Better together? A randomized controlled microtrial comparing different levels of therapist and parental involvement in exposure-based treatment of childhood specific phobia.

INTRODUCTION: Exposure is often limited to homework assignments in routine clinical care. The current study compares minimally-guided (MGE) and parent-guided (PGE) out-session homework formats to the 'golden standard' of therapist-guided in-session exposure with minimally-guided exposure at home (TGE). METHODS: Children with specific phobia (N = 55, age 8-12, 56% girls) participated in a single-blind, randomized controlled microtrial with a four-week baseline-treatment period design. Clinical interviews, behavioral avoidance tests, and self-report measures were assessed at pre-treatment, post-treatment, and at one-month follow-up. RESULTS: TGE resulted in a larger decline of specific phobia severity from baseline to post-treatment compared to MGE but not compared to PGE. Parental anxiety was found to be a moderator of less treatment efficacy of PGE from baseline to post-treatment. Overall, there was no meaningful difference in efficacy of TGE versus MGE or PGE from baseline to follow-up. CONCLUSIONS: These findings suggest that for improving short-term treatment gains, exposure exercises can best be conducted with the help of a therapist within the therapy session before they are conducted as homework assignments outside the therapy session. However, for long-term treatment gains exposure exercises can be handled by the child itself or with help of its parents.

The Strengths and Difficulties Questionnaire Parent Form: Dutch norms and validity.

OBJECTIVE: This study provides Dutch national norms for the parent-reported Strengths and Difficulties Questionnaire (SDQ) for children aged 3-14 years, and assesses the test performance of the SDQ Total Difficulties Scale (TDS) and impairment Scale. We further compared Dutch SDQ norms with those of the United Kingdom (UK), to determine potential variation in country-specific norms. STUDY DESIGN: We analyzed data of 3384 children aged 3 to 14 years. The data were obtained in schools, and in the context of Preventive Child Healthcare. Parents completed the SDQ parent form and the Child Behavior Checklist (CBCL). We determined clinical (10% elevated scores) and borderline (20% elevated scores) SDQ TDS norms. We assessed the test performance (validity) of the SDQ TDS and Impairment Score using the CBCL as criterion. RESULTS: The clinical SDQ TDS norms varied between > 10 and > 14 depending on the age group. The SDQ TDS discriminated between children with and without problems, as measured by the CBCL, for all age groups (AUCs varied from 0.92 to 0.96). The SDQ Impairment Score had added value (beyond the SDQ TDS) only for the age group 12-14 years. For the Netherlands we found lower clinical SDQ TDS norms than those previously reported for the UK (i.e. > 16). CONCLUSION: The clinical SDQ TDS norms varied between > 10 and > 14 depending on the age groups. We found good test performance at these proposed norms. Dutch norms differed somewhat from UK norms. In the Netherlands, the SDQ performed better with Dutch-specific norms than with UK-specific norms.

Effectiveness of CBT for children and adolescents with depression: A systematic review and meta-regression analysis.

BACKGROUND: Cognitive-behavioral therapy (CBT) is first choice of treatment for depressive symptoms and disorders in adolescents, however improvements are necessary because overall efficacy is low. Insights on CBT components and contextual and structural characteristics might increase the efficacy. The aim of our approach is to evaluate the efficacy of CBT for youth with depression and investigate the influence of specific components, contextual and structural factors that could improve effects. METHODS: A systematic review of randomized controlled trials was conducted, searches were undertaken in CINAHL, CENTRAL, EMBASE, MEDLINE/PubMed and PsycINFO. Outcomes were meta-analyzed and confidence in results was assessed using the GRADE-method. Meta-regression was used to pinpoint components or other factors that were associated with an in- or decrease of effects of CBT. RESULTS: We included 31 trials with 4335 participants. Moderate-quality evidence was found for CBT reducing depressive symptoms at the end of treatment and at follow-up, and CBT as indicated prevention resulted in 63% less risk of being depressed at follow-up. CBT containing a combination of behavioral activation and challenging thoughts component (as part of cognitive restructuring) or the involvement of caregiver(s) in intervention were associated with better outcomes for youth on the long term. CONCLUSIONS: There is evidence that CBT is effective for youth with a (subclinical) depression. Our analyses show that effects might improve when CBT contains the components behavioral activation and challenging thoughts and also when the caregiver(s) are involved. However, the influential effects of these three moderators should be further tested in RCTs.

Unmet Need for Specialty Mental Health Services Among Children Across Europe.

OBJECTIVE: The aim of this study was to examine the determinants of use of mental health services for children across Europe, with a specific focus on differences in the availability of mental health resources. METHODS: Data were drawn from the School Children Mental Health in Europe Project. Parent- and teacher-reported child mental health status was based on the Strengths and Difficulties Questionnaire. Sociodemographic characteristics of parents and children, as well as academic performance and use of mental health services in the previous 12 months, were collected. Countries were categorized as having high versus low mental health resources. The sample comprised 4,894 schoolchildren in seven countries. RESULTS: Across Europe, only 25.6% of children with a mental disorder had received mental health services in the previous 12 months, including 31.5% in high-resources countries and 18.9% in low-resources countries (p=.001) (N=4,867). The presence of any mental disorder, maternal psychological distress, gender, living in a single-parent home, and low academic performance were determinants of service use. The effect of resources group on the likelihood of receiving services remained significant when the analyses controlled for all predictors (odds ratio=1.41, p<.01). Determinants differed between groups-maternal psychological distress was associated with service use in high-resources countries, and gender was associated with service use in low-resources countries. CONCLUSIONS: The findings point to a substantial portion of unmet need across Europe and to major differences in access to care in low- versus high-resources countries. Efforts are needed to address unmet need among children with mental disorders, especially in low-resources countries.

Video Gaming and Children's Psychosocial Wellbeing: A Longitudinal Study.

The effects of video games on children's psychosocial development remain the focus of debate. At two timepoints, 1 year apart, 194 children (7.27-11.43 years old; male = 98) reported their gaming frequency, and their tendencies to play violent video games, and to game (a) cooperatively and (b) competitively; likewise, parents reported their children's psychosocial health. Gaming at time one was associated with increases in emotion problems. Violent gaming was not associated with psychosocial changes. Cooperative gaming was not associated with changes in prosocial behavior. Finally, competitive gaming was associated with decreases in prosocial behavior, but only among children who played video games with high frequency. Thus, gaming frequency was related to increases in internalizing but not externalizing, attention, or peer problems, violent gaming was not associated with increases in externalizing problems, and for children playing approximately 8 h or more per week, frequent competitive gaming may be a risk factor for decreasing prosocial behavior. We argue that replication is needed and that future research should better distinguish between different forms of gaming for more nuanced and generalizable insight.

The Co-Development of Parenting Stress and Childhood Internalizing and Externalizing Problems.

Although the detrimental influence of parenting stress on child problem behavior is well established, it remains unknown how these constructs affect each other over time. In accordance with a transactional model, this study investigates how the development of internalizing and externalizing problems is related to the development of parenting stress in children aged 4-9. Mothers of 1582 children participated in three one-year interval data waves. Internalizing and externalizing problems as well as parenting stress were assessed by maternal self-report. Interrelated development of parenting with internalizing and externalizing problems was examined using Latent Growth Modeling. Directionality of effects was further investigated by using cross-lagged models. Parenting stress and externalizing problems showed a decrease over time, whereas internalizing problems remained stable. Initial levels of parenting stress were related to initial levels of both internalizing and externalizing problems. Decreases in parenting stress were related to larger decreases in externalizing problems and to the (stable) course of internalizing problems. Some evidence for reciprocity was found such that externalizing problems were associated with parenting stress and vice versa over time, specifically for boys. Our findings support the transactional model in explaining psychopathology.

Relations Between Parental and Child Separation Anxiety: The Role of Dependency-Oriented Psychological Control.

Although separation anxiety is prevalent in young children, it remains unclear whether and how maternal separation anxiety is related to separation anxiety in children. This study examined associations between maternal separation anxiety and separation anxiety in children, and the potential effect psychologically controlling parenting. Mothers (N = 269) and children (N = 287) recruited for a community sample participated in two 1-year interval data-waves. Children were aged five-eight and were interviewed using an age-appropriate method for obtaining self-reports of separation anxiety and perceptions of dependency-oriented psychologically controlling parenting. Mothers reported on their feelings of separation anxiety regarding their child via a questionnaire. We found that maternal separation anxiety was positively related to separation anxiety in children within, but not over time. We did not find psychologically controlling parenting to mediate this association. Studying other factors than parenting may be an important avenue for future research in explaining separation anxiety in children.

The Strengths and Difficulties Questionnaire: psychometric properties of the parent and teacher version in children aged 4-7.

BACKGROUND: The Strengths and Difficulties Questionnaire is one of the most employed screening instruments. Although there is a large research body investigating its psychometric properties, reliability and validity are not yet fully tested using modern techniques. Therefore, we investigate reliability, construct validity, measurement invariance, and predictive validity of the parent and teacher version in children aged 4-7. Besides, we intend to replicate previous studies by investigating test-retest reliability and criterion validity. METHODS: In a Dutch community sample 2,238 teachers and 1,513 parents filled out questionnaires regarding problem behaviors and parenting, while 1,831 children reported on sociometric measures at T1. These children were followed-up during three consecutive years. Reliability was examined using Cronbach's alpha and McDonald's omega, construct validity was examined by Confirmatory Factor Analysis, and predictive validity was examined by calculating developmental profiles and linking these to measures of inadequate parenting, parenting stress and social preference. Further, mean scores and percentiles were examined in order to establish norms. RESULTS: Omega was consistently higher than alpha regarding reliability. The original five-factor structure was replicated, and measurement invariance was established on a configural level. Further, higher SDQ scores were associated with future indices of higher inadequate parenting, higher parenting stress and lower social preference. Finally, previous results on test-retest reliability and criterion validity were replicated. CONCLUSIONS: This study is the first to show SDQ scores are predictively valid, attesting to the feasibility of the SDQ as a screening instrument. Future research into predictive validity of the SDQ is warranted.

Alcohol expectancies in young children and how this relates to parental alcohol use.

According to the cognitive model of intergenerational transference, modeling of alcohol use is an indirect process in which parental drinking shapes alcohol expectancies of children, which in turn are associated with later alcohol use in adolescents. The present study examined whether parental alcohol use was related to alcohol expectancies and experimentation with alcohol use in young children. A community sample of 240 children aged 8.02 (SD=1.13) participated. Alcohol expectancies were assessed by means of the Berkeley Puppet Interview. Children reported consistently and reliably on the positive and negative consequences of alcohol use among adults. Their positive and negative expectancies were equally strong. Compared to younger children, older children had more negative and less positive expectancies. For girls, more paternal alcohol use was associated with less negative alcohol expectancies. For older children, more alcohol use of the mother was related to less positive expectancies, while more alcohol use of the father was related to more positive expectancies. The present study showed that young children already have clear ideas about the positive and negative consequences alcohol can have among adults, which can be captured with the Berkeley Puppet Interview. These expectancies are partly associated with alcohol use of their parents.

Associations between children's video game playing and psychosocial health: information from both parent and child reports.

Video games are a highly heterogeneous form of entertainment. As recent reviews highlight, this heterogeneity makes likely that video games have both positive and negative consequences for child development. This study investigated the associations between gaming frequency and psychosocial health among children younger than 12 years of age, an understudied cohort in this field. Both parents and children reported children's gaming frequency, with parents also reporting on children's psychosocial health. Given that children may be too young to report the time they spend playing video games accurately, children's reports were scaffolded by a developmentally appropriate measure. We further investigated the potential bias of having parents report both their children's gaming frequency and their children's psychosocial health (i.e., a single source bias). Parental reports of children's gaming frequency were higher than their children's reports. However, a direct test of the potential single source bias rendered null results. Notably, however, while parental reports showed negative associations between gaming and psychosocial health, children's reports showed no associations. Specifically, based on parent reports, children's gaming was associated with more conduct and peer problems, and less prosocial behavior. As children's reports produced no associations between gaming and psychosocial health, parental reports in this study may belie an erroneous set of conclusions. We therefore caution against relying on just one reporter when assessing children's gaming frequency.

Psychometric properties of the parent and teacher versions of the strengths and difficulties questionnaire for 4- to 12-year-olds: a review.

Since its development, the Strengths and Difficulties Questionnaire (SDQ) has been widely used in both research and practice. The SDQ screens for positive and negative psychological attributes. This review aims to provide an overview of the psychometric properties of the SDQ for 4- to 12-year-olds. Results from 48 studies (N = 131,223) on reliability and validity of the parent and teacher SDQ are summarized quantitatively and descriptively. Internal consistency, test-retest reliability, and inter-rater agreement are satisfactory for the parent and teacher versions. At subscale level, the reliability of the teacher version seemed stronger compared to that of the parent version. Concerning validity, 15 out of 18 studies confirmed the five-factor structure. Correlations with other measures of psychopathology as well as the screening ability of the SDQ are sufficient. This review shows that the psychometric properties of the SDQ are strong, particularly for the teacher version. For practice, this implies that the use of the SDQ as a screening instrument should be continued. Longitudinal research studies should investigate predictive validity. For both practice and research, we emphasize the use of a multi-informant approach.