Adolescent Behavioral Outcomes Research Articles

Patterns of early childhood adversity and neighborhood deprivation predict unique challenges in adolescence: A UK birth cohort study.

This study applies a comprehensive bioecological perspective to address a significant gap in the childhood adversity literature by employing latent profile analysis to examine the impact of diverse combinations of early childhood adversities and protective factors on adolescent psychosocial and behavioral outcomes. Drawing from the United Kingdom's Millennium Cohort Study (N = 19,444), we identified eight unique profiles of early childhood adversity and protective factors. These profiles provide a nuanced understanding of adversity combinations and allow for differentiation between groups with similar profiles. Latent profile membership was a significant predictor of all adolescent outcome variables, indicating that profiles differed significantly from one another on psychosocial and behavioral outcomes (Wald values ranged from 10.10-623.22; p < .001). Some findings support the cumulative risk model, indicating that exposure to multiple early adversities increases the likelihood of adverse outcomes. However, we also found that specific adversities, such as parental psychopathology, parental alcohol use, and neighborhood deprivation, uniquely impact adolescent outcomes. This study highlights the necessity for tailored interventions and policies to support children with distinct early life experiences, emphasizing the importance of addressing both cumulative and specific adversities at multiple levels to prevent psychosocial and behavioral problems in adolescence.

8256 Early Life Stress and Pubertal Predictors of Youth Substance Use Initiation: Does Sex Moderate the Relationship Between ELS, Puberty, and Substance Use Initiation?

Abstract Disclosure: A. Donovan: None. S. Assari: None. M. Shaheen: None. C. Grella: None. L. Richter: None. T.C. Friedman: None. Background: Early life stress (ELS) is a construct composed of children’s experiences of abuse, neglect, and conflict. Approximately 20% of adolescents in the United States have experienced ELS at some point, and these experiences influence adolescent and adult health behavior outcomes. Adults with a history of ELS display higher rates of substance use disorders (SUD) and report earlier initiation of substance use. Additionally, ELS has been associated with early puberty, which in turn is linked to earlier substance use initiation. Our study examines the roles of pubertal status, sex hormones (estradiol, testosterone, and DHEA) and ELS as predictors of the initiation of substance use among a nationally representative sample of male and female adolescents in NIDA’s Adolescent Brain Cognitive Development (ABCD) database. Methods: Baseline measures from the ABCD database release 5.0 were used to generate an ELS score (0-60), puberty assessed via parental report on the Pubertal Development Scale (PDS, 1-4), and sex hormones (estradiol, testosterone, and DHEA) were analyzed via salivary samples. The relationship between these scores and time to first use of alcohol, nicotine, and marijuana was determined via survival analysis utilizing a cox regression. Age was tested as a covariate in the interaction of ELS and time to first use of alcohol, nicotine, and marijuana. Data were analyzed overall and for biological boys and girls separately (N=11,866, 52%M 48%F. ages 9-11 at baseline). Results: We observed additive effects of PDS score, estradiol measure, age, and ELS on time to first use of any substance (alcohol, nicotine, or marijuana) and found age (Exp β= 1.029, p&amp;lt;0.001) and ELS (Exp β= 1.017, p&amp;lt;0.05) to be significant predictors of time to first use. After separating by sex, ELS was no longer a significant predictor for males (Exp β= 1.014, p=0.054), but remained a predictor for females (Exp β= 1.019, p&amp;lt;0.05) indicating the overall effect was driven by females. Additionally, salivary estradiol was a significant predictor of first use for females (Exp β= 1.208, p&amp;lt;0.05), while salivary DHEA and testosterone were not predictors for males or females. Conclusions: Our results indicate sex does moderate the relationship between ELS and substance use initiation within our population, with females showing increased risk of initiation with increases in estradiol. Further findings from our study will help to describe sex differences among the factors that increase the risk of substance use initiation among ELS-exposed youth and explore how these vary by substance. ABCD provides an unprecedented opportunity to explore the mechanisms behind complex effects of ELS by sex on risk factors for adolescent substance use initiation. Presentation: 6/1/2024

Adolescent-Preferred financial incentives to promote type 1 diabetes Self-Care: A discrete choice experiment

AimsThis study aimed to quantify preferences for the characteristics of a financial incentives program that would motivate adolescent engagement in type 1 diabetes (T1D) self-care. MethodWe performed a discrete choice experiment with 12–18 year-olds with T1D from two pediatric hospital endocrinology clinics (n = 317). We identified key attributes of incentives: (1) monthly value of the reward, (2) payment structure, and (3) difficulty of incentivized behaviors. In twelve choice questions, adolescents chose the incentive option from a pair of profiles that was more likely to motivate them to increase adherence to recommended self-care. Options presented were tailored to adolescents’ T1D technology use and perceived difficulty of completing each behavior. We analyzed data using a conditional logit model. ResultsThe value of the reward accounted for 60.8% of preferences. Adolescents were willing to accept lower value rewards when incentive payments used positive vs. negative reinforcement (−$10.88 (95% CI: −$12.60, −9.24)) and preferred higher incentives for performing hard vs. easier behaviors (+$14.92 (95% CI: +$12.66, +$17.28)). ConclusionsStated preferences can inform intervention design. Future research will evaluate the external validity of the discrete choice experiment-informed intervention design by assessing adolescent health and behavioral outcomes in a randomized controlled trial.

Cooperative coparenting and the associations with adolescent behavioral problems and delinquency in unmarried families.

Coparenting in unmarried families is a protective factor for positive adolescent adjustment. Although the relations between coparenting and adolescent outcomes have been investigated, it remains unclear whether the specific patterns of maternal and paternal coparenting are associated with adolescent behavioral outcomes. The present study includs a longitudinal cohort of 1143 triads of unmarried parents and their adolescents to examine the associations between different patterns of coparenting and adolescent behavioral problems and delinquency. The data were drawn from the Future of Families and Child Wellbeing Study in the United States. Our study used six waves of publicly available data at children's birth, ages 1, 3, 5, 9, and 15. The latent profile analyses identified four coparenting profiles of maternal and paternal coparenting perceived by the other unmarried parent. Comparing average levels of coparenting between mothers and fathers, the profiles were entitled Low Mom-Low Dad, High Mom-Medium Dad, Low Mom-Medium Dad, and High Mom-High Dad. Parentscharacteristics, such as cohabitation and marital status, predicted the likelihood of being in cooperative coparenting profiles. Furthermore, all the identified coparenting profiles predicted adolescent externalizing behavioral problems; only the high mom cooperative coparenting profiles predicted adolescent internalizing behavioral problems; none of the coparenting profiles predicted adolescent delinquency. Our study adds empirical evidence for coparenting research by revealing that coparenting patterns vary in unmarried families and that cooperative coparenting benefits child behavioral outcomes. The findings encourage introducing different coparenting training programs targeting unmarried parents'diverse needs, thus promoting positive adolescent adjustment.

Economic hardship and adolescent behavioral outcomes: Within- and between-family associations - CORRIGENDUM.

Economic hardship and adolescent behavioral outcomes: Within- and between-family associations - CORRIGENDUM.

Technology-Assisted Parenting Intervention Plus Therapist Coaching: A Pilot Randomized Trial in a Community Practice Setting

ABSTRACT Disruptive behaviors are the most common clinical presentation in children and adolescents, particularly among disadvantaged youth referred to community mental health clinics (CMHCs). When left unaddressed, disruptive behaviors can increase the risk of adverse mental health outcomes. While parenting interventions are known to be efficacious and efficient treatment approaches, there are many barriers to involvement in such programs, particularly for disadvantaged populations. This pilot randomized controlled trial evaluated a technology-assisted parenting intervention (Parenting Wisely, PW) with therapist coaching compared to treatment as usual (TAU) at a CMHC. Participants included 53 caregiver-adolescent dyads and 13 clinicians recruited from a CMHC. Dyads randomized to PW + therapist coaching received a multi-component intervention that utilized a technology-assisted parenting program alongside therapist coaching sessions. Feasibility/acceptability assessments were conducted and preliminary findings on parenting outcomes and adolescent behavior outcomes were collected at 3- and 6-months post-baseline. Qualitative and quantitative results supported the feasibility and acceptability of the parenting PW + therapist coaching intervention as evidenced by caregiver engagement, therapist adherence, lack of treatment withdrawals, and satisfaction ratings. Exploratory analyses did not show differences between treatment conditions for parenting and adolescent behavioral outcomes. PW + therapist coaching may be better suited for early adolescents, who are at a critical period when disruptive behavior patterns are not yet ingrained, and parents have more authority and opportunity to address family interactions. Next steps for further evaluation include testing the effectiveness, predictors, moderators, and mechanisms of treatment outcomes of PW + therapist coaching as an adjunct to usual care.

Economic hardship and adolescent behavioral outcomes: Within- and between-family associations.

Understanding how youth perceive household economic hardship and how it relates to their behavior is vital given associations between hardship and behavioral development. Yet, most studies ignore youth's own perceptions of economic hardship, instead relying solely on caregiver reports. Moreover, the literature has tended to treat economic hardship as a stable force over time, rather than a volatile one that varies month-to-month. This study addressed extant limitations by collecting monthly measures of economic hardship, specifically caregiver- and youth-reported material deprivation and youth-reported financial stress, and youth internalizing and externalizing problems from 104 youth-caregiver dyads (youth: 14-16 years, 55% female, 37% Black, 43% White) over nine months. We examined month-to-month variability of these constructs and how youth-reports of material deprivation and financial stress predicted their behavior problems, controlling for caregiver-reports of material deprivation. We found that hardship measures varied month-to-month (ICCs = 0.69-0.73), and youth-reported material deprivation positively predicted internalizing when examining both within- and between-individual variability (β = .19-.47). Youth-reported financial stress positively predicted within-individual variation in externalizing (β = .18), while youth reports of material deprivation predicted externalizing when looking between families (β = .41). Caregiver-reported material deprivation was unrelated to youth behavior when accounting for youth perceptions of economic hardship.

Family-Centeredness in Secure Residential Treatment and Its Relationship With Parental Involvement and Adolescent Behavioural Outcomes

Various Dutch secure residential youth care (SRYC) institutions are implementing a family-centered approach aiming to increase parental involvement and improve treatment outcomes. However, it remains unclear if and how family-centeredness (FC) is related to increased parental involvement and to improved treatment outcomes of adolescents. In this study, we unravelled the relation between FC, parental involvement, and behaviour problems of adolescents in SRYC. Families of 404 adolescents admitted to one of seven participating Dutch SRYC institutions completed a survey (at the start, at the end, and at 6-months follow-up) on problem behaviour of adolescents. In addition, 411 group care workers filled out a questionnaire about their residential group’s level of FC every 6 months. Moreover, the mentor of each adolescent filled out a questionnaire about the level of parental involvement. We analysed the data using multiple mediator models. Associations were found between FC and parental involvement. However, no relation was found between FC and adolescent problem behaviour, and no mediation and no moderation effects of parental involvement were found. Overall, results showed that most parents were involved during the residential stay, and, independent of FC, adolescent problem behaviour decreased over time. Implementing FC in SRYC institutions seems to be helpful in involving parents during the residential stay, but was not found to be associated with adolescent behavioural outcomes. Our results indicate that institutions could improve their level of FC by offering more informal contact moments for parents and by addressing barriers to FC among residential staff.

A tri-directional examination of adolescent personality, perceived parenting, and economic and parental adversity contexts in influencing adolescent behavioral outcomes.

Adolescent personality is consistently linked to behavioral strengths and difficulties. However, most of this work is limited in that it does not consider personality beyond the Big Five or economic or parental adversity contexts. The Tri-Directional Framework of Parent and Offspring Traits and Outcomes highlights the collective influence of personality, parenting, and context on offspring behavioral outcomes. Parent and adolescent cross-sectional data were collected from 2019 to 2021 as part of the Parents and Children Together project in the United Kingdom. Adolescents (N = 310, 48.7% female) self-reported on Dark Triad traits, parenting, and behavior. Parents (N = 288, 46.9% mothers) self-reported on socioeconomic status and adverse childhood experiences. In two path analysis models, we examined: (1) adolescent Dark Triad, context, and their interactions as predictors of perceived maternal and paternal warmth, hostility, and control; and (2) adolescent Dark Triad, perceived parenting, context, and personality-parenting interactions as predictors of adolescent behavioral strengths and difficulties. Adolescent narcissistic traits were the strongest predictors of perceived maternal parenting, whereas adolescent psychopathy and Machiavellianism were the strongest predictors of perceived paternal parenting. Adolescent personality interacted with contextual factors in predicting parenting, but not with perceived parenting in predicting behavior. Adolescent Dark Triad traits, especially narcissism, and contextual factors are important for the parent-offspring relationship and developmental outcomes. We recommend that research move beyond assessing direct trait-outcome associations to examining how these associations operate in different environments.

Paternal Communication and Sexual Health Clinic Visits Among Latino and Black Adolescent Males With Resident and Nonresident Fathers

PurposeLatino and Black adolescent males experience sexual health inequities, and their engagement in sexual health services remains low. Parents shape adolescent sexual health behavior and other youth outcomes. However, the role of Latino and Black fathers in promoting male adolescent sexual health is understudied, in part because about one in four fathers resides apart from their children and nonresident fathers are presumed to be less influential. We examined associations of paternal communication with sexual health service use and perceived paternal role modeling among Latino and Black adolescent males with resident and nonresident fathers. MethodsWe recruited 191 Latino and Black adolescent males aged 15–19 years and their fathers in the South Bronx, New York City, using area sampling methods; dyads completed surveys. We estimated bivariate and adjusted associations of paternal communication with adolescent male sexual health service use and perceived paternal role modeling using logistic and linear regressions. Effect measure modification by paternal residence was assessed. ResultsA unit increase on a five-point paternal communication scale was associated with approximately twice and 1.7 times the likelihood of clinical sexual health service use during adolescent males' lifetime and in the past 3 months, respectively; there was no significant effect measure modification by paternal residence. Paternal communication was associated with increased levels of perceived paternal role modeling and usefulness of paternal advice, with stronger associations for nonresident fathers. DiscussionBoth resident and nonresident Latino and Black fathers warrant greater consideration as partners in promoting male adolescent sexual health service use.

0759 Multidimensional Sleep Health is Associated with Emotional Well-being in Adolescents

Abstract Introduction Multidimensional sleep health (MSH) is a population-based approach to capture the 24-hour experience of sleep by incorporating measures of nighttime sleep and daytime functioning that promote physical and mental well-being. We have updated the existing adolescent MSH model to incorporate objective and subjective sleep measures and, in the present study, examined its utility in identifying associations between MSH and behavioral and emotional well-being. Methods We studied 377 adolescents (16.4 ± 2.3 yr; 46.4% female; 21.5% racial/ethnic minority) from the Penn State Child Cohort, a randomly-selected population-based sample. Using the RU-SATED framework – regularity, satisfaction, alertness, timing, efficiency, and duration – we derived an MSH composite score based on actigraphy-measured and self-reported sleep data. We examined the associations between MSH and scores on both the adolescent version of the Child Behavior Checklist (CBCL) and on the Pediatric Behavior Scale (PBS). CBCL’s internalizing, externalizing, thought and attention problems scores were self-reported, while similar behavioral and emotional cluster scores on the PBS were parent-reported. Results Higher MSH scores were associated with lower thought (r=-0.21, p&amp;lt; 0.001), externalizing (r=-0.18, p&amp;lt; 0.001), attention (r=-0.16, p&amp;lt; 0.01) or internalizing (r=-0.12, p&amp;lt; 0.05) problems. Higher MSH scores were associated with lower scores on the rule-breaking (r=-0.27, p&amp;lt; 0.001) and aggressive (r=-0.21, p&amp;lt; 0.001) externalizing subscales. For the internalizing subscales, higher MSH scores were associated with lower anxious-depressed (r = -0.17, p&amp;lt; 0.01), withdrawn-depressed (r=-0.14, p&amp;lt; 0.01), and somatic complaints (r=-0.12, p&amp;lt; 0.05) scores. Analyses based on parent reports on the more fine-grained PBS cluster scores replicated CBCL’s associations; for example, higher MSH scores were associated with lower depression (r=-0.19, p&amp;lt; 0.01) and inattention (r=-0.12, p&amp;lt; 0.05) as observed by parents. Conclusion Optimal sleep health, when considered as a multidimensional construct, is associated with emotional well-being and better behavioral outcomes in adolescents. Our MSH model, derived from objective and subjective sleep metrics, is able to capture similar trends from self-report and parent-report measures of emotion and behavior. Support (if any) National Institutes of Health (R01HL136587, UL1TR000127)

THE INFLUENCE OF RACIAL VIOLENCE IN NEIGHBORHOODS AND SCHOOLS ON THE PSYCHO-BEHAVIORAL OUTCOMES IN ADOLESCENCE

Racism in all its manifestations is violence. This study examines the effect of discrimination-based racial violence in neighborhoods and schools on adolescent psychological and behavioral outcomes, while also testing the moderating influence of civic engagement. Researchers used a cross-sectional survey design to measure neighborhood and school-based racial discrimination, civic engagement, racial identity development, racism-based stress, and aggressive behaviors in a sample of 167 13 - 23 year old adolescents and emerging adults. Participants were recruited through a cluster randomized trial to test the impact of blight remediation in preventing youth violence. Study researchers hypothesized a direct effect of racial discrimination on adolescents’ racism-based stress and aggressive behaviors and a buffering effect of civic engagement on these relationships. Researchers also examined these relationships in participants with higher-than-average racial identity development scores. Multivariate regression models revealed a significant direct effect of both neighborhood and school discrimination on adolescents’ aggressive behaviors. Civic engagement had a positive buffering effect in the relationship between neighborhood discrimination and aggressive behaviors. Similar relationships were observed among adolescents with a high racial identity with stronger effect. Study findings have implications for understanding the behavioral impact of racial violence and investing in civic engagement to mitigate its impact in adolescence and emerging adulthood.

Housing insecurity and adolescent behavioral outcomes: The mediating role of aggression in parenting

BackgroundHousing insecurity impacts millions of families with children each year and is linked with a range of adverse outcomes. Greater understanding of pathways linking housing insecurity with emotional and behavioral problem is needed to prevent enduring mental health problems. The Family Stress Model and Bronfenbrenner's Ecological Model contribute understanding to the complex dynamics underlying development from childhood to adolescence in the context of economic hardship and parental strain. ObjectiveThe present study aimed to investigate the mediating role of harsh parenting in the relationship between childhood housing insecurity and adolescent behavior problems. Participants and settingData from the Fragile Families and Child Well-being Study, and included a sample of at-risk mothers with children from 20 large U.S. cities (N = 2719). MethodsStructural equation modeling with latent variables tested direct and indirect pathways from housing insecurity at age 5 with emotional and behavioral problems at age 15 via intermediary harsh parenting at age 9. ResultsHousing insecurity directly predicted adolescent anxious/depressive behaviors (β = 0.14, p < 0.01); and indirectly predicted rule-breaking (β = 0.04, p < 0.01), aggressive (β = 0.05, p < 0.01), and anxious/depressive (β = 0.03, p < 0.05) behaviors via psychological aggression in parenting. ConclusionsFailure to address housing hardship among families with young children increases maltreatment risk and subsequent enduring mental health problems. Efforts to identify and mitigate housing hardship and maltreatment among at-risk families offer promise to promote long-term mental health in the transition from childhood to adolescence.

Effects of antenatal micronutrient supplementation regimens on adolescent emotional and behavioral problems: A 14-year follow-up of a double-blind, cluster-randomized controlled trial

Antenatal multiple micronutrient supplementation has been shown to have beneficial effects on birth outcomes and may improve child development. However, whether there is an effect of antenatal micronutrient supplementation strategies on offspring socioemotional outcomes remains unknown. We aimed to examine the effect of antenatal folic acid (FA), iron-folic acid (IFA), and multiple micronutrient (MMN) supplementation on adolescent emotional and behavioral outcomes. We conducted a double-blind, cluster-randomized trial of antenatal micronutrient supplementation in rural western China between 2002 and 2006. Pregnant females were randomized by village to receive either daily (i) 400μg FA, (ii) IFA containing 60mg iron and 400μg FA or (iii) MMN supplementation containing 30mg iron, 400μg FA plus 13 additional vitamins and minerals. A 14-year follow-up of their offspring was conducted in 2016. Adolescents were administered the locally adapted Youth Self-Report-2001 (YSR-2001) which produced internalizing, externalizing, and total behavior problem scores. We applied generalized estimating equations to assess the effect of the randomized regimens on YSR-2001 scores and explored the potential effect modification by household wealth and initial timing and duration of supplementation. A total of 1920 adolescents were included in the analysis, 1130 (58.9%) were male, and the mean (SD) age was 11.8 (0.78) years. Adolescents in IFA group had lower total (mean difference (MD):-2.89; 95% CI -5.73,-0.04) and externalizing (MD:-0.97; 95% CI -1.79,-0.15) problem scores as compared to those in FA group. There was no effect of MMN on behavior problem scores as compared to IFA and FA alone. Although, in effect modification analyses, MMN appeared to have greater beneficial effects in wealthier households than IFA and FA alone. Iron supplementation during pregnancy reduced adolescent emotional and behavioral problem scores which provides additional support for expanding coverage of iron-containing prenatal supplements in resource-limited settings. isrctn. org Identifier: ISRCTN08850194.

Do extracurricular activities contribute to better adolescent outcomes? A fixed-effects panel data approach.

Extracurricular activity participation is associated with positive academic, health, and behavioral outcomes for adolescents, but these findings may reflect unobserved confounding rather than participation effects. Data were drawn from 3885 adolescents aged 12-15 in a nationally representative cohort of Australian adolescents. Effects of participation in three kinds of extracurricular activity (team sport, individual sport, and arts) on an array of outcomes were modeled using fixed-effects regression to account for potential unobserved confounding. Strong bivariate relationships between all forms of activity participation and positive adolescent outcomes were found. These associations were much smaller in the fixed-effects analysis, but beneficial effects of sports for mental health and arts for peer group characteristics remained statistically significant. Minimal effects of extracurricular activity participation for academic achievement were found. Extracurricular activity participation has beneficial effects on adolescents' mental health and exposure to peers' delinquent behavior.

A Tri-Directional Examination of Parental Personality, Parenting Behaviors, and Contextual Factors in Influencing Adolescent Behavioral Outcomes

Links between parental personality, parenting, and adolescent behavior have been well established. However, extant research is limited by the sole focus on parental Big Five personality, and not taking home and family context into account. These gaps were addressed in two studies. In study 1, context, parental personality, and their interactions were examined as predictors of parenting in separate mother and father models (parents only). In study 2, context, parental personality, and parenting were examined as predictors of adolescent behavioral outcomes (parent–adolescent dyads). Parents (N = 283, 45.6% mothers, Mage = 45.51 years) completed assessments of socioeconomic status (SES), adverse childhood experiences (ACEs), personality (Big Five, Dark Triad), and parenting. Adolescents (N = 257, 51.4% female, Mage = 13.65 years) completed an assessment of behavior. Parent Dark Triad domains explained more variance in parental warmth and hostility than the Big Five, but equivalent variance in adolescent behavior. SES interacted with maternal personality, whereas ACEs interacted with paternal personality, to predict parenting behavior. The results showcase the importance of assessing a wider spectrum of parental personality, and examining contextual factors, in affecting adolescent development.

What do parents do? Towards conceptual clarity in the study of parental influence on adolescent developmental and behavioural outcomes

This conceptual paper utilises Situational Action Theory, the adolescence and parenting literatures, and a parental monitoring and crime use-case, to emphasise two separate but inter-related and co-existing distinctions i) between parenting behaviours that guide and control (behaviour distinction), and ii) between parenting behaviours that influence developmental and behavioural outcomes (goal distinction); and intersect these distinctions to identify four kinds of parental influence. The specificity of distinctions and their intersection are rarely made explicit in parenting research, resulting in concepts, design, analysis, and conclusions which conflate various parenting features and processes. This paper goes right back to basics and contributes to clarity in the conceptual foundations of parental influence on adolescent development and behaviour. By facilitating conceptual clarity and detailed specification of mechanisms, this paper under-labours to support the future development of better models of parental influence. In turn, this can underpin strong empirical research into the causes of adolescent behaviour that has the most utility for effective policy.

Long-term neuropsychological and behavioral outcome of mild and moderate hypoxic ischemic encephalopathy

BackgroundOutcomes for infants who survive mild-moderate hypoxic ischemic encephalopathy (HIE) into adolescence is relatively uncharted. AimsWe examined neuropsychological and behavioral outcomes in adolescents with mild and moderate HIE, using both parent and self - informants, and including healthy peers and nearest age siblings as controls. Participants23 adolescents with a history of mild-moderate HIE (M age = 14.45 years, SD = 1.03; 14 boys and 9 girls) were recruited from an original cohort of 53. A group of their nearest – age siblings (n = 13), and healthy peers (n = 14) were recruited as controls. Outcome measuresA number of neuropsychological sub-tests, taken from the WISC-V.UK, Children's Memory Scale, NEPSY, WIAT-III.UK, Rey Complex Figure Copy Test and British Picture Vocabulary Scale were administered. Behavioral adjustment was assessed using the Strengths and Difficulties Questionnaire and the competence subscales of the Child Behavior Checklist. ResultsNo differences in neuropsychological and behavioral outcomes were observed between mild and moderate HIE cohorts. Together they had significantly lower scores on tests of attention/executive functioning, verbal reasoning and sensory-motor ability compared to healthy peers, with moderate to large effect sizes. Remedial provision at school was greater in the HIE group. Parents reported elevated levels of peer problems in the HIE group compared to both siblings and healthy peers. Reduced competencies were also observed. ConclusionsWe found evidence that both mild and moderate survivors of HIE experience neuropsychological, school and peer relationship problems in adolescence.

Acceptability of an mHealth App for Youth With Substance Use and Mental Health Needs: Iterative, Mixed Methods Design.

BackgroundTreating substance use disorders (SUDs) during adolescence can prevent adult addiction and improve youth outcomes. However, it can be challenging to keep adolescents with SUDs engaged in ongoing services, thus limiting potential benefits. Developmentally appropriate tools are needed to improve treatment engagement during and between sessions for youth with SUDs and mental health disorders. Mobile health apps may augment or replace psychotherapy components; however, few have been developed specifically for youth with SUDs following user-guided design principles, which may limit their appropriateness and utility. Formative research on acceptability to intended end users is needed before the efficacy of such tools can be examined.ObjectiveThis study involves user-centered, iterative development and initial user testing of a web-based app for adolescents with SUDs and mental health concerns.MethodsAdolescents aged 14 to 17 years with past-year involvement in outpatient psychotherapy and behavioral health clinicians with adolescent SUD treatment caseloads were recruited. Across 2 assessment phases, 40 participants (alpha: 10 youths and 10 clinicians; beta: 10 youths and 10 clinicians) viewed an app demonstration and completed semistructured interviews and questionnaires about app content and functionality.ResultsParticipants expressed positive impressions of the app and its potential utility in augmenting outpatient therapy for youth with SUDs and mental health concerns. Noted strengths included valuable educational content, useful embedded resources, and a variety of activities. Adolescents and clinicians favored the app over conventional (paper-and-pencil) modalities, citing convenience and familiarity. The app was found to be user-friendly and likely to improve treatment engagement. Adolescents suggested the inclusion of privacy settings, and clinicians recommended more detailed instructions and simplified language.ConclusionsThe novel app developed here appears to be a promising, acceptable, and highly scalable resource to support adolescents with SUDs and mental health concerns. Future studies should test the efficacy of such apps in enhancing adolescent behavioral health treatment engagement and outcomes.

The effect of attending schools with higher ability peers on memory and language abilities in later‐life

AbstractBackgroundPeers influence adolescent behavior, educational, and health outcomes. Evaluating the influence of school‐mates’ cognitive aptitude on later‐life cognition is important for understanding the role of school segregation and tracking in establishing inequality. Yet, few studies have the data to study this. We used a national high‐school based study followed up 58 years later to examine if attending schools with more skilled peers predicts individual later‐life cognition.MethodIn 1960, about 5% of US high schools participated in Project Talent (n=377,000), where students reported demographics and completed aptitude tests. Some of these students were enrolled in 2018/2019 (mean age=74.6) in the Project Talent Aging Study (PTAS). For each PTAS participant, we calculated peer cognitive aptitude as the average of cognitive aptitudes of all other students who were in the same high school. The outcome, later‐life cognition, was operationalized as z‐score composites for language (semantic and phonemic fluency) and memory (CERAD learning list and delayed recall). For each outcome we estimated multilevel linear models to account for school clustering. All models were adjusted for age, sex/gender, parental education; secondary models were also adjusted for the participant’s own adolescent cognitive aptitude. To examine heterogeneity of the association, we evaluated interactions of peer ability with sex/gender, and the participant’s own adolescent cognitive aptitude.ResultParticipants were predominantly non‐Hispanic White (80.4%) and women (52.6%). Attending schools with peers who averaged 1 standard deviation higher on cognitive aptitude predicted better later‐life cognition prior to adjustment for own aptitude (language: β=0.162, 95% CI: 0.120, 0.205; memory: β=0.084, 95% CI: 0.041, 0.126), but not after adjustment. However, for women (β=0.045, 95% CI: ‐0.012, 0.101) and those with below mean adolescent cognitive aptitude (β=0.091; 95% CI: 0.016, 0.166), attending schools with higher ability peers predicted better later‐life language scores even after own ability was considered. There was no moderation of these relationships by race/ethnicity.ConclusionPeople with below average cognitive aptitude in adolescence had better language function 58 years later if they attended high schools with high aptitude peers. Future work will examine the plausible life‐course mechanisms to address why certain groups benefit more from schooling contextual factors.