Victimization by traditional bullying and cyberbullying and the combination of these among adolescents in 13 European and Asian countries.

There has been a lack of studies on bullying in non-western low-income and middle-income countries. This study reported the prevalence of traditional victimization, cybervictimization, and the combination of these, in 13 European and Asian countries, and explored how psychiatric symptoms were associated with victimization. The data for this cross-sectional, school-based study of 21,688 adolescents aged 13-15 were collected from 2011 to 2017. The main outcomes were traditional and cybervictimization obtained from student self-reports. The Strengths and Difficulties Questionnaire was used to assess psychiatric symptoms. Generalized estimating equation and logistic regression models were used to estimate odds ratios (ORs) and 95% confidence intervals (95% CIs). The mean prevalence of any victimization was 28.9%, of traditional victimization only, this was 17.7%, and for cybervictimization only this was 5.1%. Cybervictimization occurred both independently, and in combination with, traditional victimization. The mean prevalence of combined victimization was 6.1%. The mean proportion of those who were cyberbullied only among those who were either cyberbullied only or bullied both traditionally and in cyber was 45.1%. The rates of prevalence varied widely between countries. In the total sample, those who experienced combined victimization, reported the highest internalizing symptoms (girls, OR 1.25, 95% CI 1.22-1.29; boys, OR 1.29, 95% CI 1.25-1.33). The study findings suggest that anti-bullying interventions should include mental health components and target both traditional and cyberbullying. Due to the overlap between these, targeting bullying should primarily focus on how to reduce bullying behavior rather than just focusing on where bullying takes place.

Does the Incredible Years Teacher Classroom Management programme improve child-teacher relationships in childcare centres? A 1-year universal intervention in a Norwegian community sample.

The Incredible Years Teacher Classroom Management (IY TCM) programme has shown promise in reducing behaviour problems among high-risk children in childcare. However, at present, we do not know whether the IY TCM successfully improves the child-teacher relationship in childcare and whether the effects manifest in both the population and in high-risk groups. Hence, we conducted a quasi-experimental pre-post study with a matched control condition to examine the changes in child-teacher relationships in a sample of 1085 children aged 3-6 years after implementing the IY TCM programme. Linear mixed models revealed favourable group-by-time differences benefitting the intervention compared to the control condition. Subgroup analyses of children scoring at or above the 90th percentile on either internalising or externalising behaviour problems showed that the preventive effects persisted in both high-risk subsamples. In sum, the findings indicate that the IY TCM programme does improve child-teacher relationships and that the effect is present for the entire study population as well as children scoring in the clinical range on behaviour problems. This suggests that the application of the IY TCM programme in childcare settings has important preventive effects. Implications and limitations are further discussed.

Cyberbullying status and mental health in Norwegian adolescents.

The aim of the present study was to examine how the cyberbullying status (not involved, cyber-victim only, cyberbully only, cyber-victim and bully) is related to the mental health of the adolescents when controlled for traditional bullying experience. We also examined the potential moderator sex on the relationship between cyberbullying status and mental health. Univariate analyses of variance were conducted to predict mental health problems using the Strength and Difficulties Questionnaire total difficulties score and its five scales. The model consisted of five predictors in addition to an interaction term between cyberbully status and sex. Of the 2,117 adolescents, 50% were girls. The vast majority did not have any cyberbullying experience (87%), 9% of the adolescents were cyber-victims only, 1% were cyberbullies only and 3% were both cyber-victims and bullies. Overall, girl's mental health seems to be more compromised when exposed to or involved in cyberbullying than boys mental health. In general, adolescents who are not only cyberbullies and cyber-victims, but also cyber-victims only had a worse mental health compared to adolescents without cyberbullying experience. Being exposed to cyberbullying is a unique contributor to mental health problems. Preventing cyberbullying is therefore important. Especially girl's mental health seems to be negatively affected when exposed to cyberbullying.

Does parental mental health moderate the effect of a telephone and internet-assisted remote parent training for disruptive 4-year-old children?

This study explores the moderators affecting the success of an Internet-based and telephone assisted remote parent training intervention and compares them to an educational control group. We prospectively identified 464 parents who reported at a health check that their 4-year-old children showed elevated levels of externalizing behavior. The moderators explored included parental attention deficit and hyperactivity disorder (ADHD) and parental distress. The dependent variables were child externalization scores and self-reported parenting skills. The measures were completed at baseline, six and 12-months follow-up. The 232 families randomized to active treatment received 11 Internet-based training sessions with weekly phone calls from a coach. The other 232 families had access to a website that provided general positive parenting advice and one 45-minute phone-call from a coach. Using hierarchical linear models, we explored if the parental ADHD or parental distress modified the treatment effects on child externalizing behavior or parenting skills. The results showed that none of the independent variables moderated intervention effects on child externalizing behavior or parenting skills. The lack of significant moderator effects could have been due to the treatment's personalization, the format's flexibility and adaptability to when and how the parents wanted to complete the sessions or the relatively low levels of ADHD and parental distress among the participants.

Parental and child factors associated with participation in a randomised control trial of an Internet-assisted parent training programme.

BACKGROUND: Parental training is an effective way to treat and prevent children's conduct problems, but knowledge of who participates in such initiatives is limited. METHOD: This study examined child and family factors associated with participation in an Internet-assisted parent training programme. The parents of 4-year-old children with high levels of disruptive behaviour in a region of Finland were offered the opportunity to participate in a randomised controlled trial of the Strongest Families Smart Website intervention (SFSW). The participants and nonparticipants were compared using the Strengths and Difficulties Questionnaire (SDQ), duration of child problems and information about family demographics, which were routinely collected prior to randomisation to the SFSW and control group. RESULTS: We found that 464 (64.5%) of the 709 parents of children fulfilling the screening criteria, participated. In the multivariable analysis, nonparticipation was most strongly associated with a child only having minor difficulties [odds ratio (OR): 2.1; 95% confidence interval (CI): 1.5-3.0] and a shorter duration of problems, for less than 12 months (OR: 1.7, 95% CI: 1.2-2.5), after controlling for other child factors. Nonparticipation was significantly associated with mothers spending a shorter time in the education system (OR: 1.6, 95% CI: 1.2-2.3) after controlling for other parental factors. CONCLUSIONS: A larger percentage of parents of children with longer lasting and more severe problems seemed to be motivated to participate in this remote parent training programme. Future studies on how to encourage parents with shorter duration of education to participate in early intervention programmes are warranted.

Clinical decision support systems in child and adolescent psychiatry: a systematic review.

Psychiatric disorders are amongst the most prevalent and impairing conditions in childhood and adolescence. Unfortunately, it is well known that general practitioners (GPs) and other frontline health providers (i.e., child protection workers, public health nurses, and pediatricians) are not adequately trained to address these ubiquitous problems (Braddick et al. Child and Adolescent mental health in Europe: infrastructures, policy and programmes, European Communities, 2009; Levav et al. Eur Child Adolesc Psychiatry 13:395-401, 2004). Advances in technology may offer a solution to this problem with clinical decision support systems (CDSS) that are designed to help professionals make sound clinical decisions in real time. This paper offers a systematic review of currently available CDSS for child and adolescent mental health disorders prepared according to the PRISMA-Protocols (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols). Applying strict eligibility criteria, the identified studies (n = 5048) were screened. Ten studies, describing eight original clinical decision support systems for child and adolescent psychiatric disorders, fulfilled inclusion criteria. Based on this systematic review, there appears to be a need for a new, readily available CDSS for child neuropsychiatric disorder which promotes evidence-based, best practices, while enabling consideration of national variation in practices by leveraging data-reuse to generate predictions regarding treatment outcome, addressing a broader cluster of clinical disorders, and targeting frontline practice environments.

Does the Incredible Years Teacher Classroom Management Training programme have positive effects for young children exhibiting severe externalizing problems in school?: a quasi-experimental pre-post study.

BACKGROUND: Young children exhibiting severe externalizing problems in school are at risk of developing several poor outcomes. School-based intervention programs have been found to be effective for students with different problems, including those with behavioral problems, emotional distress, or social problems. The present study investigated whether the IY-TCM programme, as a universal stand-alone school intervention programme, reduced severe child externalizing problems as reported by the teacher, and evaluated if these children improved their social competence, internalizing problems, academic performances and student- teacher relationship as a result of the IY TCM training. METHODS: A quasi-experimental pre-post study was conducted, including 21 intervention schools and 22 control schools. Children in 1st - 3rd grade (age 6-8 years) assessed by their teacher as having severe externalizing problems on the Sutter-Eyberg Student Behavior Inventory-Revised (SESBI-R) total Intensity score, were included in the study, N = 83 (65 boys and 18 girls). Treatment effects were evaluated using 3- level linear mixed models analysis. RESULTS: In our study we found no differences in change between the two conditions from baseline to follow-up in externalizing problems, social skills, internalizing problems and closeness with teacher. The intervention condition did however show advantageous development in terms of student-teacher conflicts and increased academic performances. CONCLUSION: The IY Teacher Classroom Management program is not sufficient being a stand-alone universal program in a Norwegian primary school setting, for students with severe externalizing problems. However; some important secondary findings were found. Still, young school children with severe externalizing problems are in need of more comprehensive and tailored interventions.

What is the long-term outcome of boys who steal at age eight? Findings from the Finnish nationwide "From A Boy To A Man" birth cohort study.

OBJECTIVE: The aim was to study predictive associations between childhood stealing behavior at the of age 8 years with later psychiatric disorders, criminality or suicide attempts and completed suicides up to the age 25 years in a large representative population-based birth cohort. METHOD: The sample includes 2,592 Finnish males born in 1981 with information about stealing from both parents and teachers. Information about psychiatric disorders, criminality, suicide attempts requiring hospital admission and completed suicides was gathered from four different Finnish nationwide registries until the study participants were 25 years old. RESULTS: One out of ten boys had stealing behavior during the previous 12 months. After adjusting for parental education level and conduct problems or hyperactivity (i.e. potential confounds), stealing at eight independently predicted substance use and antisocial personality disorders, and high level of crimes. Stealing was also associated with completed suicide or severe suicide attempt requiring hospital admission. Comorbid stealing and frequent aggression had the strongest predictive association with any psychiatric diagnosis, crime and completed suicide or severe suicide attempt, while stealing without aggression was not associated with any of the negative outcomes. CONCLUSIONS: Stealing accompanied with aggressivity at age eight is predictive of wide range of adversities. However, no increased risk was observed among the group with stealing behaviors but without aggression.

Clinicians' experiences with videoconferencing in psychiatry.

Videoconferencing may help reduce traveling and may save time and money for patients and the health care system. Despite the fact that studies have found videoconferencing as good as face-to-face interactions for certain therapies, few in northern Norway use this tool routinely for the assessment and treatment of patients. We examined clinicians' experiences with videoconferencing and their attitudes to using this tool for psychiatric consultations, and discussed the findings in light of the Technology Acceptance Model. Obstacles to use and how they may be overcome are discussed.

The impact of case factors on the initial screening decision in child welfare investigations in Norway.

BACKGROUND: When a child welfare service agency receives a report of concern, there is an initial screening to decide whether an investigation needs to be initiated. In addition to the decision maker, case factors, external factors, and organizational factors have an impact on decision making in Child Welfare Services (CWS). Few recent studies have considered the impact of case factors on the initial screening. OBJECTIVE: This study examined case factors that have an impact on the decision to investigate in the Norwegian CWS. PARTICIPANTS AND SETTING: Participants included randomly drawn samples of case files from 16 agencies (N = 1365). METHODS: The study was designed as a cross-sectional case file study. Researchers coded the data on site at the agencies. To examine the association between a decision to investigate and case specific variables, multilevel logistic regression (generalized linear mixed model) analysis was conducted to account for case clustering effects within agencies. RESULTS: The rate of investigation was 82.3 %. Concerns of physical and sexual abuse (OR = 2.61***), parents' health and stressful events (OR = 2.20***), domestic violence or witnessing violence (OR = 2.52***), and concerns related to finances, housing, and employment (OR = 3.25**) lowered the threshold for investigation. Prior referrals were found to raise the threshold for investigation (OR = 0.88). (**p < .01, ***p < .001). CONCLUSION: Although large differences between agencies exist in decision-making processes in the Norwegian CWS, there are common case factors affecting the initial screening of referrals.

Five- to six-year outcome and its prediction for children with ODD/CD treated with parent training.

BACKGROUND: While short-term effects of parent training (PT) have been extensively evaluated, long-term outcome and present predictors of a diagnosis for children with ODD/CD treated with parent training are very limited. METHOD: In the present study, diagnostic status as outcome and predictors of treatment response were examined in a 5-6-year follow-up. Out of 99 children who had been treated in a randomised controlled trial evaluating the effects of The Incredible Years parent training (PT) or combined parent training and child treatment (PT+CT) programme, 54.5% participated in the 5-6-year follow-up study. Their diagnostic status was determined with the Kiddie-SADS interview. RESULTS: While all children qualified for a diagnosis of ODD/CD before treatment, 5-6 years later, two-thirds no longer received such a diagnosis, the same proportion as found at the 1-year follow-up. The most powerful pre-treatment predictors of diagnostic status at the 5-6-year follow-up were living with mother only and being a girl. At post-treatment the most powerful predictor was found to be high levels of child externalising problems. CONCLUSION: The findings of the study support the maintenance of positive long-term results for young children treated with parent training because of serious conduct problems, and identify characteristics of children and families in need of added support to parent training programmes.

Characteristics of young children with persistent conduct problems 1 year after treatment with the Incredible Years program.

In the present study, predictors of persistent conduct problems among children aged 4-8 years were investigated in a randomized controlled trial 1 year after treatment with the Incredible Years parent training program (PT), or combined parent training and child treatment (PT + CT). Data were collected before and after treatment and at a 1-year follow-up. Pre-treatment child characteristics predicting persistent conduct problems in the child at the 1-year follow-up were high levels of internalizing and aggression problems as reported by mothers. The only family characteristic predicting persistence of child conduct problems was having contacts with child protection services. Clinicians and researchers need to closely monitor and identify children with conduct problems not responding to parent training programs. These individuals and their families are likely to need further support.

Help-seeking behavior in Norwegian adolescents: the role of bullying and cyberbullying victimization in a cross-sectional study.

BACKGROUND: Help-seeking is considered a constructive coping style. However, the threshold at which many adolescents seek help is relatively high, and the outcomes are not necessarily always positive. OBJECTIVE: The main aim of this study was to examine if bullying and cyberbullying victimization predicted help-seeking behavior among Norwegian adolescents. METHOD: Help-seeking behavior was predicted using three different Generalized Linear Mixed Models. In addition to demographic characteristics and mental health, these models controlled for bullying and cyberbullying, respectively. RESULTS: 2054 adolescents answered questions on help-seeking behavior and if they had felt the need to seek outside help with their problems, feelings, behavior, or emotional troubles within the past 6 months. Two hundred (9.7%) reported seeking outside help. Being exposed to bullying increased the likelihood of help-seeking behavior, while being exposed to cyberbullying did not. Only when forms of bullying or cyberbullying, respectively, were added to the models, did the threat of having rumors spread, both in real life and online, increase the likelihood for seeking help. CONCLUSIONS: Many factors affect whether adolescents seek help for a problem. The fact that adolescents exposed to bullying seek help more often than those not exposed may be considered a success, as this behavior is encouraged by many adults, mental health professionals, and anti-bullying interventions. However, adolescents exposed to cyberbullying did not seem to seek help. Future studies should identify factors that lead to more and successful help-seeking among bullied and cyberbullied adolescents.

Mediating Mechanisms of the Incredible Years Teacher Classroom Management Program.

This study examined whether, and the extent to which, the Incredible Years Teacher Classroom Management program predicted positive development of children's emotional, behavioral, and social adjustment through changes in the child-teacher relationship. Using data from a longitudinal quasi-experimental intervention trial with a matched control condition, including 1,085 children (49.7% girls, meanage = 4.22 years; SDage = 0.88 years), the potential associations were tested by means of multilevel path modeling. The mediation model demonstrated that (1) children in the intervention condition achieved more favorable changes in the child-teacher relationship than the control condition; (2) changes in the child-teacher relationship were associated with changes in the target outcomes; and (3) the intervention effects were mediated via changes in the child-teacher relationship.

Treatment of oppositional defiant and conduct problems in young Norwegian children : results of a randomized controlled trial.

The efficacy of the Incredible Years parent training and child therapy programs was examined in a randomized controlled study including 127 Norwegian children aged 4-8 years. Children diagnosed with oppositional defiant disorder (ODD) or conduct disorder (CD) were randomized to parent training (PT), parent training combined with child therapy (PT + CT), or a waiting-list control condition (WLC). Assessments were carried out at baseline, posttreatment and at a one-year follow-up using standardized measures and a semi-structured interview. Both active treatment conditions reduced child conduct problems posttreatment as opposed to the WLC, while differences between the two treatment conditions were small and nonsignificant. About two thirds of the treated children functioned within normal variation after treatment, and the same proportion no longer received an ODD diagnosis at the one-year follow-up. Parental use of positive strategies increased after treatment, and the use of harsh and inconsistent discipline decreased as did mother experience of stress. The outcome of this study emphasizes the importance of offering parent training to young children with severe conduct problems exhibited at home. The findings and usefulness of the Incredible Years program in the present Norwegian replication study further support and extend positive outcomes of previous controlled trials conducted primarily in Anglo-Saxon countries.

Psychosocial interventions for disruptive and aggressive behaviour in children and adolescents: a meta-analysis.

BACKGROUND: The effects of psychotherapy in reducing aggressive behaviours in children and adolescents using meta-analysis were estimated. METHOD: Sixty-five studies were included, covering 4,971 cases. Teacher reported change in aggression, change in social functioning, and changes in parental distress were calculated. RESULTS: The mean effect size (ES) of change in aggression in studies with untreated controls was 0.62 and in studies without untreated controls the ES was 0.95. In studies with or without untreated controls, the ESs in teacher reported aggression was 0.41 and 0.63, the ESs in changes in social functioning was 0.42 and 0.49, and the ESs in changes in parental distress was 0.39 and 0.47, respectively. CONCLUSION: Psychosocial treatments aimed at reducing aggressive behaviour have positive effects and additional treatment effects are moderate. In the moderator analysis, studies with untreated controls obtained significantly larger ESs if the sample size was small. Similarly, in studies without untreated controls, studies presenting diagnostic information, and studies with younger children resulted in significantly larger ESs, and studies applying behavioural interventions obtained significantly larger ESs as compared to studies applying family therapeutic interventions. There is still a need to further develop effective outpatient interventions for children being disruptive, and especially for adolescents.

Internet-Assisted Parent Training Intervention for Disruptive Behavior in 4-Year-Old Children: A Randomized Clinical Trial.

IMPORTANCE: There is a large gap worldwide in the provision of evidence-based early treatment of children with disruptive behavioral problems. OBJECTIVE: To determine whether an Internet-assisted intervention using whole-population screening that targets the most symptomatic 4-year-old children is effective at 6 and 12 months after the start of treatment. DESIGN, SETTING, AND PARTICIPANTS: This 2-parallel-group randomized clinical trial was performed from October 1, 2011, through November 30, 2013, at a primary health care clinic in Southwest Finland. Data analysis was performed from August 6, 2015, to December 11, 2015. Of a screened population of 4656 children, 730 met the screening criteria indicating a high level of disruptive behavioral problems. A total of 464 parents of 4-year-old children were randomized into the Strongest Families Smart Website (SFSW) intervention group (n = 232) or an education control (EC) group (n = 232). INTERVENTIONS: The SFSW intervention, an 11-session Internet-assisted parent training program that included weekly telephone coaching. MAIN OUTCOMES AND MEASURES: Child Behavior Checklist version for preschool children (CBCL/1.5-5) externalizing scale (primary outcome), other CBCL/1.5-5 scales and subscores, Parenting Scale, Inventory of Callous-Unemotional Traits, and the 21-item Depression, Anxiety, and Stress Scale. All data were analyzed by intention to treat and per protocol. The assessments were made before randomization and 6 and 12 months after randomization. RESULTS: Of the children randomized, 287 (61.9%) were male and 79 (17.1%) lived in other than a family with 2 biological parents. At 12-month follow-up, improvement in the SFSW intervention group was significantly greater compared with the control group on the following measures: CBCL/1.5-5 externalizing scale (effect size, 0.34; P < .001), internalizing scale (effect size, 0.35; P < .001), and total scores (effect size, 0.37; P < .001); 5 of 7 syndrome scales, including aggression (effect size, 0.36; P < .001), sleep (effect size, 0.24; P = .002), withdrawal (effect size, 0.25; P = .005), anxiety (effect size, 0.26; P = .003), and emotional problems (effect size, 0.31; P = .001); Inventory of Callous-Unemotional Traits callousness scores (effect size, 0.19; P = .03); and self-reported parenting skills (effect size, 0.53; P < .001). CONCLUSIONS AND RELEVANCE: The study reveals the effectiveness and feasibility of an Internet-assisted parent training intervention offered for parents of preschool children with disruptive behavioral problems screened from the whole population. The strategy of population-based screening of children at an early age to offering parent training using digital technology and telephone coaching is a promising public health strategy for providing early intervention for a variety of child mental health problems. TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT01750996.

Effectiveness of school-based preventive interventions on adolescent alcohol use: a meta-analysis of randomized controlled trials.

BACKGROUND: Preventive interventions for adolescents are an important priority within school systems. Several interventions have been developed, but the effectiveness of such interventions varies considerably between studies. The purpose of this study was to assess the effectiveness of universal school-based prevention programs on alcohol use among adolescents by using meta-analytic techniques. METHOD: A systematic literature search in the databases, PubMed (Medline), PsycINFO (Ovid), EMBASE (Ovid) and WEB of Science (ISI) was conducted to search for empirical articles published in the period January 1990 to August 2014. RESULTS: In total, 28 randomized controlled studies with 39,289 participants at baseline were included. Of these 28 articles, 12 studies (N = 16279) reported continuous outcomes (frequency of alcohol use and quantity of alcohol use), and 16 studies (N = 23010) reported categorical data (proportion of students who drank alcohol). The results of the random effects analyses showed that the overall effect size among studies reporting continuous outcomes was small and demonstrated a favorable effect from the preventive interventions (Hedges' g = 0.22, p < .01). The effect size among studies reporting categorical outcomes was not significant (OR = 0.94, p = .25). The level of heterogeneity between studies was found to be significant in most analyses. Moderator analyses conducted to explore the heterogeneity showed neither significant difference between the different school levels (junior high schools and high schools), nor between the varied program intensities (low, medium and high intensity programs). The meta-regression analyses examining continuous moderators showed no significant effects for age or gender. CONCLUSIONS: The findings from this meta-analysis showed that, overall, the effects of school-based preventive alcohol interventions on adolescent alcohol use were small but positive among studies reporting the continuous measures, whereas no effect was found among studies reporting the categorical outcomes. Possible population health outcomes, with recommendations for policy and practice, are discussed further in this paper.

Parent training for young Norwegian children with ODD and CD problems: predictors and mediators of treatment outcome.

Participants were 121 children, aged 4-8 years referred for conduct problems, and their mothers. A parent training intervention was implemented in two outpatient clinics in Norway. Treatment responders were defined as children scoring below a cut-off on the Eyberg Child Behavior Inventory, a score below an optimal cut-off for children in day-care and school as reported by teachers, in addition to a 30% reduction or greater in observed negative parenting. Self-reported parenting practices were explored as potential mediators. The results of logistic regression analyses showed that high levels of maternal stress, clinical levels of ADHD, and being a girl predicted a poorer outcome in conduct problems at home, while pretreatment clinical levels of ADHD predicted a poorer outcome as perceived by the teachers. Harsh and inconsistent parental disciplining emerged as significant partial mediators of changes in conduct problems, highlighting the importance of altering parenting practices to modify young children's conduct problems.