Effectiveness of unified protocol for trans diagnostic treatment in children with anxiety disorders: A randomized control trial.

BACKGROUND: The Unified Protocol for Transdiagnostic Treatment of Emotional Disorders in Children (UP-C) is a theory-derived approach that can target the common underlying processes, such as the cognitive, emotional, and behavioral processes in emotional disorders in children aged 8-12 years. This study aimed to investigate UP-C's efficacy in treating children's anxiety disorders compared to cognitive behavior therapy (CBT). MATERIALS AND METHODS: In this randomized control trial (RCT), with pre-test, post-test, and follow-up, 34 participants aged 8-12 with anxiety disorders were selected through the restricted randomization method and allocated to intervention (UP-C) or control (CBT) groups by random allocation rule. UP-C group consisted of 15 weekly individual sessions, and CBT included 16 weekly individual sessions. The Emotion Regulation Questionnaire for Children and Adolescents (ERQ-CA) and The Screen for Child Anxiety Related Disorders (SCARED-71) were completed in the pre-test, post-test, and three-month follow-up stages. The data of participants were analyzed using the repeated measure analysis of variance. A P- value under. 05 was regarded as significant. RESULTS: Based on the repeated measures ANOVA, UP-C, and CBT significantly reduced anxiety symptoms (P = .002) and emotional suppression (P = .032). Moreover, UP-C and CBT significantly increased emotion regulation (P = .000) and cognitive reappraisal (P = .000). CONCLUSION: The individual UP-C can be effective as anxiety-oriented CBT in treating anxiety disorders. Also, in the three months follow-up, the UP-C's effects were more stable and progressive than the CBT.

Psychometric properties of Persian version of child and youth resilience measure-revised in children.

BACKGROUND: Resilience is both the individuals' capacity to navigate their way to the resources that sustain their well-being in the context of exposure to adversity and their capacity to negotiate for resources to be accessed. Hence, it is crucial for clinical settings and research centers to have access to a valid and reliable scale that can measure different components of resilience. This study aimed to determine the psychometric properties and cultural adaptation of the Persian version of the Child and Youth Resilience Measure-revised (CYRM-R) in Children. MATERIALS AND METHODS: This cross-sectional study includes the standard procedure of translation of the CYRM-R and Person Most Knowledgeable-Child and Youth Resilience Measure-revised (PMK-CYRM-R), exploration of the goodness-of-fit, and confirmatory factor analysis (CFA) of a sample of 200 parents or caregivers and their children aged 5 to 9 years who were selected by convenient sampling in Tehran, Iran. CYRM-R, PMK-CYRM-R, and The Strengths and Difficulties Questionnaire (SDQ) were completed by participants. Also, internal consistency, face, content, and criterion validity were investigated. RESULTS: A two-factor structure of CYRM-R for Iranian children was identified by CFA: Personal and Caregiver. Results indicated adequate goodness-of-fit and strong internal consistency (Cronbach's alpha = 0.88). Acceptable face, content, and criterion validity of the CYRM-R were reported by positive correlation to the PMK-CYRM-R. No significant relation was found between CYRM-R and SDQ. CONCLUSION: Findings of the present study support the robust psychometric properties and cultural adaptation of the CYRM-R in Iranian children.

Working in hospitals during a pandemic: investigating the resilience among medical staff during COVID-19 outbreak through qualitative and quantitative research.

BACKGROUND: Medical staff in hospitals were faced with great stress as a result of COVID-19's sudden and severe occurrence, which makes investigating their resilience essential. AIMS AND METHODS: Using qualitative and quantitative research methods, this research studied medical staff (n = 403) working in a hospital during the COVID-19 pandemic and followed four main goals: First was evaluating the psychometric properties of the Persian version of Adult Resilience Measure-Revised (ARM-R). The second goal was investigating the personal, relational, social, and organizational issues facing the medical staff during the COVID-19 using semi-structural interviews. The third goal was to determine predictive effects of demographic and work-related variables on resilience using stepwise regression analysis. And the fourth was comparing resilience of three groups of the medical staff (coronavirus group consisted of the medical staff in direct contact with COVID-19 patients; emergency group who work in the emergency department who deal with both COVID and non-COVID patients; and non-coronavirus group who had no contact with COVID-19 patients) using one-way ANOVA. FINDINGS: Results showed that internal reliability/consistency, content, and face validity of the Persian version of the ARM-R are acceptable. The construct validity of the test was also verified using exploratory factor analysis and indicated the two factors of personal and relational resilience. The content of the interviews was analyzed using manifest content analysis, and the results were divided into 27 subcategories and 3 main categories including personal, organizational, and family categories. Moreover, regression analysis revealed that the marital status and age of children can explain resilience variance in some medical staff groups. The results of ANOVA and post hoc test also showed that the total resilience of the non-coronavirus group was greater than the coronavirus and emergency groups; the relational resilience of the coronavirus and non-coronavirus groups was greater than the emergency, and non-coronavirus group's personal resilience was greater than the emergency group.

Comparison of the effectiveness of online supportive parenting intervention (SPACE) and timid to tiger program (FTTT) on childhood anxiety disorders and family accommodation with samples of Iranian parents.

Studies have supported the effectiveness of the From Timid to a Tiger (FTTT) and Supportive Parenting for Anxious Childhood Emotions (SPACE) program in reducing childhood anxiety. This study is the first to compare the effectiveness of the two programs in the treatment of childhood anxiety disorder and reducing family accommodations levels. Parents of children aged 6 to 9 (n = 49, 49% boys) were randomly allocated to either FTTT (n 26) or SPACE (n = 23) groups, and each attended ten online sessions following the manuals of the interventions. Throughout the study, 9 participants dropped out, resulting in a total of 49 participants, and we performed statistical analyses based on data from these 49 participants. The assessment took place pre- and post-treatment and at a ten-week follow-up on parent-rated child anxiety and family accommodation measures. Analyses of variance (repeated measures) and gain scores were conducted to examine the data. The results indicated that both treatments approaches produced significant reductions in outcome measures, and the post-treatment gains of both treatments were maintained at a ten-week follow-up, though when considering the mean differences and effect sizes across the assessment scores and between groups, overall, the FTTT was significantly more effective in reducing child anxiety scores and family accommodation levels. Our results demonstrated that FTTT significantly outperformed the SPACE program in reducing childhood anxiety problems and family accommodation levels.

Changing parenting style between two generations and its impacts on the severity of behavioral and emotional symptoms.

OBJECTIVE: The purpose of this study is to compare the perceived parenting dimensions in mothers and their daughters (differences between two generations), and study the relationship between these dimensions and the severity of daughters' behavioral and emotional symptoms. MATERIALS AND METHODS: 300 participants (150 daughters with their mothers) participated in this study. They responded to the perceived parenting styles questionnaire (PSQ), and mothers were additionally asked to answer the child symptoms inventory-4 (CSI-4). Data analysis was done by the SPSS using the paired sample t-test and multiple regressions. RESULTS: The results indicated a significant difference between perceived parenting dimensions in mothers and their daughters; specifically, acceptance and control dimensions increased through generation. It was also found that daughters' acceptance-rejection dimension could predict the severity of the symptoms of attention-deficit/hyperactivity disorders, autism spectrum disorders, depression, dysthymia, conduct disorders, and opposite defiant disorders. The control-autonomy dimension could also predict the severity of schizophrenia symptoms. CONCLUSION: The results indicate the different parenting styles between two generations and the critical role of parenting in developing the children's psychopathology symptoms.

An Individual Participant Data Meta-analysis: Behavioral Treatments for Children and Adolescents With Attention-Deficit/Hyperactivity Disorder.

OBJECTIVE: Behavioral interventions are well established treatments for children with attention-deficit/hyperactivity disorder (ADHD). However, insight into moderators of treatment outcome is limited. METHOD: We conducted an individual participant data meta-analysis (IPDMA), including data of randomized controlled behavioral intervention trials for individuals with ADHD <18 years of age. Outcomes were symptoms of ADHD, oppositional defiant disorder (ODD), and conduct disorder (CD) and impairment. Moderators investigated were symptoms and impairment severity, medication use, age, IQ, sex, socioeconomic status, and single parenthood. RESULTS: For raters most proximal to treatment, small- to medium-sized effects of behavioral interventions were found for symptoms of ADHD, inattention, hyperactivity/impulsivity (HI), ODD and CD, and impairment. Blinded outcomes were available only for small preschool subsamples and limited measures. CD symptoms and/or diagnosis moderated outcome on ADHD, HI, ODD, and CD symptoms. Single parenthood moderated ODD outcome, and ADHD severity moderated impairment outcome. Higher baseline CD or ADHD symptoms, a CD diagnosis, and single parenthood were related to worsening of symptoms in the untreated but not in the treated group, indicating a protective rather than an ameliorative effect of behavioral interventions for these children. CONCLUSION: Behavioral treatments are effective for reducing ADHD symptoms, behavioral problems, and impairment as reported by raters most proximal to treatment. Those who have severe CD or ADHD symptoms, a CD diagnosis, or are single parents should be prioritized for treatment, as they may evidence worsening of symptoms in the absence of intervention.

Rapid screening for generalized anxiety disorder in patients with migraine.

Background: Generalized anxiety disorder (GAD) often remains undiagnosed in patients with migraine, while comorbidity of GAD with migraine is associated with increased dysfunction and risk of chronic migraine. Generalized Anxiety Disorder Scale 7-item (GAD-7) and Generalized Anxiety Disorder Scale 2-item (GAD-2) are the commonly employed screening measures for generalized anxiety symptoms in different patient groups. The present study aimed to evaluate psychometric properties of the Persian version of GAD-7 and GAD-2 in migraine. Methods: In this cross-sectional study, patients were diagnosed with migraine headaches according to the International Classification of Headache Disorders, 3rd edition (ICHD-3); then they participated in the psychiatric diagnostic interview, and filled out GAD-7, GAD-2, Beck Anxiety Inventory (BAI), Headache Impact Test-6 (HIT-6), and Migraine-Specific Quality of Life Questionnaire version 2.1 (MSQv2.1). The psychometric properties of GAD-7 and GAD-2 were examined using SPSS and LISREL. Results: Final samples were 186 patients with migraine that 83 patients received a diagnosis of GAD. Confirmatory factor analysis (CFA) indicated that the one-factor model of GAD-7 fit the data well. Internal consistency, test-retest, and Guttman split-half reliability of GAD-7 and GAD-2 were good. Significant correlation results, average variance extracted (AVE), and composite reliability (CR) supported the construct validity of the GAD-7. A score of ≥ 10 in GAD-7 and ≥ 3 in GAD-2 achieved satisfactory sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) (GAD-7: 92%, 90%, 88%, and 93%, respectively; GAD-2: 79%, 88%, 71%, and 91%, respectively). Conclusion: Our findings supported GAD-7 and GAD-2 for assessing GAD in patients with migraine. It seems that GAD-7 and GAD-2 accurately diagnosed GAD in this group of patients.

Psychometric Properties of the Farsi Version of Eyberg Child Behavior Inventory (F-ECBI) in Iranian Population.

Objective: Eyberg Child Behavior Inventory (ECBI) is one of the most frequently used tools for measuring behavioral problems; however, no research has been done to evaluate its psychometric properties in Iran. Method : The present study sought for exploring the factor structure and psychometric properties of the F-ECBI in an Iranian sample. A total of 495 mothers (mean age = 33.83 years; SD = 4.78) who reported behavioral problems in their children aged 3 to 12 years (mean age = 6.36 years; SD = 2.66) were selected via convenience sampling in 2018-2019. The psychometric properties of F-ECBI, including reliability (Cronbach's alpha) and validity (exploratory and confirmatory factor analysis, and convergent validity) were assessed using SPSS version 25 and LISREL 8.80. Results: By performing EFA on the first sample part (n = 360), the examination of scree plot supported a 3-factor or 4-factor solution, and pattern matrix resulted in a 3-factor structure. The factors were called as "behavioral problems related to oppositional defiant", "behavioral problems related to inattentive", and "behavioral problems related to conduct", according to their content and the research. CFA was performed on the second part of the sample (n = 135) to test the fitness of the 3-factor solution. According to CFI (0.91), NFI (0.91), NNFI (0.90), IFI (0.91), PNFI (0.77), GFI (0.75) AGFI (0.70), PGFI (0.62) and chi-square (540.31) indexes, the model had acceptable fitness. Cronbach's alpha was employed to measure the internal consistency and it revealed to be at a good to excellent level (behavioral problems related to oppositional defiant = 0.88; behavioral problems related to inattentive = 0.84; behavioral problems related to conduct = 0.74). The 3-factors subscales were associated with total difficulties, internalizing and externalizing SDQ, indicating the good convergent validity of F-ECBI. Conclusion: The F-ECBI has good psychometric properties in Iran and can be employed as a useful instrument for measuring children's behavioral problems.

Triple p-positive parenting program for mothers of ADHD children.

OBJECTIVE: Attention deficit hyperactivity disorder (ADHD) is a chronic, highly prevalent neurodevelopmental disorder which affects 9% of school-age children. Triple P-Positive Parenting Program is an evidence-based parenting program reported to be useful in the management of this disorder. The aim of this randomized controlled trial was to evaluate the effectiveness of Triple P in mothers of ADHD children. METHODS: In this study, 30 mothers with ADHD children aged between 6 to 10 were randomly assigned to two groups (15 participants in each group). Parenting style, mother-child relationship, maternal depression, anxiety and stress, and children's behavioral problems were evaluated. The intervention group received 120 minute sessions for 5 weeks and 15-30 minute telephone contacts for 3 weeks while no intervention was done for the control group. RESULTS: Analysis of covariance revealed that mothers of the Triple P group showed significant (p < 0.01) improvements in parenting style, mother-child relationship, and considerable decrease in depression, anxiety and stress. Women trained in the Triple P group also reported significantly lower rates of child misbehavior than women of the control group. CONCLUSION: Triple P-Positive Parenting intervention is effective and acceptable for mothers of ADHD children. DECLARATION OF INTEREST: None. Clinical Trial Registration-URL: http://www.irct.ir. Unique identifier: IRCT201111288234N1.