Internalising Symptoms Research Articles

BPT for Early-Onset Behavior Disorders: Examining the Link Between Treatment Components and Trajectories of Child Internalizing Symptoms.

Behavioral Parent Training (BPT) is the standard of care for early-onset Behavior Disorders (BDs). Preliminary evidence suggests that BPT may also lead to improvement in comorbid symptomatology, particularly internalizing problems, in children with BDs, yet less is currently known about how BPT produces such cascading effects. To begin to address this gap in the literature, trajectory analyses were used to examine the link between treatment components of one mastery-based BPT program, Helping the Noncompliant Child (HNC), and child internalizing symptoms over the course of treatment. Findings revealed that parental use of the Attends skill (i.e., parental description of child activity with warmth and enthusiasm) over time was significantly associated with decreases in trajectories of child internalizing symptoms across treatment. Further probing of these effects revealed that parent use of average or above-average levels of Attends across treatment sessions led to significant reductions in child internalizing symptoms by Sessions 7 to 10 of treatment. Consistent with the movement toward a modular approach to the treatment of children, findings highlight the importance of identifying particular BPT skills that can be used in treatment to target multiple comorbid child symptom clusters. Clinical implications and future directions are discussed.

Paternal psychological distress, parenting, and child behaviour: A population based, cross-sectional study.

Child behaviour problems are common and can lead to later mental health problems. Poor maternal mental health and adverse parenting practices are known risk factors for child behaviour problems. Less is known about the association between paternal mental health and parenting, and child behaviour. We aimed to explore the association between paternal psychological distress and parenting (harsh discipline, low warmth, unreasonable expectations, and overinvolved/protectiveness) with children's internalising and externalising behaviour at 3years of age. Cross-sectional surveys of 669 (80% response) fathers of 3-year-old children, nested within a randomised controlled trial. Main outcomes of behaviour (Child Behavior Checklist), parenting (Parent Behavior Checklist and overinvolved/protective parenting scale), and psychological distress (Kessler-6) were measured. Regression modelling examined the associations between paternal factors and child behaviour, adjusting for maternal mental health and parenting, as well as child and family variables. In adjusted analyses, paternal psychological distress (b=0.43, 95% confidence interval [CI] [0.26-0.60], p<0.001), harsh discipline (b=0.20, 95% CI [0.13-0.27], p<0.001), and maternal mental health (b=0.08, 95% CI [0.03-0.12], p=0.001) were associated with externalising symptoms. However, only paternal psychological distress, harsh discipline, and being a boy were associated with borderline/clinical levels of externalising problems (all p<0.05). Paternal psychological distress, harsh discipline, overinvolved parenting, maternal mental health, and difficult child temperament were associated with internalising symptoms (all p<0.05). However, only paternal harsh discipline and overinvolved parenting were associated with borderline/clinical internalising problems. Paternal mental health and parenting are independently associated with child behaviour. Treatments for children with behavioural problems should also address paternal mental health and parenting.

Parental Monitoring and Adolescent Risk Behaviors: The Moderating Role of Adolescent Internalizing Symptoms and Gender

Parental monitoring can reduce adolescents’ engagement in risky behaviors; however, adolescents’ internalizing symptoms may alter the effectiveness of parental monitoring. The current study examines independent and interactive effects of maternal and paternal monitoring, adolescent’s internalizing symptoms, and adolescent gender on sexual behaviors and substance use with data from 659 of the 15-year-olds enrolled in the NICHD Study of Early Child Care and Youth Development. Results suggest girls who experienced less maternal monitoring and more internalizing symptoms—both independently and interactively—engaged in more risky sexual behaviors. Greater substance use was associated with less maternal and paternal monitoring for girls and boys, more internalizing symptoms for girls, and interactively with less maternal and paternal monitoring depending on girls’ levels of internalizing symptoms. The current study highlights the unique influences of mothers’ and fathers’ monitoring efforts on adolescent risky behavior based on the adolescent’s level of internalizing symptoms.

The relationship between pet ownership, social support, and internalizing symptoms in students from the first to fourth year of college

Internalizing symptoms are prevalent in students as they enter and complete college. Considering research suggesting mental health benefits of pet ownership, this study explores the relationship between pet ownership, social support (SS), and internalizing symptoms (IS) in a cohort of students across their 4-year college experience. With no differences at college entry, students growing up with pets had greater IS through the fourth year, and greater SS through the third year, than those without pets. Currently living with a pet, gender, SS and personality predicted IS in the fourth year. Females experiencing higher IS in their first year are more likely to live with pets in their fourth year, and fourth year females living with pets or greatly missing absent pets have higher IS than females without pets or missing pets less. Findings suggest a unique relationship between IS in female students and their pet relationships not seen in males.

Parenting Resilient Kids (PaRK), an online parenting program to prevent anxiety and depression problems in primary school-aged children: Study protocol for a randomised controlled trial

BackgroundPreventive efforts targeting childhood anxiety and depression symptoms have the potential to alter the developmental trajectory of depression and anxiety disorders across the lifespan. Substantial previous research suggests that modifiable parenting factors such as parental aversiveness and over-involvement are associated with childhood anxiety, depressive and internalising symptoms, indicating that parents can play a critical role in prevention. The Parenting Resilient Kids study is a new evidence-based online parenting program designed to prevent anxiety and depression problems in primary school-aged children by reducing family-based risk factors and enhancing protective factors through increased positive interactions between parent and child.Methods/designThe current study is a parallel group superiority randomised controlled trial with parent-child dyads randomised to the intervention or active-control group in a 1:1 ratio. The intervention group will receive the Parenting Resilient Kids program consisting of a feedback report on parenting behaviours and up to 12 interactive online modules personalised based on responses to the parent survey. The active-control group will receive a standardised package of online educational materials about child development and wellbeing. The trial website is programmed to run a stratified random allocation sequence (based on parent gender) to determine group membership. We aim to recruit 340 parent-child dyads (170 dyads per group). We hypothesise that the intervention group will show greater improvement in parenting risk and protective factors from baseline to 3-month follow-up (primary outcome), which will in turn mediate changes in child depressive and anxiety symptoms from baseline to 12 and 24 months (co-primary outcomes). We also hypothesise that the intervention group will show greater benefits from baseline to 3-, 12- and 24-month follow-up, with regard to: child depressive and anxiety symptoms (co-primary outcomes); and child and parent health-related quality of life, and overall family functioning (secondary outcomes).DiscussionThis randomised controlled trial will examine the efficacy of the Parenting Resilient Kids program as a preventive intervention for anxiety and depression symptoms in primary school-aged children, as well as changes in child and parent health-related quality of life. Findings from this study will examine design features that render web-based prevention programs effective and the extent to which parents can be engaged and motivated to change through a minimally guided parenting program.Trial registrationAustralian New Zealand Clinical Trials Registry (ANZCTR): Trial ID ACTRN12616000621415 Registered on 13 May 2016. Updated on 3 March 2017.

Relationships between Reading Ability and Child Mental Health: Moderating Effects of Self‐Esteem

ObjectiveChildren with reading difficulties are at elevated risk for externalising (e.g., conduct disorder) and internalising (e.g., anxiety and depression) mental health problems. Reading ability is also negatively associated with self‐esteem, a consistent predictor of child and adolescent mental health more broadly. This study examined whether self‐esteem moderated and/or mediated relationships between reading ability and mental health.MethodOne hundred and seventeen children (7–12 years) completed standardised reading assessments (Castles and Coltheart Test 2; CC2) and self‐report measures of mental health (Strengths and Difficulties Questionnaire; SDQ) and self‐esteem (Coopersmith Self‐esteem Inventory). Non‐verbal intelligence (IQ) was measured using the block design and matrix reasoning subscales of the Wechsler Abbreviated Scale of Intelligence, and was controlled for in all multivariate analyses.ResultsReading ability was negatively associated with internalising symptoms. This relationship was not moderated by self‐esteem. Poor readers also reported more total difficulties and externalising symptoms, but only at low levels of self‐esteem. There was no evidence that self‐esteem mediated relationships between reading ability and mental health.ConclusionsPoor reading was associated with internalising symptoms. Self‐esteem moderated the impact of reading ability on total difficulties and externalising symptoms, with high self‐esteem buffering against negative impacts of poor reading. However, the reliability of the self‐esteem scale used in the study was poor and findings need replication using a reliable and valid self‐esteem measure, as well as other measures of child mental health. If replicated, future research should examine whether interventions aiming to improve self‐esteem can reduce the risk of externalising problems in children with reading difficulties.

Affron®, a standardised extract from saffron (Crocus sativus L.) for the treatment of youth anxiety and depressive symptoms: A randomised, double-blind, placebo-controlled study

BackgroundSaffron has antidepressant and anxiolytic effects in adults with mild-to-moderate depression. However, this is the first study examining its mood-related effects in teenagers. MethodsIn this 8-week, randomised, double-blind, placebo-controlled study, youth aged 12–16 years, with mild-to-moderate anxiety or depressive symptoms were given tablets containing placebo or a saffron extract (affron®, 14 mg b.i.d). The youth and parent versions of the Revised Child Anxiety and Depression Scale (RCADS) were used as outcome measures. Results80 participants were enrolled and 68 completed the study. Based on youth self-reports, affron® was associated with greater improvements in overall internalising symptoms (p = 0.049), separation anxiety (p = 0.003), social phobia (p = 0.023), and depression (p = 0.016). Total internalising scores decreased by an average of 33% compared to 17% in the placebo group (p = 0.029). However, parental reports of improvements were inconsistent as mean improvements in RCADS scores were greater in the saffron group (40% vs 26%) (p = 0.026), although no other significant differences were identified. affron® was well-tolerated and there was a trend of reduced headaches in participants on the active treatment. LimitationsThe use of a self-report instrument, limited study duration, single treatment dose, and non-clinical sample used in this study limit the generalisability of study findings. ConclusionThe administration of a standardised saffron extract (affron®) for 8 weeks improved anxiety and depressive symptoms in youth with mild-to-moderate symptoms, at least from the perspective of the adolescent. However, these beneficial effects were inconsistently corroborated by parents.

Psychometric properties of the brief loss of control over eating scale (LOCES-B) in early adolescents.

The purpose of this study was to evaluate the psychometric properties of the brief loss of control over eating scale (LOCES-B) in a community sample of adolescents. Participants were 1,116 adolescents (11-15 years; 53% girls; 53% non-Hispanic White) recruited from middle schools in the Northeast United States. Participants were administered self-report surveys during school in the fall of 2016. Confirmatory factor analyses indicated that the LOCES-B total score was unidimensional, which was invariant across gender and weight status. The LOCES-B had excellent internal consistency (α = .92). The LOCES-B total score had large, positive relationships with the frequency of LOC eating episodes, objective bulimic episodes, and subjective bulimic episodes, and a small, positive relationship with objective overeating episode frequency. After adjusting for demographics, anthropometrics, and LOC eating frequency, adolescents reporting higher scores on the LOCES-B total score had greater body image dissatisfaction, more internalizing symptoms, and lower trait effortful control. Findings suggested that the LOCES-B is a reliable and valid measure of LOC eating in early adolescents. The availability of the LOCES-B has the potential to elucidate the developmental trajectories, predictors, and outcomes of LOC eating across the full severity spectrum in large cohort studies of youth.

The Wellbeing of Italian Peacekeeper Military: Psychological Resources, Quality of Life and Internalizing Symptoms.

Working as a peacekeeper is associated with the exposure to acute and/or catastrophic events and chronic stressors. Hence, the meager literature about peacekeepers’ wellbeing has mainly analyzed Post-Traumatic Stress Disorder (PTSD). This study aims to deep the analysis of the wellbeing of peacekeepers military. Based on the few studies on this population, we hypothesized that Italian peacekeeper military officers and enlisted men (n = 167; 103 males, 6 females, 58 missing) exhibit lower levels of internalizing symptoms (i.e., PTSD, depression, general anxiety, obsessions, and somatization) as compared to a control group (n = 60; 32 males, 28 females). Moreover, we hypothesized that peacekeepers have higher levels of psychological resources (i.e., self-efficacy, self-esteem, social support) and quality of life (i.e., higher life satisfaction and lower general stress). We compared the groups by means of MANOVAs on the subscales of the Psychological Treatment Inventory (PTI; Gori et al., 2015). We found that Italian peacekeepers have lower internalizing symptoms and higher levels of self-efficacy and self-esteem than the control group; however, no statistically significant differences were observed on perceived social support. Finally, peacekeepers have a higher quality of life: scores reflect higher life satisfaction and lower distress than the control group. This study is in line with previous literature supporting the claim that Italian peacekeeper military officers have sufficient psychological resources for coping with the stressful situations implied in peacekeeping missions. Future studies should deepen the analysis of the military’s psychological characteristics by comparing war veterans and peacekeeper military.

Bullying, mental health and friendship in Australian primary school children.

Frequent bullying predicts adolescent mental health problems, particularly depression. This population-based study with young Australian primary school children aimed to determine the frequency and mental health correlates of bullying, and whether friendship could be protective. Participants were a population-based sample of 1221 children aged 8-9years attending 43 primary schools in metropolitan Melbourne, Australia. Children were taking part in the Childhood to Adolescence Transition Study. Children completed online questionnaires at school to measure peer relations and emotional well-being. Parents reported on their child's mental health in questionnaires sent to the home. One in three children (29.2%) reported experiencing frequent bullying, defined as at least once a week. This included physical bullying alone (13.8%), verbal bullying alone (22.7%) and the combination (7.4%). Children who reported being frequently bullied self-reported higher internalising symptoms compared with children who did not report frequent bullying (M (SD) 1.6 (0.9) vs. 1.1 (0.8), p<.001). This difference was confirmed by parents' reports of their child's internalising symptoms (M (SD) 2.4 (2.3) vs. 2.1 (2.0), p=.026, respectively). Amongst children who reported frequent bullying, those with a group of friends had better emotional well-being. A substantial proportion of children report experiencing bullying on a weekly basis early in primary school. Given the prevalence of bullying in primary school and its relationship to children's mental health, we recommend effective school-wide antibullying programmes. Further research can explore whether intervention to foster a group of friends around bullied children can improve their emotional well-being.

Child Attachment Style as a Predictive Factor for Internalization and Externalization of Witnessing Community Violence

Internalization and externalization of negative symptomology associated with witnessing community violence can manifest in a number of disorders in children. Of those disorders diagnosed in childhood, research has shown that conduct disorder, social anxiety disorder, post-traumatic stress disorder, oppositional defiant disorder, intermittent explosive disorder, and disruptive mood dysregulation have a potential link to witnessing violence. Internalization symptoms can manifest as depressive mood, low self-esteem, and deficits in social interaction, poor interpersonal relationships, behavioral difficulties, and an overall poor adjustment. Externalization symptoms typically manifest in outwardly aggressive behaviors like physical and verbal violence, destruction of property, self-harm or self-destructive behaviors, tantrums, and antisocial tendencies. This review seeks to investigate the relation between attachment styles and the internalization and externalization of symptoms associated with witnessing community violence among African American youths who live in a lower income urban portion of the inner city. This study seeks to answer the following questions: What is the relationship between school, gender, and age of the participant and the expression of symptomology, what is the relationship between attachment style and symptomology, does violence severity moderate the relationship between witnessing community violence and symptomology, does attachment style moderate the relationship between witnessing violence and symptomology, and does attachment style moderate the relationship between violence severity and symptomology?

Psychodynamic Psychotherapy of a Child with Internalizing Symptoms: A Study of Outcomes

When psychopathology is considered as a developmental phenomenon, the data on child psychotherapy must be of interest to all therapists. The aim of this study was to assess the results of psychodynamic psychotherapy in a child with internalizing symptoms using data obtained from the patient, her mother, her teacher and her psychotherapist. A systematic single case study was performed. The data were obtained using the following tools: interviews, the Rorschach Method, the Child Behaviour Check List for Children and Adolescents, the Teachers Report Form and questionnaires completed by the patient's mother and therapist. The psychotherapeutic treatment lasted for 40 sessions and the patient was 8 years old at the start of therapy. She presented with head and stomach aches after the sudden death of her father, as well as difficulty adapting to her new school. The Rorschach results indicated improvement in cognitive triad variables, interpersonal relations and expressing affection. Data from the patient, mother and therapist converged to yield the clinical picture of a more spontaneous girl, dealing better with her feelings and more socially integrated. This points to the importance of using mixed methods to assess psychotherapies and of consulting multiple informants.

2.12 Mindfulness Training in Pregnancy, and PostPartum Internalizing Symptoms

2.12 Mindfulness Training in Pregnancy, and PostPartum Internalizing Symptoms

Depressive and anxious symptoms and the risk of secondary school non-completion.

BackgroundEvidence regarding the association between adolescent internalising symptoms and school non-completion has been limited and inconclusive.AimsTo examine whether depressive and anxious symptoms at secondary school entry predict school non-completion beyond confounders and whether associations differ by baseline academic functioning.MethodWe used logistic regression to examine associations between depressive and anxious symptoms in grade 7 (age 12-14) and school non-completion (age 18-20) in 4962 adolescents.ResultsDepressive symptoms did not predict school non-completion after adjustment, but moderation analyses revealed an association in students with elevated academic functioning. A curvilinear association was found for anxiety: both low and high anxious symptoms predicted school non-completion, although only low anxiety remained predictive after adjustment.ConclusionsAssociations between internalising symptoms and school non-completion are modest. Common school-based interventions targeting internalising symptoms are unlikely to have a major impact on school non-completion, but may prevent non-completion in selected students.

Mental health of preschool foster care children: How do foster families influence the way children cope with trauma?

Mental health of preschool foster care children: How do foster families influence the way children cope with trauma? Abstract. Parents and other significant persons have an important role when preschool children develop or cope with psychological symptoms following traumatic experiences. The underlying mechanisms of the interaction between traumatic experiences and influences of the foster family are still unclear. This study investigates foster parents' stress levels and parenting styles as moderators or mediators in the context of trau- matic experiences. Foster parents of 286 children between three and seven years participated in an online or paper-and-pencil survey. The results suggest a connection between the traumatic experiences of foster children and the stress levels as well as the parenting styles of their foster parents. While verbosity and laxness as parenting styles moderated the impact of traumatic experiences on externalising symptoms, stress levels mediated the impact of traumatic experiences on children's internalising and externalising symptoms. The results underscore the necessity of standardized preparation of and support for foster parents in order to avoid deterioration of psychological symptoms following traumatic events.

Weight-Related Abuse: Impact of Perpetrator-Victim Relationship on Binge Eating and Internalizing Symptoms

ABSTRACTDisordered eating and weight problems are associated with experiencing childhood abuse. While weight-related abuse (WRA; teasing and verbal abuse specific to one’s weight) uniquely predicts disordered eating and mood problems in adulthood, the link between WRA and adult outcomes is largely unexplored. Relationships between perpetrators and victims (e.g., family member vs. stranger) have demonstrated an impact on outcomes in research on sexual abuse, and may elucidate important aspects of the relationship between psychopathology and abuse. Thus, we investigated the effect of the perpetrator’s relationship to the victim on disordered eating symptoms in a population of young adults (N = 371) oversampled for current overweight and obesity. Parent perpetration of WRA was the strongest predictor of both depression and abuse-related emotional impact ratings. In contrast, friend and classmate perpetration of WRA were the sole predictors of binge eating and anxiety symptoms, respectively. Results highlight the importance of investigating the impact of multiple types of perpetrators of WRA, as well as the need to examine family and other close relationships in the treatment of disordered eating and internalizing symptoms.

The association between adolescent psychopathology and subsequent physical activity in young adulthood: a 21-year birth cohort study.

The beneficial effects of physical activity (PA) for both physical and mental wellbeing are well established. Given that adolescence presents a critical developmental period during which life-long patterns of PA become established, the exploration of the longitudinal impact of adolescent psychopathology on adult PA status is of interest. We analysed prospective data from 3663 young adults who participated in the Mater-University of Queensland Study of Pregnancy. Psychopathology was measured using the Youth Self-Report (YSR) at age 14. Participants' engagement in three types of PA (vigorous exercise, moderate exercise and walking) at age 21 were dichotomised into either 'none' or 'any'. For our main analysis, we examined the association between the YSR score and subsequent PA engagement using logistic regression. We also conducted sensitivity analyses of longitudinal associations between the YSR internalising and externalising symptoms score at age 14 and PA engagement at age 21. We found no longitudinal association between the total YSR score at age 14 and PA engagement at age 21. In addition, there was no longitudinal association between the YSR internalising or externalising symptoms and PA engagement. Our findings suggest that there is no longitudinal association between adolescent psychopathology and PA in young adulthood.

Black and White Parents’ Willingness to Seek Help for Children's Internalizing and Externalizing Symptoms

Understanding social and environmental factors that contribute to parental help-seeking intentions is an important step in addressing service underutilization for children in need of treatment. This study examined factors that contribute to parents' intentions to seek formal and informal help for child psychopathology (anxiety and attention-deficit/hyperactivity disorder [ADHD]). A total of 251 parents (N = 128 mothers, N = 123 fathers; 49% Black, 51% White) read 3 vignettes describing children with anxiety, ADHD, and no diagnosis. Measures of problem recognition, perceived barriers, and formal (pediatricians, psychologists, teachers) and informal (religious leaders, family/friends, self-help) help seeking were completed. Four separate hierarchical logistic regression models were used to examine parental help-seeking likelihood from formal and informal sources for internalizing and externalizing symptoms. Predictors were socioeconomic status, parent race, age, and sex, parent problem recognition (via study vignettes), and perceived barriers to mental health service utilization. Mothers were more likely than fathers to seek help from pediatricians, psychologists, teachers, and religious leaders for child anxiety and pediatricians, religious leaders, and self-help resources for child ADHD. Black parents were more likely to seek help from religious leaders and White parents were more likely to use self-help resources. Problem recognition was associated with greater intentions to seek help from almost all formal and informal sources (except from friends/family). Understanding factors that contribute to parental help seeking for child psychopathology is critical for increasing service utilization and reducing the negative effects of mental health problems. This study highlights the importance of decreasing help-seeking barriers and increasing problem recognition to improve health equity.

The Indirect Effect of Family Cohesion on Children’s Weight Status Through Maternal Quality of Life and Children’s Internalizing and Externalizing Symptoms

Obesity has serious psychosocial consequences for youth and family members and has reached epidemic levels in Portugal. This study had two goals: (1) to investigate differences in family cohesion, mothers’ quality of life (QoL), and externalizing/internalizing symptoms between children/adolescents with healthy-weight and overweight/obesity; (2) to assess the mediating role of maternal QoL and children/adolescents’ externalizing/internalizing symptoms in the association between family cohesion and weight. Children/adolescents with healthy-weight (n = 134) and with overweight/obesity (n = 163) and their mothers participated in the study. Mothers completed measures of family cohesion (FC) and QoL and children/adolescents completed measures of externalizing and internalizing symptoms. This study used a cross-sectional design. Children/adolescents with overweight/obesity reported higher levels of externalizing and internalizing symptoms than children/adolescents with healthy-weight. Mothers of children/adolescents with overweight/obesity reported lower levels of FC and QoL than mothers of children/adolescents with healthy-weight. Mothers’ QoL and children/adolescents’ externalizing symptoms sequentially mediated the relationship between FC and weight status. Specifically, an increase in FC and QoL resulted in a decreased likelihood of the child/adolescent reporting overweight or obesity, whereas an increase in externalizing symptoms resulted in a higher likelihood of the child/adolescent reporting overweight or obesity. This study identifies mechanisms that might account for the link between FC and weight, suggesting the importance of mothers’ QoL and children’s externalizing symptoms. Moreover, it provides a better understanding of the psychosocial outcomes related to pediatric obesity, highlighting the relevance of working with the parents to promote weight reduction in youths.

Long-Term Neuropsychological Outcomes of Childhood Onset Acute Disseminated Encephalomyelitis (ADEM): a Meta-Analysis.

The long-term neurocognitive prognosis of childhood onset acute disseminated encephalomyelitis (ADEM) is unclear. This review and quantitative synthesis of the available literature examined whether there are long-term impacts of childhood ADEM on neurocognitive functioning. A search of online databases (MEDLINE, EMBASE, EBSCO CINAHL, PsycINFO and the Cochrane Database of Systematic Reviews) from their inception to October 2015 and reference lists identified 13 papers eligible for inclusion in the systematic review; seven of these were eligible for inclusion in meta-analyses. The systematic review indicated that, at a group level there is a positive long-term neuropsychological outcome from childhood onset ADEM. However, despite the apparent absence of long-term negative impacts of ADEM at a group level, at an individual level impairments in the areas of IQ, attention, executive functioning, processing speed, learning and memory, visuospatial skills and internalising symptoms were found in up to 43% of patients when aggregated across the studies. No significant negative effect of ADEM for any of the neuropsychological domains examined was found in meta-analyses. However, the effects for Processing Speed (r mean=-0.296 (CI 95%=-0.605-0.013)) and Internalising symptoms (r mean=0.242 (CI 95%=-0.014-0.564)) approached significance (p=0.06), suggesting a trend towards ADEM leading to long-term reduced processing speed and elevated internalising symptoms. Together, our findings suggest that despite a generally positive neurocognitive outcome post childhood ADEM there are a subset of individuals who can suffer from ongoing specific cognitive impairments. Clinical implications and research priorities are discussed.