication in care situations. We hypothesize that HrQoL and SE for communication will increase from the beginning to after the pretend play intervention. Methods: Children with cancer from Germany and Sweden were enrolled. The pretend play intervention consisted of six to 10 play sessions. A heterogenic selection of questionnaires was used to measure children's HrQoL and SE before the first pretend play session and after the last play intervention. Results: Nineteen families were included in the presented analyses, including 14 self-reports of children and 19 proxy reports of parents. We found improvements in child-reported communication, and emotional and psychosocial well-being using generic and cancer-specific HrQoL measurements. Further, children's SE in care situations improved during the play intervention. Parents also reported minor improvements in the physical dimensions in both generic and chronic-generic HrQoL, along with improvements in independence. Discussion: Overall, the cancer-specific pretend play intervention offers young children with cancer a secure environment and can contribute to their well-being, and communication skills, during or after cancer treatment.

Systematic Review of Gender-Specific Child and Adolescent Mental Health Care.

Gender differences in mental health emerge as early as in childhood and adolescence, highlighting the potential need for gender-specific child and adolescent mental health care. However, it is unclear how gender-specific child and adolescent mental health care is implemented and whether its' approaches are useful. Therefore, this study reviews gender-specific interventions and their effectiveness for child and adolescent mental health. Five databases were searched for articles published between 2000 and 2021. In total, 43 studies were included. Most interventions were conducted in school (n = 15) or community settings (n = 8). Substance-related disorders (n = 13) and eating disorders (n = 12) were addressed most frequently. Most interventions targeted girls (n = 31). Various gender-specific aspects were considered, including gender-specific risk and protective factors (n = 35) and needs (n = 35). Although most interventions yielded significant improvements in mental health outcomes (n = 32), only few studies reported medium or large effect sizes (n = 13). Additionally, there was a lack of strong causal evidence derived from randomized controlled trials, calling for more rigorous trials in the research field. Nevertheless, our findings indicate that gender-specific mental health care can be a promising approach to meet gender-specific mental health needs.

Quality of life and mental health in children and adolescents during the first year of the COVID-19 pandemic: results of a two-wave nationwide population-based study.

BACKGROUND: The COVID-19 pandemic has disrupted the lives of children and adolescents worldwide. The German COPSY study is among the first population-based longitudinal studies to examine the mental health impact of the pandemic. The objective of the study was to assess changes in health-related quality of life (HRQoL) and mental health in children and adolescents and to identify the associated risk and resource factors during the pandemic. METHODS: A nationwide longitudinal survey was conducted with two waves during the pandemic (May/June 2020 and December 2020/January 2021). In total, n = 1923 children and adolescents aged 7 to 17 years and their parents participated (retention rate from wave 1 to wave 2: 85%). The self-report and parent-proxy surveys assessed HRQoL (KIDSCREEN-10), mental health problems (SDQ with the subscales emotional problems, conduct problems, hyperactivity, and peer problems), anxiety (SCARED), depressive symptoms (CES-DC, PHQ-2) and psychosomatic complaints (HBSC-SCL). Mixed model panel regression analyses were conducted to examine longitudinal changes in mental health and to identify risk and resource factors. RESULTS: The HRQoL of children and adolescents decreased during the pandemic, and emotional problems, peer-related mental health problems, anxiety, depressive and psychosomatic symptoms increased over time, however the change in global mental health problems from wave 1 to wave 2 was not significant, and some changes were negligible. Socially disadvantaged children and children of mentally burdened parents were at particular risk of impaired mental health, while female gender and older age were associated with fewer mental health problems. A positive family climate and social support supported the mental health of children and adolescents during the pandemic. DISCUSSION: Health promotion, prevention and intervention strategies could support children and adolescents in coping with the pandemic and protect and maintain their mental health.

The DADYS-Screen: Development and Evaluation of a Screening Tool for Affective Dysregulation in Children.

Affective dysregulation (AD) in children is characterized by persistent irritability and severe temper outbursts. This study developed and evaluated a screening questionnaire for AD in children. The development included the generation of an initial item pool from existing instruments, a Delphi rating of experts, focus groups with experts and parents, and psychometric analyses of clinical and population-based samples. Based on data of a large community-based study, the final screening questionnaire was developed (n = 771; 49.7 % female; age M = 10.02 years; SD = 1.34) and evaluated (n = 8,974; 48.7 % female; age M = 10.00 years; SD = 1.38) with methods from classical test theory and item response theory. The developed DADYS-Screen (Diagnostic Tool for Affective Dysregulation in Children-Screening Questionnaire) includes 12 items with good psychometric properties and scale characteristics including a good fit to a one-factorial model in comparison to the baseline model, although only a "mediocre" fit according to the root mean square error of approximation (RMSEA). Results could be confirmed using a second and larger data set. Overall, the DADYS-Screen is able to identify children with AD, although it needs further investigation using clinical data.

Mental health and quality of life in children and adolescents during the COVID-19 pandemic: a systematic review of longitudinal studies.

Background: The COVID-19 pandemic has significantly impacted the mental health of children and families, i.e., due to measures like social distancing and remote schooling. While previous research has shown negative effects on mental health and health-related quality of life (HRQoL), most studies have focused on pre-post comparisons in the early pandemic stages. This systematic review aims to examine longitudinal studies to understand the long-term impacts of the pandemic on children and adolescents. Methods: This systematic review adhered to the PRISMA guidelines and was preregistered in the international prospective register of systematic reviews (Record ID: CRD42022336930). We systematically searched PubMed/MEDLINE, Web of Science, PsycINFO, PSYNDEX, and the WHO-COVID-19 database and included studies published up to August 30, 2022. Based on pre-defined eligibility criteria, longitudinal and prospective studies that assessed the mental health or quality of life of children or adolescents (0-19 years) in the general population over a longer time span (at two or more measurement points) during the COVID-19 pandemic were included in the review. The methodological quality of the included studies was assessed using an adapted version of the Effective Public Health Practice Project (EPHPP) checklist. Narrative data synthesis was used to summarize the findings. Results: A total of 5,099 results were obtained from literature searches, with 4,935 excluded during title/abstract screening. After reviewing 163 full-text articles, 24 publications were included in the review. Sample sizes ranged between n = 86 and n = 34,038. The length of the investigated time periods and the number of assessment points, as well as outcomes, varied. The majority of studies were of moderate methodological quality. Mental health outcomes were more frequently studied compared to measures of HRQoL. The findings from these studies mostly suggest that children and adolescents experienced heightened mental health problems, specifically internalizing symptoms like anxiety and depression. Further, there was a decline in their overall HRQoL over the course of the COVID-19 pandemic that did not necessarily subside when lockdowns ended. Conclusion: It is crucial to continue monitoring the mental health and well-being of children and adolescents following the pandemic to identify groups at risks and plan interventions. This should ideally be conducted by large systematic studies, using validated instruments, and encompassing representative samples to obtain reliable and comprehensive insights with the aim of improving youth mental health care.

Validation of a new emotion regulation self-report questionnaire for children.

OBJECTIVE: To examine and validate the self-report Questionnaire on the Regulation of Unpleasant Moods in Children (FRUST), which is a modified and shortened version of the Questionnaire for the Assessment of Emotion Regulation in Children and Adolescents (FEEL-KJ). METHODS: The data comprised child and parent ratings of a community-screened sample with differing levels of affective dysregulation (AD) (N = 391, age: M = 10.64, SD = 1.33, 56% male). We conducted latent factor analyses to establish a factor structure. Subsequently, we assessed measurement invariance (MI) regarding age, gender, and AD level and evaluated the internal consistencies of the scales. Finally, we examined the convergent and divergent validity of the instrument by calculating differential correlations between the emotion regulation strategy (ERS) scales and self- and parent-report measures of psychopathology. RESULTS: A four-factor model, with one factor representing Dysfunctional Strategies and the three factors Distraction, Problem-Solving and Social Support representing functional strategies provided the best fit to our data and was straightforward to interpret. We found strong MI for age and gender and weak MI for AD level. Differential correlations with child and parent ratings of measures of psychopathology supported the construct validity of the factors. CONCLUSIONS: We established a reliable and valid self-report measure for the assessment of ERS in children. Due to the reduced number of items and the inclusion of highly specific regulatory behaviors, the FRUST might be a valuable contribution to the assessment of ER strategies for diagnostic, therapeutic, and research purposes.