Examining the Effectiveness of an Intensive Telemental Health Treatment for Pediatric Anxiety and OCD During the COVID-19 Pandemic and Pediatric Mental Health Crisis.

Despite research supporting the efficacy of weekly outpatient videoconferencing-based cognitive behavioral therapy (VCBT), limited evidence exists about the benefits of leveraging VCBT for brief intensive formats. We examined the effectiveness of an intensive outpatient VCBT targeting pediatric anxiety and OCD. Quasi-experimental design was used to compare outcomes of intensive, in-person, group-based cognitive-behavioral therapy with medication management and caregiver guidance pre-pandemic, to a similar VCBT peri-pandemic (n = 130). Pretreatment and posttreatment assessments included patient- and caregiver-report of anxiety and functional impairment. Analyses of covariance were conducted, examining changes in anxiety and impairment between treatment groups, controlling for admission levels. No significant differences in posttreatment anxiety or impairment were observed between conditions. This study illustrates that intensive, group-based treatment for pediatric anxiety and OCD using VCBT is associated with comparable reductions in anxiety and impairment. It marks a crucial step toward providing broader access to quality care for youth in need.

Associations between parental distress and pediatric anxiety and obsessive-compulsive disorder treatment outcomes.

This study investigated whether an intensive group-based cognitive-behavioral therapy program with family involvement for children with anxiety disorders and obsessive-compulsive disorder could help reduce parental distress by addressing the larger family system. This study also examined associations between parental distress and parent-reported child outcomes of treatment. Two hundred ninety-nine children and adolescents, ages 6-19, who were patients in the intensive treatment program and their caregivers participated in this intervention-based study. Parents reported significant reductions in their own distress from admission to discharge, and greater reductions in parent-reported distress predicted greater reductions in parents' reports of their children's anxiety symptoms and the degree of child functional impairment. Higher levels of parent-reported parent mental health symptoms at children's admission and at discharge were associated with poorer levels of functioning in children at discharge. Parents' mental health symptoms may play a critical role in children and adolescents' treatment outcomes and therefore may need to be a separate treatment target.

Clinical Outcomes Following Acute Residential Psychiatric Treatment in Transgender and Gender Diverse Adolescents.

Importance: Transgender and gender diverse (TGD) individuals, who have a gender identity that differs from their sex assigned at birth, are at increased risk of mental health problems, including depression, anxiety, self-injurious behavior, and suicidality, relative to cisgender peers. Objective: To examine mental health outcomes among TGD vs cisgender adolescents in residential treatment. Design, Setting, and Participants: This cohort study's longitudinal design was used to compare groups at treatment entry and discharge, and 1-month postdischarge follow-up. The setting was an adolescent acute residential treatment program for psychiatric disorders. Participants were TGD or cisgender adolescents enrolled in the treatment program. Statistical analysis was performed October 2019 to March 2021. Exposure: Adolescents participated in a 2-week acute residential treatment program for psychiatric disorders. Main Outcomes and Measures: Primary outcomes were depressive (the Center for Epidemiologic Studies Depression Scale [CES-D]) and anxiety (the Multidimensional Anxiety Scale for Children [MASC]) symptoms, and emotional dysregulation (the Difficulties in Emotion Regulation Scale [DERS]), measured at treatment entry and discharge, and postdischarge follow-up. Age of depression onset, suicidality, self-injury, and childhood trauma also were assessed at treatment entry. Results: Of 200 adolescent participants who completed treatment entry and discharge assessments, the mean (SD) age was 16.2 (1.5) years; 109 reported being assigned female at birth (54.5%), 35 were TGD (17.5%), and 66 (49.3%) completed 1-month follow-up. TGD participants had an earlier mean (SD) age of depression onset (TGD: 10.8 [2.4] years vs cisgender: 11.9 [2.3] years; difference: 1.07 years; 95% CI, 0.14-2.01 years; P = .02), higher mean (SD) suicidality scores (TGD: 44.4 [23.1] vs cisgender: 28.5 [25.4]; difference: 16.0; 95% CI, 6.4-25.5; P = .001), more self-injurious behavior (mean [SD] RBQ-A score for TGD: 3.1 [2.5] vs cisgender: 1.7 [1.9]; difference: 1.42; 95% CI, 0.69-2.21; P = .001) and more childhood trauma (eg, mean [SD] CTQ-SF score for emotional abuse in TGD: 12.7 [5.4] vs cisgender: 9.8 [4.7]; difference: 2.85; 95% CI, 1.06-4.64; P = .002). The TGD group also had higher symptom scores (CES-D mean difference: 7.69; 95% CI, 3.30 to 12.08; P < .001; MASC mean difference: 7.56; 95% CI, 0.46 to 14.66; P = .04; and DERS mean difference: 18.43; 95% CI, 8.39 to 28.47; P < .001). Symptom scores were significantly higher at entry vs discharge (CES-D mean difference, -12.16; 95% CI, -14.50 to -9.80; P < .001; MASC mean difference: -3.79; 95% CI, -6.16 to -1.42; P = .02; and DERS mean difference: -6.37; 95% CI, -10.80 to -1.94; P = .05) and follow-up (CES-D mean difference: -9.69; 95% CI, -13.0 to -6.42; P < .001; MASC mean difference: -6.92; 95% CI, -10.25 to -3.59; P < .001; and DERS mean difference: -12.47; 95% CI, -18.68 to -6.26; P < .001). Conclusions and Relevance: This cohort study found mental health disparities in TGD youth relative to cisgender youth, with worse scores observed across assessment time points. For all participants, primary clinical outcome measures were significantly lower at treatment discharge than at entry, with no significant differences between discharge and 1-month follow-up. Given the substantial degree of mental health disparities reported in TGD individuals, these findings warrant focused clinical attention to optimize treatment outcomes in gender minority populations.

The impact of intensive treatment for pediatric anxiety and obsessive-compulsive disorder on daily functioning.

This study investigated whether intensive group-based cognitive-behavioral therapy (CBT) with family involvement for children with anxiety disorders and obsessive-compulsive disorder (OCD) would facilitate children's return to their daily routines. The focus shifted from the usual emphasis on remission to an improvement in functioning. The aim was to capture potentially missed gains when children pursue their fears and engage in more adaptive behaviors as these efforts may result in ongoing symptoms. Two hundred twelve children and adolescents aged 8-19 years old, who were patients in an intensive outpatient group-based treatment program at an academic hospital, participated in this study. Results indicated that both children and their parents endorsed significant improvement in children's functioning from admission to discharge. Symptom reduction was assessed for reference, and both children and parents reported significant decreases in child anxiety symptoms from admission to discharge, and children endorsed decreases in their comorbid depression symptoms. Short-term group-based intensive treatment in a clinical setting may help children return to their daily activities quickly.

Co-Occurring Depressive and Substance Use Disorders in Adolescents: An Examination of Reward Responsiveness During Treatment.

The goals of the present study were to examine: (a) putative dysfunctions in reward responsiveness in a sample of adolescents (n = 40) with co-occurring depressive and substance use disorders; (b) possible links between reward responsiveness and symptoms of depression, anhedonia, anxiety, and motivation for change in relation to alcohol and drug use; and (c) potential gender differences in findings. Before and after a 2-week residential treatment, adolescents completed self-report assessments of depression, anhedonia, anxiety symptoms, and motivation for change in relation to substance use. In addition, participants completed a computer-based Probabilistic Reward Task (PRT) to examine reward responsiveness (i.e., participants' ability to modulate behavior as a function of reinforcement history). Results indicated that depression and anhedonia symptoms decreased, and motivation for change in relation to drug use increased. Improved reward responsiveness over the course of residential treatment emerged in female, but not male, participants.

Enhancing the developmental appropriateness of treatment for depression in youth: integrating the family in treatment.

Treatment models for youth depression that emphasize interpersonal functioning, particularly family relationships, may be particularly promising. This article first reviews the current state of knowledge on the efficacy of psychosocial treatments for depression in youth, with an emphasis on family involvement in treatment. It then discusses developmental factors that may impact the applicability and structure of family-focused treatment models for preadolescent and adolescent youth. Finally, two family-based treatment models that are currently being evaluated in randomized clinical trials are described: one focusing on preadolescent depressed youth and the other on adolescents who have made a recent suicide attempt.

Enhancing maternal depression recognition in health care settings: a review of strategies to improve detection, reduce barriers, and reach mothers in need.

Maternal depression is a major public health concern in the United States affecting mothers, children, and families. Many mothers experience depression, and exposure to maternal depression can put children at increased risk for psychopathology and poor psychosocial development. Early recognition of maternal depression is a critical step in promoting healthy development and preventing adverse outcomes in children and families. In this review, we examine some of the major barriers that mothers face in seeking help for depression; discuss optimal settings in which to implement maternal depression screening; review available depression screening tools for identifying mothers in need of care; discuss steps providers can take after screening; examine barriers to screening; and present information about promising initiatives developed to address these barriers.

Maternal depression, maternal expressed emotion, and youth psychopathology.

Across development, maternal depression has been found to be a risk factor for youth psychopathology generally and youth depression specifically. Maternal Expressed Emotion (EE) has been examined as a predictor of outcome among youth with depression. The present study explored the associations between youth psychopathology and two predictors-maternal depression within the child's lifetime and maternal EE-in a study of children at risk for depression. One hundred and seventy-one youth, ages 8-12, and their mothers participated. To assess maternal and youth psychopathology, dyads were administered structured diagnostic assessments, and mothers and children completed self-report measures of their own depressive symptoms. In addition, mothers completed the Achenbach Child Behavior Checklist-Parent Report Version (CBCL) for their children. Maternal EE was assessed based on the Five Minute Speech Sample. History of maternal depression was associated with high maternal EE, and the combination of maternal depression history and maternal EE was associated with children's own reports of higher depressive symptoms. Current maternal depressive symptoms were associated with mothers' reports of children's Internalizing scores on the CBCL, and maternal depression history, current maternal depressive symptoms, and maternal EE were strongly associated with mothers' reports of children's Externalizing and Total Problem scores on the CBCL. History of maternal depression and a rating of high or borderline Critical EE (characterized by maternal critical comments and/or reports of a negative relationship) were independently associated with children's depression diagnoses.

Parental expressed emotion toward children: prediction from early family functioning.

Expressed emotion (EE), an index of family member criticism and emotional overinvolvement, predicts outcome among adults and children with mental disorders. However, limited research exists on factors contributing to EE. Aims of the current study were to (a) examine EE in mothers of young children; (b) assess relationships between demographic factors and EE in a diverse sample; and (c) investigate whether family stress and functioning, including quality of marital relationship, life events, maternal stress, and family environment, predict EE. In the current study, 276 mothers completed questionnaires when their children were between 1 and 3 years of age and a measure of EE when their children were in kindergarten. Results indicated that family expressiveness was the most consistent predictor of EE. Further research seems warranted to better delineate associations between family functioning and EE.