Pragmatic language impairment general and specific associations to mental health symptom dimensions in a child psychiatric sample

Background: The results of several international studies indicate a high prevalence of language and communication impairments among children who are referred to child psychiatric services. However, these impairments are likely to remain undetected unless language and communication impairments are evaluated during the psychiatric assessment. Aims: The aim of the present study is to investigate the specific association between general and specific mental health problems, as expressed by the problem scales of Child Behavior Checklist (CBCL) and Teachers Report Form (TRF), and pragmatic skills and pragmatic language impairments (PLI) as defined the Pragmatic Composite of the Child Communication Checklist (CCC-PC). Methods: Children aged from 8 to 13 years (n = 73) were recruited in sequence following referral to a child and adolescent psychiatry (CAMHS) outpatient clinic within 12 months. Children with possible or established autism or intellectual disability were excluded. Standardized instruments measuring language, communication and mental health symptoms were distributed to parents and teachers, an intelligence test administered for clinical purposes, and demographic information was included. Results: The parent reports showed PLI among 38% of the children and revealed strong associations with the CBCL scales for emotional problems, thought problems and, especially, social and withdrawal symptoms, which mean more associations to internalized and non-externalized problems. PC-scores were at similar levels and PLI was reported by teachers at similar rates (compared to parent reports) with moderate agreement. Teacher PC-scores showed associations to only one TRF-scale, social problems. The CCC-PC subscale with the strongest associations to mental health symptoms was «Use of Context» («Social Relationships» do not contribute to the CCC-PC scores). Conclusion: There was a general increase in PC-scores and increased prevalence of PLI in this clinical sample. PC-scores correlated with symptom scores for internalizing and non-externalizing problems scales. The strongest common factors appear to be related to the social aspects of mental health. Pragmatic skills should be considered as a protective factor for mental health rather than investigating pragmatic impairment as a risk or vulnerability factor

The Interplay of Youth and Care Characteristics with a Positive Social Climate in Therapeutic Residential Youth Care

Background: Limited research exists on how therapeutic residential youth care (TRC) achieves treatment outcomes. More specifically, little is known about the association between contextual factors such as treatment organization, youth characteristics, and experienced social climate in TRC. Therefore, this study aims to investigate differences between latent classes of TRC and youth characteristics and their association with a positive perceived social TRC climate. Method: We applied a person-centered approach in a cross-sectional design with a sample of 400 adolescents and 142 staff leaders. We analyzed youth and TRC characteristics in a latent class analysis and established associations with social climate for these two groupings. Results: The two types of TRC settings we found, i.e., larger TRC settings and family-style TRC settings, show small differences in social climate. These settings only differed on youth activities and staff shifts type (more cohabitation and unorganized activities outside TRC in family-style TRC). We identified four adolescent classes: A severe problems group, youth with incidental problems, family problems, and a migrant background group. The migrant background group showed the most positive perceptions of social climate, followed by youth with incidental problems, family problems, and severe problems. Conclusions: TRC staff should acknowledge how perceived social climate is connected to TRC characteristics and the heterogeneity of adolescents in care. As social climate is subjective and dynamic, a continuous dialogue about TRC social climate between staff and youth is recommended. Future research should investigate how these aspects are associated with treatment outcomes to increase our understanding of achieving positive outcomes in TRC

Determinants and Outcomes of Social Climate in Therapeutic Residential Youth Care: A Systematic Review

Background: Previous studies on effectiveness of therapeutic residential youth care (TRC) have indicated that, compared to short-term effects, long-term effects are less convincing. Moreover, there is limited evidence on how TRC achieves treatment goals: TRC remains too much of a “black box”. To gain durable treatment results we need to know more about how results are achieved, rather than investigating the achieved results itself. One of the factors associated with this process of change is the social climate within TRC institutions. Up until now, no literature reviews about how social climate is affect by institution and youth characteristics, and how social climate affects outcomes has been performed. Objective: To provide an overview of the literature on associations between determinants and social climate and between social climate and outcomes in TRC. Method: We searched multiple databases with a predetermined set of search criteria in the years 1990 and March 2017. We identified 8408 studies and reduced the final sample to 36 studies. Most studies were empirical assessments with a correlational design and were conducted in Western countries. Results: Effect sizes for the studies ranged from small to large and varied between and within studies. Most associations were found between social climate and positive outcomes. The most mentioned social climate constructs were: an open climate, support, and autonomy. Conclusions: The results are challenging to summarize due to variations in the concepts and operationalizations of social climate. The organizational culture must support a social climate which is supportive, structured and caring, and provide youth with an environment to grow. A positive social climate must constantly be evaluated and recreated based on combining the perspectives of residents, staff and external perspectives

Development and Preliminary Evaluation of the Reaction to Unacceptable Behavior Inventory

__Background__ Monitoring the implementation of new interventions, as in this study Nonviolent Resistance (NVR) for the use in residential youth care settings, is mandatory in order to evaluate, adjust and refine the implementation process where necessary. Objective As there is no instrument for such monitoring of NVR available, the authors developed a new questionnaire, named Reaction to Unacceptable Behavior Inventory, (in short: RUBI). __Method__ This questionnaire was completed by staff of four different residential settings in the Netherlands, at different stages of the NVR implementation process. The staff members reported on the practice of their colleagues. __Results__ The results are promising, as they show good reliability, inter-item correlations and other psychometric features for the included items. Furthermore, the results show that the RUBI seems to discriminate between trained and untrained teams, defending its use in future implementation processes and implementation research. __Conclusions__ The RUBI is the first attempt to create an instrument which can be used for monitoring change during implementation of NVR, and for evaluating the degree of difference or compatibility between NVR and existing practice before implementation. Longitudinal research is needed to strengthen the documentation of validity and reliability of the RUBI in different settings, countries, and cultures. This should also be extended to the final and follow-up stages of implementation. In the future, redundant and insensitive items should be removed and standards for interpreting scale scores should be developed

Familieambulatoriet - en vellykket modellfor identifisering av sped- og småbarn i risiko?

Studien undersøkte om en pilot-implementering av Familieambulatoriet i Norge har lyktes med å rekruttere og identifisere sped- og småbarn og deres familier med forhøyet risiko basert på dokumentasjon i sykehusjournal. Familieambulatoriet er en modell for å støtte gravide/småbarnsforeldre med rus- og psykiske problemer og tilbyr oppfølging fram til barnets skolestart. Resultatene viste signifikante forskjeller mellom brukere av Familieambulatoriet og den generelle befolkningen, og at Familieambulatoriet langt på vei rekrutterer og identifiserer gravide kvinner, sped- og småbarn i risiko for psykisk skjevutvikling, men at modellen trenger økt kvalitetssikring slik at risikofaktorer systematisk blir dokumentert

Anxiety and depressive symptoms related to parenthood in a large Norwegian community sample: the HUNT2 study

The study compared anxiety and depression prevalence between parents and non-parents in a society with family- and parenthood-friendly social politics, controlling for family status and family history, age, gender, education and social class. All participants aged 30–49 (N = 24,040) in the large, non-sampled Norwegian HUNT2 community health study completed the Hospital Anxiety and Depression Scales. The slightly elevated anxiety and depression among non-parents compared to parents in the complete sample was not confirmed as statistically significant within any subgroups. Married parents and (previously unmarried) cohabiting parents did not differ in portraying low anxiety and depression prevalence. Anxiety was associated with single parenthood, living alone or being divorced, while elevated depression was found only among those living alone. Burdening selection and cultural/political context are suggested as interpretative perspectives on the contextual and personal influences on the complex relationship between parenthood and mental health

Health-related quality of life issues, including symptoms, in patients with active COVID-19 or post COVID-19; a systematic literature review

Purpose This systematic review was performed to identify all relevant health-related quality of life (HRQoL) issues associated with COVID-19. Methods A systematic literature search was undertaken in April 2020. In four teams of three reviewers each, all abstracts were independently reviewed for inclusion by two reviewers. Using a pre-defined checklist of 93 criteria for each publication, data extraction was performed independently by two reviewers and subsequently compared and discussed. If necessary, a third reviewer resolved any discrepancies. The search was updated in February 2021 to retrieve new publications on HRQoL issues including issues related to the long-term consequences of COVID-19. Results The search in April 2020 identified 3342 potentially relevant publications, and 339 publications were selected for full-text review and data extraction. We identified 75 distinct symptoms and other HRQoL issues categorized into 12 thematic areas; from general symptoms such as fever, myalgia, and fatigue, to neurological and psychological issues. The updated search revealed three extra issues experienced during active disease and long-term problems with fatigue, psychological issues and impaired cognitive function. Conclusion This first comprehensive systematic review provides a detailed overview of the wide range of HRQoL issues experienced by patients with COVID-19 throughout the course of the disease. It demonstrates the devastating impact of the disease and provides critically important information for clinicians, to enable them to better recognize the disease and to provide knowledge important for treatment and follow-up. The results provided the foundation for the international development of a COVID-19 specific patient-reported HRQoL questionnaire

Observing Change Over Time in Strength-Based Parenting and Subjective Wellbeing for Pre-teens and Teens

The focus of this study was on adolescent mental health. More specifically, the relationship between strength-based parenting (SBP) and subjective wellbeing (SWB) during adolescence was examined at three time points over 14 months (N = 202, Mage = 12.97, SDage = 0.91, 48% female). SBP was positively related to life satisfaction and positive affect at each of the three time points, and was negatively related to negative affect. SBP and SWB both declined significantly over time. When examining the causal relationships between SBP and SWB, two different statistical models were applied: latent growth-curve models (LGM) and random-intercept cross-lagged panel models (RI-CLPM). The LGM revealed a strong positive relationship between changes in SBP and SWB. Specifically, this model showed that SBP at one time point predicted adolescent SWB at future time points. However, when the more stringent statistical test was completed through RI-CLPMs, no cross-lagged paths reached significance. Thus, while parenting is a significant predictor of wellbeing for pre-teens and teens in real time, it is not predictive of wellbeing at future time points. Parents, thus, cannot assume that their current levels of SBP are ‘banked’ by their children to support future wellbeing. Instead, SBP needs to be an ongoing, contemporary parenting practice. Furthermore, the fact that perceptions of SBP decline in this age bracket suggest that SBP interventions may be helpful in supporting adolescent mental health