Applying the Unified Protocol for Transdiagnostic Treatment of Emotional Disorders in Children and Adolescents to Misophonia: A Case Example

Misophonia is a condition in which individuals suffer a wide range of intense emotions in response to sound triggers. Emotions such as anxiety, irritability, and disgust may lead individuals to engage in avoidance behaviors to escape or suppress sound triggers. Transdiagnostic treatment may serve as a practical intervention for misophonia as it addresses a broad scope of emotions and physiological sensations. This paper presents the first reported case example of misophonia treated with a transdiagnostic treatment protocol, the Unified Protocol for Emotional Disorders in Adolescents (UP-A). In this case, the UP-A was efficacious in treating a client with autism spectrum disorder, comorbid misophonia and anxiety symptoms. The client evidenced reliable change in misophonia and related problems. Future research should investigate the efficacy of the UP-A in a larger sample of youth with misophonia, as well as assess mechanisms of change in transdiagnostic treatment of this disorder in youth.Copyright © 2022 Society of Clinical Child & Adolescent Psychology.

Interactive Relationship between Mentalization, Epistemic Trust, Emotion Dysregulation and Psychopathology Risk: An Exploration in Non-Clinical Adolescents

Introduction: Mentalization is the ability to interpret one's own behaviour, as well as the behaviours of others, as caused by intentional inner mental states. It has been theoretically linked to resilience;indeed, thinking about actions in terms of mental states enables people to manage both everyday problems. Under the umbrella of mentalizing theory, growing interest has recently emerged in the concept of Epistemic Trust. Epistemic Trust is defined as the ability to evaluate incoming information from the social world as accurate, reliable, and relevant. The opening of Epistemic Trust allows the individual to assimilate information into existing knowledge domains. Recently, Luyten et al. (2020) theorized that complex trauma might disrupt the development of the capacity for epistemic Trust. Campbell et al. (2021) highlighted the mediating role of epistemic mistrust (i.e., the rigid suspiciousness toward incoming knowledge) and epistemic credulity (i.e., the inability to discriminate between trustworthy and untrustworthy information) in the association between childhood adverse experiences and psychopathological outcomes. In addition, focusing on adolescent inpatients, Orme et al. (2019) found negative associations between epistemic Trust and borderline traits. During the COVID-19 lockdown was found a protective role of Mentalization and epistemic Trust in contrast to dysregulation and perceived stress in adolescence (Locati et al., 2022). Thus, it is possible to hypothesize that both mentalizing capacity and epistemic Trust play protective roles in reducing the risk of developing psychopathology, but further evidence of these associations is needed. This study aims to investigate the relationship between mentalizing and stress, exploring how challenging circumstances interact with adolescent mentalizing capacity. This study sought to examine how Mentalization and epistemic trust were recruited in regulating and coping with emotional distress and psychopathological diseases by non-clinical adolescents. Method(s): Participants were 482 non-clinical adolescents (204 Males e 278 Females), aged between 12 and 19 years (M=15,59, DS=2,05). Adolescents were assessed using the Reflective Functioning Questionnaire for Youth, Epistemic Trust Mistrust Credulity Questionnaire, Difficulties in Emotion Regulation Scale and Youth Self Report. By means of ANOVA we test the effect of age on Mentalization and epistemic Trust (Trust, Mistrust and Credulity). We hypothesized to find a positive effect on Mentalization, but not on epistemic Trust. We performed a network analysis in order to explore the relationship between Mentalization and epistemic trust (Trust, Mistrust and Credulity), psychopathology (internalizing and externalizing), emotion dysregulation and age. Result(s): Developmental trends reveal a positive effect of age on Mentalization, Trust and Mistrust, but not on Credulity. Network analysis showed that both Trust and Mentalization are negatively associated with emotion dysregulation and externalizing problems. In addition, Trust is linked with Mentalization. On the other hand, Mistrust is positive associated with Dysregulation and Psychopathology (internalizing and externalizing problems), while Credulity is positive association only with emotion dysregulation. Conclusion(s): First, these findings underline the presence of a developmental dynamic that involves not only Mentalization but also Epistemic Trust in its Trust and Mistrust domains. These findings suggest the idea of epistemic Trust as a developmental construct that may be negotiated in the relationship with the social context, that in adolescence became challenging from the childhood phase. Nevertheless, Credulity domain may represent a different trend, maybe already defined during infancy. Moreover, these findings suggest that trust and the capacity to mentalize contrast emotional dysregulation. However, robust levels of epistemic Trust and Mentalization may have acted as protective factors that buffered psychopathology risk. Network analysis confirms the rel tionship between mistrust and credulity and psychopathological risks and emotion dysregulation, with a stronger effect of Mistrust on both internalizing and externalizing symptoms and a hidden effect of Credulity on emotion dysregulation. These findings may inform clinical treatment and prevention in adolescence, confirming the resilient role of Trust and Mentalization in contrast to externalizing behaviour risk. On the other hand, Mistrust may reveal a critical maintenance factor of internalizing behaviour problems.

Parent resolution of diagnosis and intervention fidelity in a parent-delivered intervention for pre-school children with autism: A mixed methods study

Background: There is growing interest in parent-delivered interventions (PDI) for children with autism. Treatment fidelity has been associated with child outcomes in PDI but little is known about what impacts fidelity. One factor not previously examined is parents' resolution to the autism diagnosis which involves adjusting expectations about the child and sensitively responding to their cues, strengths and needs. Relatively little is known about resolution in the context of autism but there is evidence of an association between resolution and parent wellbeing. Method: The study adopted a mixed methods approach to examine whether there is an association between PDI fidelity and parent resolution to diagnosis, and whether resolution is associated with parent wellbeing. Parents of 31 preschool children diagnosed with autism who attended up to 12 Parent-delivered Early Start Denver Model (P-ESDM) coaching sessions participated in the study. A thematic analysis of parent interviews was also undertaken to identify themes raised by resolved and unresolved parents in interviews. Results: There was no difference in overall mean fidelity scores between resolved and unresolved parents. Those classified as resolved had lower depression scores and parenting stress scores than parents classified as unresolved. The qualitative analysis revealed that parents' perceptions of their child's progress and their hopes for the future appeared to distinguish resolved and unresolved parents. Conclusions: Findings suggest that parent wellbeing and child progress may predict resolution which was not related to parent treatment fidelity in this study. Parent wellbeing and resolution status should be assessed at entry to PDI.

Psychosocial and Behavioral Problems of Children and Adolescents in the Early Stage of Reopening of Schools after the Covid-19 Pandemic: A National Cross-Sectional Study in U. P

This study aims to explore the psychosocial and behavioral problems of children and adolescents in the early stage of reopening schools. In this national cross-sectional study, a total of 11072 students from U.P were naturally divided into two groups based on their schooling status: reopened schools (RS) and home schooling (HS) group. The psychosocial and behavioral functioning were measured by Achenbach Child Behaviour Checklist (CBCL) and compared in these two groups. Multivariable logistic regression analyses were conducted to explore the independent predictors associated with the psychosocial and behavioral problems. Our results showed that the students in the RS group had more adverse behaviors than that of HS group. The RS group had the higher rates of parent-offspring conflict, prolonged homework time, increased sedentary time and sleep problems (all p < 0.001). When separate analyses were conducted in boys and girls, the RS group had the higher scores for (1) overall behavioral problems (p = 0.02 and p = 0.01), internalizing (p = 0.02 and p = 0.02) and externalizing (p = 0.02 and p = 0.004) behaviors in the 6-11 age group;(2) externalizing (p = 0.049 and p = 0.006) behaviors in the 12-16 age group. Multivariable regression showed parent-offspring conflict and increased sedentary time were the most common risk factors, while physical activity and number of close friends were protective factors for behavioral problems in RS students (p < 0.01 or 0.05). The present study revealed that students' psychosocial and behavioral problems increased in the early stage of reopening of schools unexpectedly. These findings suggest that close attention must be paid and holistic strategies employed in the school reopening process of post-COVID-19 period. Copyright © 2023, Institute of Medico-legal Publication. All rights reserved.