Gambling Habits and Attitudes among Athlete and Non-Athlete High School Students in Skåne Region, Sweden.

Previous literature has reported increased rates of gambling problems in athletes compared to non-athletes. More liberal gambling-related attitudes have been suggested as a reason, although this rarely has been researched. The present study aimed to examine gambling experience, gambling problems, and gambling-related attitudes and parental gambling experience in high school students, comparing student-athletes to students at conventional schools. This is a cross-sectional web survey study in high school students (N = 473, 53% at sports high schools, 57% male) at eleven schools in the Skåne region, Sweden, who answered a web survey addressed gambling experiences, parental gambling and gambling-related attitudes, and included validated screening instruments for gambling problems and psychological distress. A history of any gambling was common and increased with age. Problem gambling was detected in 10% (13% of males and 5% of females, p < .001), and was associated with paternal and maternal gambling but not with psychological distress. Sports high school students were not more likely (9%) than other students (10%) to endorse gambling problems and history of each gambling type. However, paternal (but not maternal) gambling was more commonly reported in athletes, who also had more positive attitudes to gambling's effects on society and gambling availability. In contrast to other studies, this study did not demonstrate higher prevalence of gambling or gambling problems among young athletes than among other students, but liberal attitudes towards gambling, and experience of parental gambling on the father's side, were more common among athletes than among non-athletes. Gambling attitudes in adolescents may need to be targeted in future preventive efforts in young athletes and others.

Concussion history associated with adolescent psychological distress but not hazardous gambling: a cross-sectional study.

BACKGROUND: Sustaining multiple concussions over one's lifetime may be associated with behavioral and mood changes beyond the acute phase of injury. The present cross-sectional study examined the relationship between concussion history, the incidence of current moderate-severe psychological distress, and lifetime adolescent hazardous gambling in high school students. METHODS: Four-hundred fifty-nine high school students from southern Sweden (age: 16.81 ± 0.83, 58.2% male) completed a survey assessing concussion history (0,1,2…>8), psychological distress using the Kessler-6 scale, and lifetime hazardous gambling using the NODS-CLiP scale. RESULTS: Participants who self-reported three or more concussions were more likely to endorse moderate-severe symptoms of psychological distress than those with no concussion history while controlling for covariates, OR = 2.71, 95% CI [1.19, 6.18]. In contrast, concussion history was not associated with hazardous gambling after controlling for confounding variables. CONCLUSIONS: Self-reporting three or more concussions was associated with increased current psychological distress beyond the acute phase of injury among high school students. Adolescents who have sustained multiple concussions should undergo mental health evaluations beyond the acute phase of injury to identify and treat psychological distress, but probing for hazardous gambling may not be clinically relevant in this previously concussed adolescent population.

When the Relationship Is at Stake: Parents' Perception of the Relationship with a Child with Problematic Gaming and Their Perceived Need for Support.

Intrapersonal parental factors play a significant role in the development of problematic gaming in children. However, few studies have explored parental perspectives on their relationship with a child engaged in problematic gaming, as well as the need for support parents perceive in relation to the child's gaming. We conducted semi-structured interviews with 12 parents (83.3% women) of 11 children (81.8% boys, Mage = 15 ± 2) to examine how parents of children with problematic gaming behavior perceive the parent-child relationship and their need for additional support. We analyzed qualitative accounts using thematic analysis to identify themes and subthemes while drawing on the theoretical frameworks of Aaron Antonovsky's theory of sense of coherence (SOC) and Jürgen Habermas' theory of logic. Participants described difficulties regarding all three components of SOC (meaningfulness, comprehensibility, and manageability) in relation to their child's gaming, with the most significant challenge being manageability. Parents primarily sought assistance from institutions and organizations, such as mental health services, to enhance manageability. The findings emphasize parents' need for relational and practical support tailored to their unique context, as well as their wish to be more involved in the treatment of their children.

Relapse prevention therapy for internet gaming disorder in Swedish child and adolescent psychiatric clinics: a randomized controlled trial.

Objectives: To evaluate the effectiveness of relapse prevention (RP) as a treatment for internet gaming disorder (IGD). Design: Randomized controlled trial. Setting: Three child and adolescent psychiatry (CAP) units in Region Skåne, Sweden. Participants: Children aged 13-18 years, coming for their first visit to CAP during 2022, were screened for gaming behavior. Those who met the proposed DSM-5 criteria for IGD were offered participation in the trial, if they had the capacity to provide written informed consent and if they spoke Swedish. A total of 111 CAP patients agreed to participate. Out of those, 11 patients were excluded due to incorrect inclusion such as young age (n = 1), or due to the absence of responses to follow-up measures (n = 9). After exclusion, 102 participants remained (intervention = 47, control = 55). Interventions: The intervention, RP, is based on cognitive behavioral treatment (CBT) and was provided individually, comprising of five to seven 45-min sessions over a period of 5 to 7 weeks versus treatment as usual. Outcome measures: Participants were assessed with Game Addiction Scale for Adolescents pre-treatment (GASA) (baseline), post-treatment (treatment group only), and 3 months after baseline (follow-up). Results: The repeated measures ANOVA showed a significant interaction effect between treatment and time. Both the control group and treatment group lowered their mean GASA score from baseline to follow-up significantly, but the improvement was greater in the treatment group (mean difference in control group -5.1, p < 0.001, 95% CI = - 3.390 to -6.755, mean difference in treatment group -9.9, p < 0.001, 95% CI = -11.746 to -8.105). Conclusion: RP was found to be superior to treatment as usual in terms of reduction of IGD symptoms. Future research should address which aspects within a given treatment are effective, who benefits from treatment, in what aspects, and why. Trial registration number: ClinicalTrials.gov, NCT05506384 https://clinicaltrials.gov/ct2/show/NCT05506384.

Adolescents' Perceptions of a Relapse Prevention Treatment for Problematic Gaming-A Qualitative Study.

Given the increasing prevalence of problematic gaming, in 2013, the diagnosis "Internet gaming disorder (IGD)" was included in the Diagnostic and Statistical Manual of Mental Disorders, 5th edition (DSM-5) as a potential diagnosis. With a new diagnosis, it is important to determine treatment options. The importance of the parent-child relationship has been emphasised in problematic gaming and its treatment. This study aims to provide more knowledge about adolescents' perceptions of a treatment for problematic gaming and understand whether such treatment may have a bearing on the parent-child relationship. We conducted individual interviews with nine adolescents who completed a treatment for problematic gaming. The interviews were analysed using thematic analysis. The analysis revealed three themes. Theme 1: adolescents' experiences of the new treatment; Theme 2: adolescents' perceptions of the effect of the treatment on their gaming behaviour; and Theme 3: adolescents' perceptions of changes in their parent-child relationships. The adolescents viewed the treatment as a way of gaining control of their gaming, a process in which a therapist played an integral part. For the majority of the adolescents in our study, the main effects of treatment were gaining insight into how their gaming and gaming-related behaviours affected other parts of their lives. The participants felt that the treatment improved their relationship with their parents through reducing everyday conflicts. This new knowledge can be used for the development of future interventions involving children and adolescents.

Study protocol for a non-randomized controlled trial of the effects of internet-based parent training as a booster to the preschool edition of PATHS®: Universal edition of the Parent Web.

Well implemented, universal parental support is often effective in families with younger children, but research on their effects on families with adolescent children is scarce. In this study, a trial of the universal parent training intervention "Parent Web" in early adolescence is added to the social emotional learning intervention Promoting Alternative Thinking Strategies (PATHS®), completed in early childhood. The Parent Web is a universal online parenting intervention based on social learning theory. The intervention aims to promote positive parenting and family interaction through five weekly modules completed over 6-8 weeks. The main hypothesis is that participants in the intervention group will exhibit significant pre- to post- intervention-related benefits relative participants in the comparison group. The aims of this study are: 1) provide Parent Web as a booster aimed at improving parenting support and practices at the transition into adolescence to a cohort of parents whose children have previously participated in preschool PATHS, and 2) examine the effects of the universal edition of Parent Web. The study has a quasi-experimental design with pre- and post-testing. The incremental effects of this internet-delivered parent training intervention are tested in parents of early adolescents (11-13 years) who participated in PATHS when 4-5 years old compared to a matched sample of adolescents with no prior experience of PATHS. The primary outcomes are parent reported child behavior and family relationships. Secondary outcomes include self-reported parent health and stress. The proposed study is one of the few trials to test the effects of universal parental support in families of early adolescents and will therefore contribute to the understanding of how mental health in children and young people can be promoted across developmental periods through a continuum of universal measures. Trial registration: Clinical trials.gov (NCT05172297), prospectively registered on December 29, 2021.

Parenting, Adolescent Sensation Seeking, and Subsequent Substance Use: Moderation by Adolescent Temperament.

Although previous research has identified links between parenting and adolescent substance use, little is known about the role of adolescent individual processes, such as sensation seeking, and temperamental tendencies for such links. To test tenets from biopsychosocial models of adolescent risk behavior and differential susceptibility theory, this study investigated longitudinal associations among positive and harsh parenting, adolescent sensation seeking, and substance use and tested whether the indirect associations were moderated by adolescent temperament, including activation control, frustration, sadness, and positive emotions. Longitudinal data reported by adolescents (n = 892; 49.66% girls) and their mothers from eight cultural groups when adolescents were ages 12, 13, and 14 were used. A moderated mediation model showed that parenting was related to adolescent substance use, both directly and indirectly, through sensation seeking. Indirect associations were moderated by adolescent temperament. This study advances understanding of the developmental paths between the contextual and individual factors critical for adolescent substance use across a wide range of cultural contexts.

Neighborhood conditions in a Swedish context-Two studies of reliability and validity of virtual systematic social observation using Google Street View.

Introduction: The goal of these studies was to investigate the reliability and validity of virtual systematic social observation (virtual SSO) using Google Street View in a Swedish neighborhood context. Methods: This was accomplished in two studies. Study 1 focused on interrater reliability and construct validity, comparing ratings conducted in-person to those done using Google Street View, across 24 study sites within four postal code areas. Study 2 focused on criterion validity of virtual SSO in terms of neighborhoods with low versus high income levels, including 133 study sites within 22 postal code areas in a large Swedish city. In both studies, assessment of the neighborhood context was conducted at each study site, using a protocol adapted to a Swedish context. Results: Scales for Physical Decay, Neighborhood Dangerousness, and Physical Disorder were found to be reliable, with adequate interrater reliability, high consistency across methods, and high internal consistency. In Study 2, significantly higher levels of observed Physical Decay, Neighborhood Dangerousness, and signs of garbage or litter were observed in postal codes areas (site data was aggregated to postal code level) with lower as compared to higher income levels. Discussion: We concluded that the scales within the virtual SSO with Google Street View protocol that were developed in this series of studies represents a reliable and valid measure of several key neighborhood contextual features. Implications for understanding the complex person-context interactions central to many theories of positive development among youth were discussed in relation to the study findings.

Relapse Prevention Therapy for Problem Gaming or Internet Gaming Disorder in Swedish Child and Youth Psychiatric Clinics: Protocol for a Randomized Controlled Trial.

BACKGROUND: Although gaming is a common arena where children socialize, an increasing number of children are exhibiting signs of problem gaming or internet gaming disorder. An important factor to the development of problem gaming is parent-child relationships. A cognitive behavioral therapy-based form of treatment, labeled relapse prevention, has been developed as a treatment for child and adolescent problem gaming or internet gaming disorder. However, no study has evaluated the effect of this treatment among Swedish children and youth nor the role of the parent-child relationships in this treatment. OBJECTIVE: This study aims (1) to evaluate a relapse prevention treatment for patients showing signs of problem gaming or internet gaming disorder recruited from child and youth psychiatric clinics and (2) to test whether the quality of parent-child relationships plays a role in the effect of relapse prevention treatment and vice versa-whether the relapse prevention treatment has a spillover effect on the quality of parent-child relationships. Moreover, we explore the carer's attitudes about parent-child relationships and child gaming, as well as experiences of the treatment among the children, their carers, and the clinicians who carried out the treatment. METHODS: This study is a 2-arm, parallel-group, early-stage randomized controlled trial with embedded qualitative components. Children aged 12-18 years who meet the criteria for problem gaming or internet gaming disorder will be randomized in a 1:1 ratio to either intervention (relapse prevention treatment) or control (treatment as usual), with a total of 160 (80 + 80) participants. The primary outcomes are measures of gaming and gambling behavior before and after intervention, and the secondary outcomes include child ratings of parent-child communication and family functioning. The study is supplemented with a qualitative component with semistructured interviews to capture participants' and clinicians' experiences of the relapse prevention, as well as attitudes about parent-child relationships and parenting needs in carers whose children completed the treatment. RESULTS: The trial started in January 2022 and is expected to end in December 2023. The first results are expected in March 2023. CONCLUSIONS: This study will be the first randomized controlled trial evaluating relapse prevention as a treatment for child and adolescent problem gaming and internet gaming disorder in Sweden. Since problem behaviors in children interact with the family context, investigating parent-child relationships adjacent to the treatment of child problem gaming and internet gaming disorder is an important strength of the study. Further, different parties, ie, children, carers, and clinicians, will be directly or indirectly involved in the evaluation of the treatment, providing more knowledge of the treatment and its effect. Limitations include comorbidity in children with problem gaming and internet gaming disorder and challenges with the recruitment of participants. TRIAL REGISTRATION: ClinicalTrials.gov NCT05506384 (retrospectively registered); https://clinicaltrials.gov/ct2/show/NCT05506384. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/44318.

Study protocol for a mixed-design evaluation of self-assured parents - A parenting support program for immigrant parents living in deprived areas in Sweden with teenage children.

Background: Immigrant parents of adolescents experience challenges in their role as parents in the new country and express a need for parental support. Still, they are underrepresented in existing parenting programs and when they do attend, their parenting practices improve less than what they do among native parents. Self-assured parents (SAP; Swe. Trygga Föräldrar) targets immigrant parents living in deprived areas in Sweden who worry about their adolescents' adjustment. This study's purposes are to examine if SAP is a feasible intervention in Swedish municipalities and if SAP is effective in reaching its aims, namely to promote parental self-efficacy and parent-adolescent communication and to reduce parents' worries in the target group. Methods: SAP will be evaluated when implemented by social workers in three Swedish municipalities using a culturally-informed mixed design procedure. Parents will be recruited to the program by local social workers. Groups leaders will be interviewed, observed, and they will fill out self-reports to measure implementation quality, including fidelity and acceptability. A group of parents will be interviewed to better understand their perceived challenges and needs in their parenting in Sweden and their experience of participating in SAP. An interrupted time series design with three measurements before, two measurements during, and two measurements after the intervention has ended will be employed using self-reports of parental self-efficacy, parent-child communication, and parents' worries. Informed consent will be collected from all study participants. Discussion: Immigrant parents living in deprived areas is an understudied and marginalized population. There is a lack of culturally-informed, evidence-based parenting programs aimed at this group in Sweden. The need for specifically developed programs for immigrant parents living in deprived areas with teenage children, has been voiced by both immigrant parents themselves and the Swedish government. Thus, this study will contribute not only to the scientific literature, but also to social service practice and potentially policy making.

Adolescent smoking, alcohol use, inebriation, and use of narcotics during the Covid-19 pandemic.

BACKGROUND: The aim of the study was to investigate how general family relations, reported changes in family interaction and involvement with peers during the Covid-19 pandemic, and following rules and recommendations during the pandemic relate to adolescent smoking, alcohol use, inebriation, and use of narcotics during Covid-19. METHODS: An online national survey of Swedish adolescents (n = 1818) aged 15-19 years was conducted in June 2020. Hierarchical regression analysis was used to predict adolescents' reported change in substance use during the pandemic. Person-oriented analyses, were used to identify clusters of participants characterized by similar patterns of substance use following ANOVA analysis with Scheffe post hoc tests testing differences between clusters in terms of family relations, reported changes in family interaction and involvement with peers during the Covid-19 pandemic, and following rules and recommendations during the pandemic. RESULTS: Higher general family conflict, increased involvement with peers, a strained relationship with parents, and less compliance with rules and restrictions during the pandemic predicted a reported increase in adolescent substance use during this period. The grouping of scores for adolescent smoking, alcohol use, inebriation, and use of narcotics resulted in a six-cluster solution. One cluster (n = 767) either did not use or had decreased use of substances during the Covid-19 pandemic. Five other clusters, thus risk clusters, had retained or increased use of substances during the pandemic. Poor general family relations, increased peer involvement, and difficulties to conform to the rules and restrictions during the covid-19 pandemic were characteristics of risk clusters. CONCLUSIONS: Most of adolescents in our study did not increase their substance use during the pandemic. However, adolescents with poor family relations who turn to peers during stressful times and who have difficulty following the government's rules and restrictions, are at risk of increased substance use during the pandemic. This is a potential threat both to adolescents themselves and others in their surroundings which is why at-risk adolescents and their families need more attention from public health and social services during this time of crisis.

Short-term longitudinal participation trajectories related to domestic life and peer relations for adolescents with and without self-reported neurodevelopmental impairments.

BACKGROUND: With maturity and development, complexity in demands and roles change. As participation is often restricted in children with disabilities, this process might be delayed in adolescents. Investigating profiles of participation for adolescents with and without neurodevelopmental impairments could provide an understanding of which factors relate to high level of participation. The aim is to investigate trajectories of participation in everyday activities across clusters based on self-rated participation patterns in frequency of participation and perceived importance of activities related to domestic life and peer-related activities for adolescents with and without self-reported neurodevelopmental impairments. METHODS AND PROCEDURES: A prospective person-based cohort study design. OUTCOMES AND RESULTS: Five typical trajectories were identified. Trajectories between clusters with high perceived involvement in peer relations were associated with sibling support and family communication. Self-reported neurodevelopmental impairments did not predict participation profiles at certain time points, nor movements between clusters when measuring self-reported attendance and importance in domestic life and in peer-related activities. CONCLUSION AND IMPLICATIONS: Perceived sibling support and family communication are important for predicting typical trajectories across clusters in frequency of attendance and the perceived importance of domestic life and peer relations. Type of impairment was less important in predicting typical trajectories.

The role of relational support in the longitudinal links between adolescent sexual harassment victimization and psychological health.

The links between sexual harassment victimization and aspects of psychopathology are well-established in adolescent research, but whether sexual harassment victimization undermines positive aspects of psychological health and the moderating role of relational support in the link between sexual harassment victimization and psychological ill-health remains unknown. Using a cross-lagged model, we examined (a) the bidirectional and longitudinal links between sexual harassment victimization and adolescent psychological health (emotional problems and well-being) and (b) the moderating role of relational support from parents, teachers, and peers (best friends and classmates) in the link between sexual harassment victimization and adolescent psychological health. We used two waves of self-reported data (separated by 1 year) from 676 Swedish adolescents (50% female; mean age = 13.85 years at the point of first data collection). Controlling for the effects of gender and subjective socioeconomic status, the cross-lagged model revealed that sexual harassment predicted emotional problems positively and well-being negatively. Moreover, well-being predicted sexual harassment negatively. Relational support from classmates moderated the link in the direction from sexual harassment victimization to emotional problems. Relational support did not moderate the link to well-being. The findings provide new and important insights into the role of sexual harassment victimization in adolescent psychological adjustment and potential approaches to intervention.

The Role of the Family's Emotional Climate in the Links between Parent-Adolescent Communication and Adolescent Psychosocial Functioning.

The current study was designed to extend the parenting literature by testing the moderating role of the family's emotional climate, operationalized with parent-adolescent emotional closeness and adolescent feelings of being overly controlled by parents on the longitudinal associations between parent-driven communication efforts (i.e. parental behavioral control and solicitation of information from their adolescent), adolescent-driven communication efforts (i.e. adolescent disclosure and secrecy) and adolescent psychosocial functioning (i.e. emotional problems, conduct problems, delinquency, and wellbeing). We conducted a series of cross-lagged models controlling for adolescent gender and ethnicity using a two-wave Swedish longitudinal set of self-report data (N = 1515, 51% girls, M age = 13.0 and 14.3 years at T1 and T2, respectively). Multi-group analyses revealed that the negative links between T1 parental control and T2 adolescent delinquency, T1 parental solicitation and T2 adolescent conduct problems and delinquency, and T1 emotional problems and T2 adolescent disclosure were moderated by the family's emotional climate. When the family's emotional climate was positive, the parenting strategies had a more positive effect on adolescent psychosocial functioning, and adolescents with emotional problems communicated more openly with their parents. These findings suggest that the relational context in the family is an important protective factor and add specificity to the previously established role of parent-adolescent communication in adolescent psychosocial development. In terms of preventive interventions, strategies to enhance the family's emotional climate should be considered prior to teaching specific parenting strategies.

Cross-Cultural Examination of Links between Parent-Adolescent Communication and Adolescent Psychological Problems in 12 Cultural Groups.

Internalizing and externalizing problems increase during adolescence. However, these problems may be mitigated by adequate parenting, including effective parent-adolescent communication. The ways in which parent-driven (i.e., parent behavior control and solicitation) and adolescent-driven (i.e., disclosure and secrecy) communication efforts are linked to adolescent psychological problems universally and cross-culturally is a question that needs more empirical investigation. The current study used a sample of 1087 adolescents (M = 13.19 years, SD = 0.90, 50% girls) from 12 cultural groups in nine countries including China, Colombia, Italy, Jordan, Kenya, Philippines, Sweden, Thailand, and the United States to test the cultural moderation of links between parent solicitation, parent behavior control, adolescent disclosure, and adolescent secrecy with adolescent internalizing and externalizing problems. The results indicate that adolescent-driven communication, and secrecy in particular, is intertwined with adolescents' externalizing problems across all cultures, and intertwined with internalizing problems in specific cultural contexts. Moreover, parent-driven communication efforts were predicted by adolescent disclosure in all cultures. Overall, the findings suggest that adolescent-driven communication efforts, and adolescent secrecy in particular, are important predictors of adolescent psychological problems as well as facilitators of parent-adolescent communication.

Does one Size Fit All?-Linking Parenting With Adolescent Substance Use and Adolescent Temperament.

Using longitudinal Swedish data from 1,373 early-adolescent youths, this study aims to answer the question of whether the previously established protective function of parental knowledge and its sources-adolescent disclosure, parental solicitation, and parental control-on substance use among early-adolescents is moderated by the adolescent's temperament. Adolescent temperament moderated several links between parental knowledge and its sources and adolescent substance use. The most pronounced moderating results were found for those adolescents with fearless, socially detached and thrill-seeking tendencies. For these "detached thrill-seekers", bidirectional links between adolescent disclosure and substance use, and negative links between parental solicitation and substance use were found. We recommend, therefore, that adolescent temperament is considered when designing parenting programs.

Parent-Adolescent Communication and Adolescent Delinquency: Unraveling Within-Family Processes from Between-Family Differences.

Understanding the factors that predict adolescent delinquency is a key topic in parenting research. An open question is whether prior results indicating relative differences between families reflect the dynamic processes occurring within families. Therefore, this study investigated concurrent and lagged associations among parental behavioral control, parental solicitation, adolescent disclosure, and adolescent delinquency by separating between-family and within-family effects in three-wave annual data (N = 1515; Mage = 13.01 years at T1; 50.6% girls). At the within-family level, parental behavioral control negatively predicted adolescent delinquency. Adolescent disclosure and delinquency, and adolescent disclosure and parental solicitation, reciprocally predicted each other. Parental solicitation negatively predicted parental behavioral control. The findings indicate a prominent role of adolescent disclosure in within-family processes concerning parental-adolescent communication and adolescent delinquency.

Aspects of the parent-adolescent relationship and associations with adolescent risk behaviors over time.

Parents' actions and knowledge of adolescents' whereabouts play key roles in preventing risk behaviors in early adolescence, but what enables parents to know about their adolescents' activities and what links there are to adolescent risk behaviors, such as substance use and delinquent behavior, remain unclear. In this study, we investigated whether different aspects of the parent-adolescent relationship predict parental knowledge, and we examined the direct and indirect longitudinal associations between these aspects of the parent-adolescent relationship and adolescents' self-reported delinquent behavior and substance use. The participants were 550 parents and their adolescent children from two small and two midsized municipalities in Sweden. Parental data were collected when the adolescents were 13 years old (mean), and adolescent data on risk behaviors were collected on two occasions, when they were 13 and 14 years of age (mean). Structural path analyses revealed that adolescent disclosure, parental solicitation, and parental control predicted parental knowledge, with adolescent disclosure being the strongest source of parental knowledge and the strongest negative predictor of adolescent risk behaviors. Parenting competence and adolescents' connectedness to parents were indirectly, through adolescent disclosure and parental solicitation and parental control, associated with substance use and delinquent behavior. Some paths differed for boys and girls. In conclusion, confident parenting and a close parent-adolescent relationship in which adolescent disclosure is promoted, seem protective of adolescent engagement in risk behaviors. (PsycINFO Database Record (c) 2019 APA, all rights reserved).