Externalizing Behavior Problems Research Articles

Is the association of chronotype with adolescent behavior problems mediated through social jetlag?

ABSTRACT We examined the associations of chronotype with behavior problems in a cross-sectional study of 957 Colombian adolescents (mean age, 14.6 years; 56% female), in addition to the mediating role of social jetlag. The midpoint of bedtime and waketime on free days, corrected for sleep debt accumulated during school week (MSFsc), was estimated from parent reports and used to assess chronotype. Behavior problems were evaluated through the Youth Self-Report (YSR) and the parent-completed Child Behavior Checklist (CBCL) questionnaires. We estimated adjusted mean differences with 95% CI in externalizing, internalizing, attention, social, and thought problem scores per one hour difference in chronotype using linear regression. Later chronotype was related to internalizing and externalizing behavior problems. Eveningness was associated with higher adjusted mean YSR scores (unit difference per hour) in externalizing behavior (1.0; 95% CI: 0.6, 1.5), internalizing behavior (0.6; 95% CI: 0.2, 1.1), attention problems (0.2; 95% CI: 0.0, 0.3), social problems (0.4; 95% CI: 0.1, 0.8), and thought problems (0.3; 95% CI: 0.1, 0.6). Similar patterns were observed with the CBCL. The associations of chronotype with somatic complaints and social problems were stronger in boys than they were in girls. Later chronotype was related to social jetlag but social jetlag was only associated with somatic complaints and attention problems, and mediated 16% and 26% of their corresponding associations with chronotype. In conclusion, later chronotype is associated with behavior problems in adolescence. Social jetlag does not substantially mediate these associations.

Stability and cross-lagged relations among callous-unemotional traits, moral identity, moral emotion attribution and externalizing behavior problems in adolescents

This study investigates the associations of adolescents callous-unemotional traits with moral constructs and the interplay of various outcomes. The present study builds on the lack of research and focuses on the longitudinal relationships between CU-traits, moral identity, moral emotion attribution and externalizing behavior problems in adolescence. The included variables were collected at test time points T1 and T2. To determine the predictive, and stability links among the variables, a cross-lagged model in SPSS AMOS 26 was conducted. Time stability path estimates were moderate to highly stable over time for all included variables. Significant cross lagged paths of moral identityT1 on moral emotion attributionT2, CU-traitsT1 on moral identityT2, externalizing behavior problemsT1 on moral emotion attributionsT2 and externalizing behavior problemsT1 on CU-traitsT2, could be found.

Latent classes of bullying perpetration and victimization among adolescents: Associations with problem behaviors

ObjectiveThis study aimed to identify latent classes of bullying perpetration and victimization among adolescents and to explore associations between latent class membership and problem behaviors. MethodsA total of 758 Chinese middle school students participated in the study. Participants were asked to complete the Olweus Bully/Victim Questionnaire, the Delaware Bullying Victimization Scale-Student (DBVS-S), the eleven-item Kutcher Adolescent Depression Scale (KADS-11), the Generalized Anxiety Disorder 7-Item Scale (GAD-7), the ten-Item Internet Gaming Disorder Test (IGDT-10) and the Generic Scale of Phubbing (GSP). ResultsLatent class analysis identified three unique subgroups, including the victimization predominant bully-victims (10.4 %), aggression predominant bully-victims (4.8 %) and the noninvolvement class (84.8 %). Male students were more likely to be aggression predominant bully-victims than females. The results revealed that students in the victimization predominant bully-victim class reported higher levels of depression than those in the aggression predominant bully-victims class (χ2 = 6.57, p < 0.05) and the noninvolvement class (χ2 = 26.89, p < 0.001). Victimization predominant bully-victims and aggression predominant bully-victims rated higher levels of anxiety, internet gaming disorder and phubbing compared with those in the noninvolvement class. ConclusionsThese findings inform anti-bullying intervention programs developed to reduce adolescents’ internalizing and externalizing problem behaviors.

부모의 정신건강 프로파일 유형 분류 및 아동의 내재화⋅외현화 문제행동 차이 비교

Objectives The purpose of this study was to classify different profiles based on the indicators of mental health at parental level and find out differences in children's internalizing/externalizing behavior problems by subtypes of parental mental health profile.&#x0D; Methods Survey data of 1,071 children and parents from the 12th Panel Study on Korean Children(PSKC) in 2019 were used for the analyses. Dyadic latent profile analysis was used for classifying subtypes of parental mental health profiles, and Three-step approach was used for testing differences in children's internalizing/externalizing behavior problems by subtypes of parental mental health profiles.&#x0D; Results First, Four subtypes(‘pattern mismatch-vulnerable mother’, ‘pattern match-vulnerable parents’, ‘pattern mismatch-vulnerable father’, ‘pattern match-stable parents’) were classified according to the indicators of parental mental health. Second, There were significant differences in children's internalizing behavior problems, ‘pattern mismatch-vulnerable mother’ and ‘pattern match-vulnerable parents’ were higher than others. Third, There were significant differences in children's externalizing behavior problem, ‘pattern match-vulnerable parents’ was the highest in externalizing behavior.&#x0D; Conclusions This study showed implications in identifying the relationships between parental mental health and children's behavior problem by exploring subtypes of parental mental health profiles in a multifaceted manner and suggested implications for improving parental mental health to attenuate children's behavior problems.

Tele-PCIT: Initial Examination of Internet Delivered PCIT for Young Children with Autism.

Parent-Child Interaction Therapy (PCIT) is an empirically supported behavioral parenting program for disruptive behavior and has been shown to also be effective for children with autism spectrum disorder (ASD). Telehealth delivery of PCIT (Tele-PCIT) is also supported, but no trials have focused on children with ASD. The purpose of the study was to examine the initial efficacy of a time limited version of Tele-PCIT within an ASD sample. Participants included parents of 20 children (ages 2-6) with ASD who received 10 sessions of Tele-PCIT. Parents reported on their parenting stress, parenting practices, and child behavior. A play observation was coded for parent use of treatment skills and for child compliance. 80% of participants completed treatment (n = 16) and results revealed significant improvements across parenting and child outcomes. Parents reported decreases in parenting stress from pre-to-post-treatment, which were maintained at a 3-month follow-up, along with decreases in negative parenting practices (i.e., Laxness and Overactivity) from pre-to-post treatment that were also maintained at follow-up. Significant increases in parent use of positive parenting skills (i.e., "Do" Skills) during child-led play and decreases in negative parenting skills (i.e., "Don't" Skills) were observed. Results also revealed significant reductions in parent rated child externalizing behavior problems from pre-to-post-treatment that were also maintained at follow-up. Results of the current study support the initial efficacy of Tele-PCIT for treating disruptive behavior in young children with ASD. Findings from this pilot will inform larger examinations of Tele-PCIT for youth with ASD.

Does the Quality of Early Childhood Education and Care Centers Mitigate the Risk of Externalizing Problems? A Genetic-Sensitive Study of Preschoolers in Germany

This paper examines the extent to which quality characteristics of early childhood education and care (ECEC) experienced at ages 4–6 influence externalizing problems at ages 6–8. Based on a random sample of 713 same-sex twins (55% female, 41% with a migration background) in 364 ECEC centers in Germany, the paper not only distinguishes between detailed ECEC quality characteristics but additionally investigates whether these characteristics affect the relevance of genetic and environmental influences on externalizing problem behavior. Results demonstrate that with educators’ further training and the child–staff ratio only a few specific ECEC quality indicators moderate the relevance of genetic and environmental influences. In particular, further training of educators reduces genetic contributions to externalizing problems in children. Although there was also evidence for gene–environment correlation owing to selection into ECEC centers with an unfavorable child–staff ratio, the findings suggest that improving educators’ training is the most promising way of counteracting externalizing problems.

Child bodyweight, cognitive abilities, and well-being: evidence from West Bank schools

ABSTRACT The present study investigates the effect of obesity and overweight on children’s cognitive abilities and well-being using survey data from West Bank schools. The results show the significant adverse impact of obesity on a child's well-being by raising externalizing (behavioral) problems and increasing the probability of classifying a child with abnormal mental health difficulties, according to the Strength and Difficulties Questionnaire (SDQ), while no such impact was founded on the cognitive test results. The analysis further exposes that teachers’ negative attitude toward obese students is an important factor that contributes to the association between obesity/overweight and higher SDQ scores.

EXTERNALISING BEHAVIOUR PROBLEMS IN ADOLESCENCE PREDICTED BY PARENTAL MONITORING, PRACTICES AND ATTACHMENT: EXPLORING THE MODERATING ROLE OF GENDER

Research suggests the differences between parenting boys and girls related to externalising behaviour problems. Self-reported measures were used on a sample of 507 Belgrade secondary school students (42.1% male) to examine the moderating effect of gender on the relationship of parental monitoring (the Scale of Parental Monitoring), parental attachment (the Inventory of Parents and Peer Attachment, IPPA), and parental practice (the Alabama Parenting Questionnaire) with externalising problems (aggressive and rule-breaking behaviour) (ASEBA, YSR). The research results show gender differences in rule-breaking behaviour, externalising problems and some parenting variables. Hierarchical regression analyses revealed significant predictors of aggressive behaviour, rule-breaking behaviour and externalising problems, whereby poor monitoring displayed the strongest relations with all of the criteria. The moderating effect of gender was identified in explaining the links between communication with the mother, positive parenting and trust in the father with rule-breaking behaviour. The research results were discussed in the context of the protective relationship in the father-son and mother-daughter dyads for rule-breaking behaviour. The practical implications of differentiation between the relevance of mothers’ and fathers’ parenting for adolescent adjustment in terms of gender are provided. Key words parenting, externalising problems, gender

0637 Associations Between Sleep Quality and Child Behavioral Problems, a Longitudinal Analysis

Abstract Introduction Internalizing and externalizing behaviors are important mental health outcomes in children. Internalizing symptoms are characterized by a disturbance in mood or emotion. Symptoms include loneliness, sadness, anxiety, rumination, and depression. Externalizing symptoms are behaviors that are aversive to others and experienced by other people. Symptoms include aggression, hyperactivity, property destruction, and losing one’s temper. This longitudinal analysis examined how children’s sleep quality related to their internalizing and externalizing behaviors. Methods 246 Children (n = 246 at T1, n = 196 at T2, n = 151 at T3), with a mean age of 9.9 (SD = 1.4) at time one, participated in a longitudinal study on sleep and substance use. Sleep quality was measured with the Adolescent Sleep Wake Scale (range 1-6); higher scores represent better sleep quality. Child internalizing and externalizing behavior problems were measured using the Childhood Behavior Checklist; higher scores indicate higher levels of behavioral problems. The associations between sleep quality, and internalizing and externalizing behavior at T1, T2, and T3 were examined. One year separated each time-point. Data were analyzed by structural equation modeling. Latent variables of sleep quality, internalizing, and externalizing were created from the observed measurements at the three time-points. Latent variables of internalizing and externalizing were regressed on sleep quality. Results The model indicated an excellent fit with the data (χ2 = 21.94, p = 0.46; CFI = 1.00; TLI = 1.00; RMSEA = 0.00). All observed variables loaded significantly onto their respective latent variables, internalizing, externalizing, and sleep quality (p &amp;lt; 0.001). Results indicated that the latent variable of sleep quality predicted both the latent variables of internalizing (b = -0.34, se = 0.09, p &amp;lt; 0.001) and latent externalizing behaviors (b = -0.31, se = 0.08, p &amp;lt; 0.001). Conclusion These results indicate children with better sleep quality have fewer internalizing and externalizing behavioral problems. This suggests that improving sleep quality could improve behavioral problems in children. Alternatively, improving behavioral problems may improve sleep quality. Future research should examine the directionality of this relationship. Future research should also test if sleep or behavioral interventions improve sleep quality and child behavioral problems. Support (if any) NIH Grant R01 AA020364

Early-life exposure to a mixture of organophosphate esters and child behavior.

Organophosphate esters (OPEs), widely used as flame retardants and plasticizers for commercial and residential purposes, are suspected of being neurotoxic. We aimed to assess exposure to an OPE mixture in early life and its relationship to parent-reported child behavior. We measured urinary concentrations of three OPE metabolites, bis-2-chloroethyl phosphate (BCEP), bis(1,3-dichloro-2-propyl) phosphate (BDCIPP), and diphenyl phosphate (DPHP), at pregnancy (16 and 26 weeks of gestation and delivery) and postnatal time points (ages 1, 2, 3, and 5 years) in the Health Outcomes and Measures of the Environment Study, a longitudinal pregnancy and birth cohort in Cincinnati, Ohio, USA (enrolled 2003-2006, n=219). We used latent variable analysis in structural equations models and quantile g-computation to investigate associations of a mixture of the three OPE metabolites with parent-reported child behaviors at 3 and 8 years, measured using the Behavioral Assessment System for Children, Second Edition. Higher log-transformed urinary OPE latent variable values at 16 weeks were associated with fewer externalizing problem behaviors (ß=-5.74; 95% CI=-11.24, -0.24) and fewer overall behavioral problems at age 3 years (ß=-5.26; 95% CI=-10.33, -0.19), whereas having higher OPEs at delivery was associated with poorer overall behavioral problems at age 3 years (ß=2.87; 95% CI=0.13, 5.61). OPE latent variable values at 16 weeks, 26 weeks, and delivery were not associated with child behavior at 8 years. However, higher OPE latent variable values at 3 years were associated with fewer externalizing behaviors at 8 years (ß=-2.62; 95% CI=-5.13, -0.12). The quantile g-computation estimates had directions largely consistent with the latent variable analysis results. Pregnancy and postnatal urinary OPE metabolite mixtures were associated with child internalizing, externalizing, and overall negative behaviors at 3 and 8 years, but we did not identify a consistent pattern in terms of the direction of the effects or a particularly sensitive time point.

Cumulative Risk and Externalizing Behaviors during Infancy in a Predominantly Latine Sample

Externalizing behavior problems are among the top mental health concerns in early childhood, and many parenting interventions have been developed to address this issue. To better understand predictors of parenting intervention outcomes in high-risk families, this secondary data analysis evaluated the moderating effect of cumulative risk on child externalizing behaviors, parenting skills, and intervention dropout after completion of a home-based adaptation of the child-directed interaction phase of parent-child interaction therapy (PCIT) called the Infant Behavior Program (IBP). The participants included 58 toddlers (53% male; average age of 13.5 months; and 95% Hispanic or Latine) who were part of a larger randomized control trial in which families were randomly assigned to receive the IBP or treatment as usual (TAU). Cumulative risk was found to moderate the effect of the intervention group on child externalizing behaviors such that the participants in the intervention group with higher cumulative risk scores had greater reductions in externalizing behaviors. A potential explanation for these unexpected findings may be that the obstacles to treatment that were previously imposed by comorbid risk factors (i.e., lack of transportation, time commitment, and language barriers) were adequately addressed such that the families who most needed the intervention were able to remain fully engaged.

Elementary Classroom Views of Nature Are Associated with Lower Child Externalizing Behavior Problems.

Exposure to nature views has been associated with diverse mental health and cognitive capacity benefits. Yet, much of this evidence was derived in adult samples and typically only involves residential views of nature. Findings from studies with children suggest that when more greenness is available at home or school, children have higher academic performance and have expedited attention restoration, although most studies utilize coarse or subjective assessments of exposure to nature and largely neglect investigation among young children. Here, we investigated associations between objectively measured visible nature at school and children's behavior problems (attention and externalizing behaviors using the Brief Problem Monitor Parent Form) in a sample of 86 children aged seven to nine years old from 15 classrooms across three schools. Images of classroom windows were used to quantify overall nature views and views of specific nature types (sky, grass, tree, shrub). We fitted separate Tobit regression models to test associations between classroom nature views and attention and externalizing behaviors, accounting for age, sex, race/ethnicity, residential deprivation score, and residential nature views (using Google Street View imagery). We found that higher levels of visible nature from classroom windows were associated with lower externalizing behavior problem scores, after confounder adjustment. This relationship was consistent for visible trees, but not other nature types. No significant associations were detected for attention problems. This initial study suggests that classroom-based exposure to visible nature, particularly trees, could benefit children's mental health, with implications for landscape and school design.

Policies Affecting Pregnant Women with Substance Use Disorder

Policies Affecting Pregnant Women with Substance Use Disorder

어머니의 통제적 양육행동과 아동의 집행기능곤란, 문제행동의 변화궤적에 따른 잠재집단 간 종단적 이행양상 분석

Objectives The purposes of this study were to identify latent classes according to the trajectory of changes in mothers' controlling controlling child-rearing behavior in infancy, executive function difficulties in early school age, and internalizing and externalizing problem behaviors in school age, and to identify the transition patterns between latent classes for finding interventions to prevent and reduce problem behaviors.&#x0D; Methods 860 mothers and children's data taken from Panel Study on Korean Children's 4th to 12th years were analyzed. For the analyses of this study, SPSS Statistics 23.0 and Mplus 8.7 were used, and latent growth model(LGM), growth mixture model(GMM), sequential-process growth mixture model(SP-GMM) were used as statistical analysis models.&#x0D; Results First, as a result of GMM, 3 latent classes for the mother's controlling child-rearing behavior, 5 latent classes for the executive function difficulties in children's early school age were found. Also, 4 latent classes for the internalizing problems in the school age of children and 3 latent classes for the externalizing problems in the school age of children were found. Second, result of SP-GMM showed that, there were high probability of transition from the latent class for high level of mother's controlling child-rearing behavior with child in infancy to the latent class for high level of executive function difficulties in children's early school age through the latent classes for high level of internalizing/externalizing problems in children's the school age.&#x0D; Conclusions In order to prevent internalizing and externalizing problem behaviors in school-age children, it is necessary to reduce and prevent executive function difficulties in early school-age children, and for prevention the executive function difficulties, interventions that reduce the mother's controlling child-rearing behavior in infancy can be helpful. In addition, this study suggests that it is more effective to implement different interventions for each latent class than to do the same intervention for all childten in order to reduce children's executive function difficulties and prevent internalizing and externalizing problem behaviors.

Investigation of the Predictive Effect of Parents' Life Positions on Preschool Children's Behavior Problems.

The aim of the study was to examine the effect of parents' life position on the prediction of behavioral problems of preschool children. The sample of the study consisted of 364 children enrolled in independent kindergartens and preschools of primary schools affiliated to Altındağ District Directorate of National Education in Turkey and their parents (290 mothers and 97 fathers). In the study, the survey model, which aims to determine the current situation among quantitative research methods, and the relational model, which aims to reveal the link between two or more variables and the strength of the link, were used (Frankel et al., 2011). The data obtained from the study in which "Family Information Form, Preschool and Kindergarten Behavior Scale and Life Positions Scale" were used as data collection tools were analyzed with Pearson Correlation Coefficient and Multiple Regression analysis methods. When the findings of the research were examined, it was found that as the "I am Okey, You are Okey" life position of the parents increased, the children's total behavior problems, which consisted of internalizing, externalizing and a combination of internalizing and externalizing behavior problems, decreased whereas "I am not Okey, You are Okey" and "I am not Okey, You are not Okey" life positions increased, the children's internalizing, externalizing and total behavior problems increased. Moreover, the regression analysis results of the study showed that parents' life positions had a statistically significant effect in predicting their children's behavior problems.

Longitudinal Relation between Family Socio-Economic Status and Problem Behaviors in Chinese Children: The Roles of Sense of Coherence and Maternal Warmth.

Literature has well-documented the relation of family socio-economic status (SES) to children's problem behaviors, yet the complex mechanisms underlying the relation are not well understood. Therefore, the primary goal of this one-year longitudinal study was to explore the mediating role of children's sense of coherence and the moderating role of perceived maternal warmth in the association between family SES and externalizing and internalizing problems in Chinese children. The sample consisted of 913 children (493 boys; Mage = 11.50 years, SD = 1.04) in fourth to sixth grades in an urban area in mainland China. Data were obtained from multiple sources, including child self-reports, parental reports, and teacher ratings. The results indicated that children's sense of coherence mediated the association between family SES and internalizing problem behaviors, but not externalizing problem behaviors. This mediating role was also moderated by maternal warmth and specifically, family SES was negatively associated with internalizing problem behaviors via the sense of coherence for children who perceived high maternal warmth. Generally, these results highlighted the possible roles of a sense of coherence and maternal warmth in the longitudinal implications of family SES for Chinese children's internalizing problems.

Measurement Efficiency of a Teacher Rating Scale to Screen for Students at Risk for Social, Emotional, and Behavioral Problems

Teacher rating scales are broadly used for psycho-educational assessment in schools. In particular, they play an important role in screening students for social, emotional, and behavioral problems. In order to optimize the efficiency of these measures, it is important to minimize the number of items comprising them while maintaining sound psychometric characteristics. This study examines the measurement efficiency of a teacher rating scale for student social, emotional, and behavioral risk. The goal was to shorten an existing behavior screening tool. A total of 139 classroom teachers and 2566 students from Grades 1-6 (Mage = 8.96 years, SD = 1.61) participated in the study. In sum, 35 items assessing internalizing and externalizing behavior problems were analyzed applying the item response theory (generalized partial credit model). The results show that social, emotional, and behavioral risks can be captured with a total of 12 items. This reduction of almost 66% of the initial item pool would take teachers about 90 s to fill out for one student. Thus, the rating scale can be used by teachers in an efficient yet psychometrically sound manner.

An Integrative Data Analysis of Main and Moderated Crossover Effects of Parent-Mediated Interventions on Depression and Anxiety Symptoms in Youth in Foster Care.

Without preventative intervention, youth with a history of foster care (FC) involvement have a high likelihood of developing depression and anxiety (DA) symptoms. The current study used integrative data analysis to harmonize data across four foster and kinship parent-mediated interventions (and seven randomized control trials) designed to reduce youth externalizing and other problem behaviors to determine if, and for how long, these interventions may have crossover effects on youth DA symptoms. Moderation of intervention effects by youth biological sex, developmental period, number of prior placements, and race/ethnicity was also examined. Youth (N = 1891; 59% female; ages 4 to 18years) behaviors were assessed via the Child Behavior Checklist, Parent Daily Report, and Eyberg Child Behavior Inventory at baseline, the end of the interventions (4-6months post baseline), and two follow-up assessments (9-12months and 18-24months post baseline), yielding 4830 total youth-by-time assessments. The interventions were effective at reducing DA symptoms at the end of the interventions; however, effects were only sustained for one program at the follow-up assessments. No moderation effects were found. The current study indicates that parent-mediated interventions implemented during childhood or adolescence aimed at reducing externalizing and other problem behaviors had crossover effects on youth DA symptoms at the end of the interventions. Such intervention effects were sustained 12 and 24months later only for the most at-risk youth involved in the most intensive intervention.

Relationships between dynamic risk factors for externalising problem behaviour and group climate in adults with mild intellectual disability in forensic treatment.

Relationships between dynamic risk factors for externalising problem behaviour and group climate were investigated in 151 adult in-patients with mild intellectual disability or borderline intellectual functioning in a Dutch secure residential facility. Regression analysis was used to predict total group climate score and Support, Growth, Repression, and Atmosphere subscales of the 'Group Climate Inventory'. Predictor variables were Coping Skills, Attitude towards current treatment, Hostility, and Criminogenic attitudes subscales of the 'Dynamic Risk Outcome Scales'. Less hostility predicted a better overall group climate, better support and atmosphere, and less repression. A positive attitude towards current treatment predicted better growth. Results indicate relationships of hostility and attitude towards current treatment with group climate. A focus on both dynamic risk factors and group climate may provide a basis for improving treatment for this target group.

Satisfaction with videoconference-delivered CBT provided as part of a blended treatment approach for children and adolescents with mental disorders and their families during the COVID-19 pandemic: A follow-up survey among caregivers and therapists

Introduction Psychotherapy delivered via videoconferencing (teletherapy) was a well-accepted treatment option for children and adolescents during the early phases of the COVID-19 pandemic. Information on the long-term satisfaction with teletherapy in routine clinical practice is missing. Methods Caregivers (parents) and psychotherapists of n = 228 patients (4–20 years) treated in a university outpatient clinic completed a follow-up survey on satisfaction with videoconference-delivered cognitive-behavioral treatment (CBT). The follow-up survey (T2) was conducted about 1 year after initial assessment of treatment satisfaction in 2020 (T1). Results At follow up, therapists reported that 79% of families had received teletherapy as part of a blended treatment approach including in-person and videoconference delivery of CBT. Wilcoxon tests revealed that satisfaction with teletherapy was stable over time. In addition, parent ratings of the impact of teletherapy on treatment satisfaction and the therapeutic relationship did not change over time. Therapists’ ratings of the impact of teletherapy on the therapeutic relationship with the caregiver were more negative at T2 compared to T1. Satisfaction with teletherapy was higher for patients with less pandemic-related stress, less externalizing behavior problems, and older age (all r < .35). Conclusion The high level of satisfaction with teletherapy for children and adolescents treated in routine clinical practice reported in 2020 was maintained after social distancing regulations were eased in 2021. Teletherapy provided as part of a blended treatment approach is a well-accepted method of treatment delivery for youths with mental health problems. The study was registered in the German Clinical Trials Register (DRKS00028639).