Zoti's Social Toolkit: Developing and piloting novel animated tasks to assess emotional understanding and conflict resolution skills in childhood.

Current methods used to investigate emotional inference and conflict resolution knowledge are limited in their suitability for use with children with language disorders due to a reliance on language processing. This is problematic, as nearly 8% of the population are estimated to have developmental language disorder (DLD). In this paper, we present 'Zoti's Social Toolkit', a set of animated scenarios that can be used to assess emotion inferencing and conflict resolution knowledge. All animated scenarios contain interpersonal situations centred around a gender-neutral alien named Zoti. Four studies investigated the face and construct validity of the stimuli. The final stimulus set can be used with children, who may or may not have language difficulties and is openly available for use in research.

Understanding the prevalence and manifestation of anxiety and other socio-emotional and behavioural difficulties in children with Developmental Language Disorder.

BACKGROUND: It is well-documented that children with Developmental Language Disorder (DLD) have a higher likelihood of experiencing anxiety, as well as other socio-emotional and behavioural (SEB) difficulties. Despite this, there is little consensus as to how these difficulties manifest. This study aims to understand the prevalence of broader SEB difficulties and anxiety, informing intervention development by understanding the relationships between them. METHODS: A mixed-methods, case-control study was conducted. First, an online survey was completed by 107 parents of either children with DLD ("DLD sample"; n = 57) or typically developing children ("typical sample"; n = 50), aged 6-12 years old. Binary SEB statements informed by previous qualitative work (e.g. "my child requires routine/sameness"; "my child has frequent tantrums") provided an insight into the prevalence of SEB difficulties in both DLD and typical samples. Validated measures of anxiety, emotion regulation, intolerance of uncertainty, insistence on sameness, family stress and coping mechanisms were also collected. Correlation and mediation analyses were run using these validated measures to understand the manifestation of anxiety in children with DLD in more detail. Qualitative interviews were then carried out with a select panel of survey respondents (n = 4). RESULTS: The DLD sample scored significantly higher on all binary SEB statements than the typical sample: experiencing anxiety (80.7%, p < .05), requiring routine and sameness (75.4%, p < .001) and emotional dysregulation (75.4%; p < .001) were the most common difficulties reported for children with DLD. Using the validated scales, family stress and coping mechanisms were found to only correlate with the manifestation of anxiety in the typical group, not the DLD group. "Intolerance of uncertainty" and "insistence on sameness" were found to fully mediate the relationship between DLD diagnosis and symptoms of anxiety. Parent's interviews provided contextual support for the analysis, as well as highlighting sensory sensitivities as a focus for future research. CONCLUSIONS: Parents of children with DLD appear to cope well with their children's complex SEB needs. Intervention focussing on intolerance of uncertainty may help the management of difficulties with anxiety. Behaviours such as insistence on sameness should be investigated further, as potential indicators for anxiety amongst children with DLD.

Exploring the Psychosocial Experiences of Individuals with Developmental Language Disorder During Childhood: A Qualitative Investigation.

Children with Developmental Language Disorder (DLD) often experience co-occurring psychosocial difficulties, the developmental trajectories of which are still not fully understood. This study sought to explore the manifestation of such difficulties during childhood, through first-hand accounts of those with DLD and their close relatives. Individual semi-structured interviews were conducted with 11 mothers of children with DLD (aged 6-12 years old) and were analysed alongside the secondary data from interviews of five adults with DLD. Interviews were conducted online; all participants resided in Europe and were fluent in spoken and written English. A process of interpretive phenomenological analysis resulted in the development of five overall themes: experiencing anxiety, social frustrations, maintaining factors, childhood strengths and the parenting experience. Cognitive appraisals appeared particularly important during childhood in both escalating and maintaining anxiety, low self-esteem, emotion dysregulation and social frustrations. High levels of isolation and stress were experienced by all mothers. The findings suggest parents in the United Kingdom and Ireland require more support and guidance at the point of diagnosis than is currently provided. Emphasis was given to the link between children's experience of anxiety and social behaviours, such as withdrawal, as well as their intolerance of uncertainty. Internalising symptoms were a prioritisation for intervention during childhood by both parents and adults with DLD.

Measurement Invariance in Longitudinal Bifactor Models: Review and Application Based on the p Factor.

Bifactor models are increasingly being utilized to study latent constructs such as psychopathology and cognition, which change over the lifespan. Although longitudinal measurement invariance (MI) testing helps ensure valid interpretation of change in a construct over time, this is rarely and inconsistently performed in bifactor models. Our review of MI simulation literature revealed that only one study assessed MI in bifactor models under limited conditions. Recommendations for how to assess MI in bifactor models are suggested based on existing simulation studies of related models. Estimator choice and influence of missing data on MI are also discussed. An empirical example based on a model of the general psychopathology factor (p) elucidates our recommendations, with the present model of p being the first to exhibit residual MI across gender and time. Thus, changes in the ordered-categorical indicators can be attributed to changes in the latent factors. However, further work is needed to clarify MI guidelines for bifactor models, including considering the impact of model complexity and number of indicators. Nonetheless, using the guidelines justified herein to establish MI allows findings from bifactor models to be more confidently interpreted, increasing their comparability and utility.

Social Cognition in Adolescents with Developmental Language Disorder (DLD): Evidence from the Social Attribution Task.

Social cognition impairments may explain social, emotional and behavioural difficulties (SEBD) in individuals with Developmental Language Disorder (DLD). In a novel approach, the Social Attribution Task (SAT) was used to examine this association. SAT narratives were coded from 53 participants [n = 26 DLD; n = 27 typical language development (TLD)] matched on age (Mage = 13;6) and gender (35.9% female). Parents reported SEBD. Adolescents with DLD performed worse than their TLD peers on the majority of SAT indices and had higher peer (d = 1.09) and emotional problems (d = .75). There was no association between social cognition abilities and SEBD. These exploratory findings suggest social cognition should be further examined in this population.

The Engage with Developmental Language Disorder (E-DLD) project: Cohort profile.

BACKGROUND: Public awareness of Developmental Language Disorder (DLD) is lower than other neurodevelopmental disorders, despite its high prevalence of 7.6%. This lower awareness means recruitment for DLD research studies is difficult. DLD is both underfunded and under-researched, resulting in relatively limited research investigating individuals with DLD. Engage with Developmental Language Disorder (E-DLD) is a response to these considerations. E-DLD is the first international participant database of those affected by DLD. Parents of children with DLD under 16 and young people and adults over 16 from anywhere in the world can sign up to be a part of the E-DLD. AIMS: This paper aims to describe the families of children with DLD and adults with DLD in the database thus far. METHODS & PROCEDURES: E-DLD members sign up via our website, reporting demographic characteristics as part of this procedure. We request all E-DLD members subsequently fill in a yearly survey. The content of the yearly survey changes dependent on the age of the child, while the yearly survey for adults remains consistent. We measure a wide range of domains, such as speech and language therapy (SLT) support, school support, socialisation skills, and early developmental milestones for our youngest members, and health care support and mental well-being measurements for our adults. We also collect parent and self-reported reflections on strengths and challenges for the person with DLD using open-ended questions and the Strengths and Difficulties Questionnaire. OUTCOMES & RESULTS: The database currently consists of 196 parents of children with DLD and 20 individuals over the age of 16 with DLD or suspected DLD across a range of socioeconomic status (SES) backgrounds. Our initial results confirm that E-DLD members meet the linguistic profile of DLD in relation to self- or parent-rated language difficulties. Both children and adults show increased rates of psychosocial difficulties compared to established norms, consistent with past research on clinical samples of people with DLD. CONCLUSIONS & IMPLICATIONS: The findings indicate that a participant database for DLD research is feasible and useful. The rates of emotional, behavioural and sleep difficulties among the child probands are higher than reported rates amongst typically developing children. Initial data indicate that adults with DLD have poorer well-being than their peers. The E-DLD is a useful collection of data on those affected by DLD and is a promising method for connecting people with DLD with academic researchers. WHAT THIS PAPER ADDS: What is already known on this subject Developmental Language Disorder (DLD) is characterised by expressive and/or receptive language difficulties in the absence of another biomedical condition that could explain these difficulties. It is critically under-researched and underfunded. As such, there is a lack of public awareness and difficulty recruiting sufficient sample sizes for DLD research studies. What this paper adds to existing knowledge Engage with Developmental Language Disorder (E-DLD) is the first international participant database of individuals with DLD. This paper provides a preliminary report on the profile of linguistic and psychosocial skills among the individuals on the database, adding to current understanding of DLD across age groups. What are the potential or actual clinical implications of this work? Our aim is that the E-DLD will provide much-needed facilitation of research into DLD. E-DLD will enable those with DLD and their families more readily to shape research agendas and to participate in studies that interest them. Families may be recruited into research that could directly translate to better clinical treatment of DLD. We also believe that the E-DLD yearly survey holds potential to provide key information on the development and longitudinal experience of children and adults with DLD.

Depression symptom clusters in adolescents: A latent class analysis in a clinical sample.

BACKGROUND: Major depression is clinically heterogeneous. We aimed to identify classes of depressed adolescents with different symptom presentations and examine if these were differentially associated with illness severity, functioning, engagement with treatment, and clinical outcomes. METHOD: Baseline depression symptoms of 454 depressed adolescents (age 11-17) from the IMPACT trial were subjected to latent class analysis. We compared classes on self-reported symptoms and social impairment at baseline and follow-up and their engagement in treatment. RESULTS: We identified three classes of participants which differed in the number and pattern of depression symptoms; Class 1-Severe- (37.2%)-endorsed almost all symptoms and were most functionally impaired; Class 2-Moderate- (41.9%)-endorsed fewer symptoms with high suicidal ideation, self-harm, and worthlessness; Class 3-Somatic (20.9%)-endorsed fewest symptoms, with high somatic symptoms. Groups did not differ on engagement, therapeutic alliance, or post-treatment symptom reduction. Adolescents in the severe and moderate subgroups reported symptom reductions after treatment ended, whilst those in the somatic subgroup did not. CONCLUSIONS: At presentation, high somatic features in depressed adolescents, rather than severity, or impairment levels, may indicate lower liability for responding to psychological treatment.

Social Functioning as a Mediator between Developmental Language Disorder (DLD) and Emotional Problems in Adolescents.

Adolescents with Developmental Language Disorder (DLD) are at risk for increased feelings of anxiety and depression compared to their typically developing (TD) peers. However, the underlying pathways involved in this relationship are unclear. In this initial study of the 'social mediation hypothesis', we examine social functioning as a mediator of emotional problems in a cross-sectional sample of adolescents with DLD and age- and sex-matched controls. Preliminary data from twenty-six participants with DLD and 27 participants with typical language development (TLD, 11-17 years) were compared on self- and parent-reported measures of social functioning and emotional outcomes. There was little evidence of group differences in self-reported social functioning and emotional outcomes, but parent-report of SDQ Peer Problems and Emotional Problems in the DLD group was significantly higher than in the TLD group. Parent-reported peer problems mediated parent-reported emotional problems, accounting for 69% of the relationship between DLD status and emotional problems. Parents of adolescents with DLD, but not adolescents themselves, report significantly higher peer and emotional problems compared to TLD peers. The hypotheses generated from these novel data suggest further investigation into adolescents' perceptions of socioemotional difficulties and friendships should be examined.

How do the prevalence and relative risk of non-suicidal self-injury and suicidal thoughts vary across the population distribution of common mental distress (the p factor)? Observational analyses replicated in two independent UK cohorts of young people.

OBJECTIVES: To inform suicide prevention policies and responses to youths at risk by investigating whether suicide risk is predicted by a summary measure of common mental distress (CMD (the p factor)) as well as by conventional psychopathological domains; to define the distribution of suicide risks over the population range of CMD; to test whether such distress mediates the medium-term persistence of suicide risks. DESIGN: Two independent population-based cohorts. SETTING: Population based in two UK centres. PARTICIPANTS: Volunteers aged 14-24 years recruited from primary healthcare registers, schools and colleges, with advertisements to complete quotas in age-sex-strata. Cohort 1 is the Neuroscience in Psychiatry Network (n=2403); cohort 2 is the ROOTS sample (n=1074). PRIMARY OUTCOME MEASURES: Suicidal thoughts (ST) and non-suicidal self-injury (NSSI). RESULTS: We calculated a CMD score using confirmatory bifactor analysis and then used logistic regressions to determine adjusted associations between risks and CMD; curve fitting was used to examine the relative prevalence of STs and NSSI over the population distribution of CMD. We found a dose-response relationship between levels of CMD and risk of suicide. The majority of all subjects experiencing ST and NSSI (78% and 76% in cohort 1, and 66% and 71% in cohort 2) had CMD scores no more than 2 SDs above the population mean; higher scores indicated the highest risk but were, by definition, infrequent. Pathway mediation models showed that CMD mediated the longitudinal course of both ST and NSSI. CONCLUSIONS: NSSI and ST in youths reflect CMD that also mediates their persistence. Universal prevention strategies reducing levels of CMD in the whole population without recourse to screening or measurement may prevent more suicides than approaches targeting youths with the most severe distress or with psychiatric disorders.

A Cross-Lagged Analysis of Emotion Regulation, Peer Problems, and Emotional Problems in Children With and Without Early Language Difficulties: Evidence From the Millennium Cohort Study.

Purpose Adolescents with a history of language difficulties are at risk for increased social and emotional difficulties; however, the pathways involved are unclear. We examine the contribution of poor emotion regulation by comparing longitudinal data from children at risk of developmental language disorder (rDLD) and the general population. Method Data from the Millennium Cohort Study were analyzed at ages 3, 5, 7, 11, and 14 years. The rDLD group (children with parent-reported difficulties and/or a score of -1.5 SDs on the Naming Vocabulary subtest at age 5 years) was compared to a general population group on parent reports of emotion regulation, peer problems, and emotional problems. Results In line with the established literature, increased socioemotional problems in individuals with language difficulties were reported. Poor emotion regulation consistently predicted subsequent peer and emotional problems throughout development in both groups. Stronger cross-lag effects were found in the rDLD group for poor emotion regulation at age 3 years predicting age 5 years emotional problems and age 5 years emotional problems predicting age 7 years emotion regulation difficulties. Stronger reciprocal cross-lag effects were also observed in the rDLD group between peer and emotional problems at ages 3 and 5 years. No significant group differences were found in adolescence. Conclusions Poor emotion regulation makes a small but significant contribution to later peer and emotional difficulties, and this relationship is stronger in children at rDLD. Early reciprocal peer and emotional difficulties are also stronger in the rDLD group, but these effects dissipate in midchildhood. Nevertheless, the consistent relationship between early emotion regulation difficulties and socioemotional problems throughout development warrants further investigation in individuals with lower language skills. Supplemental Material https://doi.org/10.23641/asha.12142059.

Trajectories of prosociality from early to middle childhood in children at risk of Developmental Language Disorder.

Longitudinal research into the development of prosociality during childhood contributes to our understanding of individual differences in social and emotional outcomes. There is a dearth of literature on the development of prosociality in children with Developmental Language Disorder (DLD). Data from the UK based Millennium Cohort Study was used to investigate prosociality from age 5 to 11 years in 738 children at risk of Developmental Language Disorder (r-DLD) and 12,972 children in a general population (GP) comparison group. Multilevel mixed effects regression models were run to investigate the mean change in prosociality and latent class growth analysis was used to identify heterogeneous groups of children who shared similar patterns of development. Overall, children at risk of DLD were less prosocial at age 5 and, although they did become more prosocial by the age of 11, they did not reach the same levels of prosociality as those in the GP group. Subsequent sub group analysis revealed four distinct developmental trajectories: stable high (19 %), stable slightly low (36 %), decreasing to slightly low (5 %), and increasing to high (40 %). Children at risk of DLD were less likely than those in the GP group to be in the stable high class and more likely to be in the stable slightly low class. For children at risk of DLD, being prosocial was protective against concurrent social and emotional difficulties. But being prosocial in early childhood was not protective against later social and emotional difficulties nor did the absence of prosociality in early childhood make social and emotional difficulties in middle childhood inevitable. Rather, the presence of prosociality in middle childhood was the key protective factor, regardless of prosociality in early childhood. Prosociality is not a key area of concern for children at risk of DLD. Instead, it is an area of relative strength, which can be nurtured to mitigate social and emotional difficulties in children at risk of DLD, particularly in middle childhood.

The influence of early familial adversity on adolescent risk behaviors and mental health: Stability and transition in family adversity profiles in a cohort sample.

Although familial adversity is associated with poorer outcomes in childhood and adulthood, little research has looked at the influence of stability or transition between distinct familial adversity subgroups or the impact in adolescence. Using data from the 9-month, 3-, 5-, and 14-year time waves of the Millennium Cohort Study (n > 18,000), we used latent class analysis to identify distinct classes of early familial adversity (marital instability/conflict, "suboptimal" parenting, economic disadvantage, and parental mental health problems) and the impact of these adversity classes on adolescent (a) mental health (including self-harm), (b) risk taking, (c) criminality, and (d) victimization. Four profiles were identified largely differing on economic hardship, family composition, and parental conflict. Across the first three time points, 72% of the sample remained stable, with the remainder transitioning between classes. Adolescents in the higher risk groups (particularly categorized by economic hardship or high parental conflict) had poorer outcomes in adolescence. Transitioning to a higher adversity group at any time in the first 5 years was associated with poorer outcomes but was particularly pronounced when the transition occurred when the child was under 3 years. These findings demonstrate the broad consequences of early familial adversity and the need for targeted early support for at-risk families.

Expressive Vocabulary Predicts Nonverbal Executive Function: A 2-year Longitudinal Study of Deaf and Hearing Children.

Numerous studies suggest an association between language and executive function (EF), but evidence of a developmental relationship remains inconclusive. Data were collected from 75 deaf/hard-of-hearing (DHH) children and 82 hearing age-matched controls. Children were 6-11 years old at first time of testing and completed a battery of nonverbal EF tasks and a test of expressive vocabulary. These tasks were completed again 2 years later. Both groups improved their scores on all tasks over this period. DHH children performed significantly less well than hearing peers on some EF tasks and the vocabulary test at both time points. Cross-lagged panel models showed that vocabulary at Time 1 predicted change in EF scores for both DHH and hearing children but not the reverse.

Relationships between concurrent language ability and mental health outcomes in a South African sample of 13-year-olds.

Children and adolescents with delayed or disordered language development are at increased risk of a number of negative outcomes, including social and emotional problems and mental health difficulties. Yet, in low- and middle- income countries, where risk factors for compromised language development are known to be prevalent, there is a lack of research on the association between child and adolescent language ability and mental health outcomes. This study evaluates data from a cross-sectional study in Khayelitsha, a semi-urban impoverished community near Cape Town, South Africa. To measure language ability, behaviour and mental health, adolescents aged 13 (n = 200) were assessed using the Riddles subtest of the Kaufman Assessment Battery for Children Version 2, the parent report Child Behaviour Checklist, and the self-report Moods and Feelings Questionnaire and the Self-Esteem Questionnaire. We conducted univariate and multivariate analyses to determine associations between language skills, self-esteem and mental health in this group of adolescents. Poor language ability was related to a range of concurrent adverse difficulties, such as attention deficits, self-esteem problems, social withdrawal, and depressive symptoms. Increased levels of language ability were related to better psychosocial profiles. In some cases, only individuals with a low level of language (bottom 10% of sample) were at increased risk of maladaptive outcomes. This study replicates the well-established relationship between language ability and poorer mental health found within high income countries in an upper middle-income country setting. Locally accessible support for children with reduced language ability is required, given the longer-term consequences of poorer mental health.

Early Risk Factors and Emotional Difficulties in Children at Risk of Developmental Language Disorder: A Population Cohort Study.

Purpose This study evaluated the pathways between developmental language disorder (DLD), psychosocial risk factors, and the development of emotional difficulties from ages 3 to 11 years within the Millennium Cohort Study. Method A total of 14,494 singletons (49.4% female) from the Millennium Cohort Study were evaluated within this study. Risk of DLD (rDLD) was defined as age 5 parent-reported language problems and/or -1.5 SDs on a Naming Vocabulary subtest at the age of 5 years. Children without rDLD formed the general population comparison group. Psychosocial risk factors included 9-month temperamental traits, parental psychological distress, and maternal attachment as well as age 3 emotional regulation abilities, parent-child relationship, and peer problems. The parent report Strengths and Difficulties Questionnaire Emotional Difficulty subscale at 3, 5, 7, and 11 years of age was the outcome variable. The trajectory of emotional difficulties was evaluated within a variable-centered approach and a person-centered approach, using growth mixture modeling. Results Children with rDLD (n = 884) had increased levels of emotional problems when compared to the general population group (n = 13,344). Psychosocial risk factors were increased in children with rDLD, fully mediated the increased emotional difficulties at 3 years, and partially mediated the increased emotional difficulties at 11 years. Children with rDLD were more likely to be included in emotional trajectory subgroups with an increasing pattern of emotional problems. rDLD was an additional risk factor for lower levels of emotional self-regulation and increased peer problems when controlling for the emotional difficulties trajectory subgroup. Conclusion This article indicates that the increased emotional difficulties found in children with rDLD are likely a function of early language difficulties influencing other domains of development, specifically social interactions (parent and peer) and emotional self-regulation abilities. Clinically, this reiterates the importance of early identification and treatment of children with language delays or clinical level language disorders. Supplemental Material https://doi.org/10.23641/asha.8323598.

The emotional and behavioural symptom trajectories of children in long-term out-of-home care in an English local authority.

The significant mental health needs of young people in out-of-home care has been well-documented. However, there is little empirical evidence on the timing or development of these difficulties, once these young people have been removed from the maltreatment-environment. Such information may provide useful clinical insight in to how problems develop and persist and whether intervention timings may allow for the prevention of later mental health problems. The current service-data study explored the emotional and behavioural symptom trajectories of 207 young people under the long-term care of a local authority in the South West of England, over their first five years in the care system. Data were extracted from the yearly carer-completed strengths and difficulties questionnaire - providing an index of emotional problems, peer problems, conduct problems and hyperactivity. Trajectories were analysed using growth mixture modelling. For most domains the largest trajectories were chronic symptom profiles, where young people were rated in the abnormal range from their first year in care and remained in this range across the full five years. These young people had significantly more placement moves than their peers on resilient trajectories. There was some evidence that later age of removal was associated with more chronic internalising problems. Overall, findings demonstrate the significant mental health needs of young people in care and particularly highlight that, in many cases, the removal from the adverse environment is simply not enough to expect a young person in care to be resilient to their earlier experiences.

Characterising the latent structure and organisation of self-reported thoughts, feelings and behaviours in adolescents and young adults.

Little is known about the underlying relationships between self-reported mental health items measuring both positive and negative emotional and behavioural symptoms at the population level in young people. Improved measurement of the full range of mental well-being and mental illness may aid in understanding the aetiological substrates underlying the development of both mental wellness as well as specific psychiatric diagnoses. A general population sample aged 14 to 24 years completed self-report questionnaires on anxiety, depression, psychotic-like symptoms, obsessionality and well-being. Exploratory and confirmatory factor models for categorical data and latent profile analyses were used to evaluate the structure of both mental wellness and illness items. First order, second order and bifactor structures were evaluated on 118 self-reported items obtained from 2228 participants. A bifactor solution was the best fitting latent variable model with one general latent factor termed 'distress' and five 'distress independent' specific factors defined as self-confidence, antisocial behaviour, worry, aberrant thinking, and mood. Next, six distinct subgroups were derived from a person-centred latent profile analysis of the factor scores. Finally, concurrent validity was assessed using information on hazardous behaviours (alcohol use, substance misuse, self-harm) and treatment for mental ill health: both discriminated between the latent traits and latent profile subgroups. The findings suggest a complex, multidimensional mental health structure in the youth population rather than the previously assumed first or second order factor structure. Additionally, the analysis revealed a low hazardous behaviour/low mental illness risk subgroup not previously described. Population sub-groups show greater validity over single variable factors in revealing mental illness risks. In conclusion, our findings indicate that the structure of self reported mental health is multidimensional in nature and uniquely finds improved prediction to mental illness risk within person-centred subgroups derived from the multidimensional latent traits.

Friendships and Family Support Reduce Subsequent Depressive Symptoms in At-Risk Adolescents.

BACKGROUND: Early life stress (ELS) consists of child family adversities (CFA: negative experiences that happened within the family environment) and/or peer bullying. ELS plays an important role in the development of adolescent depressive symptoms and clinical disorders. Identifying factors that may reduce depressive symptoms in adolescents with ELS may have important public mental health implications. METHODS: We used structural equation modelling and examined the impact of adolescent friendships and/or family support at age 14 on depressive symptoms at age 17 in adolescents exposed to ELS before age 11. To this end, we used structural equation modelling in a community sample of 771 adolescents (322 boys and 477 girls) from a 3 year longitudinal study. Significant paths in the model were followed-up to test whether social support mediated or moderated the association between ELS and depressive symptoms at age 17. RESULTS: We found that adolescent social support in adolescence is negatively associated with subsequent depressive symptoms in boys and girls exposed to ELS. Specifically, we found evidence for two mediational pathways: In the first pathway family support mediated the link between CFA and depressive symptoms at age 17. Specifically, CFA was negatively associated with adolescent family support at age 14, which in turn was negatively associated with depressive symptoms at age 17. In the second pathway we found that adolescent friendships mediated the path between peer bullying and depressive symptoms. Specifically, relational bullying was negatively associated with adolescent friendships at age 14, which in turn were negatively associated with depressive symptoms at age 17. In contrast, we did not find a moderating effect of friendships and family support on the association between CFA and depressive symptoms. CONCLUSIONS: Friendships and/or family support in adolescence mediate the relationship between ELS and late adolescent depressive symptoms in boys and girls. Therefore, enhancing affiliate relationships and positive family environments may benefit the mental health of vulnerable youth that have experienced CFA and/or primary school bullying.

Adolescents leaving mental health or social care services: predictors of mental health and psychosocial outcomes one year later.

BACKGROUND: UK service structure necessitates a transition out of youth services at a time of increased risk for the development and onset of mental disorders. Little is currently known about the mental health and psychosocial outcomes of leaving services at this time. The aim of this study was to determine predictors of mental health and social adjustment in adolescents leaving mental health or social care services. METHODS: A cohort (n = 53) of 17 year olds were interviewed and assessed when preparing to leave adolescent services and again 12 months later. Their mental health and psychosocial characteristics were compared to a same-age community sample group (n = 1074). RESULTS: At discharge 34 (64%) met DSM IV criteria for a current psychiatric diagnosis and only 3 (6%) participants met operational criteria for successful outcomes at follow-up. Impairments in mental health, lack of employment, education or training and low preparedness were associated with poor outcomes. CONCLUSIONS: The findings suggest the current organisation of mental health and care services may not be fit for purpose and even unwittingly contribute to persistent mental illness and poor psychosocial outcomes. A redesign of services should consider a model where the timing of transition does not fall at the most hazardous time for young people, but is sufficiently flexible to allow young people to move on when they are personally, socially and psychologically most able to succeed. Assessment of a young person's readiness to transition might also be useful. A youth focused service across the adolescent and early adult years may be better placed to avoid young people falling through the service gap created by poor transitional management.