Empathy plays a crucial role in children's social-emotional development. There is an increasing trend in recent studies to recognize empathy as a multi-dimensional construct, consisting of three distinct hierarchical levels: emotion contagion, attention to others' feelings and prosocial behaviors (Hoffman, Motiv Emot, 14(2), 151-172, 1990). The present study is amongst the first to use a longitudinal approach to examine the development trajectories of the distinct empathic levels, based on a sample of Chinese preschoolers aged 2 to 6 years, half of the sample being deaf or hard-of-hearing (DHH). Our results showed that according to the parental observation, DHH preschoolers manifested similar extent of emotion contagion and attention to others' feelings as their TH (typically hearing) peers over preschool years. Yet, DHH preschoolers showed fewer prosocial behaviors, compared to their TH peers. As for the longitudinal associations over time, emotion contagion contributed to more internalizing and externalizing behaviors in both groups; whilst attention to others' feelings contributed to fewer internalizing behaviors in only DHH children. Prosocial behaviors contributed to better social competence, and fewer internalizing and externalizing behaviors in both DHH and TH children just as expected. These outcomes imply that the early intervention or special education may be useful to safeguard children's empathic development, shrinking the gaps between DHH and TH children; but meanwhile, cultural factors might cause latent effects on children's understandings of empathy and impact on how empathy "regulates" children's social-emotional functioning, in a Chinese cultural context.

Anxiety sensitivity may be associated with both anxiety and eating disorder symptoms, which could contribute to the frequent comorbidity of both syndromes. This study examined the common (i.e., correlated) genetic and environmental contributions to anxiety sensitivity, cognitive symptoms of eating disorder severity, and anxiety symptoms to understand their co-occurrence in adolescence. This study analyzed data from the Twins Early Development Study. When twins were 16 years old (N = 5,111 pairs), they self-reported anxiety sensitivity via the Child Anxiety Sensitivity Index and cognitive symptoms of eating disorder severity via four items from the Eating Disorder Diagnostic Scale. Parents reported adolescent anxiety symptoms via the Anxiety Related Behaviour Questionnaire. Common genetic and non-shared environmental factors contributed to phenotypic correlations among cognitive symptoms of eating disorders. Genetic and nonshared environmental influences contributed to anxiety sensitivity and a latent variable of cognitive symptoms of eating disorder severity. Genetic, shared-, and nonshared- environmental influences contributed to anxiety symptoms. Common genetic and nonshared environmental influences contributed to anxiety sensitivity and anxiety symptoms, as well as anxiety sensitivity and cognitive symptoms of eating disorder severity. However, there was no evidence of common genetic or environmental contributions to anxiety symptoms and cognitive symptoms of eating disorder severity. This study implicates anxiety sensitivity as a potential cognitive process associated with both anxiety symptoms and cognitive symptoms of eating disorders.

Positive peer interactions are critical for adolescent development and well-being. Showing little interest in interacting socially with peers and/or extracting little reward from positive peer interactions can be markers of social anhedonia, which impacts many youths, especially girls, with social anxiety and depressive disorders. Reduced interest or reward in peer interactions may contribute to social anxiety and depression in girls through effects on positive affect (PA), though associations between social anhedonia and momentary PA have yet to be tested. The present study used ecological momentary assessment to test such associations between real-world anticipatory social reward (i.e., interest in upcoming peer events), consummatory social reward (i.e., reward extracted from positive peer interactions), and momentary PA in a sample of 129 girls (aged 11-13 years) who were oversampled for high shy/fearful temperament, a risk factor for future social anxiety and depression. Girls reported higher PA following a more socially rewarding peer interaction, and higher PA on days they reported higher anticipatory social reward. Exploratory analyses showed that these associations were specific to PA; neither anticipatory nor consummatory social reward was associated with changes in negative affect. Findings may inform the development of clinical interventions that target social anhedonia to modify PA in youth with affective disorders.

Growing research indicates that sleep problems are a robust independent risk factor for suicidal thoughts and behaviors among youth. However, relatively little is known about how this risk is conferred. This study used an intensive longitudinal design to investigate anhedonia as a mechanism linking sleep problems and next-day suicidal thoughts in a clinically high-risk sample of adolescents. Adolescents (N = 48; M=14.96; 77.1% white, 64.6% female) completed an ecological momentary assessment (EMA) study design for 28 days following discharge from acute psychiatric care for suicide risk. Daily sleep diaries were used to assess prior night total sleep time and sleep onset latency. Ecological momentary assessment was used to assess anhedonia and suicidal thoughts up to six times per day. A series of multi-level structural equation models were used to examine facets of anhedonia as parallel mediators of the association between sleep problems and next-day suicidal thoughts. Significant direct effects were found between sleep problems and consummatory anhedonia, consummatory anhedonia and suicidal thoughts, and anticipatory anhedonia and suicidal thoughts. There were significant indirect (mediated) effects between sleep problems and next-day suicidal thoughts through consummatory anhedonia, but not anticipatory anhedonia. Findings provide initial evidence as to how sleep problems may confer risk for next-day suicidal thoughts- by increasing consummatory anhedonia. Future research is needed to replicate these findings in larger samples and investigate how modifying anhedonia may mitigate suicide risk in youth.

Sexual and gender minority (SGM) individuals show disproportionately high rates of mental distress relative to their cisgender, heterosexual peers resulting from minority stress, or unique identity-related stressors. The majority of research on minority stress and mental health in SGM individuals has focused on adults, a notable gap given that SGM youth face unique developmental factors that intersect with identity development and availability of support resources. SGM youth therefore represent a critical population for the mental health workforce to serve competently. Mental health providers risk significant harm to their SGM youth clients if they do not understand the mechanisms underlying mental health disparities in this population. This article will review treatment practices that carry the potential for harm with SGM youth, including harms that are more overt and attempt to change SGM identities (i.e., so-called "conversion therapies"), and others that are more covert, such as neglecting to consider SGM identity in conceptualization and treatment (e.g., eating disorders), pathologizing SGM identity and behaviors (e.g., personality disorders, social anxiety), and reinforcing stigma related to SGM identities (e.g., obsessive-compulsive disorder). Accordingly, this article reviews each of these potential harms in detail and provides alternative recommendations for affirming and justice-based treatment for SGM youth.

Depression and alcohol use are highly comorbid, and often emerge during adolescence. Depressive symptoms may precede alcohol use, via the self-medication pathway, or alcohol use may precede depressive symptoms, via the alcohol induced disruption pathway. Yet little is known about other risks for developing comorbidity via either path. The present study hypothesized that poor cognitive and physiological emotion regulation (ER) are risk factors implicated in the development of comorbid depression and alcohol use during late adolescence. Participants were 229 (113 girls) Mexican-origin youth who reported on depressive symptoms and alcohol use at ages 17 (Time 1) and 19 years (Time 2). At age 17, cognitive reappraisal (CR), an adaptive ER strategy, and baseline respiratory sinus arrhythmia (RSA), a physiological index of ER capacity, were assessed. CR, RSA and gender were examined as predictors and moderators of the developing comorbidity of alcohol use and depression in cross-lagged panel models. Lower use of CR was concurrently associated with more depressive symptoms at age 17 and predicted greater depression at age 19. Age 17 alcohol use predicted age 19 depressive symptoms for boys. Lower RSA at age 17 also predicted more depressive symptoms at age 19 for boys. Neither CR nor RSA moderated the predicted relations between depression and alcohol use. Findings supported the alcohol induced disruption model of comorbidity for boys, and showed that poor cognitive and physiological ER increased risk for exacerbating depressive symptoms in late adolescence.

Many students with attention-deficit/hyperactivity disorder (ADHD) have negative social experiences with classmates and teachers. The Making Socially Accepting Inclusive Classrooms (MOSAIC) intervention asked teachers to give positive attention strategies to students at risk for ADHD, at a 3:1 ratio compared to their peers. Evidence suggested that although MOSAIC students at risk for ADHD reported improved relationships with teachers, they were more disliked by their classroom peers, relative to counterparts in a typical practice control group. The current study sought to investigate how classroom peers may have interpreted the teacher strategies. An independent sample of 191 children (ages 5-10; 102 boys) watched video vignettes displaying a teacher using MOSAIC strategies with a student. Participants were randomized into one of four conditions manipulating (a) the ADHD status of the student in the video (ADHD or Neurotypical), and (b) the equality in the teacher's implementation of the strategies across all students in the class (Equality or Inequality). Results suggested that children believed the teacher to be less genuine when delivering strategies to a student with ADHD relative to a neurotypical student. When teachers delivered strategies unequally (preferentially to the target student) relative to equally across all students, children found the teacher's actions to be less justified. Children's ratings of desired social contact with ADHD targets improved after watching the teacher use the MOSAIC strategies, but remained low overall. These findings underscore the importance of assessing children's interpretations of teacher-delivered intervention strategies, and have implications for future iterations of MOSAIC.

Untreated anger and aggression in youth confer heightened risk for subsequent psychosocial problems. However, engaging youth in treatment for anger can be difficult given barriers to accessing care and high rates of attrition. This study examined whether learning relaxation skills and practicing them using a videogame, whose operation was contingent upon keeping heart rate close to baseline levels, could help children learn to manage anger and aggression. Youth ages 7-17 with elevated levels of anger (N = 39) were randomized to receive the active video game condition or a control game that displayed heart rate but did not stop the game if heart rate became elevated. Youth underwent baseline screening, 6 treatment sessions, and follow-up assessments at 2-weeks and 3-months. Compared to the control condition, children in the active condition demonstrated significantly greater improvements in clinician-rated aggression severity (d = 1.48) and youth-rated emotion dysregulation (d = 3.46) at 2-weeks post-treatment. The active group maintained these improvements at 3-month follow-up, but no longer significantly differed from the control group. Intervention effects were nonsignificant for parent-reported emotion dysregulation and aggression. In addition, the intervention group youth, but not control group, experienced increased time with heart rate below baseline over the course of the 6 sessions. Findings suggest a promising brief intervention for reducing aggression and emotion dysregulation in children while they are waiting for longer-term outpatient therapy. Clinical Trial Registration Number: NCT03270813.

The current conceptual review highlights considerations surrounding the potential for non-beneficence and undue coercion within the practices of psychologists and other clinicians providing substance use treatment for youth. The potential for nonbeneficence and undue coercion is assessed at three key stages of treatment for youth with substance use disorders (SUDs): the informed consent process, maintaining confidentiality, and treatment planning. We explore these concerns as they relate to the ethical principles of psychologists as outlined by the American Psychological Association (American Psychological Association [APA], 2017), as well as pertinent state and national legislative guidelines. The paper culminates in actionable recommendations to resolve these inconsistencies in practice and emphasizes opportunities for professionals at all career stages to engage in ethical policy initiatives. These endeavors aim to reduce potential for undue coercion and nonbeneficence from psychologists treating youth with substance use disorders and to elucidate beneficial treatment pathways for youth navigating substance use challenges.

Measurement-based care (MBC), the use of routine assessment to guide clinical decision-making, has the potential to significantly enhance the quality of mental health services for youth by improving the detection and prevention of harm. Concerns exist, however, that widespread efforts to implement MBC may have a negative impact on youth mental health care. We explore both perspectives by describing how MBC can be leveraged as a tool to detect and prevent harmful treatment in youth and how misapplication of MBC also has the potential to cause harm. This discussion focuses on how MBC can help therapists identify harm caused by ineffective practices (i.e., deterioration or no symptoms changes), poor client engagement (e.g., early drop-out, poor alliance), and adverse events (e.g., injury caused by treatment). We also discuss multi-level applications of aggregated MBC data to prevent harm through workforce development and organizational and health systems quality and cost of care improvement initiatives. Misapplication of MBC by failing to adhere to MBC best practices, overreliance on data above clinical judgement, providing insufficient organizational support, and using MBC data to justify cost containment are all discussed as possible sources of harm. We conclude with a discussion of future directions for research needed to advance the application of MBC to the prevention of harm in youth psychotherapy.

Weight-centric health practices are based on the principle that excess weight predicts chronic disease, informing a growing sociopolitical movement to address an "obesity epidemic." This hyper-focus on preventing obesity may contribute to weight stigma (i.e., the devaluation and discrimination of individuals based on body size) and other iatrogenic outcomes for youth, including the development and maintenance of eating disorders (EDs). Current evidence-based treatments for EDs include language and practices that may reinforce fears of fatness, body shame, and unhealthy dietary restriction without guidance on addressing weight stigma. Here, we present case examples from three adolescent patients across ED presentations and body sizes to (1) elucidate the role of weight stigma in ED development, (2) highlight the ubiquity and harms of weight stigma within ED treatments, and (3) outline thoughtful protocol adaptations to avoid further harm and facilitate recovery. We conclude with a call for immediate action to advance research characterizing the harms of weight-centric approaches in existing ED interventions to reduce the risk of iatrogenic effects on youth with EDs and advance weight-inclusive approaches to ED treatment.

Individuals with autism spectrum disorder (ASD) display heterogeneity in adaptive functioning, underscoring the need to identify predictors to inform clinical and scientific interventions. We investigated the longitudinal associations between an autism diagnosis, co-occurring psychopathology symptoms, executive functions (EF) and subsequent adaptive functioning in individuals with and without ASD (IQ > 70). Sixty-six individuals (26 with ASD, 40 without ASD) were assessed at baseline (mean age = 11.8 years, SD = 2.1) and at 10-year follow-up (mean age 21.4, SD = 2.3). The diagnostic evaluation comprised a comprehensive assessment of autism symptoms and emotional and cognitive functioning. Co-occurring psychopathology symptoms were assessed with two measures: self-reported depressive symptoms with the Short Mood and Feelings Questionnaire and parent-reported total problems with the Child Behavior Checklist 6-18. Participants completed neuropsychological tests to evaluate EF. We investigated adaptive functioning by using the Weiss Functional Impairment Rating Scale (WFIRS) which is a self-report measure of impairment in the following domains: family, work, school, life skills, self-concept, social and risk-taking. Among the emerging adults previously diagnosed with ASD, 46% reported living independently, 75% had at least one friend, and 71% were employed or in education. Individuals with ASD reported significantly lower adaptive functioning compared to individuals without ASD (WFIRS Total, Hedges' g = 0.92). Greater EF difficulties in childhood/adolescence predicted lower adaptive functioning in emerging adulthood, surpassing the influence of autism diagnosis and co-occurring symptoms. The findings highlight the influential role of EF, implying that interventions targeting EF difficulties could improve long-term outcomes for individuals with ASD.

We examined the intergenerational association of ODD symptoms between parents and child offspring, elaborating a model whereby parental childhood ODD symptoms influence their children's ODD symptoms through dyadic interactions within the current family system. The sample included 731 children (aged 6-11, 64.3% boys) and their parents. In a sample of Chinese families, parents reported their childhood ODD symptoms and their marital quality, their negative parenting practices, and their children's ODD symptoms at T1 and T2, about half a year apart. Results indicated that parents' childhood ODD symptoms positively predicted children's T1 ODD symptoms, especially for boys. Path analysis revealed gender-based differences. That is, mothers' childhood ODD symptoms negatively predicted parental marital relationship quality at T1, which in turn positively predicted boys' ODD symptoms at T2. Yet fathers' childhood ODD symptoms were positive predictors of fathers' negative parenting practices at T1, which in turn positively predicted girls' ODD symptoms at T2. Our findings support a gender preference in the intergenerational association of psychopathology. In the current study, such a gender preference is mainly reflected in the stronger direct association between parental childhood ODD symptoms and the T1 ODD symptoms of male offspring than female ones.

Existing research on callous-unemotional (CU) traits and conduct problems primarily focuses on the concurrent or unidirectional associations between these constructs (i.e., from CU traits to CP), with less attention given to their dynamic interplay during middle childhood. It is possible that socialization agents, such as peers, play a significant role in shaping the dynamic relation between CU traits and conduct problems early in development. Additionally, prior studies have shown that both CU traits and conduct problems are associated with poorer peer functioning. Considering the social information processing theory, which emphasizes the impact of cognitive processes on emotions and behavior in youth, this study evaluated the moderating role of cognitive appraisals (i.e., rumination, self-blame, and other-blame) in the context of peer conflict on the bidirectional association between callous-unemotional (CU) traits and conduct problems over the course of 1 academic year. The sample included 349 third- through fifth-grade students (51% boys; 53.2% Hispanic/Latinx) and their homeroom teachers (n = 30). At Time 1, children reported on their cognitive appraisals in response to peer conflict. Teachers provided reports of children's CU traits and conduct problems at Time 1 and Time 2. Results indicated that conduct problems and other-blame uniquely predicted increases in CU traits over time. Further, high levels of self-blame and rumination exacerbated the prospective link from CU traits to subsequent conduct problems. These findings highlight the importance of addressing cognitive processes in prevention approaches aimed at reducing the risk of conduct problems and CU traits among children.

Parental monitoring and knowledge of their teens' activities might enable parents to keep teens safe, reducing the risk of potentially traumatic events. This paper investigated that possibility using a large, nationwide sample of 11,880 early adolescent teens followed longitudinally from ages 10-11 to 13-14 years old. At annual assessments, teens completed measures of parental monitoring/knowledge and of potentially traumatic events. Data were analyzed using multilevel models to separate between- and within-family associations. Because within-family associations cannot be explained by the many systematic differences between families with low vs. high monitoring, they comprise more rigorous evidence of a potential causal relationship. We tested both concurrent associations between monitoring/knowledge and PTEs and prospective associations over 12 months. At the between-family level, every tested association was significant (p < .001): greater monitoring and/or knowledge predicted fewer PTEs. However, at the within-family level, few associations were significant. Greater knowledge (p = 0.005) or combined monitoring/knowledge (p = 0.01) predicted fewer PTEs concurrently, but greater monitoring alone did not (p = 0.14). No prospective within-family associations were statistically significant. We replicated this pattern of findings in a different set of observations from the same sample, using different measures of each construct. We conclude that most of the apparent association between parental monitoring/knowledge and PTEs is explained by confounding factors, rather than a causal relationship. However, we found some evidence supporting a causal link in models of concurrent associations, suggesting any causal relationship between monitoring/knowledge and PTEs may unfold over shorter timescales.

Prior studies have found an association between reduced P3 brain responses-a neural marker of task engagement-and increased depressive symptoms during adolescence. However, it is unclear whether P3 correlates with depression globally, or with certain facets. Existing depression studies have also typically quantified P3 as a cross-trial average, neglecting possible trial-by-trial effects. Among 72 adolescents (44% female), the current study evaluated relations of distinct depression symptom facets-anhedonia and negative mood-with P3s from a three-stimulus go/no-go task, quantified both in average- and trial-level terms. Although no relationship was evident between overall depressive symptoms and average P3 amplitudes, opposing relations were found for each symptom facet with P3 to frequent and infrequent 'go' stimuli: higher anhedonia predicted smaller P3, whereas increased negative mood predicted larger P3. Single-trial, multilevel modeling analyses clarified these effects by showing reduced P3 across stimuli types at task outset, along with greater trial-to-trial attenuation of P3 to infrequent-go stimuli, for adolescents experiencing greater anhedonia. Conversely, increased negative mood was distinctly related to larger P3 at task onset but was unrelated to amplitude change across trials. Results demonstrate differential relations for anhedonic and negative mood symptoms with P3-indicative of task disengagement versus heightened vigilance, respectively-that may be obscured in analyses focusing on overall depressive symptoms. The divergent associations for anhedonia and negative mood with P3 underscore the need to consider these distinct symptom facets in research aimed at clarifying the nature of neural-circuitry dysfunction in depression.

The increasing prevalence of anxiety problems during adolescence underscores the importance of a better understanding of the development of anxiety. Existing literature has documented a prospective association between error responsivity - characterized by the ERP component of error-related negativity (ERN) - and anxiety in youths. However, it remains unclear to what extent the ERN-anxiety relationship may be moderated by emotion regulation, another attribute critical to the development of anxiety. We collected two waves of data from 115 healthy early adolescents (66 girls; Mean age/SD at T1 = 11.00/1.16 years), approximately one year apart. Participants completed an EEG Go/No-Go task and reported on their anxiety symptoms at T1 and T2; they also reported on their emotion regulation tendencies (i.e., cognitive reappraisal [CR] and expressive suppression [ES]) at T2. The ERN was quantified via a principal component analysis. We found a moderating effect of ES on the ERN-anxiety association. Specifically, a larger T1 ERN predicted greater T2 anxiety symptoms for youths with higher, but not lower, ES. Interestingly, the moderating effect of CR on the ERN-symptom association was conditioned on age. Among older youths (upper age tercile) only, the association between T1 ERN and T2 symptoms was significant for those with lower, but not higher, CR. These findings contribute novel evidence on the moderating effect of emotion regulation on the prospective ERN-anxiety relationship in early adolescence. Our results elucidate age-specific patterns in the moderating effect of CR. Future studies can leverage these findings to tailor emotion regulation interventions for youths of different ages.

Exposure to direct and intergenerational adversity can negatively affect the mental health (e.g., depressive symptoms) of adolescents. Black adolescents are at particularly heightened risk for experiencing adversity due to systematic exposure to racism-related stress and discrimination; yet most Black youth do not develop mental health problems. Given this context, the current study explored social-ecological protective factors (e.g., internal assets, mother-adolescent communication, community cohesion) that Black adolescents may access to mitigate depressive symptoms. The sample included 141 Black adolescents and their mothers. Adolescents ranged in age from 11 to 17 (M = 13.70; SD = 2.02) and more than half identified as girls (64.08%). Mothers were between the ages of 28 and 64 (M = 37.91; SD = 7.64). Hierarchical linear regression modeling was used to (1) assess the direct effects of social-ecological factors and adversity-related variables on depressive symptoms while controlling for socioeconomic status, and (2) examine the moderating effects of the social-ecological factors on the association between direct adversity and depressive symptoms. Results indicated that less adversity exposure, more internal assets, and better mother-adolescent communication were associated with fewer depressive symptoms. Further, mother-adolescent communication moderated the relation between adolescents' adversity exposure and their depressive symptoms, such that more effective mother-adolescent communication reduced the strength of the relation between adversity and depressive symptoms. Future interventions targeting depression in Black adolescents may benefit from focusing on familial communication and bolstering internal assets.

Many adolescents fear disclosing self-injurious thoughts and behaviors (SITBs) due to stigma or concern about responses from others. The current study examined rates of disclosure for nonsuicidal self-injury (NSSI), suicide ideation, and suicide attempts in a clinical sample of adolescents, and identified the individuals to whom they disclosed their SITBs. Differences in reasons for living (parent and peer support, future optimism, self-acceptance, and fear of suicide) were examined across disclosure groups. The sample included 100 adolescent inpatients (mean age = 14.61). Rates of disclosure were relatively high: 77% for NSSI, 75% for suicide ideation, and 83.7% for suicide attempts. Adolescents who disclosed NSSI reported higher scores on subscales of self-esteem and future optimism compared to those who did not disclose. No differences were found for adolescents disclosing to parents vs. others; only the fear of suicide subscale was significantly different, and was lower for adolescents who disclosed NSSI to peers vs. others. Adolescents with suicide ideation disclosure reported more parent support compared to those who had not disclosed, those with peer disclosure reported lower fear of suicide than those disclosing to others, and there were no differences for disclosing to parents vs. others. For suicide attempts, only self-acceptance subscale scores were significantly different, and lower for adolescents who disclosed to peers vs. others. There were no differences for disclosing suicide attempts to parents versus other people. The willingness to disclose self-harm behaviors seems influenced by the perception of safety and anticipated support from parents or others to whom adolescents disclose.

Parent report is frequently used to assess children's psychopathology, however, researchers have expressed concerns about the validity of parent reports. Some parental characteristics, attitudes, or beliefs may systematically bias a parent's report of their child's behaviors and functioning. Informed by social information processing models of parenting risk, parents with more difficulties reflecting on and interpreting their children's behavior may be at risk for less accurate reports. The present study conducted two regularized moderated non-linear factor analyses with LONGSCAN data to examine how parents' self-reported negative parenting cognitions were associated with structural parameters of parent-reported child aggression and attention problems. While differential item functioning (DIF) was present on the aggression and attention problems subscales as a function of negative parenting cognitions, the DIF was small in magnitude, inconsistent in directionality and did not significantly alter factor-level parameters. Negative parenting cognitions did demonstrate a small but significant negative impact on all latent externalizing factors (aggression and attention problems), such that caregivers with fewer negative parenting cognitions endorsed fewer items, and this was associated with a lower mean of each latent variable. Given that accounting for DIF did not contribute to meaningful differences in impact parameters or improve criterion validity, findings suggest that the aggression and attention subscales are functionally invariant to negative parenting cognitions, suggesting that externalizing symptoms can be reliability compared across parents of varying parenting cognitions.

The potential harms related to interventions for adults with suicide-related risk, particularly hospitalization, have been well documented. Much less work has focused on the potential harms related to interventions with youth struggling with suicidal thoughts and behaviors. Young people are most likely to receive mental health services in schools, which are recognized as meaningful sites for effective suicide prevention work. However, no overviews have conceptualized the potential harms to youth when schools engage in ineffective suicide prevention efforts. In this article, we discuss three prominent overlapping areas of potential harms: (1) privacy-related, (2) relationship-related, and (3) mental health-related. We then discuss key factors thought to influence the development and maintenance of these potential harms. We conclude by noting ways in which school-based mental health providers may attempt to reduce unintentional harms in this area, with an overarching goal of helping support school mental health providers and the youth they serve.

Beyond achievement, educational settings offer informal supports that may be critical for child and youth mental health. However, children's educational environments have experienced significant disruption with the coronavirus pandemic. School settings offer unique opportunities to support children's mental health, but research must identify powerful points of intervention. This study examined school factors (aspirations, perceived competence, sense of belonging, and emotional engagement) as predictors of children's mental health, and the potential consequences of increasing screen time in and outside of school. Participants (N = 707) were parents and their children (6-18 years) from community and clinical settings who completed prospective surveys about children's school experiences and mental health symptoms (November 2020-May 2022). Standardized measures of depression, anxiety, irritability, inattention, and hyperactivity were collected. Structural equation modelling tested longitudinal associations between screen time, school factors, and mental health outcomes. Positive associations between each of the school factors (B = 0.14 [SE = 0.04] to B = 0.43 [SE = 0.04]) suggested they may reinforce one another. Longitudinally, sense of belonging and emotional engagement at school predicted lower severity for symptoms of depression, anxiety, irritability, and inattention (B=-0.14 [SE = 0.07] to B =-0.33 [SE = 0.10]). Greater screen time was associated with lower aspirations and perceived competence (B = - 0.08 [SE = 0.04] to B = - 0.13 [SE = 0.06]). Results suggest that school factors beyond achievement may be key correlates of child and youth mental health. While curriculum expectations emphasize academic achievement, an investment in supporting positive attitudes and aspirations at school is also warranted.

Individuals with ADHD are at risk for substance use initiation in adolescence and escalation to problematic use in adulthood. Little is known about the impact of psychosocial ADHD treatment on substance use. Based on existing theory, both therapeutic (i.e., through reducing symptoms and impairments) and iatrogenic effects (i.e., through improved social functioning) of psychosocial treatment for ADHD on adolescent substance use initiation are plausible. A primarily ethnic/racial minority sample (~ 95% Latinx or Black) of rising ninth grade students with ADHD (n = 106) were randomly assigned to receive high intensity (i.e., Summer Treatment Program-Adolescent, parent training, and school consultation) or lower intensity (parent training, organization skills training, and school consultation) intervention the summer before entering high school. Participants were followed four-years post-baseline and substance use was documented. Analyses tested treatment effects on substance use initiation (alcohol and/or marijuana) and mediators of main effects. After controlling for covariates, participants assigned to HI (37.5%) were significantly more likely than LI (18.6%) to initiate substance use by end of high school, indicating an iatrogenic effect of HI treatment. No significant mediators were detected. Post-hoc exploration of moderators suggested that youth with elevated Posttraumatic Stress Disorder (PTSD) symptoms may have experienced a benefit of HI treatment on substance use whereas youth without elevated PTSD symptoms experienced iatrogenic effects. Large, well-powered, samples should examine moderated mediational models to better understand who is most risk for iatrogenic effects of ADHD psychosocial treatment and why. Clinicians delivering psychosocial treatment to adolescents with ADHD should monitor for potential iatrogenic effects.

Limited studies have investigated differential treatment responses to family-based treatment programs and subgroup trajectories in youth in a high-risk context. This study pioneered an examination of Multisystemic Therapy for Child Abuse and Neglect (MST-CAN) and built on prior research that identified subgroups with different psychopathologies. Participants included 208 parent-child dyads enrolled in the MST-CAN evaluation in Switzerland. Parents reported their children's (M = 10.27 years, SD = 3.5, 44.2% girls, 55.8% boys, 98.6% White) emotional and behavioral problems. Longitudinal data were examined to analyze the differential changes within the pre- and post-treatment (T1 and T2) subgroups. The T1 cluster and T2 cluster were cross-tabulated to examine changes in the symptom class over time. Overall, the treatment proved to be highly beneficial. Subgroup analyses revealed that four out of the five subgroups (80%) showed positive changes in at least two outcome measures. The treatment was most successful for children with externalizing symptoms. Children with multiple symptoms also showed improvements across different symptoms. Regarding specific symptoms, children with anxious-avoidant symptoms benefited from the treatment. Additionally, the treatment was beneficial for children with normative emotions and behavior. Meanwhile, the treatment did not have any significant effects for children with internalizing symptoms. Notably, child neglect was reduced in three (60%) subgroups. The symptom class remained stable across time for children with externalizing and multiple symptoms. Ultimately, MST-CAN reduced emotional and behavioral problems and child neglect in most families. Understanding children's differential treatment responses to complex treatment programs is essential to adequately address different needs.

Temperament is thought to influence the development of early maladaptive schemas (EMSs). However, whether temperament is longitudinally related to EMSs beyond attachment, the best known predictor of EMSs, has been underexplored. Hence, this study investigated (1) Whether middle childhood temperament is longitudinally related to late adolescent EMSs, (2) To what extent temperament explains EMSs beyond middle childhood attachment, and (3) Whether attachment moderates this temperament-EMSs link. In total, 157 children (M = 10.91 in middle childhood, M = 16.71 in late adolescence) participated in this study. Adolescent EMSs were assessed along with middle childhood temperamental negative affect, affiliation, surgency, and effortful control, and attachment at both explicit and implicit levels. Results indicated that all temperamental features were longitudinally related to later EMSs; the majority of the temperament-EMSs links did not survive after controlling for attachment, except for some limited correlations between EMSs and negative affect and effortful control; and an inconsistent moderating effect for attachment on the temperament-EMSs link. This study provides further insight into the role of child factors (middle childhood temperament and late adolescent attachment) in understanding EMSs variability in late adolescence. It suggests that EMSs are informed more by past relational experiences (attachment) than children's inborn tendencies (temperament).

Pediatric obsessive-compulsive disorder (OCD) can be debilitating and chronic unless treated early with efficacious intervention. The past several decades of intervention research have identified cognitive-behavioral therapy (CBT) with exposure and response/ritual prevention (ERP) as the first-line, evidence-based psychological intervention for pediatric OCD. Yet, many youths with OCD unfortunately remain inadequately treated. In well-meaning but misguided efforts to treat this complex disorder, clinicians holding misconceptions about ERP may fail to apply evidence-based treatments, misapply generic CBT techniques and ERP principles, or turn to non-evidence-based interventions. Potentially harmful treatments may worsen symptoms, while ineffective treatments can waste resources, impede patient access to efficacious treatment, and weaken public confidence in psychotherapy. The overarching goals of this review paper are to describe potentially harmful and ineffective practices in the treatment of pediatric OCD and to offer recommendations aligned with evidence-based practice. First, we dispel common misconceptions about ERP that may underlie its underuse among clinicians. We then describe potentially harmful and ineffective interventions for pediatric OCD, starting with misapplication of generic CBT techniques and ERP principles. We also identify non-evidence-based treatments for pediatric OCD that have limited conceptual or empirical foundations. Finally, we conclude with recommendations for clinicians who treat pediatric OCD, intervention researchers, training programs across mental health-related disciplines, and policymakers.

Childhood callous-unemotional (CU) traits are associated with a neurocognitive response style of high reward and low punishment sensitivity, which may make these children particularly vulnerable to substance misuse. However, the mechanisms explaining the link between CU traits and substance use are poorly understood. This study investigated the mediating influences of reward and punishment sensitivity on the association between childhood CU traits and adolescent substance use. Using data from the UK Millennium Cohort Study, mediation analyses were conducted to investigate the potential indirect effects of age 14 reward and punishment sensitivity in risk-taking on the relationships between age 11 CU traits and alcohol, cannabis, and other illicit drug use at age 17. No direct effects of CU traits on substance use were found when accounting for gender, baseline alcohol use, poverty, emotional symptoms, conduct problems, hyperactivity, and verbal ability at age 11. Indirect effects of increased reward sensitivity on the relationship between CU traits and increased use were seen for alcohol, cannabis, and other drugs. There was a significant indirect effect of reduced punishment sensitivity on the relationship between CU traits and increased alcohol use, but not cannabis or other substance use. Findings suggest that reward and punishment sensitivity may have independent effects on decision-making processes contributing to adolescent substance use. Prevention and early intervention for substance use should consider modifying intervention strategies to fit the needs of adolescents with a callous interpersonal style and a neurocognitive profile characterized by a high drive for rewards and low risk aversion.

Individuals with ADHD symptoms are at an increased risk of lifetime trauma exposure. However, research has yet to fully examine whether symptoms of ADHD function as a temporal risk factor for experiencing trauma and specific mechanisms that may explain the association between symptoms of ADHD and trauma exposure. Two constructs that may account for the relation between ADHD symptoms and trauma are deviant peer association and neighborhood disadvantage. The present study sought to 1) elucidate the temporal nature of ADHD symptoms and exposure to trauma and 2) examine whether peer deviancy and/or neighborhood disadvantage mediate the relation between childhood ADHD symptoms and subsequent trauma exposure across a 20-year longitudinal cohort study. Participants (N = 616) were predominantly Black/African American (86%; Male n = 389) from an urban school district. Using structural equation modeling, total trauma exposures during young adulthood (Years 17-20) were regressed on parent- and teacher-rated ADHD symptoms in Grade 1 (Year 1). A significant indirect path from ADHD symptoms to trauma exposure through deviant peer affiliation (Year 16) indicated that having childhood ADHD symptoms predicted deviant peer affiliation 16 years later, which in turn predicted greater exposures to traumatic events during young adulthood, controlling for neighborhood disadvantage. Neighborhood disadvantage was not a significant mediator when accounting for peer deviancy. Taken together, findings contribute to a limited body of research that utilizes a prospective design to examine the association between childhood ADHD symptoms and trauma exposure in young adulthood among Black/African American youth. Potential targets for intervention are proposed.

Anxiety disorders are among the most prevalent of all mental health disorders, often originating in early childhood and extending into later childhood, adolescence, and adulthood. Determining salient risk factors that precede their development is important for prevention and intervention efforts. Towards this end, we examined the role of temperament, theory of mind, inhibitory control, and prosocial behavior on child anxiety symptoms in the first 5 years of life. A community sample of children and their parents (N = 399) enrolled in a longitudinal study of emotion processing were assessed when the children were infants and at ages 2 years, 3 years, and 5 years. Linear mixed models and linear regression models revealed that greater anxiety at 5 years was associated with greater negative affectivity and behavioral inhibition, lower effortful control, lower theory of mind scores on the "desires" domain, and higher scores on the "intentions" domain (assessed from infancy to 3 years of age). These characteristics may be useful to assess in clinical settings to evaluate a patient's risk for developing anxiety. They may also be useful in developing interventions targeting specific vulnerabilities.

Rates of child and adolescent mental disorder have risen sharply while access to community-based mental health care options continues to be elusive for many families. Substantial and persistent barriers to community-based mental health care have prompted multiple stakeholders to pursue an approach that emphasizes health promotion and intervention practices within the context of ecologically valid and more accessible environments. The most prominent of these environments has been schools that can serve as local and centralized access points to various services, including mental health care. The rapid expansion of school-based mental health service delivery systems, however, carries both risk of perniciousness as well as significant promise with respect to effective and equitable care. This article summarizes key concerns surrounding school-based mental health service delivery systems, including non-beneficence and harm, support disparities, unsustainable implementation, oppressive school climate, and linkage to punitive and discriminatory practices. Broad-based recommendations to help realize the promise of effective and equitable care for students with mental health and behavioral challenges are also presented vis-à-vis each of these concerns. At the same time, natural tensions between various mandates assigned to schools as well as between schools and their surrounding communities will need to be addressed to reach the full potential of school-based mental health service delivery systems.