At-risk Youth Research Articles

COMT Val/Met, stressful life events and externalizing behaviors in youth: A longitudinal study from the ABCD sample

Early adolescence is a crucial time for understanding and detecting the risk factors that may influence youth externalizing/disruptive behaviors and disorders. Previous literature reported evidence that risk factors for disruptive behaviors include catechol-O-methyltransferase (COMT) Val158Met (rs4680) polymorphism and environmental influences. An unanswered question is whether there is a change in these risk factors over stages of youth development. This longitudinal study examines the interaction effect of Val158Met and stressful life events (SLE) on youth externalizing behaviors from ages 9–11. Participants were 2363 children of European ancestry recruited as part of the Adolescent Brain Cognitive Development study. Repeated measures linear mixed models were used to examine the effect of the interaction between Val158Met and SLE (G × E) on disruptive behaviors over development. Externalizing behaviors were analyzed at both baseline and two-year follow-up. Both Val158Met genotype and SLE scores demonstrated significant main effects on disruptive behaviors in youth, and those effects were consistent at both time points. G × E was not associated with externalizing behaviors. Youth who carried the Val allele and/or were exposed to higher SLE consistently had increased externalizing behavior scores. To our knowledge, this is the first study to longitudinally examine the interaction effects of Val158Met and SLE on externalizing behaviors in youth. The results highlight the importance of understanding the genetic and environmental factors underlying externalizing behaviors for better detection of at-risk youth, helping further with early prevention efforts. The findings propose that COMT Val158Met genotype may act as a biomarker for development of novel treatment strategies for disruptive behaviors.

Heightened neural activity and functional connectivity responses to social rejection in female adolescents at risk for depression: Testing the Social Signal Transduction Theory of Depression

BackgroundAlthough social rejection is among the strongest proximal precipitants of major depressive disorder (MDD), little is known about the underlying neurobiological mechanisms and whether neural sensitivity to social rejection may help explain differences in MDD risk. To address this issue, we tested whether neural responses to social threat differed in female adolescents at high vs. low maternal risk for MDD. MethodFemale adolescents with (high-risk; n = 22, Mage = 14.68) and without (low-risk; n = 30, Mage = 15.07) a maternal history of depression were experimentally exposed to negative and neutral social evaluation while undergoing an fMRI scan. Neural responses were assessed by event-related activity and functional connectivity, as well as multivoxel pattern analysis. Activity and functional connectivity analyses focused on a priori-selected regions of interest implicated in self-referential processing and emotion regulation. ResultsCompared to low-risk female adolescents, high-risk female adolescents exhibited greater increases in self-reported depression and social disconnection following social evaluation. Moreover, compared to low-risk female adolescents, high-risk female adolescents exhibited greater amygdala responses to negative social evaluation and a differential pattern of functional connectivity in brain regions related to emotion regulation, self-referential processing, and negative affect. Additionally, these markers of neural threat reactivity were related to depressive symptoms. LimitationsA cross-sectional study design and relatively small, Western sample. ConclusionsThese results suggest that exaggerated neural reactivity to social threat—and an atypical pattern of related functional connectivity—is evident in individuals with a preclinical risk factor for depression. Targeting such responding may thus be a fruitful strategy for preventing depression in at-risk youth.

Intrapersonal and Interpersonal Disengagement Coping: Associations with Emotions of Youth At-Risk for Huntington's Disease.

Families in which a parent has Huntington's disease (HD) are faced with significant stressors that can contribute to difficulties in communicating together about illness-related concerns. Family members who use more disengagement coping strategies, including denial and avoidance, to deal with illness-related stressors may have the greatest challenges to effective communication. The current study examined the associations of intrapersonal and interpersonal disengagement coping responses with observed and reported emotions of adolescents and young adults (AYA) at genetic risk for HD. Families included 42 AYA (n = 26 females) ages 10 to 34 (M = 19 years, 11 months; SD = 7 years, 6 months) and their parent with HD (n = 22 females, M age = 46 years, 10 months; SD = 9 years, 2 months). Dyads participated in observations of communication and completed questionnaires about disengagement coping and internalizing symptoms. Disengagement coping of AYA was unrelated to their observed and reported emotional difficulties (intrapersonal coping). However, there was evidence for the importance of interpersonal disengagement coping, as AYA's negative affect was observed and reported to be highest when both AYA and their parents reported using high levels of avoidance, denial, and wishful thinking to cope with HD-related stress. The findings underscore the importance of a family-oriented approach to coping and communication in families affected by HD.

Needs-Based Mentoring in Schools: A Holistic Approach for Working with Youth at-Risk

This article describes a theoretical framework for a school-based mentoring (SBM) approach that addresses identified limitations of current adult-youth mentoring practices in schools and augments them with evidence-based components. The Needs-Based Mentoring (NBM) approach includes five elements: (1) Engage, (2) Teach, (3) Structure, (4) Advocate, and (5) Assess. These elements include component practices. Throughout NBM, mentors collaborate with mentees to identify goals based on an informal assessment of the student-mentee’s willingness and ability to engage in the activities involved in each element of mentoring. A description of each element is provided, as well as recommendations for training school-based professionals (e.g., teachers, administrators, school counselors, staff and paraprofessionals) as mentors for efficiency and sustainability. This applied approach will enhance school-based mentoring for the future of one-on-one targeted mentoring with youth at-risk of school dropout to improve school engagement and social-emotional outcomes.

The SPEAK study rationale and design: A linguistic corpus-based approach to understanding thought disorder.

Psychotic symptoms are typically measured using clinical ratings, but more objective and sensitive metrics are needed. Hence, we will assess thought disorder using the Research Domain Criteria (RDoC) heuristic for language production, and its recommended paradigm of "linguistic corpus-based analyses of language output". Positive thought disorder (e.g., tangentiality and derailment) can be assessed using word-embedding approaches that assess semantic coherence, whereas negative thought disorder (e.g., concreteness, poverty of speech) can be assessed using part-of-speech (POS) tagging to assess syntactic complexity. We aim to establish convergent validity of automated linguistic metrics with clinical ratings, assess normative demographic variance, determine cognitive and functional correlates, and replicate their predictive power for psychosis transition among at-risk youths. This study will assess language production in 450 English-speaking individuals in Australia and Canada, who have recent onset psychosis, are at clinical high risk (CHR) for psychosis, or who are healthy volunteers, all well-characterized for cognition, function and symptoms. Speech will be elicited using open-ended interviews. Audio files will be transcribed and preprocessed for automated natural language processing (NLP) analyses of coherence and complexity. Data analyses include canonical correlation, multivariate linear regression with regularization, and machine-learning classification of group status and psychosis outcome. This prospective study aims to characterize language disturbance across stages of psychosis using computational approaches, including psychometric properties, normative variance and clinical correlates, important for biomarker development. SPEAK will create a large archive of language data available to other investigators, a rich resource for the field.

Police Mentoring of At-Risk Youth: Case Study of Police-Led Mentoring Program Leadership Development

Police-led organizations provide officers with the ability to mentor youth in a nurturing environment that empowers them to succeed academically, behaviorally, and socially. This article focuses on how police officers mentor youths in a major urban area in the southeast. A case study was presented of a police-led organization, which included in-depth interviews with program leaders and mentors, participant observations, and a review of secondary sources over 2 years. The main findings from the study are as follows: (1) program leaders emphasize that caring mentors need to be empathetic toward youth exposed to gun violence, (2) officers’ previous experiences matter for their motivation to become mentors, and (3) officers stimulate students by taking them out of their usual social environments. This research expands the theoretical understanding of how police-led organizations influence the lives of youth exposed to gun violence. The characteristics of police officers who serve as mentors are crucial and can impact program outcomes. Practical implications for program leaders are discussed.

Risk and Protective Factors and Interventions for Reducing Juvenile Delinquency: A Systematic Review

Juvenile delinquency is a pressing problem in the United States; the literature emphasizes the importance of early interventions and the role of the family in preventing juvenile delinquency. Using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) framework, PudMed, and Scopus, we included 28 peer-reviewed articles in English between January 2012 and October 2022. We evaluated the existing literature regarding the risk factors, protective factors, and interventions related to juvenile delinquency. We searched articles that discussed reducing juvenile delinquency and recidivism in the U.S. and coded them into four overarching themes: ‘family conflict and dysfunction’, ‘neglect and maltreatment’, ‘individual and family mitigating factors’, and ‘family- and community-based interventions. We found that family conflict and dysfunction and neglect and maltreatment were two primary predictors of juvenile delinquency. Notably, higher academic achievement and strong and positive parental relationships were factors that protected against delinquency amongst at-risk youth. Interventions that yielded optimal efficacy in curbing recidivism included family-based interventions, specifically family therapy, and community-based interventions. Considering multi-dimensional factors that affect delinquent behaviors, interventions should consider the influence of family, peers, neighborhood, schools, and the larger community.

Examining Sexual and Dating Violence by Gender Identity Among High School Students

PurposeThis study examined the reporting of sexual and dating violence among high school students using a standard gender identity question. MethodsUsing data from the 2017 and 2019 Youth Risk Behavior Surveys, multivariable regression models estimated the association between gender identity and four measures of sexual and dating violence, adjusted for confounding by race/ethnicity, grade, and reported sex. ResultsOf the 198,900 teenagers, 1.8% identified as transgender, 1.6% were not sure, and 1.9% responded that they did not know what question was being asked. Across all measures of violence, transgender, “unsure” and “don't understand” students were significantly more likely than cisgender students to report having been victimized. DiscussionStandard analysis practices of eliminating unsure and/or don't understand responses to gender identity questions may underestimate at-risk youth. Researchers seeking to understand disparities in youth violence by gender identity will need to ensure that they employ inclusive measures.

Spirituality Discipline in Building Insaniah Values for Selected At-Risk Youth Group in Malaysia: A Literature Review

Spirituality Discipline in Building Insaniah Values for Selected At-Risk Youth Group in Malaysia: A Literature Review

The Importance of the Younger Generation in Combating the Dangers of Juvenile Delinquency

This research explored the pivotal role of the younger generation in addressing the dangers associated with juvenile delinquency. The study examined the multifaceted benefits of involving youth in preventative and intervention strategies to curb delinquent behaviors. Through a comprehensive literature review and analysis, the research highlighted key findings. 1) Early intervention and prevention programs targeting at-risk youth offer a promising approach to disrupting the trajectory of delinquent behaviors. Engaging the younger generation through mentorship, education, and community involvement equips them with essential life skills and values that act as deterrents. 2)The influence of peers and positive role models plays a vital role in shaping behavior. 3) Empowering young individuals to take ownership of change promotes a sense of responsibility and agency. 4) The effective communication methods employed by the youth, such as social media, facilitate the dissemination of anti-delinquency messages. The research emphasized the long-term societal impact of involving the youth. By nurturing responsible, empathetic individuals, society sets the stage for sustained positive change, as engaged youth transition into responsible adults who contribute positively to their communities. Collaborative approaches that involve young individuals in understanding the root causes of delinquency led to more comprehensive solutions. The active involvement of the younger generation through early intervention, positive peer influence, empowerment, effective communication, and community collaboration not only addresses immediate challenges but also shapes a future defined by safer communities and responsible citizenship.

Effectiveness of Youth Risk Prevention Programs When Virtually Adapted

PurposeCOVID-19 forced many youth risk prevention programs to be adapted to virtual formats. It remains unclear whether virtual programming is as effective as in-person programming. This study examined program logistics, differences in reach of at-risk youth and risk reduction in a youth substance use prevention program before and after being adapted to a virtual platform due to COVID-19. MethodsRural high school students in a substance use prevention program completed baseline and follow-up surveys. Data were included from two program cohorts, one in 2020 (In-person; N = 331) and the second in 2021 (virtual; N = 426). Survey data were analyzed to compare differences between cohorts in ability to reach at-risk youth and effects on risk reduction. Data on program logistics were drawn from open-ended facilitator questionnaires and site observation reports. These data were analyzed to understand benefits and challenges with virtual program implementation. ResultsIn-person participants were older, in a higher grade, and reported higher rates of substance abuse, reported higher rates of substance use, sexual behaviors, and risky sex. Virtual program participants reported higher rates of unprotected sex and future intentions of unprotected sex. Neither program showed significant reduction in risk intermediary factors. Positive attitudes about the benefits of substance use increased during the virtual program. Thematic analysis revealed problems with implementing the virtual program, including low attendance and technology issues. DiscussionIn-person programs moved to virtual delivery may be less effective at reaching at-risk youth, may have smaller impact on risk prevention and may encounter logistical problems. Because previous research has found that technology-based interventions can be effective, future research should seek to evaluate how to strengthen evidence-based practices when delivery modality changes.

Evaluating the Effectiveness of Suicide Prevention Gatekeeper Trainings as Part of an American Indian/Alaska Native Youth Suicide Prevention Program

According to the Centers for Disease Control suicide rates in 2022 for American Indian/Alaska Native youth are 2.5 times higher than the national average. An Urban Indian Health Organization’s response to this crisis was to provide community and State-wide Gatekeeper trainings between 2012 and 2019 to teach trainees (N = 810) to respond appropriately to youth at-risk of suicide. We report data on pre-, post-, and six-month follow-up surveys with trainees. Data were analyzed using generalized linear models repeated measures to test within-subject, and between-subject mean score changes on suicide prevention-related measures “knowledge,” “ask directly,” “respond,” “comfort,” and “preparedness.” Results indicated improved capacity to be prepared to address suicide in the short term and that having a graduate degree enhanced baseline suicide prevention knowledge. Over time those with less education benefited the most and better retained content. Future Trainings should engage young people and those with less education to realize the largest benefit.

Educating Youth to Civic Engagement for Social Justice: Evaluation of a Secondary School Project.

The positive effects of youth civic engagement can be felt both at the individual level (e.g., better emotional regulation, a greater sense of empowerment) and at the community level (e.g., a greater likelihood of participation in civic and political activities). They may also be a protective factor for at-risk youth in the short and long term and a valuable element for positive identity development in general. The purpose of this longitudinal study was to assess the impact of an educational intervention implemented in secondary schools to promote youth civic engagement (N = 508 at Time 1, N = 116 at Time 2). The study is divided into two parts: first, it examines the changes stimulated by the project, and second, it uses a path analysis model to explain the intention to participate. Results show that after participation, hostile and benevolent sexism, classic and modern ethnic prejudice, and social dominance orientation decreased, while trust in institutions increased. In addition, the path analysis showed that policy control, social trust, and civic engagement increased the intention of civic engagement at time T1. Despite some limitations, this study may provide useful guidance for those designing and implementing civic education interventions for young people.

Item Validity and Reliability in Building Insaniah Value for Selected At-Risk Youth Groups in Malaysia

Item Validity and Reliability in Building Insaniah Value for Selected At-Risk Youth Groups in Malaysia

An "All-Data-on-Hand" Deep Learning Model to Predict Hospitalization for Diabetic Ketoacidosis in Youth With Type 1 Diabetes: Development and Validation Study.

Although prior research has identified multiple risk factors for diabetic ketoacidosis (DKA), clinicians continue to lack clinic-ready models to predict dangerous and costly episodes of DKA. We asked whether we could apply deep learning, specifically the use of a long short-term memory (LSTM) model, to accurately predict the 180-day risk of DKA-related hospitalization for youth with type 1 diabetes (T1D). We aimed to describe the development of an LSTM model to predict the 180-day risk of DKA-related hospitalization for youth with T1D. We used 17 consecutive calendar quarters of clinical data (January 10, 2016, to March 18, 2020) for 1745 youths aged 8 to 18 years with T1D from a pediatric diabetes clinic network in the Midwestern United States. The input data included demographics, discrete clinical observations (laboratory results, vital signs, anthropometric measures, diagnosis, and procedure codes), medications, visit counts by type of encounter, number of historic DKA episodes, number of days since last DKA admission, patient-reported outcomes (answers to clinic intake questions), and data features derived from diabetes- and nondiabetes-related clinical notes via natural language processing. We trained the model using input data from quarters 1 to 7 (n=1377), validated it using input from quarters 3 to 9 in a partial out-of-sample (OOS-P; n=1505) cohort, and further validated it in a full out-of-sample (OOS-F; n=354) cohort with input from quarters 10 to 15. DKA admissions occurred at a rate of 5% per 180-days in both out-of-sample cohorts. In the OOS-P and OOS-F cohorts, the median age was 13.7 (IQR 11.3-15.8) years and 13.1 (IQR 10.7-15.5) years; median glycated hemoglobin levels at enrollment were 8.6% (IQR 7.6%-9.8%) and 8.1% (IQR 6.9%-9.5%); recall was 33% (26/80) and 50% (9/18) for the top-ranked 5% of youth with T1D; and 14.15% (213/1505) and 12.7% (45/354) had prior DKA admissions (after the T1D diagnosis), respectively. For lists rank ordered by the probability of hospitalization, precision increased from 33% to 56% to 100% for positions 1 to 80, 1 to 25, and 1 to 10 in the OOS-P cohort and from 50% to 60% to 80% for positions 1 to 18, 1 to 10, and 1 to 5 in the OOS-F cohort, respectively. The proposed LSTM model for predicting 180-day DKA-related hospitalization was valid in this sample. Future research should evaluate model validity in multiple populations and settings to account for health inequities that may be present in different segments of the population (eg, racially or socioeconomically diverse cohorts). Rank ordering youth by probability of DKA-related hospitalization will allow clinics to identify the most at-risk youth. The clinical implication of this is that clinics may then create and evaluate novel preventive interventions based on available resources.

Neurocognitive and clinical characteristics of elementary school-aged children with a history of suicidal thoughts and behaviors

BackgroundSuicidal thoughts and behaviors (STBs) in elementary school-aged youth have increased in recent years. Understanding the risks associated with childhood STBs is necessary for prevention efforts. MethodsThe current study examined clinical and neurocognitive characteristics of a community sample of elementary school-aged children with (STB+) and without (STB-) a history of STBs. The final sample included 93 families with children average age of 7.8 years (SD = 1.3). Children in this sample were racially diverse, evenly split by sex, and most identified as non-Hispanic. Neurocognitive functioning was assessed using computerized behavioral measures. Child clinical characteristics were assessed using self-report measures and STB history was assessed using semi-structured interviews. ResultsOf the 93 families, 64 STB- children and 29 STB+ children participated. On average, STB+ children were older, reported higher levels of depressive and anxiety symptoms, and were more likely to have a parental history of suicidal behavior (PH+). Regarding neurocognitive functioning, STB+ children exhibited lower raw scores for both the NIH Dimensional Change Card Sort Task (NIH-DCCS) and NIH Flanker Inhibitory Control and Attention Test (NIH-Flanker). Multivariable regression analyses revealed raw scores for NIH-DCCS and NIH-Flanker, PH+ status, and child age were associated with childhood STBs. LimitationsProspective data is needed to confirm cross-sectional findings. ConclusionsPoorer neurocognitive functioning and PH+ status may serve as risk markers for STBs in elementary school-aged children. Targeting prevention programming for these risks may reduce the likelihood of STBs in at-risk elementary school-aged youth.

Substance familiarity in middle childhood and adolescent substance use

BackgroundChildhood familiarity with (knowledge of) substances is a potentially important, currently understudied adolescent substance use risk factor. We aimed to describe changes in childhood familiarity with substances and to test whether baseline familiarity predicts early adolescent substance use. MethodsUtilizing the Substance Use Module of the longitudinal cohort study, Adolescent Brain Cognitive Development (ABCD; US youth aged 9–10 years followed for 10 years) through Data Release 4 (n=7896; individuals who completed all six assessments in the first three years), we conducted longitudinal mixed models and survival analyses to describe changes in familiarity and to determine the adjusted odds of substance use by age 13 based on number of familiar substances at baseline. ResultsThe sample consisted of 3754 females and 4142 males, aged 9–10 at baseline, with majority White individuals (68.9%). Unconditional time models indicated age significantly predicted familiarity (B=0.08, p<0.001; R2=0.288) with ~3.59 familiar substances at 9 years increasing to ~7.43 substances at 13 years. Family history, home use, peer use, and neighborhood availability predicted familiarity, accounting for 1% of additional variance (R2=0.299; ∆R2=0.011). For each additional familiar substance at baseline, adjusted odds of future use increased 1.28 times (95% CI 1.22, 1.34). ConclusionsThis is the first study to characterize substance familiarity in this age range as a predictor of future substance use. Familiarity increases with age (age being the most predictive indicator). Familiarity at age 9–10 predicts early adolescent substance use. As such, childhood familiarity may represent an easily implemented screening tool for at-risk youth.

Lipoprotein(a): a Case for Universal Screening in Youth.

Lipoprotein(a) has emerged as a strong independent risk factor for cardiovascular disease. Targeted screening recommendations for Lp(a) measurement exist for adults and youth known to be at high-risk. However, Lp(a) measurements are not included in universal screening guidelines in the US; hence, most families in the US with high Lp(a) levels who are at risk of future atherosclerotic heart disease, stroke, or aortic stenosis are not recognized. Lp(a) measurement included as part of routine universal lipid screening in youth would identify those children at risk of ASCVD and enable family cascade screening with identification and early intervention for affected family members. Lp(a) levels can be reliably measured in children as young as two years of age. Lp(a) levels are genetically determined. The Lp(a) gene is inherited in a co-dominant fashion. Serum Lp(a) attains adult levels by two years of age and is stable for the lifetime of the individual. Novel therapies that aim to specifically target Lp(a) are in the pipeline, including nucleic acid-based molecules such as antisense oligonucleotides and siRNAs. Inclusion of a single Lp(a) measurement performed as part of routine universal lipid screening in youth (ages 9-11; or at ages 17-21) is feasible and cost effective. Lp(a) screening would identify youth at-risk of ASCVD and enable family cascade screening with identification and early intervention for affected family members.

Feasibility of a universal suicidality tool for adolescents.

The suicide rate among adolescents has been increasing rapidly over the past several years. Adequate screening for suicide risk in this population, particularly youth of color, is lacking. The Ask Suicide-Screening Questions (ASQ) tool was implemented at two adolescent-focused health clinics in a large U.S. city. This project followed the Ottawa Model of Research Use. Participating clinicians were surveyed before and after receiving an educational module on suicide risk screening, the ASQ tool, and clinical pathways. Clinicians were also asked about the feasibility and acceptability of the ASQ tool in their practice. An electronic medical records software was used to gather data on patients newly screened for suicide risk using the ASQ tool. Among eligible patients, 40.2% were screened using the ASQ tool during the 4-month duration of the project. Most clinicians reported that using the tool was feasible within their practice (66%) and 100% endorsed its acceptability (i.e., reporting that they were comfortable screening for suicide and that the ASQ was easy to use). The ASQ may be a promising screening tool for clinicians to use to address the mental health needs of at-risk youth. This project supports the universal acceptability and feasibility of its use in inner-city primary care clinics.

The Value of Mental Health Screening for Adolescents Attending School-Based Health Centers

Although 65% of school-based health centers (SBHCs) offer mental health services, at-risk youth are commonly overlooked or do not follow up when referrals are made. Universal screenings may increase identification of those in need of mental health support. We examined the number of youth at three SBHCs referred for mental health consultations. Comparisons were made between provider referrals and those with elevated scores on the Youth Pediatric Symptom Checklist-17 (Y-PSC-17). Of the 585 patients in this study, 37 (6.32%) were referred solely by their Y-PSC-17 score, 36 (6.15%) youth were singularly referred by providers, and 19 (3.25%) were referred by both modalities. Almost three-quarters ( n = 67; 72.8%) of identified youth elected to receive psychotherapeutic services. Approximately half of the youth referred by providers ( n = 19; 52.8%) received individual services, while 36.11% ( n = 13) received group services. Smaller proportions of youth with elevated Y-PSC-17 scores received individual ( n = 7; 18.9%) and group services ( n = 11; 29.7%). Youth referred solely by a medical provider had significantly lower scores than those identified through an elevated Y-PSC-17 score. Findings highlight the necessity of universal screening in pediatric settings in addition to physician referrals to provide a supplemental layer of prevention and early identification of behavioral health concerns. In this study, 40% referrals would have been missed if both modalities were not in place. Educating medical providers on youth mental health concerns may enhance identification of those in need of mental health supports and in turn improve long-term outcomes.