Qualitative exploration of a targeted school‐based mindfulness course in England

McGeechan, G. J. et al. | Qualitative exploration of a targeted school‐based mindfulness course in England | Child and Adolescent Mental Health | published 27 June 2018

Abstract

Background

Mindfulness‐based training has been shown to provide benefits for adults with numerous conditions such as cancer, chronic pain, and depression. However, less is known about its impact for young people. Early adolescence (typically 10–14 years) is a time fraught with challenges such as cognitive changes, social, and academic pressures in the form of exams, all of which can provoke anxiety. While there is a lack of effectiveness studies, there is growing interest in the potential for school‐based mindfulness programmes to help young people cope with the pressures of modern life.

Methods

This study outlines a qualitative exploration of a school‐based targeted mindfulness course. We interviewed 16 young people who had taken part in a 10‐week mindfulness course, and held a focus group with three members of teaching staff who delivered the programme. Interviews and focus groups were analysed using applied thematic analysis.

Results

While young people felt that they had to take part, once they started the programme they enjoyed it. Young people felt that they learned a range of coping skills, and it had a positive impact on their behaviour. However, the targeted approach of the intervention could lead to young people being stigmatised by their peers. Teaching staff could see the potential benefit of mindfulness courses in schools but felt there were some barriers to be overcome if it were to be implemented in the long term.

Conclusions

Young people were willing to engage in mindful practice and felt it better equipped them to deal with stressful situations.

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Parent-child therapy helps young children with depression

New research demonstrates that an interactive therapy involving parents and their depressed preschoolers can reduce rates of depression and lower the severity of children’s symptoms | The American Journal of Psychiatry | via ScienceDaily

Children as young as three can be clinically depressed, and often that depression recurs as they get older and go to school. It also can reappear during adolescence and throughout life.

New research from Washington University School of Medicine demonstrates that an interactive therapy involving parents and their depressed children can reduce rates of depression and lower the severity of children’s symptoms:

Abstract
Objective:
Clinical depression in children as young as age 3 has been validated, and prevalence rates are similar to the school-age disorder. Homotypic continuity between early and later childhood depression has been observed, with alterations in brain function and structure similar to those reported in depressed adults.

These findings highlight the importance of identifying and treating depression as early as developmentally possible, given the relative treatment resistance and small effect sizes for treatments later in life. The authors conducted a randomized controlled trial of a dyadic parent-child psychotherapy for early childhood depression that focuses on enhancing the child’s emotional competence and emotion regulation.

Method:
A modified version of the empirically tested parent-child interaction therapy with a novel “emotion development” module (PCIT-ED) was compared with a waiting list condition in a randomized controlled trial in 229 parent-child dyads with children 3–6.11 years of age. Both study arms lasted 18 weeks.

Results:
Children in the PCIT-ED group had lower rates of depression (primary outcome), lower depression severity, and lower impairment compared with those in the waiting list condition. Measures of child emotional functioning and parenting stress and depression were significantly improved in the PCIT-ED group.

Conclusions:
The findings from this randomized controlled trial of a parent-child psychotherapy for early childhood depression suggest that earlier identification and intervention in this chronic and relapsing disorder represents a key new pathway for more effective treatment. Manualized PCIT-ED, administered by master’s-level clinicians, is feasible for delivery in community health settings.

Luby, J. L. et al. |  A Randomized Controlled Trial of Parent-Child Psychotherapy Targeting Emotion Development for Early Childhood Depression | American Journal of Psychiatry | Published Online 20 June 2018

Why do People Overthink?

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Background:

The meta-cognitive model of rumination is a theoretical model regarding the relationship between rumination and depression. Although meta-cognitive therapy for rumination was established based on this model, insufficient longitudinal studies addressing this model have been conducted. Moreover, the uncontrollability of rumination, suggested to be driven by negative meta-beliefs about rumination, has not been examined using this meta-cognitive model.

Aims: We longitudinally examined the meta-cognitive model and its relationship with uncontrollability of rumination and depressive symptoms. Method: Undergraduate students (n = 117) were asked to complete two measurements (with a 6-month gap between them) of positive and negative meta-beliefs about rumination, causal analysis, understanding, uncontrollability of rumination and depression.

Results: Cross-lagged effect modelling revealed that positive meta-beliefs predicted high causal analytic rumination. However, the results did not support the causal analytic and understanding aspects of how rumination predicted negative meta-beliefs. Negative meta-beliefs predicted high depressive symptoms, and depressive symptoms predicted high negative meta-beliefs. Negative meta-beliefs predicted high uncontrollability of rumination, whereas uncontrollability of rumination did not predict depressive symptoms.

Conclusions: The results partially supported the meta-cognitive model. The prediction of depressive symptoms on negative meta-beliefs suggests that depression-related cognition might be involved in increasing negative meta-beliefs, rather than the repetitive causal analytic and understanding aspects of rumination. In line with meta-cognitive therapy, negative meta-beliefs could be a target for treating depression.

Full reference: Matsumoto, N., & Mochizuki, S. | Why do People Overthink? A Longitudinal Investigation of a Meta-Cognitive Model and Uncontrollability of Rumination |  Behavioural and Cognitive Psychotherapy | Vol 46(4), July 2018 | p504-509

Tackling bullying could help reduce depression in autistic teens

University of Bristol| June 2018 | Tackling bullying could help reduce depression in autistic teens

A new study from Bristol University has found teenagers with difficulties in social communication, including autism, have greater rates of depression, especially if they are being bullied. 

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The researchers used data from a longitudinal study and  discovered that children with autism, and young people with autistic traits, had greater symptoms of depression at age 10 than peers without autism. This trend continued until the children and young people were 18 (via Science Daily).

 

The full news story is available to read from Science Daily

An article based on this study has been published in JAMA Psychiatry

Abstract

Importance  Population-based studies following trajectories of depression in autism spectrum disorders (ASD) from childhood into early adulthood are rare. The role of genetic confounding and of potential environmental intermediaries, such as bullying, in any associations is unclear.

Objectives  To compare trajectories of depressive symptoms from ages 10 to 18 years for children with or without ASD and autistic traits, to assess associations between ASD and autistic traits and an International Statistical Classification of Diseases, 10th Revision (ICD-10) depression diagnosis at age 18 years, and to explore the importance of genetic confounding and bullying.

Design, Setting, and Participants  Longitudinal study of participants in the Avon Longitudinal Study of Parents and Children birth cohort in Bristol, United Kingdom, followed up through age 18 years. Data analysis was conducted from January to November 2017.

Main Outcomes and Measures  Depressive symptoms were assessed using the Short Mood and Feelings Questionnaire (SMFQ) at 6 time points between ages 10 and 18 years. An ICD-10 depression diagnosis at age 18 years was established using the Clinical Interview Schedule–Revised. Exposures were ASD diagnosis and 4 dichotomized autistic traits (social communication, coherence, repetitive behavior, and sociability). An autism polygenic risk score was derived using the Psychiatric Genomics Consortium autism discovery genome-wide association study summary data. Bullying was assessed at ages 8, 10, and 13 years.

Results  The maximum sample with complete data was 6091 for the trajectory analysis (48.8% male) and 3168 for analysis of depression diagnosis at age 18 years (44.4% male). Children with ASD and autistic traits had higher average SMFQ depressive symptom scores than the general population at age 10 years (eg, for social communication 5.55 [95% CI, 5.16-5.95] vs 3.73 [95% CI, 3.61-3.85], for ASD 7.31 [95% CI, 6.22-8.40] vs 3.94 [95% CI, 3.83-4.05], remaining elevated in an upward trajectory until age 18 years (eg, for social communication 7.65 [95% CI, 6.92-8.37] vs 6.50 [95% CI, 6.29-6.71], for ASD 7.66 [95% CI, 5.96-9.35] vs 6.62 [95% CI, 6.43-6.81]). Social communication impairments were associated with depression at age 18 years (adjusted relative risk, 1.68; 95% CI, 1.05-2.70), and bullying explained a substantial proportion of this risk. There was no evidence of confounding by the autism polygenic risk score. Analysis in larger samples using multiple imputation led to similar but more precise results.

Conclusions and Relevance  Children with ASD and ASD traits have higher depressive symptom scores than the general population by age 10 years, which persist to age 18 years, particularly in the context of bullying. Social communication impairments are an important autistic trait in relation to depression. Bullying, as an environmental intermediary, could be a target for interventions.

 

The article can  be read in full at JAMA Psychiatry 

Full reference:

Rai D, Culpin I, Heuvelman H, et al.| Association of Autistic Traits With Depression From Childhood to Age 18 Years| JAMA Psychiatry | Published online June 13, 2018| doi:10.1001/jamapsychiatry.2018.1323

 

More screen time associated with insomnia and less sleep in adolescents

Science Daily | June 2018 | Study links screen time to insomnia symptoms and depressive symptoms in adolescents

A new US study which used data from over 2000 adolescents has found an association between high screen usage and insomnia and shorter sleep duration in young people. Xian Stella Li, PhD, one of the researchers in the study said: “Higher rates of depressive symptoms among teens may be partially explained through the ubiquitous use of screen-based activities, which can interfere with high quality restorative sleep (via Science Daily).” 

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Principal investigator Lauren Hale, said: “These results suggest that parents, educators and health care professionals could consider educating adolescents and regulating their screen time, as possible interventions for improving sleep health and reducing depression.”

The full news article is available from Science Daily

 

US study uses phone app to screen for autism

Science Daily |June 2018 | Mobile app for autism screening yields useful data

A new US study that uses a smartphone app to screen young children for signs of autism has found the application produces reliable data. It was also accessible for children and praised by caregivers (via Science Daily).


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During the year-long  there were over 10000 downloads of the app; parents completed more than 5000 surveys and uploaded 4441 videos. These data were collected, 88 per cent of the videos yielding useful data.  The app uses video footage of the adolescents filmed while watching films and designed to identify patterns of emotion and attention, autism risk factors, on the device.  The videos are then analysed by behavioural coding software which tracks the child’s response and quantifies their emotions and attention.

A member of the research team Geraldine Dawson, Director of the Duke Center for Autism and Brain Development, remarked “This demonstrates the feasibility of this approach.

“Many caregivers were willing to participate, the data were high quality and the video analysis algorithms produced results consistent with the scoring we produce in our autism program here at Duke.”

The full news article is available from Science Daily 
The study has now been published in the open access journal npj Digital Medicine. It can be accessed through Nature 

Full reference:

Egger, H. L. et al .| 2018| Automatic emotion and attention analysis of young children at home: a ResearchKit autism feasibility study |npj Digital Medicine| Vol. 1 |DOI: 10.1038/s41746-018-0024-6

For anxiety a single intervention is not enough

Science Daily |May 2018 | For anxiety, a single intervention is not enough 

A study that tracked over 300 young people aged between 10-25 with a diagnosis of separation, social or general anxiety disorder has shown that irrespective of the treatment they receive, only 1 in 5 will stay well over the longer- term 
via Science Daily).

The full news article is available here 

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The article has been published in  Journal of the American Academy of Child & Adolescent Psychiatry

To report anxiety outcomes from the multisite Child/Adolescent Anxiety Multi-modal Extended Long-term Study (CAMELS). Rates of stable anxiety remission (defined rigorously as the absence of all DSM-IV TR anxiety disorders across all follow-up years) and predictors of anxiety remission across a 4-year period, beginning 4 to 12 years after randomization to 12 weeks of medication, cognitive behavioral therapy (CBT), their combination, or pill placebo were examined. Examined predictors of remission included acute treatment response, treatment assignment, baseline child and family variables, and interim negative life events.

Method

Data were from 319 youths (age range 10.9−25.2 years; mean age 17.12 years) originally diagnosed with separation, social, and/or generalized anxiety disorders and enrolled in the multi-site Child/Adolescent Anxiety Multimodal Study (CAMS). Participants were assessed annually by independent evaluators using the age-appropriate version of the Anxiety Disorders Interview Schedule and completed questionnaires (e.g., about family functioning, life events, and mental health service use).

Results

Almost 22% of youth were in stable remission, 30% were chronically ill, and 48% were relapsers. Acute treatment responders were less likely to be in the chronically ill group (odds ratio = 2.73; confidence interval = 1.14−6.54; p < .02); treatment type was not associated with remission status across the follow-up. Several variables (e.g., male gender) predicted stable remission from anxiety disorders.

Conclusion

Findings suggest that acute positive response to anxiety treatment may reduce risk for chronic anxiety disability; identified predictors can help tailor treatments to youth at greatest risk for chronic illness.

Full reference:

Ginsburg, G. et al |2018| Results From the Child/Adolescent Anxiety Extended Long-Term Study (CAMELS): Primary Anxiety Outcomes | Journal of the American Academy of Child & Adolescent Psychiatry | 10.1016/j.jaac.2018.03.017