Mobile Technologies for Supporting Mental Health in Youths: Scoping Review of Effectiveness, Limitations, and Inclusivity.

BACKGROUND: Over the past decade, there has been growing support for the use of mobile health (mHealth) technologies to improve the availability of mental health interventions. While mHealth is a promising tool for improving access to interventions, research on the effectiveness and efficacy of mHealth apps for youths is limited, particularly for underrepresented populations, including youths of color and economically marginalized youths. OBJECTIVE: This scoping review study sought to evaluate the following research questions: (1) What is the extent of the current literature on mHealth apps that provide intervention for mental health problems in children and adolescents? (2) What is known from the existing literature about the effectiveness or efficacy of delivering mental health services via mHealth apps? (3) What are the gaps in the knowledge base in the fields of technology and mental health? (4) Do the reviewed mHealth apps address issues of cultural sensitivity or have they been tested with underrepresented groups (ie, youths of color or economically marginalized groups)? METHODS: An electronic database search was conducted using relevant search terms. Seven independent reviewers screened identified studies, including title and abstract review to determine if studies met the following inclusion criteria: (1) targeted samples with mental health symptomology or disorders, (2) studied youth participants aged 6-17 years, and (3) examined the use of a mobile app-based platform for intervention. Relevant studies were subjected to full-text review to extract and chart relevant data based on a priori research questions. RESULTS: The initial database search yielded 304 papers published from 2010 to 2021. After screening and selection, the final review included 10 papers on the effectiveness and efficacy of mental health intervention apps for youths aged 8 to 17 years. Identified apps targeted a broad range of mental health challenges in youths (ie, depression, self-harm, autism spectrum disorder, anxiety, and obsessive-compulsive disorder). Results identified only a small number of studies suggesting that current effectiveness and efficacy research in this area are limited. While some studies provided general support for the effectiveness of mHealth apps in improving mental health outcomes in youths, several notable limitations were present across the literature, reducing the generalizability of findings. Additionally, considerations around racial, ethnic, and socioeconomic diversity were scarce across studies. CONCLUSIONS: Although some studies cited in this scoping review provide support for the effectiveness and efficacy of mHealth apps targeting mental health concerns in youths, the overall body of literature remains quite limited. Moreover, mHealth apps expressly developed to be culturally responsive are almost nonexistent. Further efforts are needed to recruit youths who are typically underrepresented in research and invite stakeholder participation and collaborative input in the early stages of the mHealth app development process.

Propelling the Global Advancement of School Mental Health.

Rates of mental health problems and disorders in children and youth have been increasing for at least three decades, and these have escalated due to the pandemic and multiple other societal stressors. It is increasingly recognized that students and families frequently struggle to receive needed care through traditional locations such as specialty mental health centers. Upstream mental health promotion and prevention strategies are gaining support as a public health approach to supporting overall population well-being, better utilizing a limited specialty workforce, and reducing illness. Based on these recognitions, there has been a progressive and escalating movement toward the delivery of mental health support to children and youth "where they are," with a prominent and more ecologically valid environment being schools. This paper will provide a brief review of the escalating mental health needs of children and youth, advantages of school mental health (SMH) programs in better meeting these needs, example model SMH programs from the United States and Canada, and national and international SMH centers/networks. We conclude with strategies for further propelling the global advancement of the SMH field through interconnected practice, policy, and research.

Screening for Cognitive Impairment with the Quick Memory Check: Validation of a Caregiver Administered Cognitive Screen.

BACKGROUND: Self or home-administered cognitive screening instruments (CSIs) can reduce barriers to the early detection of mild cognitive impairment (MCI) and dementia. OBJECTIVE: To examine the acceptability and diagnostic accuracy of a caregiver-administered CSI, the Quick Memory Check (QMC). METHODS: Components of the Quick Mild Cognitive impairment (Qmci) screen (orientation, verbal fluency, and logical memory) were re-weighted to create the QMC, scored out of 100 points. Participants, attending a university hospital memory clinic, were provided administration instructions beforehand. Area under the curve (AUC) scores, adjusted for age and education, were compared with the Qmci screen and Montreal Cognitive Assessment (MoCA). Caregivers or family scored the QMC. RESULTS: In all, 366 participants were recruited; 53 with subjective memory complaints (SMC), 74 with MCI, 193 with dementia, and 46 normal controls. Median QMC scores for controls were 70±13 versus 60±20 for SMC, 52±18 for MCI, and 31±21 for dementia. The QMC had excellent accuracy (AUC 0.97) for cognitive impairment (MCI/dementia from controls), similar to the Qmci screen (AUC 0.98, p = 0.17) and MoCA (AUC 0.95, p = 0.13). At a cut-off of <52/100, the QMC had 83% sensitivity and 100% specificity for cognitive impairment. The QMC had lower accuracy differentiating MCI from SMC (AUC 0.73), albeit similar to the MoCA (AUC 0.70). CONCLUSION: The QMC, administered by caregivers in advance of clinic, compared favorably to established CSIs scored by trained raters. This caregiver, home-administered CSI is acceptable and can identify cognitive impairment, potentially improving efficiency by reducing testing time and patient stress in busy clinical settings.

Effectively Supporting Youth with Chronic Illness in Schools: External Partnerships and Training Recommendations.

Across Western countries, approximately 15% to 20% of school-aged children and adolescents have a health-related disorder, with incidence rates of childhood chronic health conditions (CHCs) increasing. This contribution comprehensively reviews disease-level, school-level, and systems-level issues related to effectively supporting children with CHCs succeed from both psychosocial and educational perspectives. This article also delineates training needs as they pertain to graduate preparation and/or professional development to equip school personnel to appropriately address students' needs. The article concludes with recommendations for evidence-based prevention and intervention strategies and potential avenues for interdisciplinary collaboration and models of coordinated care for these medically compromised youth.

Integrating Behavioral Health in Primary Care: Lessons from Interdisciplinary Collaboration in School Mental Health.

Integrating behavioral health care into pediatric primary care (PPC) settings can increase access to behavioral health promotion services and treatment. Efficient models for integrated PPC are emerging. Recent reviews call for integrated PPC research to better identify efficient teaming and processes, particularly in areas of building integrated PPC team member capacity and adopting practices that promote "upstream" behavioral wellness specific to community needs. Research in integrating behavioral health in schools has identified key practices relevant to these gaps in integrated primary care (IPC) research. This article discusses possibilities to apply findings from integrated school behavioral health research to IPC settings.

Associations between parent posttraumatic stress symptoms (PTSS) and later child PTSS: Results from an international data archive.

The extant literature indicates that parent and child posttraumatic stress symptoms (PTSS) are associated. However, the magnitude of this association at different time points and in the context of covariates has been difficult to quantify due to the methodological limitations of past studies, including small sample sizes. Using data from the Prospective studies of Acute Child Trauma and Recovery Data Archive, we harmonized participant-level parent and child data from 16 studies (N = 1,775 parent-child dyads) that included prospective assessment of PTSS during both the acute and later posttrauma periods (i.e., 1-30 days and 3-12 months after exposure to a potentially traumatic event, respectively). Parent and child PTSS demonstrated small-to-moderate cross-sectional, ρs = .22-.27, 95% CI [.16, .32], and longitudinal associations, ρ = .30, CI [.23, .36]. Analyses using actor-partner interdependence models revealed that parent PTSS during the acute trauma period predicted later child PTSS. Regression analyses demonstrated that parent gender did not moderate the association between parent and child PTSS. The findings suggest that parent PTSS during the acute and later posttrauma periods may be one of a constellation of risk factors and indicators for child PTSS.

Taming Tris(bipyridine)ruthenium(II) and Its Reactions in Water by Capture/Release with Shape-Switchable Symmetry-Matched Cyclophanes.

Electron/proton transfers in water proceeding from ground/excited states are the elementary reactions of chemistry. These reactions of an iconic class of molecules─polypyridineRu(II)─are now controlled by capturing or releasing three of them with hosts that are shape-switchable. Reversible erection or collapse of the host walls allows such switchability. Some reaction rates are suppressed by factors of up to 120 by inclusive binding of the metal complexes. This puts nanometric coordination chemistry in a box that can be open or shut as necessary. Such second-sphere complexation can allow considerable control to be exerted on photocatalysis, electrocatalysis, and luminescent sensing involving polypyridineRu(II) compounds. The capturing states of hosts are symmetry-matched to guests for selective binding and display submicromolar affinities. A perching complex, which is an intermediate state between capturing and releasing states, is also demonstrated.

Effects of hyperinsulinemia on pancreatic cancer development and the immune microenvironment revealed through single-cell transcriptomics.

BACKGROUND: Hyperinsulinemia is independently associated with increased risk and mortality of pancreatic cancer. We recently reported that genetically reduced insulin production resulted in ~ 50% suppression of pancreatic intraepithelial neoplasia (PanIN) precancerous lesions in mice. However, only female mice remained normoglycemic, and only the gene dosage of the rodent-specific Ins1 alleles was tested in our previous model. Moreover, we did not delve into the molecular and cellular mechanisms associated with modulating hyperinsulinemia. METHODS: We studied how reduced Ins2 gene dosage affects PanIN lesion development in both male and female Ptf1aCreER;KrasLSL-G12D mice lacking the rodent-specific Ins1 gene (Ins1-/-). We generated control mice having two alleles of the wild-type Ins2 gene (Ptf1aCreER;KrasLSL-G12D;Ins1-/-;Ins2+/+) and experimental mice having one allele of Ins2 gene (Ptf1aCreER;KrasLSL-G12D;Ins1-/-;Ins2+/-). We then performed thorough histopathological analyses and single-cell transcriptomics for both genotypes and sexes. RESULTS: High-fat diet-induced hyperinsulinemia was transiently or modestly reduced in female and male mice, respectively, with only one allele of Ins2. This occurred without dramatically affecting glucose tolerance. Genetic reduction of insulin production resulted in mice with a tendency for less PanIN and acinar-to-ductal metaplasia (ADM) lesions. Using single-cell transcriptomics, we found hyperinsulinemia affected multiple cell types in the pancreas, with the most statistically significant effects on local immune cell types that were highly represented in our sampled cell population. Specifically, hyperinsulinemia modulated pathways associated with protein translation, MAPK-ERK signaling, and PI3K-AKT signaling, which were changed in epithelial cells and subsets of immune cells. CONCLUSIONS: These data suggest a potential role for the immune microenvironment in hyperinsulinemia-driven PanIN development. Together with our previous work, we propose that mild suppression of insulin levels may be useful in preventing pancreatic cancer by acting on multiple cell types.

Identifying Relationally Aggressive Students: How Aligned are Teachers and Peers?

Relational aggression is characterized by attempts to damage another's relationships or social status and is a major concern affecting academic, socioemotional, behavioral, and health outcomes, particularly for urban, minority youth. Teachers and peers frequently disagree about which students are relationally aggressive. Factors associated with peer and teacher discordant and concordant identification of relationally aggressive students were explored including prosocial behavior, perceived popularity, academic competence, and gender. Participants included 178 3rd-5th grade students across 11 urban classrooms. Findings revealed that students were more likely to be rated as relationally aggressive by their peers but not their teacher as scores on peer nominations for prosocial behavior decreased, while teacher-rated academic motivation/participation increased. Female students were more likely to be concordantly identified by peers and teachers as relationally aggressive when ratings for overt aggression increased. These results highlight the utility of obtaining ratings from multiple informants as well as the difficulty in accurately identifying all students who may benefit from interventions targeting relational aggression. Findings also suggest factors that may be related to the potential shortcomings of current measures and provide avenues for additional research to improve detection of relationally aggressive students.

Executive Functioning Predicts Adaptive Functioning and Self-Care Independence in Pediatric Sickle Cell Disease.

OBJECTIVE: This study examined the impact of executive functioning (EF) on adaptive functioning and self-care independence in pre-transition youth with sickle cell disease (SCD). METHODS: Thirty-four youth with SCD (ages 12-18 years) completed a brief neuropsychological battery and their caregivers completed questionnaires assessing adaptive functioning, EF behaviors, and independence in completing self-care tasks, including disease management. Hierarchical linear regression analyses were utilized to investigate if EF predicted significantly more variability in adaptive functioning and self-care independence than what is accounted for by socioeconomic status (SES), disease knowledge, and estimated intellectual functioning. RESULTS: Mean performance on standardized measures assessing working memory, processing speed, and EF skills fell in the low average range. Performance-based EF and caregiver-reported EF behaviors predicted variance in adaptive functioning and self-care independence above and beyond that accounted for by SES, disease knowledge, and intelligence, with moderate to large effect sizes. CONCLUSIONS: EF skills may support the ability of youth with SCD to adequately achieve independence in self-care, including medical self-care, and other adaptive skills, which may increase the likelihood of successful transition to young adulthood. These findings provide support for the role of neuropsychological screening and individualized intervention in interdisciplinary transition programs.

Use of language in the medical decision-making process for biologic therapy: Youth and parent perspectives.

BACKGROUND: Youth with chronic illnesses and their parents make complex medical decisions and also need to develop medical decision-making skills for transition of care to adult care. The use of inclusive (e.g. 'we decided …') and exclusive (e.g. 'they decided …') language in youth and parents' medical decision-making experiences provides insights into perceptions of engagement. This study assessed youth and parents' perceptions of engagement in medical decision-making about biologic therapy. METHODS: This exploratory mixed-methods secondary analysis of semistructured interview data included youth with juvenile idiopathic arthritis (JIA) and Crohn's disease (CD) and parents. Iterative qualitative coding of interviews generated themes. Exploratory analyses of variance (ANOVAs) and analyses of covariance (ANCOVAs) investigated differences in language use between youth and parents. RESULTS: Parents used more inclusive language in perceptions of medical decision-making experiences than youth, which exploratory analyses found significant (p < 0.05). Youth used more exclusive language than parents in perceptions of medical decision-making. CONCLUSION: This research suggests that youth with chronic illnesses perceived limited engagement in medical decision-making, with parents perceiving higher engagement. This presents challenges for youth as they prepare for the transition to adult care. Future research should assess how inclusive and exclusive language use impacts psychosocial and health outcomes.

Exposure to Multiple Forms of Bias Victimization on Youth and Young Adults: Relationships with Trauma Symptomatology and Social Support.

Research has documented that a significant portion of youth are exposed to bias victimization. However, less is known about whether experiencing certain types of bias victimization (e.g., sexual orientation bias) is more or less likely to be related to a more extensive bias victimization history (i.e., experiencing multiple types of bias victimization) and whether exposure to multiple types of bias victimization explains any relationships between specific types of bias victimization and negative outcomes. To address these gaps, the current study explores relationships between exposure to multiple types of bias-motivated victimization, trauma symptomatology and perceived social support. Participants were 854 youth and young adults (60.9% female) from three higher risk communities who completed a survey on personal experiences with bias-related victimization. The average age of participants was 16.6 years; 28.5% of the sample described themselves as Black or African American; 13.4% as Hispanic or Latino (any race); 45.3% as White, and 12.8% as another race. Sixty-nine percent of the sample described their sexual orientation as heterosexual; 8.9% as gay, lesbian, or homosexual; 12.5% as bisexual; and 9.5% as another sexual orientation. Sixty-three percent of participants reported at least one type of bias victimization in their lifetime, and more than one in three youth (38.7%) experienced two or more types of bias victimization in their lifetimes (18.1% two types, 12.1% three types, and 8.5% four or more types). Experiencing multiple types of bias victimization was related to higher trauma symptomatology and less perceived social support. Experiencing multiple types of bias victimization attenuated or eliminated the association between individual types of bias victimization and well-being. The findings contribute to a growing body of research demonstrating the damaging mental health effects of occupying multiple marginalized statuses, and points to the cumulation of bias victimization experiences as an important factor contributing to significant differences in well-being and support among youth and young adults.

Executive function "drives" differences in simulated driving performance between young adults with and without autism spectrum disorder.

Individuals with autism spectrum disorder (ASD) may experience greater difficulty learning to drive than peers who do not have ASD, but reasons for those differences are unclear. This study examined how diagnostic symptoms of ASD and commonly co-morbid executive dysfunction relate to differences in simulated driving performance between young, inexperienced drivers with and without ASD. Participants included 98 young adults, ages 16-26 years, half of which were diagnosed with ASD. Participants with ASD completed the Autism Diagnostic Observation Schedule (ADOS-2) and self- and parent-report versions of the Social Responsiveness Scale (SRS-2) to confirm diagnosis and assess the severity of ASD symptoms. All participants completed neuropsychological tests measuring executive functioning. Driving behaviors, including speed and lane positioning, were assessed on a virtual reality driving simulator. Analyses were conducted to first examine relationships between autism severity and driving behaviors, and then to examine whether neurocognitive performance mediated differences in driving behaviors between young adults with and without ASD. Controlling for age, gender, and licensure status, ASD symptom severity was not significantly related to driving. Neurocognitive variables were grouped into three factors: Speed of Information Processing, Auditory Attention and Working Memory, and Selective and Divided Attention. Speed of Information Processing significantly mediated group driving differences. Results suggest that assessment of executive functions such as processing speed may be more useful than the diagnostic assessment of ASD symptoms for evaluation of driving readiness.

The Resilience Songwriting Program for Adolescent Bereavement: A Mixed Methods Exploratory Study.

Music therapy research with youth who are grieving often reports on a combination of interventions, such as lyric analysis, improvisation, and/or songwriting. Unfortunately, the lack of theoretical transparency in how and why these interventions affect targeted outcomes limits interpretation and application of this important research. In this exploratory study, the authors evaluated the impact of an 8-session, theory-driven group songwriting program on protective factors in adolescent bereavement, and also sought to better understand adolescents' experiences of the program. Using a single-group, pretest-posttest convergent mixed methods design, participants were enrolled from three study sites and included 10 adolescents (five girls and five boys), ages 11-17 years, who self-identified as grieving a loss. Outcomes measured included grief, coping, emotional expression, self-esteem, and meaning making. Qualitative data were captured through in-session journaling and semi-structured interviews. There were no statistically significant improvements for grief, self-esteem, coping, and meaning making. Individual score trends suggested improvements in grief. The majority of the participants reported greater inhibition of emotional expression, and this was statistically significant. Thematic findings revealed that the program offered adolescents a sense of togetherness, a way to safely express grief-related emotions and experiences verbally and nonverbally, and opportunities for strengthening music and coping skills. These findings suggest that engaging in collaborative therapeutic songwriting with grieving peers may decrease levels of grief, enhance creative expression, and provide social support. More research is needed on measuring self-esteem, emotional expression, coping, and meaning making outcomes in ways that are meaningful to adolescents.

Molecular memory with downstream logic processing exemplified by switchable and self-indicating guest capture and release.

Molecular-logic based computation (MLBC) has grown by accumulating many examples of combinational logic gates and a few sequential variants. In spite of many inspirations being available in biology, there are virtually no examples of MLBC in chemistry where sequential and combinational operations are integrated. Here we report a simple alcohol-ketone redox interconversion which switches a macrocycle between a large or small cavity, with erect aromatic walls which create a deep hydrophobic space or with collapsed walls respectively. Small aromatic guests can be captured or released in an all or none manner upon chemical command. During capture, the fluorescence of the alcohol macrocycle is quenched via fluorescent photoinduced electron transfer switching, meaning that its occupancy state is self-indicated. This represents a chemically-driven RS Flip-Flop, one of whose outputs is fed into an INHIBIT gate. Processing of outputs from memory stores is seen in the injection of packaged neurotransmitters into synaptic clefts for onward neural signalling. Overall, capture-release phenomena from discrete supermolecules now have a Boolean basis.

Driving Comparisons Between Young Adults with Autism Spectrum Disorder and Typical Development.

OBJECTIVE: Many individuals with autism spectrum disorder (ASD) are reluctant to pursue driving because of concerns about their ability to drive safely. This study aimed to assess differences in simulated driving performance in young adults with ASD and typical development, examining relationships between driving performance and the level of experience (none, driver's permit, licensed) across increasingly difficult driving environments. METHOD: Participants included 50 English-speaking young adults (16-26 years old) with ASD matched for sex, age, and licensure with 50 typically-developing (TD) peers. Participants completed a structured driving assessment using a virtual-reality simulator that included increasingly complex environmental demands. Differences in mean speed and speed and lane variability by diagnostic group and driving experience were analyzed using multilevel linear modeling. RESULTS: Young adults with ASD demonstrated increased variability in speed and lane positioning compared with controls, even during low demand tasks. When driving demands became more complex, group differences were moderated by driving experience such that licensed drivers with ASD drove similarly to TD licensed drivers for most tasks, whereas unlicensed drivers with ASD had more difficulty with speed and lane management than TD drivers. CONCLUSION: Findings suggest that young adults with ASD may have more difficulty with basic driving skills than peers, particularly in the early stages of driver training. Increased difficulty compared with peers increases as driving demands become more complex, suggesting that individuals with ASD may benefit from a slow and gradual approach to driver training. Future studies should evaluate predictors of driving performance, on-road driving, and ASD-specific driving interventions.

Picosecond ultrasonic study of surface acoustic waves on periodically patterned layered nanostructures.

We have used the ultrafast pump-probe technique known as picosecond ultrasonics to generate and detect surface acoustic waves on a structure consisting of nanoscale Al lines on SiO2 on Si. We report results from ten samples with varying pitch (1000-140 nm) and SiO2 film thickness (112 nm or 60 nm), and compare our results to an isotropic elastic calculation and a coarse-grained molecular dynamics simulation. In all cases we are able to detect and identify a Rayleigh-like surface acoustic wave with wavelength equal to the pitch of the lines and frequency in the range of 5-24 GHz. In some samples, we are able to detect additional, higher frequency surface acoustic waves or independent modes of the Al lines with frequencies close to 50 GHz. We also describe the effects of probe beam polarization on the measurement's sensitivity to the different surface modes.

Lighting-up protein-ligand interactions with fluorescent PET (photoinduced electron transfer) sensor designs.

The fluorescence of sensors 1 and 6, which are designed in terms of photoinduced electron transfer (PET), is switched 'on' by factors of 15 and 6 with avidin in a rather selective manner. Sensors 3 and 7, simpler derivatives of 1, are switched 'on' by factors of 16 and 7.5 with bovine serum albumin, though at 30-fold higher concentrations.