Adolescent Self-reports Research Articles

Internal and External Validity of Self-Report and Parent-Report Measures of Sluggish Cognitive Tempo in South Korean Adolescents

This study evaluated the internal and external validity of self-report and parent-report measures of sluggish cognitive tempo (SCT) in South Korean adolescents. Adolescents (N = 469, ages 13–17 years; 50.2% boys) completed self-report measures of SCT and attention-deficit/hyperactivity disorder inattention (ADHD-IN) in addition to measures of internalizing and externalizing psychopathology, social problems, and grades. Parents rated adolescents on SCT, ADHD-IN, internalizing and externalizing psychopathology, and social problems. Using adolescent self-report, 11 of 15 SCT symptoms showed convergent and discriminant validity with ADHD-IN. Using parent-report, all 15 SCT symptoms showed convergent and discriminant validity with ADHD-IN. For within source analyses, SCT showed unique and stronger associations than ADHD-IN with internalizing psychopathology whereas ADHD-IN showed unique and stronger associations than SCT with externalizing psychopathology. SCT and ADHD-IN showed similar unique associations with social problems, whereas ADHD-IN was more strongly related than SCT to grades. Across source analyses also supported the differential unique associations of SCT and ADHD-IN with internalizing and externalizing psychopathologies. This study provides initial evidence for the internal and external validity of SCT with South Korean adolescents, extending support for the transcultural validity of SCT to the important developmental period of adolescence.

Family Mealtime Communication in Single- and Dual-Headed Households Among Hispanic Adolescents With Overweight and Obesity

ObjectiveTo investigate the association of adolescent self-report of family mealtime communication on obesity-related behaviors in single- and dual-parent households and by sex in a sample of overweight and obese Hispanic adolescents. DesignCross-sectional analysis of a randomized control trial SettingEighteen middle schools in Miami-Dade County, Florida. ParticipantsTwo-hundred and eighty Hispanic seventh- and eighth-grade students Main Outcome MeasuresPhysical activity, fruit and vegetable intake, and added sugar intake. AnalysisStructural equation modeling. ResultsThe findings indicate that mealtime communication was associated with fruit and vegetable consumption in boys (β = .30; P = .001; 95% confidence interval [CI], 0.52–2.68) and physical activity in girls (β = .26; P = .010; 95% CI, 0.16–1.30). Moreover, a single-parent household was associated with dietary consumption in boys (fruit and vegetable intake [β= .18; P = .039; 95% CI, 0.02–2.60] but had a moderating effect on fruit and vegetable consumption in girls (β = .21; P = .015; 95% CI, 0.14–2.19). Conclusions and ImplicationsFamily mealtime communication may impact dietary and physical activity outcomes in Hispanic adolescents with overweight and obesity, but differentially across gender and household parent makeup. These findings, together with the prevalence of single parents, point to the importance of targeting Hispanic single parents as agents of change to promote healthy lifestyle behaviors in their children via positive mealtime interactions.

Do parent and self-report rating scales of executive function measure the same constructs with adolescents?

Objective: There are numerous measures of executive function (EF), yet the multiple definitions and constructions of EF suggest that these measures may not be measuring the same construct or domains within EF. The purpose of this study was to examine the concurrent validity of the BRIEF and the CEFI parent and self-report forms with adolescents.Method: Adolescent participants, ages 12–17 years, were recruited using a snowball method with recruitment targeting individuals from under-represented groups, as well as the general population. The resulting sample consisted of 52 cases with parent report. The adolescents were predominantly female (55.77%) and white (40.38%) with a mean age of 14.56 (1.72).Results: For parent and adolescent self-report on both the BRIEF and CEFI, mean global scores were within the average range. To examine whether the two rating scales were measuring the same underlying constructs of EF, a multi-trait-multi-method (MTMM) model was conducted using correlated traits correlated methods (CTCM) and correlated traits uncorrelated methods (CTUM).Conclusion: While the global scores obtained for the instruments measure EF similarly, there is less consistency in how the subdomains parse out and are labeled for each of the two scales. Implications for practice are discussed.

The Association Between Symptoms of Depression and School Absence in a Population-Based Study of Late Adolescents.

ObjectiveSchool attendance is an important functional marker in adolescence, and knowledge of the correlates of school absence is important to inform preventive efforts. The main aim of the present study was to investigate the association between symptoms of depression and school absence in late adolescence, adjusting for sociodemographic characteristics and externalizing problems.MethodsData stem from the youth@hordaland-survey, a population-based survey of adolescents between 16 and 19 years old attending upper secondary education in Hordaland County, Norway, in spring 2012. Administrative data on school absence was provided for 8222 adolescents. In addition to days and hours absent the past semester, a variable of total absence was calculated and divided into quartiles of absence. Symptoms of mental health problems and sleep duration was based on adolescent self-reports.ResultsReports of depressive symptoms were significantly associated with school absence when investigated as continuous variables. The strength of the association attenuated but remained statistically significant when controlling for sociodemographic factors and externalizing problems. When investigating the association at different levels of school absence, adolescents in the second, third and fourth quartile of school absence reported significantly higher depression scores compared to adolescents in the first quartile. The association between reports of symptoms of depression and school absence was partially mediated by sleep duration.ConclusionThe association between reported symptoms of depression and school absence was evident even at low levels of school absence, indicating a role for universal prevention strategies. The findings suggest both depression and sleep problems as possible targets for intervention in late adolescence.

Family negativity and delinquent behavior in adolescence: a predictive multivariate latent growth analysis

ABSTRACT The current study had three aims: (1) to explore whether there is over-time change in adolescent delinquency and negativity in the parent–adolescent, sibling and marital relationships during adolescence; (2) to examine the interactions of negativity across subsystems; and (3) to examine whether levels and changes in adolescent delinquency are predicted by levels and changes in negativity in all family subsystems. Data of 497 families participating in the RADAR-young study were used. Ratings of all family members were used to measure negativity in family relationships, and adolescent self-report was used for delinquency. Multivariate latent growth curve models showed over-time increases in mother-adolescent negativity and over-time decreases in sibling negativity, as well as significant individual differences in these changes. Second, evidence for both social contagion and compensatory processes in family negativity was found. Third, initial levels of parent–adolescent negativity were related to initial levels but not over-time changes of adolescent delinquency, whereas initial levels of sibling negativity were related to over-time changes but not initial levels of adolescent delinquency. Finally, increases in parent–adolescent negativity were related to faster increases in adolescent delinquency, and decreases in sibling negativity were related to slower increases in adolescent delinquency. Implications of these results are discussed.

Assessing readiness for independent self-care in adolescents with type 1 diabetes: Introducing the RISQ

AimTo design and evaluate psychometrics of adolescent self-report and parent proxy-report questionnaires assessing readiness for independent self-care in adolescents with type 1 diabetes (RISQ-T and RISQ-P). Methods178 adolescents with type 1 diabetes (ages 13–17 years) and their parents completed the 20-item RISQ-T and 15-item RISQ-P, along with diabetes-specific measures of parent involvement, self-efficacy, burden, and treatment adherence. Evaluation of psychometric properties included calculation of internal consistency, adolescent and parent agreement, test-retest reliability, concurrent and predictive validity. ResultsThe RISQ-T (α = 0.78) and RISQ-P (α = 0.77) demonstrated sound internal consistency. Higher RISQ-T and RISQ-P scores (indicating more adolescent readiness for independent self-care) showed significant associations with less parent involvement in diabetes care (adolescent r = −0.34; parent r = −0.47; p < .0001), greater adolescent diabetes self-efficacy (adolescent r = 0.32; parent r = 0.54; p < .0001), less parent-endorsed diabetes-related burden (parent r = −0.30; p < .0001), and greater treatment adherence (adolescent r = 0.26, p = .0004; parent r = 0.31, p < .0001). Adolescent and parent scores were significantly correlated (r = 0.35; p < .0001); test-retest reliability was reasonable (ICC RISQ-T r = 0.66; RISQ-P r = 0.71). Higher baseline RISQ-P scores significantly predicted reduced family involvement after six months (β = −0.14, p = .02). ConclusionsRISQ-T and RISQ-P demonstrate sound psychometric properties. Surveys may help inform diabetes teams of the level of support needed to facilitate shift to independent self-management.

Exploring the Relationship between Student and Teacher/Proxy-Respondent Scores on the Self-Determination Inventory

ABSTRACT The Self-Determination Inventory (SDI) is a suite of tools developed to measure self-determination. The SDI: Student Report was recently validated for adolescents aged 13 to 22 with and without disabilities across diverse racial/ethnic backgrounds. A parallel, proxy report version to be completed by teachers or parents, the SDI: Parent/Teacher Report is also available; however, limited research has explored the congruence of ratings made on the self and proxy report versions. The present study utilized multi-group confirmatory factor analysis to compare ratings on the SDI made by adolescents and their teachers. Findings suggest that the same set of items can be used to measure self-determination using the Self-Determination Inventory across students and teachers, but that there are low correlations between self- and proxy-scores. Teacher respondents tended to report that adolescents had lower levels of self-determination, although the discrepancy between adolescent self-report and teacher proxy-report varied based on the disability status and race/ethnicity of the student. Implications for future research and practice are discussed.

Differential associations between passive and active forms of screen time and adolescent mood and anxiety disorders.

To quantify the strength of association between passive and active forms of screen time and adolescent major depressive episode and anxiety disorders. Data from the 2014 Ontario Child Health Study, a representative sample of 2,320 adolescents aged 12-17years in Ontario (mean age = 14.58, male = 50.7%) were used. Screen time was measured using adolescent self-report on time spent on screen-based activities. Past 6-month occurrence of DSM-IV-TR defined major depressive episode, social phobia, generalized anxiety disorder, and specific phobia which were assessed using the Mini International Neuropsychiatric Interview for Children and Adolescents. Adolescents reporting 4 or more hours of passive screen time per day, compared to those reporting less than 2h, were three times more likely to meet the DSM-IV-TR criteria for major depressive episode [OR = 3.28(95% CI = 1.71-6.28)], social phobia [OR = 3.15 (95% CI = 1.57-6.30)] and generalized anxiety disorder [OR = 2.92 (95% CI = 1.64-5.20)]. Passive screen time continued to be significantly associated with increased odds of disorders, after adjusting for age, sex, low income, active screen time use, sleep and physical activity. A small-to-moderate attenuation of the estimated ORs was observed in the fully adjusted model. In contrast, associations between active screen time use and depression and anxiety disorders were smaller in magnitude and failed to reach statistical significance. Passive screen time use was associated with mood and anxiety disorders, whereas active screen time was not. Further research is needed to better understand the underlying processes contributing to differential risk associated with passive versus active screen time use and adolescent mood and anxiety disorders.

Feasibility of Electronic Monitoring of Daily Oral Medications in Adolescents with Sickle Cell Disease

Background: The field has made significant strides in understanding the mechanisms underlying pediatric sickle cell disease (SCD), and the coming years will likely see the approval of several new medications to treat SCD. The impact of these medications on clinical outcomes, however, will be dependent on patient adherence. Adolescents with SCD are at particular risk for non-adherence, and as disease management increasingly includes self-administration of oral medications, adherence assessment will become a critical component of research on medication effectiveness and clinical care. While electronic monitoring devices (bottles with computer chips that record date- and time-stamps of device openings) such as MEMS® bottles are considered the "gold standard" for adherence assessment in other populations, their feasibility among adolescents with SCD remains unknown. Objectives: The primary aims of this study were to examine data on MEMS® bottle use among adolescents (ages 13-21 years) with SCD to: 1) evaluate the feasibility of MEMS® bottle use; and 2) elicit barriers and facilitators to MEMS® bottle use. Methods: As part of a larger study of a self-management intervention, adolescents were asked to use a MEMS® bottle to store and administer their daily oral medication (hydroxyurea or deferasirox) for the 18-week study duration. The larger study included baseline, post-treatment, and follow-up assessments, at which adolescents were asked to provide their MEMS® bottle for data download. Descriptive statistics were calculated to assess multiple domains of MEMS® bottle feasibility including: initial uptake (% enrolled), MEMS® initiation (% initiated), and MEMS® sustained use (% completed; % provided bottles for download ±2 weeks of scheduled study visit = "on time"). Barriers and facilitators to MEMS® use were elicited via adolescent self-report. Results: In the larger study, 18 non-Hispanic African-American adolescents (M = 17.8 years, SD = 2.6; 61% male) with HbSS were asked to use a MEMS® bottle to store their hydroxyurea (n = 14) or deferasirox (n = 4). Initial uptake was 94.7%, with 18 of 19 eligible adolescents enrolling in the study. Of the 18 enrolled adolescents, all initiated MEMS® use (100%) and 11 sustained MEMS® use through the final study endpoint (61.1%). Eight (44.4%) and 2 (11.1%) adolescents provided their MEMS® bottle for download "on time" at post-treatment (42 days) and follow-up (126 days), respectively. Barriers to MEMS® use included medication changes (i.e., medication holds, dose timing changes) and transitioning from pediatric to adult care. Facilitators included tip sheets (e.g., places to store bottle, reminder to place refills in bottle) and reminder calls. Participants took a median of 26.2% of doses using the MEMS® across the 126 days (SD = 22.4; range 0.79% - 79.3%), illustrating that electronic monitoring devices are not a solution to medication adherence, but are one component of an adherence support strategy. See Figure 1 for adherence rates over time. Discussion: Data suggest that MEMS® are acceptable to adolescents with SCD. Ensuring sustained MEMS® use, however, will likely require additional supports. For example, electronic monitors which automatically transmit data in real-time via Bluetooth or cellular connections would eliminate the need for adolescents to bring bottles to study visits for data downloads. Researchers and clinicians interested in using electronic monitoring devices are encouraged to consider remote monitoring capabilities along with other device features when selecting a product. Larger studies are needed to evaluate concordance between rates of adherence obtained via electronic monitoring and other assessments and to validate electronically-monitored medication adherence with clinically-relevant outcomes for adolescents with SCD. Figure 1 Disclosures Quinn: Celgene: Membership on an entity's Board of Directors or advisory committees; Amgen: Other: Research Support.

Longitudinal link between trait motivation and risk-taking behaviors via neural risk processing

Prior research has emphasized the importance of the motivational system in risky decision-making, yet the mechanisms through which individual differences in motivation may influence adolescents’ risk-taking behaviors remain to be determined. Based on developmental neuroscience literature illustrating the importance of risk processing in explaining individual differences in value-based decision making, we examined risk processing as a potential mediator of the association between trait motivations and adolescents’ risk-taking behaviors. The sample consisted of 167 adolescents (47% females) annually assessed for three years (13–14 years of age at Time 1). Approach and avoidance motivations were measured using adolescent self-report. Risk preference was estimated based on adolescents’ decisions during a modified economic lottery choice task with neural risk processing being measured by blood-oxygen-level-dependent responses in the bilateral insular cortex for chosen options. Adolescents’ risk-taking behaviors were assessed by laboratory-based risky decision making using the Stoplight task. Longitudinal mediation analyses revealed a significant indirect effect of approach motivation, such that higher motivation was correlated with increases in risk-taking behaviors via decreases in neural activation in the bilateral insular cortex during risk processing. The findings illustrate a neural pathway through which approach motivation is translated into the vulnerability to risk taking development.

Examining parent and child agreement in the diagnosis of adolescent depression.

The diagnosis of depression in adolescents relies on identifying the presence of specific core and additional symptoms. Symptoms can be identified using structured or unstructured interviews and a range of questionnaire measures, which are completed by the young person and by a parent or carer. The aim of this research was to examine the inter- and intra-rater reliability of parent report and adolescent self-report of depression symptoms. In a sample of parent-child dyads, where young people aged 13-17 were referred to a mental health service for depression, we examined adolescents' (n=46) and parents' (n=46) independent responses to the Schedule for Affective Disorders and Schizophrenia in School-Age Children (Journal of the American Academy of Child and Adolescent Psychiatry, 36, 1997, 980) and the Mood and Feelings Questionnaire (Journal of the American Academy of Child and Adolescent Psychiatry, 27, 1988, 726). In the clinical interview, diagnostic criteria were more often met based on the adolescent's report, and adolescents endorsed more symptoms of depression than their parents. Tentative results also suggest that parent-child agreement about specific symptoms was low. Comparing different measures of depression revealed that adolescent report on the questionnaire and interview was significantly correlated. However, there was no significant correlation between parent questionnaire and interview report. These results suggest that relying solely on parents to identify depression in their children may result in young people with depression being missed and therefore untreated. Young people themselves should be encouraged and enabled to recognise the symptoms of depression and have an established pathway to services that offer assessment and treatment. Key Practitioner Message Diagnosis of depression in adolescents requires the identification of specific symptoms and can be identified using interviews or questionnaires. Previous research has suggested that parents and young people provide differing reports regarding symptoms of adolescent depression. Results indicated that diagnostic criteria were more often met based on young person report and that parents reported significantly less symptoms. Parent-child agreement about specific symptoms was found to be low. Assessment of adolescent depression should not rely solely on parental report. Young people should be encouraged and enabled to recognise symptoms of depression and be able to access mental health services.

Validity Aspects of the Strengths and Difficulties Questionnaire (SDQ) Adolescent Self-Report and Parent-Report Versions Among Dutch Adolescents.

In this study, validity aspects of the Strengths and Difficulties Questionnaire (SDQ) self-report and parent-report versions were assessed among Dutch adolescents aged 12 to 17 years (community sample: n = 962, clinical sample: n = 4,053). The findings mostly support the continued use of both SDQ versions in screening for psychosocial problems as (a) exploratory structural equation analyses partially supported the grouping of items into five scales; (b) investigation of associations between scales of the SDQ and the Child Behavior Checklist, Youth Self-Report, and Intelligence Development Scales-2 provided evidence for the SDQ versions’ convergent and divergent validity; and (c) receiver operating characteristics curves yielded evidence for both SDQ versions’ criterion validity by showing that these questionnaires can be used to screen for psychosocial problems, except for the adolescent-reported version for males. Regardless of the adolescent’s gender, the receiver operating characteristics curves showed both SDQ versions to be useful for screening for three specific types of problems: anxiety/mood disorder, conduct/oppositional deviant disorder, and attention-deficit/hyperactivity disorder. Additionally, parent-rated SDQ scores were found to be useful for screening for autism spectrum disorder.

Family Communication and Psychological Health in Children and Adolescents Following a Parent's Death From Cancer.

Parentally bereaved children and adolescents are at risk of developing psychological health problems. Evidence for a correlation between communication and broad measures of psychological health exists in other populations. The aim of this study was to examine associations between family communication and specific aspects of psychological health for children and adolescents following a parent's death from cancer using parent-proxy and adolescent self-reports. Parent-proxy reports for children and adolescents, and adolescent self-reports for Parent-Adolescent Communication, Strengths and Difficulties Questionnaire, and Prolonged Grief-13 child were analyzed using descriptive statistics and Spearman's correlation. Parents rated communication as moderate in quality and reported good psychological health for children and adolescents. Adolescent self-reports indicated low-quality communication with their parent and poor psychological health. Significant associations between Parent-Adolescent Communication subscales and Strengths and Difficulties Questionnaire subscales were found for each group. Prolonged grief was associated with emotional problems but not communication for all three groups.

Examining Parental Factors as Moderators Between Maltreatment and Adolescent Delinquency.

There is a well-established relationship between child maltreatment and delinquency, indicating that maltreated youth are at a heightened risk for later delinquency. However, the literature is unclear as to why some maltreated youth proceed to engage in delinquent behaviors, whereas others do not. The present study examined whether parental or family factors moderated the relation between a history of maltreatment and engagement in delinquent behavior during adolescence. Parental and family moderators included parental monitoring, parental emotional distress (depression and everyday stressors), parent-child relationship quality, family community and religious disengagement, poverty, and negative life events. This study utilized data on 1,149 children from the Longitudinal Studies of Child Abuse and Neglect (LONGSCAN), a collaborative effort across research sites that collected data regarding the risk factors and consequences of child maltreatment. For the purposes of this study, we utilized adolescent self-reports of delinquency, caregiver reports of parental and family variables, and administrative data on child maltreatment. Community and religious disengagement was the only variable that moderated the relation between maltreatment and delinquency. The effects of community and religious disengagement varied by maltreatment group such that greater community and religious disengagement was related to increased delinquent involvement for those in the no maltreatment, childhood-only maltreatment, and persistent maltreatment groups. Child maltreatment was not a significant predictor of delinquency over and above the effect of parenting and family variables that were measured during adolescence. Findings point to the importance of considering proximal parenting and family factors in understanding the maltreatment-delinquency relationship.

Predicting hazardous drinking in late adolescence/young adulthood from early and excessive adolescent drinking - a longitudinal cross-national study of Norwegian and Australian adolescents.

BackgroundResearch has consistently shown that early onset of drinking (EOD) is associated with alcohol-related problems in adulthood. However, recent reviews have identified several limitations in the early onset literature, including the use of retrospective reports, insufficient control for potential confounders, ambiguous definitions of the concept, and an assumption that early onset is independent of cultural norms and national alcohol policies. This study addresses these limitations by examining whether EOD, independent of early onset of excessive drinking (EOE), prospectively predicts hazardous drinking in late adolescence/young adulthood in Norway and Australia, two countries with different drinking cultures.MethodsData were drawn from two population-based longitudinal studies; the Norwegian Tracking Opportunities and Problems Study (n = 329) and the Australian International Youth Development Study (n = 786). Data were collected prospectively from mid adolescence (14–16 years) to late adolescence/young adulthood (18–25 years) and a modified Poisson regression approach was used to estimate prevalence ratios. Adolescent self-reports included measures of EOD and EOE. Young adults completed the Alcohol Use Disorders Identification Test (AUDIT). The results were adjusted for adolescent factors; age, gender, impulsivity, hyperactivity, conduct problems, smoking, early sexual intercourse and friends’ substance use, and family factors; alcohol and drug use in the family, maternal education, family management and monitoring.ResultsHazardous drinking was identified in 46.8 and 38.9% of young adults in Norway and Australia, respectively. Both EOD and EOE in adolescence were significantly related to an increased risk of alcohol-related problems in late adolescence/young adulthood in both studies, even when adjusting for possible confounders.ConclusionOur findings indicate that adolescent drinking behaviour is an indicator of alcohol-related problems in late adolescence/young adulthood, even when controlling for a variety of covariates. This finding is in contrast to previous research on older adults, where no association between adolescent drinking and later alcohol-related problems were found when controlling for covariates. The divergence in findings may suggest that the impact of EOD/EOE is limited to the late adolescent and young adult period. Preventing drinking in early adolescence may thus have some impact on the drinking patterns in late adolescence/young adulthood.

The Influence of Food Reinforcement and Eating Disorder Pathology on Weight Change in Adolescents (P21-057-19)

ObjectivesBoth the relative reinforcing value (RRV) of food, or the motivation to obtain food, and eating disorder (ED) pathology have been shown to independently predict weight gain. However, less is known about how the interaction between the RRV of food and ED pathology predicts weight gain over time. Therefore, the purpose of this study was to examine the combined effects of the RRV of food and ED pathology on weight change over 6 months in a sample of adolescents. MethodsParticipants included 77 12–14 year old adolescents participating in a longitudinal study examining factors that predict changes in weight status. Data presented are from baseline and 6 months. The RRV of food was assessed using a computer task. Participants earned points for energy dense food by pressing a mouse button on a computer across escalating schedules of reinforcement. Participants were classified as “low” or “high” in RRV based on a median split of their total responses. Global ED pathology was assessed at baseline using adolescent self-report on the Eating Disorder Examination Questionnaire. Participants were classified as “low” or “high” in ED pathology based on a median split of their global ED pathology. Four groups were created: low ED pathology/low RRV (n = 20), high ED pathology/low RRV (n = 23), low ED pathology/high RRV (n = 15), and high ED pathology/high RRV (n = 19). Height and weight were measured at both baseline and 6 months and used to calculate zBMI. ANOVA was used to examine differences in zBMI change over 6 months by RRV/ED pathology group. ResultszBMI change from baseline to 6 months differed by RRV/ED pathology group (P < .05). Changes in zBMI over 6 months were as follows: - 0.025 ± 0.298 for low ED pathology/low RRV; 0.010 ± 0.322 for high ED pathology/low RRV; - 0.095 ± 0.181 for low ED pathology/high RRV; and 0.186 ± 0.268 for high ED pathology/high RRV. Follow-up contrasts revealed that the high ED pathology/high RRV group experienced greater zBMI changes than the other groups (ps < 0.05). ConclusionsWhile the RRV of food and ED pathology are both independently associated with weight gain, the current study indicates that there may be something unique about the combination of high RRV of food and high ED pathology related to risk of weight gain. Future work is needed to identify strategies to limit weight gain in this vulnerable population. Funding SourcesNational Institutes of Health.

Let Them Speak for Themselves: Improving Adolescent Self-Report Rate on Pre-Visit Screening

BackgroundAdolescent pre-visit screening on patient-generated health data is a common and efficient practice to guide clinical decision making. However, proxy informants (eg, parents or caregivers) often complete these forms, which may lead to incorrect information or lack of confidentiality. Our objective was to improve the adolescent self-report rate on pre-visit screening. MethodsWe conducted an interventional study using an interrupted time series design to compare adolescent self-report rates (percent of adolescents ages 12−18 years completing their own pre-visit screening) over 16 months in general pediatric ambulatory clinics. We collected data using a computerized clinical decision support system with waiting room electronic tablet screening. Preintervention rates were low, and we created and implemented 2 electronic workflow alerts, one each to the patient/caregiver and clinical staff, reminding them that the adolescent should answer the questions independently. We included the first encounter from each adolescent and evaluated changes in adolescent self-reporting between pre- and postintervention periods using interrupted time series analysis. ResultsPatients or caregivers completed 2670 qualifying pre-visit screenings across 19 preintervention, 7 intervention, and 44 postintervention weeks. Self-reporting by younger adolescents nearly doubled, with a significant increase of 19.3 percentage points (confidence interval [CI], 9.1−29.5) from the baseline 20.5%. Among older adolescents, the stable baseline rate of 53.6% increased by 9.2 absolute percentage points (CI, −7.0 to 25.3). There were no significant pre- or postintervention secular trends. ConclusionsTwo automated alerts directing clinic personnel and families to have adolescents self-report significantly and sustainably improved younger adolescent self-reporting on electronic patient-generated health data instruments.

Adolescent clinical populations and associations between trauma and behavioral and emotional problems.

Trauma exposure is common during childhood and adolescence and is associated with youth emotional and behavioral problems. The present study adds to the current literature on trauma exposure among adolescent clinical populations by examining the association between trauma exposure and adolescent self-report of emotional and behavioral problems broadly, including internalizing and externalizing symptoms, in addition to the trauma-specific symptoms of posttraumatic stress disorder (PTSD). This study included 94 female (64%) and male (36%) adolescents, ages 13-19, representing 4 clinical populations: those seeking inpatient psychiatry, outpatient psychiatry, residential substance abuse, and outpatient medical services. Adolescents self-reported trauma history and internalizing, externalizing, and PTSD symptoms. Most adolescents reported experiencing at least 1 traumatic event (83%; M = 2.28, SD = 1.83). Multiple regression analyses controlling for age, race/ethnicity, gender, and treatment setting indicated a greater number of types of trauma are associated with externalizing symptoms (β = .31, p < .01) and PTSD symptoms (β = .35, p < .01). Trauma is a common experience among adolescents, particularly those presenting for behavioral health services, making trauma-informed care essential in these service delivery settings. Treatment that addresses adolescent risk behaviors and prevents recurrent trauma may be particularly important given the negative impact of multiple traumatic events on developing adolescents. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Adolescents notice fewer tobacco displays after implementation of the point-of-sale tobacco display ban in Finland.

INTRODUCTIONFinland implemented a point-of-sale (POS) display ban for tobacco products and their trademarks in 2012, and for electronic cigarettes in 2016. In this study we examine whether noticing tobacco products changed among adolescents after the implementation of the display ban and describe the noticing of e-cigarette displays post-implementation.METHODSRepeated cross-sectional national survey data of 12-to 16-year-olds from years 2011, 2013, 2015 and 2017 were used. Measures included adolescent self-report on noticing displays of tobacco and e-cigarettes in shops, kiosks and service stations. Adjusting for age, gender, smoking and academic achievement, logistic regression analyses were conducted by retailer type to test the association between survey year and noticing POS tobacco displays.RESULTSThe proportions of adolescents noticing tobacco displayed in shops, kiosks and service stations decreased from 2011 to 2013 (from over 80% to about 30%). Between 2013 and 2017, exposure to tobacco displays decreased for kiosks but slightly increased for shops and service stations. However, in all retailer types, rates in 2017 were still well below the pre-ban levels of 2011. In 2017, noticing e-cigarette displays by 12- to16-year-old adolescents was reported by 5.6% in shops, 20.5% in kiosks and 5.1% in service stations.CONCLUSIONSThe pronounced decline in adolescents’ exposure to tobacco products at POS observed in the current study implies adherence to the ban, as intended by the law. We encourage more countries to enact POS tobacco advertising and display bans, and to enforce the POS regulations to all tobacco products and novel nicotine delivery systems.

ADHD and depressive symptoms in adolescents: the role of community violence exposure.

Comorbid depression is common in adolescents with attention-deficit/hyperactivity disorder (ADHD). As yet, however, little is known about the factors associated with co-occurring depression in this population. To address this research gap, the current study examined the role of community violence exposure in the association between ADHD symptoms and depression. Data came from 505 Russian adolescents [mean age 14.37 (SD = 0.96)] who had teacher-reported information on ADHD symptoms that was collected in conjunction with the Social and Health Assessment (SAHA). Adolescent self-reports of witnessing and being a victim of community violence were also obtained while depressive symptoms were self-assessed with an adapted version of the Center for Epidemiologic Studies-Depression Scale (CES-D). Logistic regression analyses were performed to examine associations. In univariable analyses, both witnessing and being a victim of violence were associated with significantly increased odds for depressive symptoms in adolescents with ADHD symptoms compared to non-ADHD adolescents who had not experienced community violence. However, in the multivariable analysis only being a victim of violence continued to be associated with significantly increased odds for depression [odds ratio (OR) 4.67, 95% confidence interval (CI) 1.33-16.35]. Exposure to community violence may be associated with depression in adolescents with ADHD symptoms. Clinicians should enquire about exposure to community violence in adolescents with ADHD/ADHD symptoms. Early therapeutic interventions to address the effects of violence exposure in adolescents with ADHD may be beneficial for preventing depression in this group.