{ "items": [ "\n\n
BACKGROUND: \u2002 Repeated self-harm in adolescents is common and associated with elevated psychopathology, risk of suicide, and demand for clinical services. Despite recent advances in the understanding and treatment of self-harm there have been few systematic reviews of the topic. AIMS: \u2002 The main aim of this article is to review randomised controlled trials (RCTs) reporting efficacy of specific pharmacological, social or psychological therapeutic interventions (TIs) in reducing self-harm repetition in adolescents presenting with self-harm. METHOD: \u2002 Data sources were identified by searching Medline, PsychINFO, EMBASE, and PubMed from the first available year to December 2010. RCTs comparing specific TIs versus treatment as usual or placebo in adolescents presenting with self-harm were included. RESULTS: \u2002 Fourteen RCTs reported efficacy of psychological and social TIs in adolescents presenting with self-harm. No independently replicated RCTs have been identified reporting efficacy of TIs in self-harm reduction. Developmental Group Psychotherapy versus treatment as usual was associated with a reduction in repeated self-harm, however, this was not replicated in subsequent studies. Multisystemic Therapy (MST) versus psychiatric hospitalisation was associated with a reduction of suicidal attempts in a sample of adolescents with a range of psychiatric emergencies. However, analyses focusing only on the smaller subgroup of adolescents presenting with deliberate self-harm at the initial psychiatric emergency, did not indicate significant benefits of MST versus hospitalisation. CONCLUSIONS: \u2002 Further research is urgently needed to develop TIs for treating self-harm in adolescents. MST has shown promise but needs to be evaluated in a sample of adolescents with self-harm; dialectic behavioural therapy and cognitive behavioural therapy for self-harm require RCTs to evaluate efficacy and effectiveness.
\n \n\n \n \nBACKGROUND: Extreme appraisals of internal states correlate with and prospectively predict mood symptoms in adults, and discriminate individuals with bipolar disorder from individuals with unipolar depression and non-clinical controls. AIMS: These findings required replication in adolescents. This study sought to investigate the relationships between appraisals of internal states, mood symptoms and risk for bipolar disorder in an adolescent sample. METHOD: A non-clinical sample (n = 98) of adolescents completed measures of mood symptoms, appraisals, and mania risk, alongside covariates. RESULTS: Appraisals of internal states were associated with analogue bipolar symptoms, independently of impulsivity and responses to positive affect. Positive appraisals of activated mood states were uniquely associated with hypomania, whilst negative appraisals were uniquely associated with depression and irritability symptoms. Individuals who appraised activated states as both extremely positive and extremely negative were more likely to score at high or moderate risk for future mania. CONCLUSIONS: This study is the first to demonstrate associations between appraisals of internal states, analogue mood symptoms and mania risk in adolescents. Clinical implications are discussed.
\n \n\n \n \nWorry-prone individuals have less residual working memory capacity during worry compared to low-worriers (Hayes, Hirsch, & Mathews, 2008). People typically worry in verbal form, and the present study investigated whether verbal worry depletes working memory capacity more than worry in imagery-based form. High and low-worriers performed a working memory task, random interval generation, whilst thinking about a worry in verbal or imagery form. High (but not low) worriers had less available working memory capacity when worrying in verbal compared to imagery-based form. The findings could not be accounted for by general attentional control, amount of negatively-valenced thought, or appraisals participants made about worry topics. The findings indicate that the verbal nature of worry is implicated in the depletion of working memory resources during worry among high-worriers, and point to the potential value of imagery-based techniques in cognitive-behavioural treatments for problematic worry.
\n \n\n \n \nBACKGROUND: Social anxiety disorder is common and typically starts in childhood or adolescence. Cognitive Therapy for Social Anxiety Disorder (CT-SAD) in adults is a well-established treatment that shows strong evidence of differential effectiveness when compared to other active treatments. In contrast, CBT approaches to social anxiety in young people have yet to demonstrate differential effectiveness and there is some evidence that young people with social anxiety disorder respond less well than those with other anxiety disorders. AIMS: To adapt CT-SAD for use with adolescents and conduct a pilot case series. METHOD: Five adolescents, aged 11-17 years, with a primary DSM-5 diagnosis of social anxiety disorder received a course of CT-SAD adapted for adolescents. Standardized clinical interview and questionnaire assessments were conducted at pre and posttreatment, and 2 to 3-month follow-up. RESULTS: All five participants reported severe social anxiety at baseline and achieved remission by the end of treatment. Significant improvements were also observed in general anxiety, depression, concentration in the classroom, and putative process measures (social anxiety related thoughts, beliefs and safety behaviours). CONCLUSIONS: An adapted form of CT-SAD shows promise as a treatment for adolescents.
\n \n\n \n \nBACKGROUND: Many young people are exposed to traumatic events and a significant minority of these individuals will go on to experience posttraumatic stress disorder (PTSD). Valid and reliable measurement tools for assessing PTSD are essential and can aid screening, clinical diagnosis, treatment planning and outcome monitoring. METHODS: This article outlines the range of instruments available for these aspects of measurement, including assessment of PTSD in very young children, with a focus on those scales with good clinical utility and sound psychometric properties. FINDINGS: This is a particularly challenging time for clinicians working with children and young people with PTSD: all instruments will need to be revised and updated in order to better reflect the recent revisions to the diagnostic criteria for PTSD with the publication of the DSM-5 and no doubt the anticipated ICD-11. Despite this, measurement tools can still play a vital role in assessing PTSD in children and young people.
\n \n\n \n \nBACKGROUND: Mindfulness-Based Cognitive Therapy (MBCT) has been shown to be effective in preventing relapse of depression in adults, but has not previously been applied to adolescents who have residual symptoms of depression following treatment. METHOD: An 8-week MBCT group was adapted for adolescents, and evaluated using qualitative and quantitative measures. RESULTS: Participants report high levels of satisfaction with the group intervention. Qualitative analysis of semi-structured interviews provides areas for future development of this intervention. Pilot data indicate reductions in depressive symptoms, alongside positive change in mindfulness skills, quality of life and rumination. CONCLUSIONS: Preliminary evidence for the use of MBCT with this group of adolescents is provided.
\n \n\n \n \nSocial anxiety disorder is a condition characterised by a marked and persistent fear of being humiliated or scrutinised by others. Age-of-onset data point to adolescence as a developmentally sensitive period for the emergence of the condition, at a time when the peer group becomes increasingly important. Social anxiety in adolescence is associated with considerable impairment that persists through to adulthood. There are clear potential benefits to delivering effective interventions during adolescence. However, there is limited evidence on the specific efficacy of available therapies. This is in contrast to adults, for whom we have interventions with very specific treatment effects. One such treatment is individual cognitive therapy. Cognitive therapy is based on the cognitive model of social anxiety proposed by Clark and Wells (in: Heimberg, Leibowitz, Hope, Scheiber (eds) Social phobia: diagnosis, assessment and treatment, The Guilford Press, New York, 1995). The present review examines the potential application of this adult cognitive model to the understanding of adolescent social anxiety and considers additional adolescent-specific factors that need to be accommodated. It is suggested that a developmentally sensitive adoption of the cognitive model of social anxiety disorder (Clark and Wells 1995) for adolescents may lead to better treatment outcomes.
\n \n\n \n \nAims and method. The Health of the Nation Outcome Scale for Acquired Brain Injury (HoNOS-ABI) is a relatively new outcome measure designed to assess the neuropsychiatric sequelae of brain damage.This study investigated the interrater reliability of this scale. Fifty patients with traumatic brain injury receiving rehabilitation were each rated twice on the HoNOS-ABI, by two different raters.There were 24 raters in total. Results. Weighted kappa values ranged from 0.43 to 0.84 and intraclass correlation coefficients from 0.58 to 0.97 for the ten items assessed.This indicated that agreement was moderate to substantial for all items. Clinical implications. The scales consistently measured the items of interest across different raters.This indicates that HoNOS-ABI is a reliable outcome measure when applied by different raters in routine clinical practice.
\n \n\n \n \nRumination, or dwelling repeatedly on negative thoughts about the past, can prolong depression and make it worse. When treating clients with depression, it can be important to consider the behavioural, cognitive and emotional impact of rumination on their life. Previous research has examined adult experience of rumination, but the current study was the first to examine how young people with depression experience rumination. Seven young people with depression were interviewed about the cognitive content of their rumination episodes, the associated feelings, and any behavioural start and stop triggers. Interview transcripts were analysed using interpretative phenomenological analysis (IPA). Participants reported experiencing rumination as a disorientating cognitive battle, in which they felt under attack. The process elicited sadness predominantly, but also anger and anxiety, with mood and rumination often maintaining each other. Interpersonal interaction played a key role in starting and stopping rumination episodes. CBT-based interventions specifically targeting the ruminative process may be important for young people with depression, particularly interventions which consider the impact of family members or other systemic factors on rumination behaviour.
\n \n\n \n \nThe authors assessed the number of referrals to neuropsychiatry services covering South London, Kent, Surrey, and Sussex (population 6,887,000) over a 2-year period. The average referral rate was 11.2 per 100,000 per population for each year. Geographical distance from the specialist provider strongly affected referral rates, with clinicians in South London making more referrals than those from outside London. Assessment of appropriateness of referrals indicated that more than 86% of referrals were highly appropriate, and thus the higher level of referrals from close proximity cannot be attributed to inappropriate referrals. A survey of clinicians reported lower awareness of services and how to access these services among those clinicians working at a greater distance from the service provider, which likely results in unmet needs. Greater attempts should be made to improve access to neuropsychiatric services for clinicians who do not practice within close proximity of a specialist neuropsychiatry service.
\n \n\n \n \nThis study investigated the constraints underlying developmental improvements in complex working memory span performance among 120 children of between 6 and 10 years of age. Independent measures of processing efficiency, storage capacity, rehearsal speed, and basic speed of processing were assessed to determine their contribution to age-related variance in complex span. Results showed that developmental improvements in complex span were driven by 2 age-related but separable factors: 1 associated with general speed of processing and 1 associated with storage ability. In addition, there was an age-related contribution shared between working memory, processing speed, and storage ability that was important for higher level cognition. These results pose a challenge for models of complex span performance that emphasize the importance of processing speed alone.
\n \n\n \n \nOBJECTIVE: To investigate the factor structure of the Rivermead Post Concussion Symptoms Questionnaire (RPQ) among individuals seen as part of routine follow-up following traumatic brain injury. METHODS: RPQ data from 168 participants was examined (mean age 35.2, SD 14.3; 89% with post traumatic amnesia duration<24 hours) six months after admission to an Accident & Emergency Department following TBI. Structural equation modelling was carried out to evaluate proposed models of the underlying structure of post-concussion symptoms (PCS). RESULTS: The results support the existence of separate cognitive, emotional and somatic factors, although there was a high degree of covariation between the three factors. A two-factor model that collapsed the emotional and somatic factors together showed a similar goodness-of-fit to the data, whilst a one-factor model proved a poor fit. CONCLUSION: The results support the notion of post-concussion symptoms as a collection of associated but at least partially separable cognitive, emotional and somatic symptoms, although questions persist regarding symptom specificity. The use of the RPQ is discussed, and classification bands for use in clinical practice are suggested.
\n \n\n \n \nBACKGROUND: The identification of negative self-imagery as a maintenance factor in adult social anxiety has led to enhanced treatments for this population. Whilst intrusive negative imagery is commonly reported by socially anxious adolescents, no studies have demonstrated that it plays a causal role in maintaining symptoms. To assess this possibility, we undertook an experimental study manipulating social self-imagery in high socially anxious adolescents. METHODS: High socially anxious adolescents undertook two conversations under different conditions. During one conversation they held a negative social self-image in mind, and in the other they held a benign social self-image in mind. Self-report, conversation partner report and independent assessor ratings were taken. RESULTS: When participants held a negative self-image in mind, they reported feeling more anxious, and believed they looked more anxious and performed more poorly. Furthermore, they overestimated how anxious they looked compared to conversation partner ratings. As well as distorting participants' perception of their anxious appearance, holding a negative image in mind also had observable effects on the interaction. Participants were rated as looking more anxious and performing less well by their conversation partner when they held such images in mind, and the conversation was rated more critically by conversation partners and independent observers. Finally, a preliminary mediation analysis suggested that the detrimental effect of negative imagery on the social interaction may be partly due to the spontaneous use of avoidant safety behaviours. CONCLUSIONS: The findings provide support for a causal role of negative self-imagery in adolescent social anxiety and point to the potential clinical value of techniques targeting imagery to treat the disorder.
\n \n\n \n \nBACKGROUND: Cognitive therapy, based on the Clark and Wells (1995) model, is a first-line treatment for adults with social anxiety disorder (SAD), and findings from research settings suggest it has promise for use with adolescents (Cognitive Therapy for Social Anxiety Disorder in Adolescents; CT-SAD-A). However, for the treatment to be suitable for delivery in routine clinical care, two questions need to be addressed. AIMS: Can therapists be trained to achieve good outcomes in routine Child and Adolescent Mental Health Services (CAMHS), and what are the costs associated with training and treatment? METHOD: CAMHS therapists working in two NHS trusts received training in CT-SAD-A. They delivered the treatment to adolescents with SAD during a period of supervised practice. We examined the clinical outcomes for the 12 patients treated during this period, and estimated costs associated with treatment and training. RESULTS: Treatment produced significant improvements in social anxiety symptoms, general anxiety and depression symptoms, and reductions in putative process measures. Seventy-five per cent (9 out of 12) patients showed a reliable and clinically significant improvement in social anxiety symptoms, and 64% (7/11) lost their primary diagnosis of SAD. The total cost to the NHS of the CT-SAD-A treatment was \u00a34047 (SD = \u00a31003) per adolescent treated, of which \u00a31861 (SD = \u00a3358) referred to the specific estimated cost of face-to-face delivery; the remaining cost was for training and supervising therapists who were not previously familiar with the treatment. CONCLUSIONS: This study provides preliminary evidence that clinicians can deliver good patient outcomes for adolescents with SAD in routine CAMHS during a period of supervised practice after receiving a 2-day training workshop. Furthermore, the cost of delivering CT-SAD-A with adolescents appeared to be no more than the cost of delivering CT-SAD with adults.
\n \n\n \n \nCompared to neurotypical peers, autistic adolescents show greater cognitive inflexibility (CI) which manifests at the behavioral and cognitive level and potentially increases vulnerability for the development of internalizing (INT) and externalizing (EXT) symptoms. This systematic review and meta-analysis explored the association between CI and INT/EXT in autistic adolescents. PubMed, EMBASE, MEDLINE, PsycINFO and Web of Science databases were searched to identify relevant studies until April 2022 (PROSPERO protocol: CRD42021277294). Systematic review included 21 studies (n\u00a0=\u00a01608) of CI and INT, and 15 studies (n\u00a0=\u00a01115) of CI and EXT. A pooled effect size using Pearson's correlation between CI and INT/EXT was calculated and the moderating effects of age, sex, IQ and study quality were investigated using meta-regressions. Sensitivity analyses were completed to investigate the impact of measure variance for CI and co-occurring ADHD on the overall effects. Greater CI is associated with increased INT (nine studies; n\u00a0=\u00a0833; r\u00a0=\u00a00.39 (moderate effect), 95% confidence interval [0.32, 0.46]) and EXT (six studies; n\u00a0=\u00a0295; r\u00a0=\u00a00.48 (large effect), 95% confidence interval [0.38, 0.58]). Results withheld when only using parental reports of CI and excluding autistic adolescents with co-occurring ADHD. Increased CI may be a transdiagnostic vulnerability factor that can increase autistic adolescents' rigid or perseverative patterns of unhelpful cognition and behaviors and reduce their ability to access psychological interventions. Addressing CI may improve autistic children and adolescents' engagement with psychological therapy for co-occurring mental health difficulties.
\n \n\n \n \nBACKGROUND: Safety behaviours have been shown to be a key maintaining factor in Social Anxiety Disorder (SAD). In adults, a two-factor structure of safety behaviours reflecting 'avoidance' and 'impression-management' types has been identified. This has not yet been investigated in adolescents. AIMS: We set out to investigate the factor structure of safety behaviours in relation to adolescent social anxiety symptoms and SAD, the extent to which this varies by age, and then to examine the association between the derived factor scores and other social anxiety related phenomena. METHOD: Questionnaire measures of social anxiety symptoms, cognitions and safety behaviours, peer relationship outcomes, general anxiety and depression were collected from a community sample of 584 younger (11-14 years) and 208 older (16-18 years) adolescents, and a clinical sample of 80 adolescents (11-18 years) with a primary diagnosis of SAD. Four hypotheses were investigated using exploratory and confirmatory factor analyses, regressions, correlations and path analyses. RESULTS: A two-factor structure reflecting 'avoidance' and 'impression-management' safety behaviours was supported in the community and clinical sample. Older adolescents were found to use 'impression-management' behaviours more than younger adolescents after controlling for overall safety behaviour score. Both types of safety behaviour were significantly positively associated with social anxiety symptoms and cognitions. Path analyses revealed an indirect effect of social anxiety symptoms on peer victimisation, social satisfaction and friendship quality via 'avoidance', but not 'impression-management' safety behaviours. CONCLUSIONS: Both 'avoidance' and 'impression-management' safety behaviours are associated with social anxiety symptoms and cognitions in youth, with age-related differences in their frequency. 'Avoidance' behaviours are specifically associated with negative outcomes for quality of peer relationships.
\n \n\n \n \nBACKGROUND: Educational achievement is an independent predictor of many life outcomes and so it is important to understand its causes and correlates. Internalising symptoms, encompassing anxiety and depression symptoms, are one candidate influence. METHODS: Using a prospective and genetically-informative design, the present study investigated the associations between internalising symptoms and educational achievement, controlling for IQ at age 7\u00a0years and socioeconomic status, among participants of the Twin and Early Development Study (up to N\u00a0=\u00a010,791). Internalising symptoms were measured by the parent-rated Anxiety Related Behaviours Questionnaire (ages 7, 9, 16\u00a0years), and educational attainment were indexed by UK-wide standardized examination results at ages 16 and 18\u00a0years, and self-reported transition to university education. RESULTS: Negative affect was the only internalising symptom subtype that was uniquely associated with academic underachievement at all timepoints, from mid-adolescence to early adulthood. The association between negative affect and achievement became non-significant when using MZ twin difference scores, suggesting that the majority of the relationship is accounted for by genetic and shared environmental effects. LIMITATIONS: Limitations include the reliance on parent-reported internalising symptoms. CONCLUSIONS: Negative affect in youth may be an important marker of later academic underachievement. Findings suggest that academic underachievement is not simply a consequence of the disruption caused by negative affect symptoms and therefore educational interventions may be required to optimise outcomes.
\n \n\n \n \n