Mindful awareness and resilience skills for adolescents (MARS-A): a mixed-methods study of a mindfulness-based intervention for a heterogeneous adolescent clinical population.

OBJECTIVES: Mindful Awareness and Resilience Skills for Adolescents (MARS-A) is a mindfulness-based intervention adapted for the adolescent population. While previous studies have explored the benefits of MARS-A in various single-diagnosis populations, the aim of this study was to assess MARS-A for a heterogenous clinical adolescent population with mental health and/or chronic diagnoses, focusing on the underlying suffering present in all these conditions rather than its effects on a single diagnosis itself. METHODS: Qualitative data was collected through interviews to understand post-intervention participant perspectives and experiences. Quantitative data was collected through measures to investigate preliminary secondary outcomes. RESULTS: After participating in MARS-A, participants reported qualitative benefits in enhanced well-being, including coping with difficult emotions and managing sleep and/or pain. Quantitative results showed a reduction in functional disability, psychological distress, perceived stress, and depressive symptoms; increase in positive affect; and benefit in coping with pain and chronic conditions. CONCLUSIONS: MARS-A shows great potential in a heterogeneous clinical adolescent population.

Trajectories of nonsuicidal self-injury during adolescence.

OBJECTIVE: Although nonsuicidal self-injury is a public health concern, there is little information on how it changes across adolescence or what contributes to stability or change. We aimed to identify trajectories of stability and change in self-injury from ages 13 to 17 years, and to identify interpersonal and intrapersonal correlates that differentiate between trajectories of stability and change. METHOD: We used five annual waves of cohort-sequential data, targeting 7th and 8th graders attending all public schools in three municipalities in central Sweden. The data were gathered via questionnaires, using a multi-item measure of non-suicidal self-injury and assessing negative experiences at home, in school, with peers, and in romantic settings, as well as intrapersonal issues (internalizing symptoms and difficulties with emotional, and behavioral regulation). The analytic sample was 3195 adolescents (51.7% boys, 48.3% girls; ages 12-16 years at T1, M = 13.61; SD = 0.66), most of whom were born in Sweden (88.6%) to at least one parent of Swedish origin (77.4%). RESULTS: Latent growth curve modeling revealed three self-injury trajectories: a stable-low, a low-increasing, and an increasing-decreasing trajectory. Adolescents in the stable-low class reported the best overall adjustment at ages 13 and 16. Comparatively, adolescents in the other two classes reported similar levels of difficulty interpersonally and intrapersonally. Where they differed, the increase-decrease class fared worse than the low-increasing class. CONCLUSIONS: This study suggests the need to frame self-injury as having multiple directions of development during adolescence and develop theory that aligns with differential patterns of self-injury development.

Transition to adulthood: prospective content in joint parent-youth conversations for young people with intellectual or developmental disabilities (IDD).

Problem and Objective: Transition to adulthood for young people with (IDD) is challenging for both youth and parents. Prospection, an important human adaptive tool and critical for independent living, involves constructing, encoding, and remembering the future. It may be jointly enacted between parents and young people as they discuss the future. This study identified and described evidence of prospective content in parent-youth conversations about the transition to adulthood. Method: This study involved the content analysis is of eight parent-youth conversations about this transition. Two mother-daughter, three father-daughter, and three mother-son dyads, representing a range of IDD diagnoses, provided 790 min of joint conversations and reflection on them. These conversations were examined for the following characteristics of prospection: simulation, reasoning about counterfactuals, constructing multiple possible futures, and episodic memory of the past. Findings: Among the four characteristics, simulation and episodic memory of the past were used most frequently and reasoning about counterfactuals the least. Giving advice and scaffolding were additional strategies that emerged from the data. Conclusion: Identifying how prospection may be fostered in joint parent-youth conversations provides a step toward future research.

Experiences With Genetic Counseling, Testing, and Diagnosis Among Adolescents With a Genetic Condition: A Scoping Review.

Importance: The number of adolescents who are diagnosed with a genetic disorder is increasing as genome sequencing becomes the standard of clinical diagnostic testing. However, the experience of receiving a diagnosis of a genetic condition has not been extensively studied in adolescents. Objective: To identify how adolescents with a genetic condition engage with genetic or genomic counseling services as well as interpret, adapt to, and experience their diagnosis. Evidence Review: A literature search of MEDLINE, Embase, CINAHL, and PsycINFO was undertaken. Articles (primary literature, knowledge syntheses, and gray literature) in English that investigated the experiences of adolescents between 10 and 19 years of age who received genetic or genomic counseling were included. Data were extracted from 45 eligible articles and analyzed descriptively. Findings: A total of 45 studies were included, most of which were quantitative in nature (21 of 45 [47%]) and conducted in the US (n = 13), followed by the UK (n = 8), Australia (n = 8), and Canada (n = 6). A total of 29 distinct monogenic disorders were investigated. Sample sizes ranged from 1 to 930, with a median of 23 participants, and the year of publication ranged from 1977 to 2019. Included studies addressed all aspects of genetic counseling, but a preponderance of articles assessed knowledge about genetic conditions (n = 17) and challenges of communication within families (n = 16). Fewer articles addressed the experiences of adolescents adapting to their genetic conditions (n = 8) and the genetic counseling process (n = 4). Only 1 study addressed any aspect of genetic counseling in relation to genome sequencing. Conclusions and Relevance: This scoping review found that most of the included studies focused on adolescents' knowledge about their genetic condition and communication about genetic risks, whereas fewer studies explored their adaptation to the condition and the genetic counseling process. A systematic reconsideration of the genetic counseling process may be undertaken to provide an evidence-informed health care service that is tailored to the needs of this adolescent population.

Conditions for shared decision making in the care of transgender youth in Canada.

Information is lacking on the role shared decision making plays in the care of transgender (trans) youth. This qualitative, descriptive study explored how trans youth, parents and health care providers engaged or did not engage in shared decision-making practices around hormone therapy initiation and what conditions supported shared decision-making approaches in clinical practice. Semi-structured interviews were conducted with 47 participants in British Columbia, Canada, and analyzed using a constructivist grounded theory approach. While formal shared decision-making models were not used in practice, many participants described elements of such approaches when asked about their health care decision-making processes. Others described health care interactions that were not conducive to a shared decision-making approach. The key finding that emerged through this analysis was a set of five conditions for supporting shared decision making when making decisions surrounding initiation of hormone therapy with trans youth. Both supportive relationships and open communication were necessary among participants to support shared decision making. All parties needed to agree regarding what decisions were to be made and what role each person would play in the process. Finally, adequate time was needed for decision-making processes to unfold. When stakeholders meet these five conditions, a gender-affirming and culturally safer shared decision-making approach may be used to support decision making about gender-affirming care. Implications for clinical practice and future research are discussed.

Hormone therapy decision-making processes: Transgender youth and parents.

INTRODUCTION: This study explored how transgender (trans) youth and parents of trans youth made decisions around hormone therapy initiation as well as trans youth experiences of barriers to care. METHODS: Participants included 21 trans youth (ages 14-18) and 15 parents of trans youth who resided in British Columbia, Canada. Data for this grounded theory research consisted of transcripts and lifeline drawings collected through semi-structured interviews conducted August 2016 through February 2017. RESULTS: The decision-making processes of youth and of parents are illustrated in three-phase temporal models, starting with discovery, leading to (inter)action while seeking care, and reflection after hormone therapy initiation. Youth who sought hormone therapy were clear about their decision to access this care. Throughout these processes, youth experienced numerous parent- and system-related barriers to care. Youth with the lowest levels of parent support experienced more system barriers, with non-binary/genderfluid youth experiencing greater barriers and less support for hormone therapy than youth with binary genders. A new barrier identified in this study was health care provider imposed requirements for parental involvement and/or approval, which rendered some youth unable access to hormone therapy. CONCLUSIONS: Health care providers should be aware of the deliberation and information-seeking in which youth engage prior to seeking care as well as the temporally misaligned decision-making processes of youth and parents. Understanding the challenges trans youth experience due to insufficient parental support and system barriers can provide important context for health care providers striving to provide accessible, gender-affirming care and decision-making support for trans youth.

Eating Disorder Diagnoses and Symptom Presentation in Transgender Youth: a Scoping Review.

PURPOSE OF REVIEW: This scoping review includes recent literature on eating disorder diagnoses and evaluation of eating disorder symptom presentation among transgender youth (ages 8-25). RECENT FINDINGS: A total of 20 publications from the previous 5 years were identified, including case reports, retrospective chart reviews, and surveys. Significantly higher rates of eating disorder symptoms were documented in transgender youth compared to cisgender youth. Similarly, some studies reported transgender youth were more likely to be diagnosed with an eating disorder than cisgender youth, though the proportion of youth with eating disorder diagnoses varied across studies. A consistent theme across case studies was engagement in food restriction and/or compensatory eating behaviors to prevent puberty onset or progression, suggesting that for some transgender youth, these behaviors may be understood as a means of coping with gender-related distress. Clinical care could be enhanced through establishment of best practices for screening in settings offering eating disorder treatment and gender-affirming care, as well as greater collaboration among these programs. Research is needed to validate eating disorder measures for use with transgender youth and evaluate the effects of eating disorder treatment and gender-affirming medical interventions on the well-being of transgender youth.

Depressive symptoms and non-suicidal self-injury during adolescence: Latent patterns of short-term stability and change.

INTRODUCTION: Depressive symptoms and non-suicidal self-injury not only increase in prevalence during adolescence, but they can also occur together. Both psychological problems seem to have similar precipitating conditions, suggesting they have transdiagnostic conditions-personal or contextual characteristics that contribute to co-occurrence. We sought to understand when these two problems co-occur and what is related to their co-occurrence. METHODS: Using a pattern-centered approach and two waves of longitudinal data collected annually, we examined latent profiles of depressive symptoms and self-injury among a Swedish sample of adolescents aged 12 to 16 (MageT1 = 13.65 years, SD = 0.64), 53.7% boys and 47.3% girls. Most of the adolescents were Swedish (89%), with parents who were married or cohabitating (68%). We also examined the transitions between profiles over time. RESULTS: Our results suggest that during this time frame, depressive symptoms and self-injury tend to emerge and stabilize or abate together. We also examined a broad array of predictors, including individual characteristics, emotion dysregulation, experiences with friends, parents' negative reactions to behavior, and school stress. The significant unique predictors suggest that adolescents who reported being subjected to relational aggression, having negative experiences while drinking, and low self-esteem had a greater probability of moving from moderate to high levels or maintaining high levels of depressive symptoms and self-injury, compared to adolescents classified in the other statuses. CONCLUSIONS: Focusing on negative interpersonal experiences and selfesteem as transdiagnostic conditions may guide research and aid clinicians in supporting adolescents who feel depressed and engage in self-injury.

Investigating site-level longitudinal effects of population health interventions: Gay-Straight Alliances and school safety.

There is limited research on evaluating nonrandomized population health interventions. We aimed to introduce a new approach for assessing site-level longitudinal effects of population health interventions (SLEPHI) by innovatively applying multiple group multilevel (MG-ML) modeling to repeated cycles of cross-sectional data collected from different individuals of the same sites at different times, a design commonly employed in public health research. For illustration, we used this SLEPHI method to examine the influence of Gay-Straight Alliances (GSAs) on school-level perceived safety among lesbian, gay, and bisexual (LGB) and heterosexual (HET) adolescents. Individual-level data of perceived school safety came from 1625 LGB students (67.4% female; mean age, 15.7 years) and 37,597 HET students (50.2% female; mean age, 15.4 years) attending Grades 7-12 in 135 schools, which participated in 3 British Columbia Adolescent Health Surveys (BCAHS: 2003, 2008, 2013) in Canada. School-level data of GSA length since established were collected by telephone in 2008 and 2014. Nested MG-ML models suggested that after accounting for secular trend, cohort effects, measurement error, measurement equivalence, and student age, GSA length linearly related to increased school-level perceived safety among LGB students (b = 1.57, SE = 0.21, p < .001, ß = 0.32) and also among HET students (ß = 0.34 in 2003 & 2013, ß = 0.32 in 2008) although statistical differences between years for HET youth were likely due to the large sample size. By conducting MG-ML analysis on repeated cross-sectional surveys, this SLEPHI method accounted for many confounding factors and followed schools for a longer period than most longitudinal designs can follow individuals. Therefore, we drew a stronger conclusion than previous observational research about GSAs and LGB students' well-being. The SLEPHI method can be widely applied to other repeated cycles of cross-sectional data in public health research.

Transition to Adulthood as a Joint Parent-Youth Project for Young Persons With Intellectual and Developmental Disabilities.

Eight dyads ( N = 16) residing in Western Canada participated in this investigation of how young adults with intellectual and developmental disabilities (IDD) and their parents jointly construct, articulate, and act on goals pertinent to the young adults' transition to adulthood. Using the action-project method to collect and analyze conversations and video recall data, cases were grouped representing the ways goal-directed projects brought relationship ( n = 4), planning ( n = 3) or both ( n = 1) to the foreground as joint projects. Resources internal to the dyad such as emotional resources, and external to the dyad, facilitated formulation and pursuit of projects. Lack of external supports and limited parental knowledge about IDD hindered joint project formulation.

Crafting continuity and change in Saudi society: Joint parent-youth transition-to-adulthood projects.

Little is known about the transition to adulthood in traditional, developing countries such as Saudi Arabia. Previous research in other countries has revealed the importance of considering parents' support during the transition to adulthood. Thus, the purpose of this research was to examine how two generations negotiated the transition to adulthood. We asked the research question, What are the joint projects in which parents and youth plan and act on their plans for the youth's future? We used the action project method, an established qualitative approach, to answer these questions by observing the joint conversations of 14 parent and youth dyads. Our results provided evidence of an overarching higher level goal, or intentional framework, of crafting generational change and continuity within which participants' joint projects were embedded. Joint projects were organized into three groups: (a) negotiating educational and career futures, (b) promoting gender roles and marriage, and (c) shaping independence.

The transition to adulthood of young adults with IDD: Parents' joint projects.

INTRODUCTION: Parents have found the transition to adulthood for their sons or daughters with intellectual and/or developmental disabilities (IDD) particularly challenging. The literature has not examined how parents work together and with others in face of this transition nor has it highlighted parental goals in this process. This study used a perspective based on joint, goal-direct action to describe the projects that Canadian parents engaged in together and with others relative to this transition. METHODS: Using the qualitative action-project method, joint projects between parents and with others were identified from their conversations and followed for 6 months. FINDINGS: Three groups of projects were described: equipping the young adult for adult life, connecting for personal support and managing day-to-day while planning for the future. CONCLUSIONS: Parents act together and with others relative to the transition to adulthood of their young adult children with IDD. These projects are complex and differ in goals, steps, resources and emotional regulation and motivation.

Prospective content in the friendship conversations of young adults.

Prospection is cognitive processes that involve constructing, encoding, and remembering the future. Less is known about the how these processes are evident in the prospective content of conversations. This study sought to identify and describe evidence of the prospective content in the conversations of friends as they transition to adulthood. The present secondary content analysis of the videotaped conversations of 15 young adult friendship dyads (n = 30, 16 females, 14 males, mean age = 21.3 years) in Canada examined these conversations based the following characteristics of prospection: simulation, reasoning about counterfactuals, constructing multiple possible futures, and episodic memory of the past. Four categories of prospective content were evident in these conversations, these processes were used sparingly in all but one conversation, and relatively few of them were collaborative in that dyad partners did not appear to serve to augment, clarify, or disconfirm prospective content.

Pinch, cinch or step: Evaluating the effectiveness and acceptability of mid upper arm circumference measurements in adolescents with eating disorders.

PURPOSE: Mid Upper Arm Circumference (MUAC) measurement is proposed as an adjunctive measure of re-nutrition progress in youth with eating disorders. We propose that MUAC is a clinically-useful measurement that can be used to inform clinicians about treatment progress. The aims of this study were twofold: 1) to test whether assessments of MUAC can track weight restoration in a similar pattern to direct measures of weight and 2) to examine adolescents' self-reported feelings in response to assessments of MUAC, weighing, and skinfolds (SF). METHODS: The study involved two phases of data collection. Participants in both phases of the study were female patients who fulfilled DSM IV-TR diagnostic criteria for an eating disorder. In Phase 1, MUAC measurements and weight assessments were collected weekly to examine changes in these values during the first 8weeks of treatment. In Phase 2, participants reported their feelings towards three different anthropometric measures - weight, SF and MUAC. RESULTS: Simple contrasts between the weekly weight and MUAC assessments prospectively collected in Phase 1 (N=40) reveal that MUAC and weight follow similar patterns over time. Phase 2 (N=30) data indicate that participants felt more relaxed, and less angry, scared or embarrassed during MUAC measurements than weighing and SF. MUAC also emerged as the measurement that was most preferred by participants. CONCLUSIONS: MUAC measurements are a useful adjunct to measurements of weight, and are perceived to be less distressing than routinely used measurement techniques of weight and SF.

Parent-adolescent joint projects involving leisure time and activities during the transition to high school.

Leisure research to date has generally overlooked planning and organizing of leisure time and activities between parents and adolescents. This investigation examined how a sample of Canadian adolescents and their parents jointly constructed and acted on goals related to adolescents' leisure time during the move from elementary to high school. Using the Qualitative Action-Project Method, data were collected over an 8-10 month period from 26 parent-adolescent dyads located in two urban sites, through video-taped conversations about leisure time, video recall interviews, and telephone monitoring interviews. Analysis of the data revealed that the joint projects of the 26 dyads could be grouped into three clusters: a) governance transfer or attempts to shift, from parent to adolescent, responsibility over academic demands, organizing leisure time, and safety with peers, b) balancing extra-curricular activities with family life, academics, and social activities, and c) relationship adjustment or maintenance.

Peer sexual harassment and deliberate self-injury: longitudinal cross-lag investigations in Canada and Sweden.

PURPOSE: Although the receipt of peer sexual harassment in schools has been linked to deliberate self-injury, the direction of association over time has not been tested. Two longitudinal studies examined whether receipt of peer sexual harassment within schools predicts engagement in deliberate self-injury or vice versa. Differences between boys and girls were also tested. METHODS: Surveys were conducted in two countries, Canada and Sweden. Measures of sexual harassment and deliberate self-injury were administered yearly in classrooms. Two waves of data were collected in the Canadian study (N = 161, 59.6% girls, mean age = 13.82 years); three waves of data were collected in Sweden (N = 513, 47% girls, mean age = 13.23 years). RESULTS: In the Canadian study, deliberate self-injury predicted subsequent peer sexual harassment; the converse relationship was not significant. No significant gender differences were found. Across the three waves of the Swedish study, peer sexual harassment predicted self-injury from T1 to T2, and self-injury predicted peer sexual harassment from T2 to T3. However, self-injury did not mediate peer sexual harassment at T1 and T3. Tests of gender differences revealed self-injury predicted sexual harassment from T2 to T3 among Swedish girls but not boys. CONCLUSIONS: Adolescents who deliberately self-injure may be vulnerable to sexual harassment by peers at school. Cultural norms may have a role in whether this process applies primarily to girls or to both genders. Sexual harassment by peers may also increase self-injury, but this is not subsequently linked to increases in receipt of sexual harassment.

Non-suicidal self-injury and depressive symptoms during middle adolescence: a longitudinal analysis.

Previous research has shown a consistent positive association between non-suicidal self-injury and depressive symptoms. However, the direction of the effects has not been examined. To understand whether non-suicidal self-injury predicts depressive symptoms or vice versa, we examined the relations between non-suicidal self-injury and depressive symptoms across three waves of self-report data collected 1 year apart from 506 Swedish adolescents (47% girls; M age = 13.21; SD = .57) who were attending 7th grade at the onset of the study. The results suggest that depressive symptoms predict increases in non-suicidal self-injury 1 year later between the first and second waves of the study. Between the second and third waves of the study depressive symptoms and non-suicidal self-injury were significantly correlated indicating co-occurrence with no direction of effect rather than depressive symptoms predicting non-suicidal self-injury or vice versa. Group comparisons revealed no differences for boys and girls. The findings help clarify the relationships between non-suicidal self-injury and depressive symptoms during middle adolescence.

An examination of the reciprocal relationships between adolescents' aggressive behaviors and their perceptions of parental nurturance.

This study examined reciprocal relationships between adolescents' perceptions of parental nurturance and two types of adolescent aggressive behaviors (indirect and direct aggression) using a transactional model. Three waves of longitudinal data were drawn from the Canadian National Longitudinal Survey of Children and Youth. The sample included 1,416 (735 female) adolescents who were 10- and 11-year-olds at Time 1 and became 14-and 15-year-olds at Time 3. The findings failed to support reciprocal effects, but confirmed parental effects at different ages for girls and boys. For girls, perceptions of parental nurturance at age 10 were negatively associated with both indirect and direct aggression at age 12. For boys, perceptions of parental nurturance at age 12 were negatively associated with both aggressive behaviors at age 14. Future research should continue to investigate reciprocal effects in parent-adolescent relationships to identify developmental periods where the effect of adolescents' or their parents' behavior may be stronger.

Comparing differential responses within child protective services: a longitudinal examination.

This study examines the efficacy of a family differential response program to lower rates of (1) reentry into child protective services (CPS) and (2) child removal. Data were collected over 20 months from one region of British Columbia, Canada. Comparisons between family development response (FDR) and cases assigned to regular investigation (INV) suggest that FDR does not decrease recidivism to CPS. However, fewer children in the FDR group were removed than children in the INV group.

A domain-specific approach to adolescent reporting of parental control.

This study evaluated the psychometric properties of a newly developed adolescent-reported domain-specific measure of parental behavioral control. In addition, this study examined the relationships between domains of perceived behavioral control and adolescent problem behaviors and tested whether psychological control played a mediating role in these associations. Participants were 267 students, ranging in age from 9 to 16 years. Both high maternal and paternal use of behavioral control in the friendship domain were positively associated with externalizing behaviors. Low paternal use of control in the prudential and multifaceted domains was also positively associated with externalizing behaviors. Psychological control mediated the association between behavioral control in the friendship domain and externalizing behaviors, suggesting a potential overlap between perceptions of parental behavioral and psychological control. These findings highlight the need to study adolescents' perceptions of parental control in specific domains to fully understand its relationship with adolescent outcomes.