Originalarbeiten / Original Articles. Die Bedeutung von Selbstregulation in der Entwicklung internalisierender Symptome während der mittleren Kindheit / The Importance of Self-Regulation in the Development of Internalizing Symptoms During Middle Childhood.

The Importance of Self-Regulation in the Development of Internalizing Symptoms During Middle Childhood Current research discusses low self-regulation abilities during childhood as risk factors for the development of internalizing symptoms. However, longitudinal studies investigatingmultiple self-regulation facets simultaneously are scarce. We examined whether impairments in various self-regulation facets (emotional reactivity, inhibition, inhibitory control, planning behavior) in middle childhood predict internalizing symptoms two years later and whether they make an incremental contribution when established risk factors (gender, family adversity) are considered. Furthermore, we investigated whether self-regulation facets predict later internalizing symptoms under consideration of internalizing symptoms at baseline.The sample consisted of 1,617 children (t1:Mage = 9.1, t2:Mage = 11.1 years), assessed at two measurement points. Internalizing symptoms were rated by parents on the Emotional Problems Scale of the Strengths and Difficulties Questionnaire. Self-regulation facets were measured at the first measurement point using various methods and informants. A stepwise regression analysis revealed that increased emotional reactivity, reduced inhibitory control, and reduced planning behavior significantly predicted later internalizing symptoms, explaining 14.8 % of the variance. Adding risk factors increased the explained variance by 2.5 %. Under consideration of baseline internalizing symptoms, reduced inhibition and inhibitory control significantly predicted later internalizing symptoms, while other self-regulation facets and risk factors did not. Results of this study may inform prevention and intervention measures.

Attenuated LPP to Emotional Face Stimuli Associated with Parent- and Self-Reported Depression in Children and Adolescents.

Individuals diagnosed with a depressive disorder have been found to show reduced reactions to emotional information consistent with the hypothesis of an emotional context insensitivity. However, there are contradictory findings of enhanced reactivity and mood-congruent processing. Electroencephalography (EEG) recordings of the late positive potential (LPP) can display such blunted or enhanced activity. Due to these contradictory findings, there is a need to clarify the role of the LPP in the emergence and presence of depressive disorders especially in children. We used an emotional Go/NoGo task to investigate modulations of the LPP to emotional (fearful, happy, sad) and calm faces in a sample of children and adolescents (age 11;00-14;11) diagnosed with a depressive disorder according to diagnostic parent interviews (K-SADS-PL) (n = 26) compared to a group of age-matched healthy controls (n = 26). LPP positivity was attenuated in children and adolescents with a depressive disorder as well as with higher self-reported depressive symptoms, suggesting reduced reactivity to emotional and calm faces. This is the first study to find generally blunted LPP responses in a clinical sample of depressed youth across reporters. Such dysfunctional modulation of neural activity may represent a potential biomarker for depressive disorders. The results call for further prospective studies investigating the course of the LPP before and after the onset of a depressive disorder in youth.

Assessing psychological and physical abuse from children's perspective: Factor structure and psychometric properties of the picture-based, modularized child-report version of the Parent-Child Conflict Tactics Scale - Revised (CTSPC-R).

Child victims' reports of psychological and physical abuse by caregivers are a fundamental source of information beyond official records and caregiver reports. However, few or no sensitive and age-appropriate child-report instruments exist that have undergone in-depth validity and reliability testing across a broad age-range. Our study addresses this gap by examining psychometric properties of a picture-based, modularized version of the Parent-Child Conflict Tactics Scale (CTSPC-R), encompassing the maltreatment subtypes of psychological and physical abuse. A sample of 904 children and adolescents aged 4-16 years from the community (n = 568), child psychiatric services (n = 159), and from Child Protective Services (CPS; n = 177) completed the CTSPC-R. Measures to test convergent (maltreatment in parent interviews and CPS records) and concurrent validity (psychiatric symptoms) were collected. The CTSPC-R comprises 22 items, arranged in three severity modules by increasing level of psychological and physical abuse by caregivers. Companion picture cards were provided for children aged 4 and 8 years. The best fit to the data was attained with a second-order factor model, assuming three inter-correlated factors corresponding to the three severity modules, and a latent second-order factor representing combined physical and psychological abuse. The three factors showed good internal consistencies. Supporting convergent validity at the global and subtype-level of maltreatment, the CTSPC-R severity scale was associated with lifetime CPS-contact, presence of caregiver-reported emotional maltreatment and physical abuse, and dimensions of chronicity and severity. Discriminant validity was supported by non-significant correlations with caregiver-reported lack of supervision, failure to provide, and sexual abuse. Bolstering concurrent validity, moderate and severe physical abuse predicted caregiver-reported internalizing and externalizing symptoms. These effects were independent of child age, gender or community vs. non-community samples. Our study supports the CTSPC-R as a scientifically and clinically sound tool for ascertaining the child's own perspective on psychological and physical abuse from an early age onwards.

Endocrinological and subjective stress responses in children with depressive, anxiety, or externalizing disorders.

In this study, we used a stress test to investigate endocrinological and subjective stress responses of 8- to 14-year-old children with internalizing or externalizing disorders and healthy controls. The sample (N = 170) consisted of clinical and community children. Parents were given a diagnostic interview to diagnose their children's psychiatric condition. We measured saliva cortisol and subjectively experienced arousal in children before and after the Trier Social Stress Test for Children. Children also rated their performance immediately after the stress test, and 1 hr later they rated their positive and negative thoughts about this stressful event. Children with internalizing or externalizing disorders exhibited a blunted cortisol response compared to healthy controls. Depressed children rated their test performance lower and reported more negative thoughts after the test in comparison to healthy controls, anxious children reported more arousal before and after the task, and children with externalizing disorders reported more positive thoughts. In regression analyses, cortisol and subjective stress responses were both predictive of psychiatric disorders. The study extends previous work on the relation between psychiatric disorders and children's stress responses to an experimentally induced stress task by including a broad range of psychiatric disorders and by integrating endocrinological and subjective stress responses.

Self-Esteem of 8-14-Year-Old Children with Psychiatric Disorders: Disorder- and Gender-Specific Effects.

In this study, we investigated the relation between global and domain-specific self-esteem and psychiatric disorders. A sample of 577 children aged 8-14 years was recruited via psychiatric hospitals and from the general population. Parents were given a diagnostic interview to assess children's psychiatric diagnoses (current/past). Parents and children completed questionnaires on child symptoms. Children completed a questionnaire on global and domain-specific self-esteem (scales: scholastic competence, social acceptance, athletic performance and physical appearance, global self-esteem). Self-esteem of children with current psychiatric disorders was lower than that of healthy controls (η p2 between 0.01 and 0.08). Concerning scholastic competence, social acceptance and global self-esteem, children with past psychiatric disorders scored also lower than healthy controls. Different current psychiatric disorders showed specific but small effects on dimensions of self-esteem (ß between -0.08 and 0.19). Moreover, we found a gender × group interaction, indicating that girls with depressive and adjustment disorders were specifically impaired in their global self-esteem and perception of their physical appearance. Findings might help clinicians to focus on particular domains of self-esteem during the diagnostic process and to define adequate treatment goals.

FKBP5 polymorphisms moderate the influence of adverse life events on the risk of anxiety and depressive disorders in preschool children.

FKBP5 is thought to be involved in the pathogenesis of stress-related disorders. Studies have shown that FKBP5 genotypes moderate the risk of post-traumatic stress disorder and depression in traumatized adults. We aimed to replicate this finding in a sample of preschool children. Parents of preschoolers (N = 186) were interviewed using the Preschool Age Psychiatric Assessment (PAPA) to evaluate the presence of anxiety and depressive disorders and to quantify the child's exposure to adverse events. All FKBP5 polymorphisms showed significant interactions with mild to moderate life events, but not with severe life events, in predicting the risk of anxiety and/or depressive disorders (p = 0.003-0.019). Children who experienced a high number of mild to moderate life events had a higher risk of developing an anxiety and/or depressive disorder if they were carriers of the minor allele compared to major allele homozygotes. Results indicate that genetic variation in FKBP5 influences the risk of anxiety and/or depressive disorders in preschool age by altering the sensitivity to the deleterious effects of mild to moderate adverse events. In case of severe life events, the FKBP5 genotype does not seem to play a role, suggesting that severe life events might influence directly the risk of anxiety and/or depressive disorders independent of an FKBP5 genotype-dependent vulnerability.

The hyporeactivity of salivary cortisol at stress test (TSST-C) in children with internalizing or externalizing disorders is contrastively associated with α-amylase.

BACKGROUND: Stress biomarkers of the autonomic nervous system and hypothalamic-pituitary-adrenal axis (HPA-axis) can be measured via alpha-amylase (AA) and cortisol and cortisone in saliva. Objectives were to determine 1) the response patterns of cortisol, cortisone, and AA under both circadian conditions and the Trier Social Stress Test for Children (TSST-C), 2) which reactivity index is most suitable to differentiate internalizing or externalizing disorders from controls, and to explore 3) the interaction between AA and cortisol in the presence of internalizing or externalizing disorders. METHODS: Saliva samples (n = 2893) from children with internalizing (n = 55) or externalizing disorders (n = 33) and healthy children (n = 81) were analyzed for cortisol, cortisone, and AA under circadian conditions and TSST-C. RESULTS: Circadian rhythm of three biomarkers did not differ between diagnostic groups. Age and gender were significant predictors for cortisol and awakening time influenced all three biomarkers significantly. TSST-C responses appeared sequentially in the order of AA, cortisol, and cortisone. Trajectories of cortisol and cortisone responses, not in AA, were significantly lower in children with internalizing or externalizing disorders than in healthy children. Cortisol percentage increase appeared to be the most suitable reactivity index to detect the difference between the diagnostic groups. Internalizing disorders had a negative association between AA decrease and cortisol increase (ß = -.199, p < .05, R(2) = .304). Externalizing disorders had a positive association between AA baseline and cortisol increase (ß = .229, p < .05, R(2) = .304). CONCLUSION: An altered HPA-axis response during stress might result from chronic allostatic load in internalizing disorders and underaroused stress response system in externalizing disorders.

Maternal stress and internalizing symptoms in preschoolers: the moderating role of narrative coherence.

In the present study, we examined whether maternal psychosocial stress and children's coherence in story-stem narratives are associated with preschool children's internalizing symptoms and disorders, and whether narrative coherence moderates the association between maternal stress and children's internalizing symptoms and disorders. The sample consists of 236 preschool children (129 girls, 107 boys; Mage = 5.15 years) and their mothers. Mothers completed questionnaires on their psychosocial stress burden and on child symptoms. A diagnostic interview (the Preschool Age Psychiatric Assessment; Egger & Angold, 2004) was conducted with one of the parents to assess children's psychiatric diagnoses. Children completed 8 story stems of the MacArthur Story Stem Battery (Bretherton & Oppenheim, 2003). Story-stem narratives were coded for narrative coherence. Multivariate analyses were controlled for children's age, gender, verbal performance, and externalizing symptoms. Results showed that maternal psychosocial stress was significantly associated with child internalizing symptoms and disorders. Neither maternal stress nor children's internalizing symptoms or disorders were associated with narrative coherence. However, narrative coherence moderated the association between maternal stress and child internalizing symptoms. For children with more incoherent narratives, the association between maternal psychosocial stress and children's internalizing symptoms was significantly stronger than for children with more coherent narratives. The moderation effect of narrative coherence concerning children's internalizing disorders was found not to be significant. Our findings indicate that preschool children's cognitive-emotional organization in dealing with relational conflict themes seems to buffer their mental health when exposed to adverse circumstances in their everyday family life.