Måleegenskaper ved den norske versjonen av Autism Spectrum Screening Questionnaire (ASSQ)

Autism Spectrum Screening Questionnaire (ASSQ) ble publisert i 1999 av Ehlers, Gillberg og Wing. og er oversatt til norsk av Anita Eriksson og Anne Mari Sund. Testen er utviklet for å være et screeningverktøy for å identifisere barn med mulig autismespekterforstyrrelse, beregnet på utfylling fra voksne informanter som kjenner barnet godt. ASSQ har en enkelt hovedskala og anbefalte grenseverdier (indikasjon på mulig autisme) for lærere og foreldre. Testen består av 27 ledd og det er ingen formelle kompetansekrav for bruk eller tolkning. Litteratursøk resulterte i 121 treff, hvorav 21 norske og 9 svenske eller danske artikler ble inkludert. Disse inneholdt dokumentasjon på interraterreliabilitet, begrepsvaliditet, kriterievaliditet, diskriminant validitet og normer for en avgrenset aldersgruppe. Det ble funnet middelverdier for ulike kliniske grupper (autisme, cerebral parese, nevrologiske tilstander, premature barn, barn av mødre med rusmisbruk eller røyking i svangerskapet). ASSQ har utmerket test-retest reliabilitet. Testens begrepsvaliditet synes å være tilfredsstillende, selv om det er behov for mer forskning på testens konvergerende og diskriminerende validitet. ASSQ synes å ha gode egenskaper som klinisk screeningverktøy i den forstand at lærer- eller foreldrerapporterte skårer over grenseverdi indikerer mulig autismespekterforstyrrelse som bør utredes nærmere av en kliniker. Ved bruk i forskningsprosjekter er det usikkert hvor treffsikkert det er å bruke skåre over klinisk grenseverdi som proxy for diagnostisert autisme da det blir mange falske positive uten at testresultatene suppleres med en grundig diagnostisk vurdering. Validiteten til det å bruke totalskåren som et kontinuerlig mål på hvor en befinner seg på autismespekteret er også usikkert.publishedVersio

Scar, vulnerability, or both? A longitudinal study of the association between depressive tendencies and global negative self-esteem from early adolescence to young adulthood with gender as a moderating factor

Purpose Many studies on adolescents have investigated whether self-esteem affects depression (the vulnerability model) or vice versa (the scar model), but only recently have studies begun distinguishing differences between individuals (state-like) from differences within individuals (trait-like). The resulting findings for the scar and vulnerability model have been mixed. In this study, we thus explore both models in a Norwegian sample spanning ages 13 to 23. We also test if gender moderation can account for the mixed findings. Methods Our sample consisted of 985 adolescents (54,8 % boys and 45,2 % girls) who were surveyed at six time points from age 13 to 23 on global negative self-esteem and depressive tendencies. We tested both an unconstrained and constrained RI-CLPM based on equal time lags. Finally, we tested with moderation by gender. Results Moderately strong vulnerability effects were found from ages 13 to 14 and ages 14 to 15 while small scar effects were found from ages 15 to 18 and ages 18 to 21. No moderation by gender was indicated. A high association was also found between trait-like and state-like global negative self-esteem and depressive tendencies. Conclusion Our findings suggest that vulnerability and scar effects might differ depending on the stage of adolescence.publishedVersio

Explaining the intention of dental health personnel to report suspected child maltreatment using a reasoned action approach

Background: This study provides an empirical test of the reasoned action approach (RAA) socio-cognitive theory with the aim of 1) predicting the intention of public dental health personnel (PDHP) to report suspected child-maltreatment to child welfare services (CWS); 2) estimating the effects of the theoretical constructs of RAA, including experiential and instrumental attitudes, injunctive and descriptive norms, and perceived capacity and autonomy regarding PDHP’s behavioural intentions; and 3) exploring whether the RAA operates equivalently (i.e., is invariant) in male and female providers. Methods: This national cross-sectional study was conducted in Norway. An electronic survey was distributed to 1542 dentists and dental hygienists working in the public dental health service. The survey included RAA items constructed in accordance with the recommendations for the RAA model. Structural equation modelling (SEM) was used to identify factors derived from the theory of RAA to predict PDHP reporting intentions. Results: A total of 77.8% (1200) of those surveyed responded to the survey. The present study provided support for the utility of the RAA across both male and female providers in predicting their intention to report suspected child-maltreatment to the CWS. The final modified SEM model revealed that instrumental attitudes and perceived behavioural control (based on merged capacity and autonomy parameters) were the strongest predictors of intention to report, followed by the reporting of descriptive norms, injunctive norms and experiential attitudes. These factors explained 63.6% of the observed variance in the reporting intention. Conclusions: The large amount of explained variance suggests that RAA is a well-functioning theory that predicts PDHP’s reporting intentions to CWS across gender, and gives an understanding of the socio-cognitive factors involved. To strengthen reporting intention among dental personnel, this study suggests educators should focus on the value and positive consequences of reporting, the resources available and how to overcome obstacles; attention to normative expectations and individuals’ feelings about reporting may also be helpful.publishedVersio

An App-Based Intervention for Adolescents Exposed to Cyberbullying in Norway: Protocol for a Randomized Controlled Trial

Background: Adolescents exposed to negative online events are at high risk to develop mental health problems. Little is known about what is effective for treatment in this group. NettOpp is a new mobile app for adolescents who have been exposed to cyberbullying or negative online experiences in Norway. Objective: The aim of this paper is to provide a description of the content of the intervention and about a randomized controlled trial that will be conducted to examine the effectiveness of NettOpp. This protocol is written in accordance with the Spirit 2013 Checklist. Methods: An effectiveness study with a follow-up examination after 3 months will be conducted to evaluate the mobile app. Adolescents will be recruited through schools and will be randomly assigned to the intervention (NettOpp) group and a waiting-list control group. The adolescents (aged 11 to 16 years) will respond to self-report questionnaires on the internet. Primary outcomes will be changes in mental health assessed with the Strengths and Difficulties Questionnaire, the WHO-Five Well-being Index, and the Child and Adolescent Trauma Screen. Results: Recruitment will start in January 2022. The results from this study will be available in 2023. Conclusions: There are few published evaluation studies on app-based interventions. This project and its publications will contribute new knowledge to the field

ASSERT - The Autism Symptom SElf-ReporT for adolescents and adults: Bifactor analysis and validation in a large adolescent population

With a view to developing a brief screening instrument for autism symptoms in a general population of adolescents, seven items from the Asperger syndrome (and high-functioning autism) diagnostic interview were adapted for use as self-report in an online questionnaire for youths aged 16–19 years (N = 10,220). The selected items target lack of social understanding (4 items) and rigid and repetitive behavior and interests (RRBI; 3 items). Factor analyses were performed, and the seven items were also validated against self-reported ASD diagnosis. Best statistical model fit was found for a bifactor model with one general factor and two domain specific factors tied to social difficulties and RRBI. Both the general and the domain specific factors were associated with self-reported ASD diagnoses. The scale (referred to as the Autism Symptom SElf-ReporT for Adolescents and Adults – ASSERT) had good screening properties with a receiver operating curve-area under the curve (ROC-AUC) of 0.87 and a diagnostic odds ratio (DOR) of 15.8. Applying a modified scoring of the scale further improved the screening properties leading to a ROC-AUC of 0.89 and a DOR of 24.9. The ASSERT holds promise as a brief self-report screen for autism symptoms in adolescents, and further studies should explore its usefulness for adults.publishedVersio

Trends in physical health complaints among adolescents from 2014 – 2019: Considering screen time, social media use, and physical activity

The rising rates of physical and mental health complaints among adolescents observed in many countries have coincided with an increased time spent on screen-based devices, including social media use. We sought to document recent trends in physical health complaints (PHC) and whether co-occurring trends in screen time, social media use, and physical activity may account for these trends. To achieve these aims, we used data from the nationwide Ungdata surveys conducted annually at the municipality level in Norway, comprising 419,934 adolescents aged 13–18 from six survey years (2014–2019). Six items assessed PHC, including neck and shoulder pain, headache, and abdominal pain, during the past month. To account for the nesting structure of Ungdata, and to exploit the variation within and between municipalities, we used multilevel analyses with adolescents nested in municipality-years (n = 669), nested in municipalities (n = 345). We found a small to moderate linear increase in number of PHC among boys and girls from 2014 to 2019. Screen time and social media use moderately attenuated the trend for girls, and to a lesser extent for boys. Screen time and social media use were further positively associated with PHC across the between and within-municipality levels, and social media use was more strongly associated with PHC for girls than boys across all levels of analysis. A similar pattern emerged when considering each symptom individually. The results suggest that the prevalence of PHC rose in tandem with a group-level shift towards higher screen time and social media use. Moreover, the results indicate that higher screen time and social media use may have led to changes in the youth culture with potential consequences for adolescents’ well-being.publishedVersio

Negative Life Events, Protective Factors, and Substance-Related Problems: A Study of Resilience in Adolescence

Background There is compelling evidence for an association between negative life events (NLE) and substance-related problems (SRP) during adolescence. The literature is, however, still limited with regards to protective factors for SRP among adolescents exposed to NLE. Methods A large population-based survey including 9,611 Norwegian adolescents aged 16 to 19 years, comprised the dataset of this study. The main explanatory variable was NLE. The main outcome variable was SRP, assessed by the CRAFFT scale. Potential protective factors were measured with five subscales from the Resilience Scale for Adolescents (READ) questionnaire. The potential protective factors and sex were explored as moderators for the associations between NLE and SRP. Results NLE were strongly associated with SRP. Four out of five potential protective factors (i.e., Goal Orientation, Self-confidence, Family Cohesion, and Social Support) showed evidence of a protective-stabilizing effect. Even if they had protective effect across all levels of exposure to NLE, these effects were even stronger for adolescents with high exposure. For Family Cohesion a protective-stabilizing effect was only evident for boys, while a direct protective effect was found for girls. Finally, Social Competence was the only factor that did not show any evidence of promoting resilience toward SRP. Conclusions NLE had a strong relation with SRP in this study. Protective factors buffered against SRP for all adolescents – but particularly so for adolescents who had high exposure to NLE. These findings highlight the need for preventive efforts to strengthen protective factors that may promote resilience among adolescents at risk for SRP.publishedVersio

Development and examination of the reactive attachment disorder and disinhibited social engagement disorder assessment interview

The fifth edition of the Diagnostic and Statistical Manual ( DSM) categorizes reactive attachment disorder (RAD) and disinhibited social engagement disorder (DSED) as two separate disorders, and their criteria are revised. For DSED, the core symptoms focus on abnormal social disinhibition, and symptoms regarding lack of selective attachment have been removed. The core symptoms of RAD are the absence of attachment behaviors and emotional dysregulation. In this study, an international team of researchers modified the Child and Adolescent Psychiatric Assessment for RAD to update it from DSM-IV to DSM-5 criteria for RAD and DSED. We renamed the interview the reactive attachment disorder and disinhibited social engagement disorder assessment (RADA). Foster parents of 320 young people aged 11 to 17 years completed the RADA online. Confirmatory factor analysis of RADA items identified good fit for a three-factor model, with one factor comprising DSED items (indiscriminate behaviors with strangers) and two factors comprising RAD items (RAD1: failure to seek/accept comfort, and RAD2: withdrawal/hypervigilance). The three factors showed differential associations with clinical symptoms of emotional and social impairment. Time in foster care was not associated with scores on RAD1, RAD2, or DSED. Higher age was associated with lower scores on DSED, and higher scores on RAD1

Past Year Cannabis Use Among Norwegian Adolescents: Time Trends Based on the Ungdata Surveys 2010–2019

Aims: To describe trends in cannabis use from 2010 to 2019 among Norwegian adolescents and relate these to individual- and municipal-level variables. Design: Data from nationwide repeated cross-sectional surveys collected in 2010–2013 (T1), 2014–2016 (T2), and 2017–2019 (T3) were used to describe secular trends in proportions of adolescent cannabis use. Setting: Cross-sectional surveys in 410 of the total 428 municipalities of Norway. Participants: A total of 628,678 survey responses from adolescents aged ~13–19 years of age, in which 566,912 survey responses were eligible for analyses, representing data from 340 municipalities. Measurements: Respondent's past year cannabis use, time, gender, school grade, municipality, geographical location, and municipality population. Findings: Boys reported overall higher cannabis use, with ~2:1 gender ratio for any past year cannabis use and a 3:1 gender ratio for frequent cannabis use. Adolescents in Eastern Norway reported higher cannabis use compared with other areas in the country, and adolescents from municipalities with a higher population size reported higher rates of cannabis use than smaller municipalities. A gradual increase in cannabis use from T1 to T3 was found in Eastern Norway and in the largest municipalities. More generally, proportions of past year cannabis use showed a marked increase from T2 to T3 across genders, grade/age groups, geographical location, and municipality population, with few exceptions. Conclusions: Our findings indicate that proportions of past year cannabis use have increased among Norwegian adolescents in recent years. Preventive interventions to hinder initiation of cannabis use, as well as measures to address frequent cannabis use among Norwegian adolescents, are needed.publishedVersio

Divorce and adolescent academic achievement: Heterogeneity in the associations by parental education

Background The link between parental divorce and adolescents’ academic achievement may depend on parental educational levels. However, findings have been inconsistent regarding whether the negative associations between parental divorce and adolescents’ academic outcomes are greater or smaller in highly educated families. The present study aimed to investigate the possible heterogeneity in the associations between divorce and adolescents’ academic achievement by parental educational levels, within the context of the elaborate Norwegian welfare state. Methods The population-based cross-sectional youth@hordaland study of adolescents aged 16–19 years conducted in Norway in 2012, provided information about parental divorce and was linked to national administrative registries (N = 9,166) to obtain high-quality, objective data on the adolescents’ grade point average (GPA), and their parents’ educational qualifications and income. Results The negative association between parental divorce and GPA was stronger among adolescents with educated or highly educated parents compared to adolescents with less educated parents. This heterogeneity was driven by maternal educational qualifications, whereby divorce was more strongly and negatively associated with GPA among adolescents with educated mothers compared to those with less educated mothers, independent of paternal educational levels and income measures. Conclusions Among adolescents whose parents have low educational qualifications, parental divorce is not associated with their academic achievement. Educated divorced mothers appear less likely to transfer their educational advantages onto their children than nondivorced equally educated mothers, perhaps due to a “double-burden” regarding work pressure and child-rearing responsibilities. There is a need for future studies to detail the mechanisms underlying this finding.publishedVersio