Role of Psychologist in Adolescent Medicine: An International Perspective.

Adolescent Medicine addresses the health care of adolescents, young adults, and their families. Adolescent psychology constitutes an important part. The COVID-19 pandemic has given insight into adolescent needs, bringing the focus on prevention rather than mere correction. One needs to factor in the unique aspects of adolescence, their need to impress peers and gain acceptance, and their unique information processing, not calculating trade-offs between risk and reward the way adults might, in a linear, rational, logical, and verbal manner. The article focuses on the need for collaborative training among the various stakeholders in Child and Adolescent Mental Health.

A synergistic mindsets intervention protects adolescents from stress.

Social-evaluative stressors-experiences in which people feel they could be judged negatively-pose a major threat to adolescent mental health1-3 and can cause young people to disengage from stressful pursuits, resulting in missed opportunities to acquire valuable skills. Here we show that replicable benefits for the stress responses of adolescents can be achieved with a short (around 30-min), scalable 'synergistic mindsets' intervention. This intervention, which is a self-administered online training module, synergistically targets both growth mindsets4 (the idea that intelligence can be developed) and stress-can-be-enhancing mindsets5 (the idea that one's physiological stress response can fuel optimal performance). In six double-blind, randomized, controlled experiments that were conducted with secondary and post-secondary students in the United States, the synergistic mindsets intervention improved stress-related cognitions (study 1, n = 2,717; study 2, n = 755), cardiovascular reactivity (study 3, n = 160; study 4, n = 200), daily cortisol levels (study 5, n = 118 students, n = 1,213 observations), psychological well-being (studies 4 and 5), academic success (study 5) and anxiety symptoms during the 2020 COVID-19 lockdowns (study 6, n = 341). Heterogeneity analyses (studies 3, 5 and 6) and a four-cell experiment (study 4) showed that the benefits of the intervention depended on addressing both mindsets-growth and stress-synergistically. Confidence in these conclusions comes from a conservative, Bayesian machine-learning statistical method for detecting heterogeneous effects6. Thus, our research has identified a treatment for adolescent stress that could, in principle, be scaled nationally at low cost.

Editorial: The times they are a-changin': paradigm shifts in child and adolescent psychology and psychiatry.

The world is a different place than it was more than 2 years ago, at the start of the COVID-19 pandemic. The times are always changing, but events of the recent past have radically shifted how we work, when and how we interact with each other, and how we understand our history. The papers in the current issue echo this spirit of change, challenging us to fundamentally re-think how we conceptualize psychopathology, where we define boundaries between 'normal' and 'abnormal' (and, who gets to define those boundaries), and whether our current conceptual models are generalizable to ever more diverse groups. These challenges represent healthy and timely critiques of dominant paradigms. Collectively, the authors who contributed to the current Annual Research Review make the case that these new frameworks will have big pay-offs in terms of improving clinical practice and policy.

Comparison of mental health outcomes in seropositive and seronegative adolescents during the COVID19 pandemic.

Post-COVID19 complications such as pediatric inflammatory multisystem syndrome (PIMS) and Long-COVID19 move increasingly into focus, potentially causing more harm in young adolescents than the acute infection. To better understand the symptoms of long-term mental health outcomes in adolescents and distinguish infection-associated symptoms from pandemic-associated symptoms, we conducted a 12 question Long-COVID19 survey. Using this survey, we compared the responses on neurocognitive, general pain and mood symptoms from seropositive and seronegative adolescents in a cross-sectional study design. Since May 2020, students grade 8-12 in fourteen secondary schools in Eastern Saxony were enrolled in the SchoolCovid19 study. Serostatus was assessed regularly in all participants. In March/April 2021, 1560 students with a median age of 15 years participated at the regular study visit after re-opening of the schools in mid-March and responded to our Long-COVID19 survey as part of this visit. 1365 (88%) students were seronegative, 188 (12%) were seropositive. Each symptom asked in the Long-COVID19 survey was present in at least 35% of the students within the last seven days before the survey. With the exception of seropositive students being less sad, there was no significant difference comparing the reported symptoms between seropositive students and seronegative students. The lack of differences comparing the reported symptoms between seropositive and seronegative students suggests that Long-COVID19 might be less common than previously thought and emphasizes on the impact of pandemic-associated symptoms regarding the well-being and mental health of young adolescents.Clinical Trial Registration: SchoolCoviDD19: Prospektive Erfassung der SARS-CoV-2 Seropositivität bei Schulkindern nach Ende der unterrichtsfreien Zeit aufgrund der Corona-Schutz-Verordnung (COVID-19), DRKS00022455, https://www.drks.de/drks_web/navigate.do?navigationId=trial.HTML&TRIAL_ID=DRKS00022455.

Anxiety among urban, semi-urban and rural school adolescents in Dhaka, Bangladesh: Investigating prevalence and associated factors.

BACKGROUND: Anxiety disorder is one of the emerging public health problems in many low- and middle-income countries (LMICs). Likewise, in Bangladesh, a growing number of adolescents are experiencing such symptoms though we have very limited research evidence available. The purpose of this study was to investigate the prevalence of anxiety and the factors associated with this condition among urban, semi-urban, and rural school adolescents in Bangladesh. METHODS: This cross-sectional study used a two-stage cluster sampling procedure. A self-administered questionnaire was conveyed to 2355 adolescents from nine secondary schools of Dhaka, Bangladesh. Of the respondents, 2313 completed the seven-item Generalized Anxiety Disorder (GAD-7). Besides, sociodemographic information, self-reported body image as well as modification of Leisure Time Exercise Questionnaire (LTEQ) and WHO Global PA Questionnaire (GPAQ) were used to determine the sociodemographic and lifestyle factors associated with anxiety among adolescents. RESULTS: A total of 20.1% of adolescents were experiencing moderate to severe anxiety; of them, a significantly higher proportion (49.9%) of female adolescents were suffering more than males (40.1%). Furthermore, age, student's grade, father's educational level, number of family members, and residential setting were found to be significantly associated with anxiety among adolescents. In terms of lifestyle factors, irregular physical activity (AOR: 1.31; 95% CI: 1.05-1.63), high screen time (AOR: 1.51; 95% CI:1.21-1.88), sleep dissatisfaction (AOR: 3.79; 95% CI: 3.02-4.76), and underweight body image (AOR: 2.37; 95% CI:1.70-3.28) were found to be significantly associated with anxiety among school adolescents of urban, semi-urban, and rural residential settings. CONCLUSIONS: Anxiety is prevalent among urban, semi-urban, and rural school adolescents in Dhaka, Bangladesh. To lessen this prevalence of anxiety among Bangladeshi adolescents, evidence-based health programs- healthy school trials-and policies should therefore be taken based on the findings of this study.

Associations between Food Preferences, Food Approach, and Food Avoidance in a Polish Adolescents' COVID-19 Experience (PLACE-19) Study Population.

Food preferences are among the strongest predictors of the food choices of adolescents. These are associated with appetitive traits (food approach and avoidance) to some extent. However, no research has been conducted so far analyzing the association between food preferences and appetitive traits of adolescents. The aim of this study was to evaluate the associations between food preferences and appetitive traits in adolescents (aged 15-20 years) within the Polish Adolescents' COVID-19 Experience (PLACE-19) Study population. The PLACE-19 Study was carried out in a population-based sample of 2448 secondary school students sampled across the country (random quota sampling). Food preferences (including the preference for vegetables, fruit, meat/fish, dairy, snacks, and starches) of the adolescents were assessed using the validated Food Preference Questionnaire (FPQ) while their appetitive traits (hunger, food responsiveness, emotional overeating, enjoyment of food, satiety responsiveness, emotional undereating, food fussiness, slowness in eating) were assessed using the validated Adult Eating Behavior Questionnaire (AEBQ). The k-means clustering was performed to identify the homogenous clusters of respondents based on their preferences, and linear regression was performed to determine the relationship between food preferences and appetitive traits with a model adjusted for sex and age. Based on their preferences, three homogenous clusters of respondents were defined: low-preferring respondents (low preference for all food categories), respondents preferring snacking foods (low preference for all food categories, except for fruit and snacks), and high-preferring respondents (high preference for all food categories). The low-preferring respondents showed the lowest values for all appetitive traits (p = 0.0008), as well as the lowest total score (p = 0.0001), except for food fussiness, for which they showed the highest value (p = 0.0008). All preference scores were positively associated with traits such as hunger, food responsiveness, enjoyment of food, and emotional under-eating, while negatively associated with food fussiness (all p < 0.05). The largest amount of variance was observed for preference for dairy (14.6%; R2 = 0.146, p = 0.008) and snacks with respect to enjoyment of food (16.2%; R2 = 0.162, p = 0.008), for vegetable with respect to food fussiness (22%; R2 = 0.220, p = 0.008), and for meat/fish with respect to enjoyment of food (19.9%; R2 = 0.199, p = 0.008) and food fussiness combined (19.1%; R2 = 0.191, p = 0.008). These results support the association of food preferences with both food approach traits and food avoidance traits.

Moderation of Technology Use in the Association Between Self-Isolation During COVID-19 Pandemic and Adolescents' Romantic Relationship Quality.

The purpose of this study was to examine the moderating effects of technology use for relationship maintenance on the longitudinal associations among self-isolation during the coronavirus-19 (COVID-19) pandemic and romantic relationship quality among adolescents. Participants were 239 (120 female; M age = 16.69, standard deviation [SD] = 0.61; 60 percent Caucasian) 11th and 12th graders from three midwestern high schools. To qualify for this study, adolescents had to be in the same romantic relationship for the duration of the study, ∼7 months (M length of relationship = 10.03 months). Data were collected in October of 2019 (Time 1) and again 7 months later in May of 2020 (Time 2). Adolescents completed a romantic relationship questionnaire at Time 1 and again at Time 2, along with questionnaires on frequency of self-isolation during the COVID-19 pandemic and use of technology for romantic relationship maintenance. Findings revealed that increases in self-isolation during the COVID-19 pandemic related positively to the use of technology for romantic relationship maintenance and negatively to Time 2 romantic relationship quality. High use of technology for romantic relationship maintenance buffered against the negative effects of self-isolation during the COVID-19 pandemic on adolescents' romantic relationship quality 7 months later, whereas low use strengthened the negative relationship between self-isolation during the COVID-19 pandemic and romantic relationship quality. These findings suggest the importance of considering the implications of societal crisis or pandemics on adolescents' close relationships, particularly their romantic relationships.

The COVID-19 Pandemic and Adolescents' Experience in Sub-Saharan Africa: A Cross-Country Study Using a Telephone Survey.

The public health measures instituted by governments to combat the coronavirus disease 2019 (COVID-19) may cause developmental and educational losses to adolescents. The impacts of the COVID-19 pandemic and its mitigation strategies on adolescents in sub-Saharan Africa are unclear. This study aimed to examine adolescents' knowledge, perceptions, and practices related to COVID-19 and the impacts of the pandemic on the daily lives of adolescents in sub-Saharan Africa. The survey was conducted in Burkina Faso, Ethiopia, and Nigeria using computer-assisted telephone interviews to enable rapid and remote data collection. Two sites were included in each country, with approximately 300 adolescents per site and 1,795 adolescents in total. Variations across the six sites were noted for the proportions of the adolescents who could correctly identify all key COVID-19 symptoms (4-25%), transmission methods (16-59%), and prevention approaches (33-79%). Most (> 72%) of the adolescents were no longer going to school due to school closures. Many adolescents (23-81%) were not receiving any education during the pandemic. A considerable proportion of the adolescents (44-83%) self-assessed as having less ability to learn during the pandemic; many expected it to be very difficult to catch up on education after the pandemic. Decreases in the consumption of major food groups were common across sites. Urgent actions are needed in sub-Saharan Africa to address the inadequate knowledge of COVID-19 among adolescents and the impacts of the pandemic on adolescent education and nutrition.

Debate: Is there a true global children and young people's mental health crisis, fact or fiction?

Following COVID-19, there has been increasing concern about the well-being of children and young people across the United Kingdom; however, our major problem is the lack of robust data. We discuss emerging research capturing the impact of restrictions and experiences of COVID-19 on children and young people. We suggest further and more detailed analysis is urgently required to inform an evidence-based response. We conclude that although most of the UK's kids are probably OK, it is essential that those who are in need of support receive timely and informed intervention.

Psychological impact of COVID-19 lockdown in children and adolescents from San Carlos de Bariloche, Argentina: Parents' perspective. / Impacto psicológico del aislamiento por COVID-19 en jóvenes de San Carlos de Bariloche, Argentina: la mirada de los padres.

INTRODUCTION: From an infectious perspective, children and adolescents were not highly affected by the COVID-19 pandemic. However, social isolation measures have deeply changed their lifestyle, which is believed to have a psychological impact on them. The objective was to assess the impact of COVID-19 lockdown on the emotional health of children and adolescents attending primary or secondary school. POPULATION AND METHODS: Parents of children and adolescents from San Carlos de Bariloche participated in the study. Adults' perception of the emotional and behavioral impact of lockdown on children and adolescents, changes in sleeping habits, screen use, sports-related activities, eating, and medical consultations, was assessed. RESULTS: A total of 267 parents were included. Of them, 96.3 % noticed emotional and behavioral changes. The most common ones were that their children were more bored (76.8 %), more irritable (59.2 %), more reluctant (56.9 %), and angrier (54.7 %). It was observed that they woke up and went to bed later, and slept 30 minutes more. Moreover, leisure screen use increased by 3 hours on weekdays. Time dedicated to physical activities did not change, but the type of activities did: swimming and team sports were replaced by biking, walking, and skiing. CONCLUSIONS: COVID-19 lockdown affected the emotional health and habits of children and adolescents. Boredom, irritability, and reluctance were more present during lockdown. The possibility of doing outdoor physical activities allowed them to keep practicing sports.

Introducción. Los jóvenes no fueron muy afectados desde el punto de vista infeccioso por la pandemia de COVID-19. Sin embargo, las medidas de aislamiento social modificaron de manera profunda su estilo de vida, y se cree que esto los afecta psicológicamente. El objetivo fue evaluar el impacto del aislamiento por COVID-19 en la salud emocional de jóvenes en escolaridad primaria o secundaria. Población y métodos. Participaron del estudio padres de jóvenes de San Carlos de Bariloche. Se evaluó la percepción del adulto sobre el impacto emocional y de comportamiento del aislamiento sobre el joven, cambio de hábitos de sueño, uso de pantallas, actividades deportivas y alimentación y de asistencia a consulta médica. Resultados. Se incluyeron 267 padres. El 96,3 % observó cambios emocionales y de comportamiento. Los más frecuentes fueron que estaban más aburridos (el 76,8 %), irritables (el 59,2 %), desganados (el 56,9 %) y enojados (el 54,7 %). Se observó que se levantaban y acostaban más tarde y dormían 30 minutos más. Además, el uso de pantallas por esparcimiento aumentó 3 horas durante los días hábiles. El tiempo dedicado a la actividad física no varió, pero sí cambió el tipo de actividades: la natación y los deportes de equipo fueron reemplazados por ciclismo, caminatas y esquí. Conclusiones. El aislamiento por COVID-19 impactó sobre la salud emocional y los hábitos de los jóvenes. El aburrimiento, la irritabilidad y el desgano estuvieron más presentes durante el aislamiento. La posibilidad de realizar actividades al aire libre permitió que continuaran practicando deportes.

[Impact of social distancing for covid-19 on the psychological well-being of youths: a systematic review of the literature.] / Impatto del distanziamento sociale per covid-19 sul benessere psicologico dei giovani: una revisione sistematica della letteratura.

BACKGROUND: During the first semester 2020 almost all country implemented rigid measures of social distances, including schools closure, to limit the transmission of SARS-CoV-2 infection. Up to now, however, the efficacy of school closure to reduce the spread of the disease in the community still remains unclear and no much is known about the potential negative effects of such measures on physical health and psychological wellbeing of youths, mainly if protracted for long periods. OBJECTIVE: To summarize the data of a systematic review on the impact of the 2020 school closure and social distances measures implemented in response to covid-19 pandemic on youths' physical health and psychological wellbeing. In the present paper we describe the impact on psychological wellbeing. METHODS: We searched 11 international databases up to 1st September 2020 to retrieve cohort studies, cross sectional surveys, uncontrolled pre-post studies and modelling studies. Methodological quality of included studies has been assessed with validated checklists. RESULTS: Sixty-four studies have been included; 27 assessed the impact on psychological wellbeing. All the studies have been conducted during the first wave of pandemic and assessed the short-term effect of social distances measures implemented for relatively short periods. The majority of the studies were conducted in the UK (37,6%) and China (27%). The 42.3% has been judged of high methodological quality. Two studies reported an increase of suicides, while two studies reported a reduction of the access to Psychiatric Emergency Department, Maltreatment allegations decreased substantially, likely due to a reduction in reports rather than actual incidence. Prevalence of anxiety among adolescents ranged between 19% and 64%, depression between 22.3% and 43.7%. Among children 5-12 years old, prevalence of anxiety varied between 19% and 78%, while depression between 6.3% and 22.6%. Among pre-school children, some studies found worsening of behavioural and emotional problems while others did not. CONCLUSIONS: Most of the studies reported relevant worsening of the psychological wellbeing, mainly among adolescents. If school closure and rigid social distances measures will extend for a long time, an even more pronounced negative effect can be expected. Further studies are needed on the long-term effect of prolonged social distances measures, as well as a careful harm-benefit analysis of the impact of such measures.

Impact of the COVID-19 lockdown on screen media use in patients referred for ADHD to child and adolescent psychiatry: an introduction to problematic use of the internet in ADHD and results of a survey.

The COVID-19 outbreak and lockdown have been associated with multiple consequences for mental health, including an excessive and potentially harmful increase in screen media use. The specific consequences for children, adolescents and young adults with ADHD are still unknown. In the first part of this study, a short review of problematic use of the internet (PUI) in ADHD is presented, showing that patients with ADHD are at risk for different aspects of PUI, such as excessive gaming or problematic social media use. In the second part, we report original data of an online survey on screen media use before, during and after the lockdown completed by parents of children and adolescents clinically referred for ADHD. Parents rated children's/adolescents' media-related behavior and media time on a new screening questionnaire for PUI. Each item was rated three times, referring to the observed behavior before, during and 1-2 months after the lockdown. N = 126 parents of patients referred for ADHD aged 10-18 years participated in the study. Total media time increased by 46% during the lockdown and did not completely return to pre-Corona levels afterwards. Patients with difficulties concentrating, high irritability or deterioration of ADHD problems under lockdown spent more time with screen media than those with milder or no such problems. While the effects of the lockdown on screen media use and its negative impact on everyday life appear to be largely reversible, a small proportion of patients with ADHD apparently continue to show increased media use.

Mental Health and Physical Activity among Children and Adolescents during the COVID-19 Pandemic.

Coronavirus disease 2019 (COVID-19) is causing disruptions in the global social system. Japanese children and adolescents have had their schools closed, government-mandated activity restrictions imposed, and interactions outside the home reduced. These restrictions can have a considerable psychological impact on children and adolescents. This review aims to describe the impacts of COVID-19 pandemic on physical activity and psychological status of this population. The review was conducted by searching PubMed for information on the impact of COVID-19-related activity restrictions on children and adolescents. The search identified 11 articles, three of which contained data on anxiety and psychological problems due to physical inactivity. Next, a PubMed search was conducted about physical activity and psychological status in children and adolescents under psychological stress. The search identified 368 articles, 28 of which were included in the review. For children, data that revealed a correlation between physical activity and psychological health and sedentary time leading to mood disorders were included. For adolescents, there were nine studies that reported a correlation between physical activity and psychological health and four studies that reported no correlation between physical activity and psychological health. Of the studies that reported a correlation, seven reported that physical activity improves psychological health. The impact of psychologically stressful situations such as COVID-19 on children and adolescents has been experienced worldwide. Physical activity has been correlated with psychological health, and it may improve psychological status; physical activity should be recommended to better support the psychological health of children and adolescents under the influence of COVID-19.

Remote delivery of a therapeutic intervention to court-mandated youths of Haitian descent during COVID-19.

The threat generated by the COVID-19 pandemic has triggered sudden institutional changes in an effort to reduce viral spread. Restrictions on group gatherings and in-person engagement have increased the demand for remote service delivery. These restrictions have also affected the delivery of court-mandated interventions. However, much of the literature has focused on populations that voluntarily seek out face-to-face medical care or mental health services, whereas insufficient attention has been paid to telehealth engagement of court-mandated populations. This article draws on data gathered on an NIH/NIDA-funded study intervention implemented with juvenile justice-involved youths of Haitian heritage in Miami-Dade County, Florida, during the COVID-19 public health crisis. We explore the process of obtaining consent, technological access issues, managing privacy, and other challenges associated with remote delivery of family-based therapy to juvenile justice-involved youth. Our aim is to provide some insights for consideration by therapists, healthcare workers, advocates, researchers, and policymakers tasked with finding alternative and safer ways to engage nontraditional populations in health services. The clinical trial registration number is NCT03876171.

Review: The mental health implications for children and adolescents impacted by infectious outbreaks - a systematic review.

BACKGROUND: This systematic review synthesized available research on the psychological implications for children and adolescents who either were directly or indirectly exposed to an infectious outbreak. On this basis, the current paper aims to provide recommendations for future research, practice and policy regarding children during pandemics. METHOD: A total of 2195 records were retrieved from the PsycINFO, SCOPUS and MEDLINE databases, and three from Google Scholar. RESULTS: Including only those papers that focused on children or adolescent's mental health in association with respiratory infectious outbreaks, 11 articles were identified. The majority of research utilized qualitative or retrospective hospital record data. Children and adolescents reported fear and anxiety, as well as disruptions to their day to day routines as a result of outbreaks. However, children were also able to demonstrate resilience during outbreaks with the right support. CONCLUSIONS: Children's psychological response to the outbreak appeared to be largely attributed to how their parents, healthcare providers and the media communicated the event. Recommendations for policy, practitioners and researchers concerning the current COVID-19 outbreak concludes the paper.

[Impact of the lockdown on children and families: a survey of family pediatricians within a community.] / Impatto del lockdown sui bambini e sulle famiglie: un'indagine dei pediatri di famiglia all'interno di una comunità.

OBJECTIVES: The recent lockdown, resulting from the SARS-CoV-2 pandemic, has had a strong social and psychological impact on the most fragile individuals and family structures. In the present work we investigated the experience of families without specific elements of social or health vulnerability during the quarantine period that occurred in the spring of 2020. MATERIALS AND METHODS: Between May and July 2020, 22 primary care pediatricians belonging to AUSL Romagna administered to a number of families a questionnaire to detect changes that occurred, during the lockdown, in family environment, school attendance and personal attitudes. RESULTS: A total of 721 questionnaires were collected, analyzing the associations between variables relating to home environment, daily rhythms, school and warning signs in relation to the age of children. As a result of the lockdown, family habits changed in 31% of cases, with a greater presence of the reference figure in 68% of these. Three out of four families reported they had sufficient domestic spaces, and nine out of ten had access to an outdoor, private or condominium space. Daily rhythms were preserved in 56.7% of cases; mood disorders appeared in 30% of adolescent children, followed by sleep, appetite and psychosomatic disorders. One in three children has made progress in terms of evolution and behavior, and one in 5 children has seen their relationships improve. The overall resilience of families during the lockdown period was considered good in 66.3%, sufficient in 31.3% and not satisfactory in only 2.4% of cases. CONCLUSIONS: Our data show that, in the interviewed families, the simultaneous presence of adults and children at home has generally intensified. Families refer, on the whole, a positive and resilient behavior in the lockdown period, even if initial emotional problems are reported in one out of three children-adolescents. The ability to maintain a family organized structure seems to be partially compromised. Forced cohabitation leads to competition for the same resources of time and space and affects the entire family unit. The school institution emerges as a protective factor for children, young people and also for the well-being of families themselves.