Real-time personalized feedback in mHealth for adolescents.

Mobile Health (mHealth) interventions have the potential to improve early identification, prevention, and treatment of mental health problems. Grow It! is a multiplayer smartphone app designed for youth aged 12-25, allowing them to monitor their emotions and engage in daily challenges based on Cognitive Behavioral Therapy (CBT) principles. Recently, a personalized mood profile was added to improve the app. We investigated whether real-time personalized feedback on mood enhances app engagement, user experience, and the effects on affective and cognitive well-being. Sample A (N = 1269, age = 18.60 SD = 3.39, 80.6% girls, 95.4% Dutch) played the original app without feedback on their mood, and an independent Sample B (N = 386, age = 16.04 SD = 3.21, 67.6% girls, 82.9% Dutch) received the renewed version with personalized real-time feedback on their mood. Participants who received personal feedback did not have higher app engagement (t(1750,400) = 1.39, P = .206, d = 0.07; t(692,905) = 0.36, P = .971, d = 0.0) nor higher user experience (t(177,596) = 0.21, P = .831, d = 0.02; (t(794) = 1.28, P = .202, d = 0.12; χ2 (659,141) = 2.83, P = .091). Players of the renewed version (Sample B) experienced significant improvements in affective (t(175) = 3.01, P = .003, d = 0.23) and cognitive well-being (t(175) = 3.48, P = <.001, d = 0.26) over the course of three weeks. The renewed version Grow It! has the potential to enhance youths' affective and cognitive well-being. However, adding real-time insights did not seem to affect app engagement nor user experience.

Development, validity, and reliability of the parent-adolescent communication about adolescents' social media use scale (PACAS).

Adolescents spend a substantial portion of their time using social media. Yet, there is a lack of understanding regarding how often parents and adolescents communicate about this social media use. To address this gap, we developed the Parent-Adolescent Communication about Adolescents' Social Media Use Scale (PACAS). In a first data wave, among 388 Dutch adolescents (13-15 years; 54% girls), exploratory and confirmatory factor analyses distinguished four scales: parental solicitation, adolescent disclosure, adolescent secrecy, and parental knowledge. All four scales had strong internal reliability and correlated in the expected directions. We re-established the validity and internal reliability and obtained test-retest reliability in a second wave, in which 330 adolescents were surveyed again. The findings show that parents and adolescents infrequently communicate about social media. Parental knowledge about adolescents' social media use strongly depends on the communication efforts of both parties. Altogether, the PACAS provides a valuable tool to explore the dynamics of parent-adolescent communication about social media.

Prior State of Knowledge: Adolescents use social media around the clock. This raises concerns among parents about what their adolescents do and experience on social media. Yet, our understanding of how parents and adolescents communicate about these issues is limited. Novel Contributions: This study developed the Parent-Adolescent Communication about Adolescents' Social Media Use Scale (PACAS), which consists of four scales: parental solicitation, adolescent disclosure, adolescent secrecy, and parental knowledge. The findings show that parents and adolescents infrequently communicate about social media. Practical Implications: The findings emphasize that parents should not only solicit information but also foster open communication so that adolescents can willingly disclose information about their social media use. Only then can parents keep informed about their adolescents' social media experiences.

Within-family associations of parent-adolescent relationship quality and adolescent affective well-being.

BACKGROUND: Parent-adolescent relationship quality is theorized to be an important correlate of adolescent affective well-being. Little is known about the within-family processes underlying parent-adolescent relationship quality and affective well-being over a period of months. This three-wave, preregistered study examined within- and between-family associations between parent-adolescent relationship quality (support and conflict) and adolescent well-being (negative and positive affect). In addition, we examined whether the associations differed between mothers and fathers, and for adolescents' affective well-being in different social contexts (at home, at school, with peers). METHODS: The sample consisted of 244 Dutch adolescents (61.5% girls; age range: 12-17 years; mean age = 13.8 years). Random-intercept cross-lagged panel models were used. RESULTS: At the between-family level, higher levels of support and lower levels of conflict were associated with higher levels of positive affect and lower levels of negative affect. At the within-family level, increases in support and decreases in conflict were concurrently associated with increases in positive affect and decreases in negative affect. More parent-adolescent conflict than typical also predicted increases in negative affect, 3 months later, and more negative affect and less positive affect than typical predicted increased conflict, 3 months later. These within-family effects were largely similar for fathers and mothers. Associations for conflict occurred through bidirectional processes: Parent-adolescent conflict shaped and was shaped by adolescents' emotions at home, at school, and with peers. CONCLUSION: Results suggest that parent-adolescent relationship quality (especially conflict) and adolescent affective well-being cofluctuate and predict each other over time within families.

Like No Other? A Family-Specific Network Approach to Parenting Adolescents.

Numerous theories suggest that parents and adolescents influence each other in diverse ways; however, whether these influences differ between subgroups or are unique to each family remains uncertain. Therefore, this study explored whether data-driven subgroups of families emerged that exhibited a similar daily interplay between parenting and adolescent affective well-being. To do so, Subgrouping Group Iterative Multiple Model Estimation (S-GIMME) was used to estimate family-specific dynamic network models, containing same- and next-day associations among five parenting practices (i.e., warmth, autonomy support, psychological control, strictness, monitoring) and adolescent positive and negative affect. These family-specific networks were estimated for 129 adolescents (Mage = 13.3, SDage = 1.2, 64% female, 87% Dutch), who reported each day on parenting and their affect for 100 consecutive days. The findings of S-GIMME did not identify data-driven subgroups sharing similar parenting-affect associations. Instead, each family displayed a unique pattern of temporal associations between the different practices and adolescent affect. Thus, the ways in which parenting practices were related to adolescents' affect in everyday life were family specific.

Applications of the experience sampling method (ESM) in paediatric healthcare: a systematic review.

BACKGROUND: With the Experience Sampling Method (ESM) participants are asked to provide self-reports of their symptoms, feelings, thoughts and behaviours in daily life. This preregistered systematic review assessed how ESM is being used to monitor emotional well-being, somatic health, fatigue and pain in children and adolescents with a chronic somatic illness. METHODS: Databases were searched from inception. Studies were selected if they included children or adolescents aged 0-25 years with a chronic somatic illness and used ESM focussing on mental health or psychosocial wellbeing, biopsychosocial factors and/or somatic health. Two reviewers extracted data of the final 47 papers, describing 48 studies. RESULTS: Most studies evaluated what factors influence medical or psychological symptoms and how symptoms influence each other. Another common purpose was to study the feasibility of ESM or ESM as part of an app or intervention. Study methods were heterogeneous and most studies lack adequate reporting of ESM applications and results. CONCLUSIONS: While ESM holds great potential for providing results and feedback to patients and caregivers, little use is being made of this option. Future studies should consider what they report in their studies, conduct a priori power analyses and how ESM can be embedded in clinical practice. IMPACT: While ESM has many clinical applications, it is currently mostly used for research purposes. Current studies using ESM are heterogeneous and lack consistent, high-quality reporting. There is great potential in ESM for providing patients and parents with personalised feedback.

The direction of effects between parenting and adolescent affective well-being in everyday life is family specific.

Numerous theories and empirical studies have suggested that parents and their adolescent children reciprocally influence each other. As most studies have focused on group-level patterns, however, it remained unclear whether this was true for every family. To investigate potential heterogeneity in directionality, we applied a novel idiographic approach to examine the effects between parenting and adolescent well-being in each family separately. For 100 days, 159 Dutch adolescents (Mage = 13.31, 62% female) reported on affective well-being and four parenting dimensions. The family-specific effects of pre-registered ( https://osf.io/7n2jx/ ) dynamic structural equation models indeed revealed that a reciprocal day-to-day association between parenting and adolescent affective well-being was present only in some families, with the proportion of families displaying a reciprocal association varying across the four parenting dimensions (11-55%). In other families, either parenting predicted the adolescent's affective well-being (8-43%) or vice versa (10-27%), or no day-to-day associations were found (16-60%). Adolescents with higher trait levels of environmental sensitivity and neuroticism were more strongly affected by parenting. Thus, findings suggest that the ways in which parents and adolescents influence each other in everyday life are unique, stressing the need to move towards an idiographic parenting science.

Quaranteens: Prepandemic relationship quality and changes in adolescent internalizing problems during the COVID-19 pandemic.

This preregistered longitudinal study examined changes in adolescents' depressive and anxiety symptoms before and during the COVID-19 pandemic using latent additive piece-wise growth models. It also assessed whether support from and conflict with mothers, fathers, siblings, and best friends explained heterogeneity in change patterns. One hundred and ninety-two Dutch adolescents (Mean age: 14.3 years; 68.8% female) completed online biweekly questionnaires for a year (November 2019-October 2020), consisting of a prepandemic, lockdown, and reopening phase. Depressive symptoms increased following the lockdown and decreased upon reopening. Anxiety symptoms showed an immediate decrease followed by a gradual increase in the reopening phase. Prepandemic family and best friend support and conflict did not explain heterogeneity in depressive and anxiety symptoms during the COVID-19 pandemic.

A moment of autonomy support brightens adolescents' mood: Autonomy support, psychological control and adolescent affect in everyday life.

This experience sampling study examined whether autonomy-supportive and psychologically controlling interactions with parents are intertwined with adolescents' momentary affect. For 7 days (in 2020), 143 adolescents (Mage = 15.82; SDage = 1.75; 64% girls; 95% European, 1% African, 3% unknown) reported 5 or 6 times a day how they felt and how interactions with parents were experienced. Preregistered dynamic structural equation models on 1439 (including 532 adjacent) parent-adolescent interactions revealed significant within-family associations: Adolescents experienced more positive affect during and following autonomy-supportive interactions, and vice versa. Adolescents felt more negative affect during and 3 h before psychologically controlling interactions. Between-family associations showed significant linkages between parenting and affect. These findings show that a moment of autonomy support can alter adolescents' everyday well-being.

Smartphone-Tracked Digital Markers of Momentary Subjective Stress in College Students: Idiographic Machine Learning Analysis.

BACKGROUND: Stress is an important predictor of mental health problems such as burnout and depression. Acute stress is considered adaptive, whereas chronic stress is viewed as detrimental to well-being. To aid in the early detection of chronic stress, machine learning models are increasingly trained to learn the quantitative relation from digital footprints to self-reported stress. Prior studies have investigated general principles in population-wide studies, but the extent to which the findings apply to individuals is understudied. OBJECTIVE: We aimed to explore to what extent machine learning models can leverage features of smartphone app use log data to recognize momentary subjective stress in individuals, which of these features are most important for predicting stress and represent potential digital markers of stress, the nature of the relations between these digital markers and stress, and the degree to which these relations differ across people. METHODS: Student participants (N=224) self-reported momentary subjective stress 5 times per day up to 60 days in total (44,381 observations); in parallel, dedicated smartphone software continuously logged their smartphone app use. We extracted features from the log data (eg, time spent on app categories such as messenger apps and proxies for sleep duration and onset) and trained machine learning models to predict momentary subjective stress from these features using 2 approaches: modeling general relations at the group level (nomothetic approach) and modeling relations for each person separately (idiographic approach). To identify potential digital markers of momentary subjective stress, we applied explainable artificial intelligence methodology (ie, Shapley additive explanations). We evaluated model accuracy on a person-to-person basis in out-of-sample observations. RESULTS: We identified prolonged use of messenger and social network site apps and proxies for sleep duration and onset as the most important features across modeling approaches (nomothetic vs idiographic). The relations of these digital markers with momentary subjective stress differed from person to person, as did model accuracy. Sleep proxies, messenger, and social network use were heterogeneously related to stress (ie, negative in some and positive or zero in others). Model predictions correlated positively and statistically significantly with self-reported stress in most individuals (median person-specific correlation=0.15-0.19 for nomothetic models and median person-specific correlation=0.00-0.09 for idiographic models). CONCLUSIONS: Our findings indicate that smartphone log data can be used for identifying digital markers of stress and also show that the relation between specific digital markers and stress differs from person to person. These findings warrant follow-up studies in other populations (eg, professionals and clinical populations) and pave the way for similar research using physiological measures of stress.

Better, for worse, or both? Testing environmental sensitivity models with parenting at the level of individual families.

According to environmental sensitivity models, children vary in responsivity to parenting. However, different models propose different patterns, with responsivity to primarily: (1) adverse parenting (adverse sensitive); or (2) supportive parenting (vantage sensitive); or (3) to both (differentially susceptible). This preregistered study tested whether these three responsivity patterns coexist. We used intensive longitudinal data of Dutch adolescents (N = 256, Mage = 14.8, 72% female) who bi-weekly reported on adverse and supportive parenting and their psychological functioning (tmean = 17.7, tmax = 26). Dynamic Structural Equation Models (DSEM) indeed revealed differential parenting effects. As hypothesized, we found that all three responsivity patterns coexisted in our sample: 5% were adverse sensitive, 3% vantage sensitive, and 26% differentially susceptible. No adolescent appeared unsusceptible, however. Instead, we labeled 28% as unperceptive, because they did not perceive any changes in parenting and scored lower on trait environmental sensitivity than others. Furthermore, unexpected patterns emerged, with 37% responding contrary to parenting theories (e.g., decreased psychological functioning after more parental support). Sensitivity analyses with concurrent effects and parent-reported parenting were performed. Overall, findings indicate that theorized responsivity-to-parenting patterns might coexist in the population, and that there are other, previously undetected patterns that go beyond environmental sensitivity models.

When Too Much Help is of No Help: Mothers' and Fathers' Perceived Overprotective Behavior and (Mal)Adaptive Functioning in Adolescents.

Although parental overprotection is theorized to have lasting negative effects throughout a child's life, there is limited empirical evidence available on its long-term significance on adolescent well-being. This preregistered, three-wave longitudinal study investigated the association of maternal and paternal perceived overprotection in early adolescence with the development of (mal)adaptive psychological, academic, and social functioning throughout adolescence. Data (N = 2229; 50.7% girls) from the longitudinal TRacking Adolescents' Individual Lives Survey (TRAILS) in the Netherlands were used (Mage T1 = 11.11, T2 = 13.57, T3 = 16.28). At T1, adolescents reported on their mothers' and fathers' overprotection. From T1 to T3 adolescents and teachers reported about internalizing problems, academic achievement, prosocial, and antisocial behavior. The results showed concurrent associations between higher levels of perceived overprotection and higher levels of internalizing problems, antisocial behaviors, and (after controlling for parental warmth and rejection) lower levels of academic achievement. Perceived overprotection was positively associated with decreased internalizing problems over time. This longitudinal association disappeared after controlling for baseline levels of internalizing problems, suggesting that this result was less robust than expected. Mothers and fathers did not differ in their associations between perceived overprotection and (mal)adaptive functioning. The findings showed that perceived overprotection is mainly concurrently associated with (mal)adaptive adolescent functioning. Future research recommendations are discussed in terms of stability and bidirectional relations.

Daily affect intensity and variability of adolescents and their parents before and during a COVID-19 lockdown.

INTRODUCTION: The corona virus (COVID-19) pandemic may have a prolonged impact on people's lives, with multiple waves of infections and lockdowns, but how a lockdown may alter emotional functioning is still hardly understood. METHODS: In this 100-daily diaries study, we examined how to affect intensity and variability of adolescents (N = 159, Mage = 13.3, 61.6% female) and parents (N = 159, Mage = 45.3, 79.9% female) changed after the onset and during (>50 days) the second COVID-19 lockdown in the Netherlands, using preregistered piecewise growth models. RESULTS: We found only an unexpected increase in parents' positive affect intensity after the lockdown onset, but no immediate changes in negative affect intensity or variability. However, both adolescents and parents reported gradual increases in negative affect intensity and variability as the lockdown prolonged. Lockdown effects did not differ between adolescents and parents. However, within groups, individuals differed. The individual differences in the effects were partly explained by life satisfaction, depressive symptoms, and self-reported lockdown impact. CONCLUSIONS: Overall, these findings suggests that a lockdown triggers changes in daily affective well-being especially as the lockdown prolongs. Individual differences in the effects indicate heterogeneity in the impact of the lockdown on daily affect that was partly explained by baseline life satisfaction and depressive symptoms. However, more knowledge on the causes of this heterogeneity is needed to be able to increase resilience to lockdown effects in the population.

Testing transactional processes between parental support and adolescent depressive symptoms: From a daily to a biennial timescale.

Transactional processes between parental support and adolescents' depressive symptoms might differ in the short term versus long term. Therefore, this multi-sample study tested bidirectional within-family associations between perceived parental support and depressive symptoms in adolescents with datasets with varying measurement intervals: Daily (N = 244, Mage = 13.8 years, 38% male), bi-weekly (N = 256, Mage = 14.4 years, 29% male), three-monthly (N = 245, Mage = 13.9 years, 38% male), annual (N = 1,664, Mage = 11.1 years, 51% male), and biennial (N = 502, Mage = 13.8 years, 48% male). Preregistered random-intercept cross-lagged panel models (RI-CLPMs) showed negative between- and within-family correlations. Moreover, although the preregistered models showed no within-family lagged effect from perceived parental support to adolescent depressive symptoms at any timescale, an exploratory model demonstrated a negative lagged effect at a biennial timescale with the annual dataset. Concerning the reverse within-family lagged effect, increases in adolescent depressive symptoms predicted decreases in perceived parental support 2 weeks and 3 months later (relationship erosion effect). Most cross-lagged effects were not moderated by adolescent sex or neuroticism trait level. Thus, the findings mostly support adolescent-driven effects at understudied timescales and illustrate that within-family lagged effects do not generalize across timescales.

Universal ingredients to parenting teens: parental warmth and autonomy support promote adolescent well-being in most families.

Even though each adolescent is unique, some ingredients for development may still be universal. According to Self-Determination Theory, every adolescent's well-being should benefit when parents provide warmth and autonomy. To rigorously test this idea that each family has similar mechanisms, we followed 159 Dutch parent-adolescent dyads (parent: Mage = 45.34, 79% mothers; adolescent: Mage = 13.31, 62% female) for more than three months, and collected 100 consecutive daily reports of parental warmth, autonomy support, positive and negative affect. Positive effects of parental warmth and autonomy support upon well-being were found in 91-98% of the families. Preregistered analysis of 14,546 daily reports confirmed that effects of parenting differed in strength (i.e., some adolescents benefited more than others), but were universal in their direction (i.e., in fewer than 1% of families effects were in an unexpected direction). Albeit stronger with child-reported parenting, similar patterns were found with parent-reports. Adolescents who benefited most from need-supportive parenting in daily life were characterized by higher overall sensitivity to environmental influences. Whereas recent work suggests that each child and each family have unique developmental mechanisms, this study suggests that need-supportive parenting promotes adolescent well-being in most families.

Promoting Daily Well-being in Adolescents using mHealth.

Adolescents are at increased risk for developing mental health problems. The Grow It! app is an mHealth intervention aimed at preventing mental health problems through improving coping by cognitive behavioral therapy (CBT)-inspired challenges as well as self-monitoring of emotions through Experience Sampling Methods (ESM). Yet, little is known about daily changes in well-being and coping during a stressful period, like the COVID-19 pandemic. The current study aimed to elucidate daily changes in positive and negative affect, and adaptive coping, and to better understand the within-person's mechanisms of the Grow It! app. The sample consisted of 12-25-year old Dutch adolescents in two independent cohorts (cohort 1: N = 476, Mage = 16.24, 76.1% female, 88.7% Dutch; cohort 2: N = 814, Mage = 18.45, 82.8% female, 97.2% Dutch). ESM were used to measure daily positive and negative affect and coping (cohort 1: 42 days, 210 assessments per person; cohort 2: 21 days, 105 assessments). The results showed that, on average, adolescents decreased in daily positive affect and adaptive coping, and increased in their experienced negative affect. A positive relation between adaptive coping and positive affect was found, although independent of the CBT-based challenges. Latent class analysis identified two heterogeneous trajectories for both positive and negative affect, indicating that the majority of participants with low to moderate-risk on developing mental health problems were likely to benefit from the Grow It! app.

Who benefits most from using social media, the socially rich or the socially poor?

Research has shown that some individuals benefit from using social media because it may help them to obtain social capital. This article questions who are most likely to benefit: the socially rich (i.e., individuals with a preference for social interaction, support, or without interpersonal problems) or the socially poor? It is hard to provide a definite answer to this question: Previous empirical studies have yielded mixed findings and were difficult to compare due to varying conceptualizations and analytic approaches. To better understand the complex interplay between individuals' social media use and social capital, we discuss the added value of within-person analyses and person-specific designs.

Social media, parenting, and well-being.

One of the key challenges faced by many parents is to manage the pervasiveness of social media in adolescents' lives and its effects on adolescents' well-being (e.g., life satisfaction) and ill-being (e.g., depressive symptoms). Parents may manage adolescents' social media use and social media-induced well-being and ill-being through media-specific parenting: parental actions to restrict, regulate, and discuss adolescents' social media use. Recent evidence suggests that media-specific parenting may reduce adolescents' anxiety and depressive symptoms and minimize the effects of cyberbullying on adolescents' depressive symptoms. However, more robust evidence regarding the moderating role of media-specific parenting and the direction of effects has to be established to understand how parents may shape the effects of social media on adolescents' well-being and ill-being.

A Smartphone Serious Game for Adolescents (Grow It! App): Development, Feasibility, and Acceptance Study.

BACKGROUND: Anxiety and mood problems in adolescents often go unnoticed and may therefore remain untreated. Identifying and preventing the development of emotional problems requires monitoring and effective tools to strengthen adolescents' resilience, for example, by enhancing coping skills. OBJECTIVE: This study describes the developmental process, feasibility, and acceptance of Grow It!, a multiplayer serious game app for adolescents aged 12-25 years. The app consists of the experience sampling method (ESM) to monitor thoughts, behaviors, and emotions in daily life to enhance self-insight and daily cognitive behavioral therapy-based challenges to promote adaptive coping. METHODS: Our approach entails an iterative game design process combined with an agile method to develop the smartphone app. The incorporated game features (ie, challenges, chat functionality, and visual representation) in the Grow It! app were co-designed with adolescent end users to increase participant engagement and adherence. RESULTS: The Grow It! app was delivered for Android and iOS in May 2020. Grow It! was offered to adolescents during the COVID-19 crisis between May and December 2020. Participants of the Grow It! COVID-19 study (sample 1: N=685; mean age 16.19, SD 3.11 years; 193/685, 28.2% boys; sample 2: N=1035; mean age 18.78, SD 3.51 years; 193/1035, 18.64% boys) completed 31.5% (13.2/42) to 49.5% (10.4/21) of challenges. Compliance of ESM was suboptimal (35.1/210, 16.7% to 32.5/105, 30.9%). Follow-up questionnaires indicated an overall score of the app of 7.1 out of 10. Moreover, 72.6% (278/383) to 75.6% (487/644) would recommend the app to friends. CONCLUSIONS: To our knowledge, Grow It! is the first gamified ESM app that both measures individual differences in emotional dynamics and offers an integrated cognitive behavioral therapy-based intervention. Our findings support the feasibility and acceptance, and therefore applicability, of the Grow It! app in adolescents. Further iterations of this serious game app will focus on the increase of compliance and on providing participants feedback through their personal mood profiles.

Parent-adolescent interaction quality and adolescent affect-An experience sampling study on effect heterogeneity.

Person-environment interactions might ultimately drive longer term development. This experience sampling study (Data collection: 2019/20 the Netherlands) assessed short-term linkages between parent-adolescent interaction quality and affect during 2281 interactions of 124 adolescents (Mage  = 15.80, SDage  = 1.69, 59% girls, 92% Dutch, Education: 25% low, 31% middle, 35% high, 9% other). Adolescents reported on parent-adolescent interaction quality (i.e., warmth and conflict) and momentary positive and negative affect five to six times a day, for 14 days. Preregistered dynamic structural equation models (DSEM) revealed within-family associations between parent-adolescent interaction quality and adolescent affect (concurrently: r = -.22 to .39; lagged effects: ß = -.17 to .15). These effects varied significantly between families. These findings stress the need for more person-specific research on parenting processes.

Measuring parent-adolescent interactions in natural habitats. The potential, status, and challenges of ecological momentary assessment.

Few people are as important for an adolescent's development as their parents. However, most research on parent-adolescent relationships describes long-term population-wide effects. Therefore, little is known about everyday interactions between adolescents and parents in individual families. Ecological momentary assessment (EMA) measures families several times a day as they go through daily life. This approach provides ecologically valid insights into which interactions took place and how they were experienced. State-of-the-art EMA studies suggest that within-family fluctuations in parenting may trigger changes in an adolescent's well-being and behaviors. In practice, moreover, EMA may strengthen family support and intervention research. This article reviews recent empirical work, highlights the (un)used theoretical and practical promise of EMA and identifies key-challenges to unlock this full potential.