Maternal Social Anxiety, Verbal Information Transfer, and Child Play Representations in the Context of Starting School

Background Anxiety is a common childhood psychological difficulty, however little is known about the development of anxiety symptoms in early childhood. By understanding such processes, early identification and targeted prevention work may be possible. Anxiety runs in families, and research suggests verbal information transfer may be one way in which vulnerabilities to developing anxiety may be transmitted from parents to children. Method A community sample of mothers and their preschool children (N = 65) completed observational tasks relating to the upcoming event of the child starting school. Mothers gave a verbal description to their children about social aspects of school, then children completed a brief play assessment with a researcher involving ambiguous, school-based social scenarios. Mothers completed self-report questionnaires on social anxiety symptoms, general anxiety and depressive symptoms, fear of negative self-evaluation, and fear of negative child evaluation. Mothers also completed a questionnaire on child anxiety symptoms. Results There were a number of non-significant associations. However, a significant positive association was found between maternal social anxiety symptoms and a lack of positive general comments in mothers’ school descriptions. There was also a significant positive association between maternal fear of negative child evaluation and lack of consistent positivity in their descriptions of school. A one-item question asking mothers if they were personally worried about their child starting school was also associated with maternal descriptions. While no relationship was found between maternal descriptions and Maternal Social Anxiety, Verbal Information Transfer and Child Play Representations 2 child representational positivity, significant associations were found between overall maternal positivity, as well as overall maternal negativity, and child representational negativity. Conclusions Further research is needed to replicate these findings before firm conclusions can be drawn, but they provide tentative support for the theory that verbal information transmission may be influenced by maternal anxiety/specific concerns regarding their child, and that this information transmission affects child representations

Adapting brief Behavioural Activation (BA) for adolescent depression: a case example

There is an increasing evidence base for the effectiveness of Behavioural Activation in treating adult depression; however, there has been little investigation of using this approach with adolescents. This article reports on the adaptation of brief Behavioural Activation for Depression (BATD) for adolescents (BATD-A). A case study is reported to illustrate the brief structured approach, treatment response as indicated by routine outcome measures, and the family’s view of the intervention. The adaptations made to the adult BATD manual are discussed including parental input, adapted values and activities, and engagement issues. It is hoped that following further evaluation, BATD-A could be successfully delivered as a low-intensity intervention for depression

Associations between interpretation bias and depression in adolescents

Interpretation biases have been shown to play a role in adult depression and are a target in cognitive behavioural therapy. Adolescence is a key risk period for the development of depression and a period of rapid cognitive and emotional development but little research has investigated the relationship between interpretation biases and depression in adolescents. This study adapted a measure of interpretation bias, the Ambiguous Scenarios Test for Depression, for adolescents and evaluated its reliability and validity. A community sample of 206 young people aged 12 to 18 years completed a validated measure of depression symptoms (Mood and Feelings Questionnaires) and the adapted Ambiguous Scenarios Test. The Ambiguous Scenarios Test for Depression in Adolescents had good internal consistency and split half reliability. Depression symptoms were associated with participants’ ratings of the valence of ambiguous situations and with interpretation biases. Importantly, symptoms of depression and anxiety were independently associated with interpretation bias. This research suggests that interpretation biases can be measured in this age group, that negative interpretation biases exist in adolescents and that these are associated with depression symptoms

Brief Behavioural Activation (Brief BA) for adolescent depression: a pilot study

Background: Depression in adolescence is a common and serious mental health problem. In the UK, access to evidence based psychological treatments is limited and training and employing therapists to deliver these is expensive. Brief Behavioral Activation for the Treatment of Depression (BATD) has great potential for use with adolescents and to be delivered by a range of healthcare professionals, but there is limited empirical investigation with this group. Aims: To adapt BATD for depressed adolescents (Brief BA) and conduct a pilot study to assess feasibility, acceptability and clinical effectiveness. Methods: Twenty depressed adolescents referred to the local NHS Child and Adolescent Mental Health service (CAMHs) were offered 8 sessions of Brief BA followed by a review around one month later. Self- and parent- reported Routine Outcome Measures (ROMs) were collected at every session. Results: Nineteen of the 20 young people fully engaged with the treatment and all reported finding some aspect of Brief BA helpful. Thirteen (65%) required no further psychological intervention following Brief BA, and both young people and parents reported high levels of acceptability and satisfaction with the approach. The pre-post effect size of Brief BA treatment was large. Conclusions: Brief BA is a promising innovation in the treatment of adolescent depression. This approach requires further evaluation to establish effectiveness and cost effectiveness compared with existing evidence-based treatments for adolescent depression. Other questions concern the effectiveness of delivery in other settings and when delivered by a range of professionals

Brief Behavioural Activation treatment for depressed adolescents delivered by non-specialist clinicians: a case illustration

Behavioural Activation (BA) can be as effective as Cognitive Behaviour Therapy (CBT) for the treatment of depression in adults, but to date, there is little research with adolescents. This is problematic given the recognised need to increase access to evidence based interventions for depression in young people. We have developed a new adaptation of Brief Behavioural Activation (Lejuez, Hopko, Acierno, Daughters, & Pagoto, 2011) specifically for young people; Brief Behavioural Activation for depressed adolescents (Brief BA). In this paper we use a case example with session by session measurement to show how a non-specialist clinician can deliver this intervention successfully. We discuss the key themes arising from this training case, challenges the clinician faced, and how these were managed through training and supervision

Clinical characteristics of adolescents referred for treatment of depressive disorders

Background: Adolescence is a period of increased risk for the development of depression. Epidemiological and clinical studies suggest that the phenomenology of depression may differ during childhood and adolescence. However, participants in these studies may not reflect depressed young people referred to routine clinical services. The aim of this paper is to describe referrals for depression to a UK routine public healthcare service for children and adolescents with mental health difficulties. Method: This paper describes a consecutive series of adolescents (N = 100, aged 12-17 years), referred for depression to a routine public healthcare child and adolescent mental health service, in the south of England. Young people and their caregivers completed a structured diagnostic interview and self report measures of anxiety and depression. Results: Fewer than half of young people referred for depression met diagnostic criteria for a depressive disorder. The key symptoms reported by those with depression were low mood or irritability, cognitive disturbances, sleep disturbances and negative self-perceptions. Suicidal ideation was common and was considerably higher than reported in other studies. Caregiver and young person’s accounts of adolescent symptoms of depression and anxiety were uncorrelated. Caregivers also reported fewer symptoms of depression in their child than adolescents themselves. Conclusions: These data have direct relevance to the design and delivery of public mental health services for children and adolescents. However, we do not know how representative this sample is of other clinical populations in the UK or in other countries. There is a need to collect routine data from other services to assess the needs of this group of high risk adolescents

Brief Behavioural Activation (Brief BA) in secondary schools: a feasibility study examining acceptability and practical considerations

Aims: This paper reports on a feasibility study of delivering Brief Behavioural Activation in schools, focusing on acceptability, demand, implementation, practicality, adaptation and integration. Rationale: Depression in adolescence is a common and serious mental health problem, with long-term negative impacts on social and academic functioning. In the UK, access to evidence based psychological treatments is limited and training and employing therapists to deliver these is expensive. Treatments are typically offered in specialist Child and Adolescent Mental Health services (CAMHs) following a General Practitioner (GP) referral, yet few depressed young people seek help from their GP or other health professionals. In the UK there are current proposals to significantly increase the role of schools in providing access to mental health treatment for children and young people but currently there is little evidence that this is acceptable, feasible or effective. Behavioural Activation (BA) is an evidence-based treatment for depression in adults. BA has recently been adapted for young people (Brief Behavioural Activation; Brief BA, Pass & Reynolds, 2014). The adaptation is developmentally sensitive, acceptable to parents and young people, links behaviours to values and is highly collaborative. Method: Brief BA was introduced into five schools where feasibility data were collected. Brief BA was delivered by four therapists from differing professional backgrounds and experience. Findings: Initial data suggest that Brief BA is feasible to deliver in schools. Brief BA was integrated successfully with some adaptation, demand was high, and the service was highly acceptable to students, parents and school staff. Conclusions: This study provides early evidence to support the use of Brief BA to treat adolescent depression in schools, with clear learning points for future feasibility evaluation

Verbal information transfer in real-life: when mothers worry about their child starting school

Verbal information transfer, one of Rachman’s three pathways to fear, may be one way in which vulnerability for anxiety may be transmitted from parents to children. A community sample of mothers and their preschool-aged children (N = 65) completed observational tasks relating to the child starting school. Mothers were asked to tell their child about social aspects of school; then children completed a brief play assessment involving ambiguous, school-based social scenarios. Mothers completed self-report questionnaires on social anxiety symptoms, general anxiety and depressive symptoms as well as a questionnaire on child anxiety symptoms and indicated whether they were personally worried about their child starting school. There was a significant difference in the information given to children about school between mothers who stated they were worried and those who stated they were not, with mothers who were worried more likely to mention unresolved threat, use at least one anxiety-related word, and show clear/consistent negativity (all ps < .01). Significant associations were also found between the emotional tone of mothers’ descriptions of school and children’s own representations of school. These findings support the theory that the information mothers give to their child may be influenced by their own concerns regarding their child, and that this verbal information affects child representations

How adolescents understand their values: a qualitative study

An important component of some psychological therapies is the use of clients’ values to motivate behaviour change. Values are understood to be developed during childhood and adolescence but there has been limited exploration of how young people experience values and their function across contexts. This study aimed to explore adolescents’ understanding of the concept of ‘values’ and to elicit their experiences of values. Semi-structured, individual interviews were conducted with 11 adolescents aged 12–17 years. Thematic analysis was used to identify themes. Young people were readily able to discuss the meaning of ‘values’ and their own personal values. Three main themes were identified: (1) what values are (in general, and specific to themselves), (2) where values come from (relationships, education, growing up), and (3) why values are important (prioritising/decision making, reflecting on values is helpful). The adolescents in this study demonstrated an in-depth understanding of the meaning, origins and functions of values. The results suggest young people may welcome and benefit from opportunities to discuss their values, including in therapy