It has been demonstrated in multiple randomized trials that the PAX Good Behavior Game is an effective school-based program for reducing the severity and progression of childhood emotional and behavioral problems that are prognostic of mental disorders, personality disorders, and self-harm behavior in adolescence and early adulthood. Embedding effective programs into routine practices of frontline settings is a global priority for mental health prevention, however, little is known about what strategies effectively support program implementation in schools. The purpose of this study was to test the effect of a multicomponent implementation strategy on the adoption and efficacy of the PAX Good Behavior Game, using a cluster randomized controlled trial with a type-3 implementation-effectiveness design. The trial was conducted in 25 primary schools across New South Wales, Australia. Schools were randomly assigned to receive the PAX Good Behavior Game plus an implementation toolkit to support adoption (intervention group) or the PAX Good Behavior Game only (control group). The primary outcome was change in rate of program adoption, measured as current use or support of the PAX Good Behavior Game, first measured at 6weeks post-registration (T0). The secondary effectiveness measure was change in students' emotional and behavioral problems, using the teacher-reported Strengths and Difficulties Questionnaire (SDQ). The first measure of the SDQ occurred at trial registration, prior to program implementation (T0). Both adoption and effectiveness were re-measured at 6months post-registration (T1). All data were analyzed using intention-to-treat methods. Early program adoption was higher in the intervention group compared to control group (93.6% vs 45.2%: OR = 21.20, 95% CI [3.50, 128.45], z = 3.32, p < 0.001), with no differential effects at 6months (96.8% vs 95.7%: OR = 1.21, 95% CI [0.16, 9.04], z = 0.18, p = 0.855). Emotional and behavioral problems reduced in both groups from baseline to 6months (p < 0.001, d = - 0.25), with no differential effects observed at T1 (p = 0.474, d = - 0.08). There was a positive linear relationship between adoption and the perceived acceptability, appropriateness, and feasibility of the program for the pooled sample. It seems that providing implementation support early in the process of establishing new innovations in schools may help accelerate early adoption by increasing perceived appropriateness and acceptability, but uncertainty remains as to what support is needed to optimize implementation and effectiveness longer term. The protocol was retrospectively registered with the Australian New Zealand Clinical Trials Registry, ACTRN12621001125819.

Adolescents in Gaza have been repeatedly exposed to war-related trauma, mass displacement, and severe humanitarian crises, placing them at heightened risk of psychological distress. Drawing on cognitive-behavioral and social-ecological frameworks, this study examined how posttraumatic stress and prosocial behavior shape the relationship between cumulative trauma exposure and psychosocial functioning among war-affected adolescents. A cross-sectional study was conducted between July and August 2025 among 717 displaced adolescents (aged 12-17years) and their caregivers living in shelters and tented camps across the Gaza Strip. Participants completed the Child and Adolescent Trauma Screen (CATS), Strengths and Difficulties Questionnaire (SDQ), and Primary Care PTSD Screen for DSM-5 (PC-PTSD-5). Mediation and moderation analyses were used to examine posttraumatic stress as a mechanism linking cumulative trauma exposure to emotional-behavioral difficulties and to test prosocial behavior as a potential resilience factor. Nearly four in five adolescents (78.4%) met the CATS cutoff for probable PTSD, and almost half (48.5%) met full DSM-5 diagnostic criteria. SDQ assessments indicated that more than half of the participants were classified in the abnormal range for total difficulties on both self- and parent-reports (54.1% and 55.4%, respectively). Peer relationship problems and emotional symptoms were the most prominent, affecting 90.5% and 43.2% of adolescents, respectively. In contrast, prosocial behavior remained relatively preserved, with about three-quarters scoring within the normal range. Strong agreement between self- and parent-reported ratings (r = 0.63) supported the robustness of these findings. PTSD symptoms statistically explained roughly two-thirds of the link between cumulative trauma and emotional-behavioral difficulties, emphasizing posttraumatic stress as a key factor in psychosocial impairment. Conversely, higher prosocial tendencies appeared to buffer the effect of trauma on PTSD severity, suggesting that empathy, cooperation, and helping behaviors help reduce the psychological impact of war exposure. The findings reveal an alarming prevalence of posttraumatic stress and psychosocial dysfunction among Gazan adolescents amid ongoing conflict. Although the findings are cross-sectional and cannot confirm causal mediation, PTSD symptoms appear to represent a key pathway linking trauma exposure to emotional and behavioral difficulties, while prosocial engagement serves as a significant resilience factor. Trauma-informed, family-centered, and strength-based interventions are urgently warranted to address both psychological distress and the social capacities that foster recovery and resilience.

BackgroundAdolescents are particularly vulnerable to mental disorders, with over 75% of lifetime cases emerging before the age of 25 years. Yet most young people with significant symptoms do not seek support. Digital phenotyping, leveraging active (self-reported) and passive (sensor-based) data from smartphones, offers a scalable, low-burden approach for early risk detection. Despite this potential, its application in school-going adolescents from general (nonclinical) populations remains limited, leaving a critical gap in community-based prevention efforts.ObjectiveThis study evaluated the feasibility of using a smartphone app to predict mental health risks in nonclinical adolescents by integrating active and passive data streams within a machine learning (ML) framework. We examined the utility of this approach for identifying risks related to internalizing and externalizing difficulties, eating disorders, insomnia, and suicidal ideation.MethodsParticipants (n=103; mean age 16.1 years, SD 1.0) from 3 UK secondary schools used the Mindcraft app (Brain and Behaviour Lab) for 14 days, providing daily self-reports (eg, mood, sleep, and loneliness) and continuous passive sensor data (eg, location, step count, and app usage). We developed a deep learning model incorporating contrastive pretraining with triplet margin loss to stabilize user-specific behavioral patterns, followed by supervised fine-tuning for binary classification of 4 mental health outcomes, namely, the Strengths and Difficulties Questionnaire (SDQ)-high risk, insomnia, suicidal ideation, and eating disorder. Performance was assessed using leave-one-subject-out cross-validation (LOSO-CV), with balanced accuracy as the primary metric. Comparative analyses were conducted using CatBoost (Yandex) and multilayer perceptron (MLP) models without pretraining. Feature importance was assessed using Shapley Additive Explanations (SHAP) values, and associations between key digital features and clinical scales were analyzed.ResultsIntegration of active and passive data outperformed single-modality models, achieving mean balanced accuracies of 0.71 (0.03) for SDQ-high risk, 0.67 (0.04) for insomnia, 0.77 (0.03) for suicidal ideation, and 0.70 (0.03) for eating disorder. The contrastive learning approach improved representation stability and predictive robustness. SHAP analysis highlighted clinically relevant features, such as negative thinking and location entropy, underscoring the complementary value of combining subjective and objective data. Correlation analyses confirmed meaningful associations between key digital features and mental health outcomes. Performance in an independent external validation cohort (n=45) achieved balanced accuracies of 0.63‐0.72 across outcomes, suggesting generalizability to new settings.ConclusionsThis study demonstrates the feasibility and utility of smartphone-based digital phenotyping for predicting mental health risks in nonclinical, school-going adolescents. By integrating active and passive data with advanced machine modeling techniques, this approach shows promise for early detection and scalable intervention strategies in community settings.

Behavioral and Emotional Challenges in Children With Spinal Muscular Atrophy.

Adolescent emotional and behavioral problems are highly prevalent yet often stigmatized. Within Bangladesh's male-dominated societal context, where traditional and religious norms disproportionately restrict women, gender becomes a pivotal factor for psychological well-being. This study therefore employs a gender-specific lens to explore these problems among secondary school students, examining their prevalence and variation across gender. This study draws upon data from the first author’s master's thesis. Using a quantitative, cross-sectional design, a survey was administered to 320 eighth-grade adolescents (143 boys, 177 girls) from five co-educational rural secondary schools across Bangladesh, selected via convenience sampling. Problem behaviors were assessed using a self-reported Bengali adaptation of Goodman and Mullick's (2000) Strengths and Difficulties Questionnaire (SDQ). The results indicated that girls reported significantly higher levels of overall problem behavior than boys. This difference was particularly pronounced in the domains of emotional symptoms and hyperactive-inattentive behaviors. The results underscore the critical importance of developing targeted support programs that address the distinct challenges faced by female adolescents.

Background: Adolescents are a vulnerable population to emotional and mental health problems due to rapid biological, psychological, and social changes. National surveys have reported increasing levels of anxiety, loneliness, and behavioral problems among adolescents; however, local evidence describing the distribution of adolescent emotional and mental health problems remains limited, particularly in school settings. Objective: This study aimed to describe the distribution and profile of emotional and mental health problems among adolescents based on school-based psychosocial screening in Bandung Regency, Indonesia. Methods: A descriptive quantitative study with a cross-sectional design was conducted involving 1,304 adolescents who participated in a school-based mental health screening program in 2025. Emotional and behavioral problems were assessed using the Strengths and Difficulties Questionnaire (SDQ), covering five domains: emotional symptoms, conduct problems, hyperactivity, peer relationship problems, and prosocial behavior. Data were analyzed descriptively using frequencies and percentages. Results: Most adolescents were classified as normal in the domains of emotional symptoms (67.9%), conduct problems (67.2%), hyperactivity (81.8%), and prosocial behavior (57.8%). However, a relatively high proportion of abnormal scores was observed in peer relationship problems (27.1%) and emotional symptoms (20.6%). Based on the total difficulties score, 3.4% of adolescents were categorized as abnormal, indicating the presence of a psychosocial risk burden within the adolescent population. These findings suggest that peer relationship difficulties and emotional problems constitute prominent areas of concern. Conclusion: This study provides a descriptive overview of emotional and mental health problems among adolescents identified through school-based psychosocial screening. The findings underscore the potential role of routine screening in supporting early identification of adolescents at risk of psychosocial difficulties. Further evaluative and longitudinal studies are needed to assess the effectiveness of screening programs and related interventions in improving adolescent mental health outcomes

The ongoing war in Gaza since 2023 has caused unprecedented trauma and widespread displacement, with nearly 200,000 casualties and over 90% of the population displaced into crowded shelters and makeshift tents. Evidence on the mental health effects on children during this crisis remains scarce. A cross-sectional study was conducted in May 2025 among displaced children aged 3-12 years living in shelters and tented communities across the inhabited areas of the Gaza Strip. The study used a multistage purposive and convenience sampling strategy. Caregivers filled out questionnaires assessing sociodemographic characteristics, war exposures, forced migrations, and caregiver PTSD, as well as the caregiver-reported versions of the Child and Adolescent Trauma Screen (CATS) for PTSD symptoms and the Strengths and Difficulties Questionnaire (SDQ) for psychosocial functioning. Multivariable logistic regression analyses were conducted to examine associations between sociodemographic factors, war exposures, and child PTSD. The final sample included 933 children (50.4% boys, 49.6% girls), with an average age of 7.6 years (SD = 2.8). Caregivers reported that children experienced an average of 6.7 forced displacements and 6.6 out of 10 surveyed war-related exposures. Nearly all experienced hunger (98%) and house destruction (95%). Based on age-appropriate CATS cutoffs, 57.8% of children met criteria for probable PTSD. SDQ results showed high rates of emotional and behavioral problems, with over 46.3% classified as abnormal on the Total Difficulties score. Boys were significantly more likely than girls to have experienced the loss of a close family member (57.0% vs. 49.9%, p = 0.035), although no other significant sex differences were found in the average number of traumas experienced or in the rates of other surveyed war exposures. Additionally, boys were significantly more likely to have more conduct problems and to score lower on prosocial behaviors (p < 0.001). In regression analyses, greater psychosocial difficulties (SDQ; OR = 1.18, 95% CI: 1.14-1.22), higher trauma exposure (OR = 1.17, 95% CI: 1.09-1.26), and more severe parental PTSD symptoms (OR = 1.26, 95% CI: 1.12-1.41) were consistently associated with increased odds of child PTSD. Non-marital parental status (OR = 1.62, 95% CI: 1.04-2.51) and non-maternal caregiving (OR = 2.61, 95% CI: 1.40-4.88) were also associated with higher odds. In the backward elimination model, older age showed a modest protective effect (OR = 0.95, 95% CI: 0.90-1.00), while female sex was associated with higher odds of PTSD (OR = 1.36, 95% CI: 1.02-1.82). Displaced children in Gaza are experiencing extraordinarily high levels of trauma exposure, PTSD symptoms, and psychosocial difficulties. The findings highlight both the acute and generational mental health burden of war on children and underscore the urgent need for scalable, context-sensitive psychosocial interventions.

The parent-report Strengths and Difficulties Questionnaire (SDQ) is a widely used child and adolescent mental health screening tool. However, challenging environments, such as public health crises, may influence the construct validity of measures. To assess this, we examine SDQ measurement invariance, internal consistency, convergent and discriminant validity, composite, test-retest, and interrater reliability across parents from the United Kingdom (n = 9,001) and Japan (n = 365). We replicate the five-factor structure, which held across children's age, gender, and between parent- and adolescent-report. We provide new evidence of SDQ invariance for special educational needs (SEN), across 6- and 1-month reporting windows, over different periods of restrictions, and between English (UK) and Japanese versions. Taken together, our findings suggest that parents interpreted the SDQ items in similar ways to pre-pandemic norms. Yet relatively low reliability of the conduct and peer relationship subscales, in particular, indicates a need for caution and scale revisions, especially when used for screening and diagnosis.

Pet ownership and parent-reported mental health in pediatric transplantation. A cross-sectional study from the European reference network Transplantchild. The pink study

ABSTRACTObjectivesThis study examines the continuity and comparability of internalizing and externalizing symptom spectra from adolescence to young adulthood, addressing measurement challenges across developmental stages. Leveraging the Hierarchical Taxonomy of Psychopathology (HiTOP) framework, it explores whether symptom spectra in adolescence predict corresponding symptoms in young adulthood.MethodsData were drawn from JEPSY, a follow‐up of the national KiGGS cohort (N = 2172, age 18–26). Adolescent internalizing and externalizing symptoms were assessed via the Strengths and Difficulties Questionnaire (SDQ) and substance use items. Adult outcomes included the Patient Health Questionnaire (PHQ‐4), DSM‐5 Cross‐Cutting Symptom Measure (DSM‐5 CC), and Personality Inventory for DSM‐5 (PID‐5). Factor analyses assessed structural consistency, and robust regression examined associations between adolescent and adult symptom spectra over 7–10 years.ResultsA four‐factor model best captured the SDQ structure. In young adulthood, three spectra emerged: internalizing symptoms, externalizing traits, and substance use. Adolescent emotional and peer problems predicted internalizing symptoms in adulthood. Conduct problems and hyperactivity predicted externalizing traits. Substance use was associated with hyperactivity, smoking, and risky drinking—but negatively with peer problems.ConclusionThe findings support the continuity of broad psychopathological spectra and demonstrate that harmonized approaches can bridge measurement gaps and enhance longitudinal comparability.

Objective: To investigate the association between cosleeping and emotional-behavioral problems in preschool children, and analyze their differences across sleep anxiety status. Methods: A data analysis was conducted from June 2024 to October 2025. The prospective cohort data were derived from the Shanghai Children's Health, Education and Lifestyle Evaluation-Preschool cohort (SCHEDULE-P). Using a stratified cluster random sampling method, 20 899 newly enrolled preschool children from 191 kindergartens in Shanghai were recruited in November 2016 completed the first survey. Follow-up surveys were carried out in April 2018 and April 2019, during which parents completed structured questionnaires. Children's emotional-behavioral problems including emotional problems, conduct problems, hyperactivity problems, peer relationship problems, and prosocial behavior problems were assessed using the strengths and difficulties questionnaire (SDQ). Children's sleep quality was evaluated by the children's sleep habits questionnaire (CSHQ). The sleep anxiety status was evaluated by the sleep anxiety subscale and cosleeping status was reported via the question "Does the child sleep alone in their own bed?" of CSHQ. Mixed-effects Logistic regression models were used to examine the relationship between cosleeping and emotional-behavioral problems. A moderation model was constructed by including the interaction term between cosleeping and sleep anxiety, and further stratified analysis were conducted by dividing children into 2 groups based on the presence or absence of sleep anxiety, to clarify the association between cosleeping and emotional-behavioral problems within each group. Results: After excluding invalid data, a total of 15 679 children were included in the final analysis, including 8 082 boys (51.5%) and 7 597 girls (48.5%). The age was (3.73±0.29) years and 75.7% (11 872/15 679) of the children practiced cosleeping at the first survey. The mixed-effects Logistic regression model showed that preschool children who practiced cosleeping had a higher risk of emotional-behavioral problems compared with those who slept independently (OR=1.12, 95%CI 1.03-1.21, P=0.006), particularly in the domains of emotional problems, hyperactivity problems, and prosocial behavior problems (all P<0.01). The moderation model indicated statistically interaction effects between cosleeping and sleep anxiety on the total score and all subscales of SDQ (all P<0.01). Simple effect analyses revealed that in children with sleep anxiety, cosleeping was associated with lower risks of emotional-behavioral problems (OR=0.87, 95%CI 0.77-0.99, P=0.033), especially in peer relationship and conduct problems (both P<0.05).In contrast, among children without sleep anxiety, cosleeping was associated with higher risks of peer interaction and prosocial behavior problems (both P<0.05). Conclusions: The association between cosleeping and emotional-behavioral problems differs depending on the presence of sleep anxiety in preschool children. For children with sleep anxiety, cosleeping is linked to fewer emotional-behavioral problems; whereas for children without sleep anxiety, cosleeping tends to be associated with more emotional-behavioral problems.

An adaptive machine learning framework integrating large language models to assess and enhance emotional intelligence in adolescents.

Differential impacts of stuttering and stressful life events on the well-being of children: A comparative analysis.

BackgroundMyopic adolescents face multiple psychological challenges, including anxiety, depression, and social isolation, necessitating multidimensional assessment. One such assessment tool is the Strengths and Difficulties Questionnaire (SDQ), though it has not yet been validated in this specific population. This study aimed to evaluate the reliability, validity, responsiveness, and the minimal clinically important difference (MCID) of the SDQ in this specific population.MethodsFollowing the consensus-based standards for the selection of health measurement instruments (COSMIN) guidelines, we conducted a psychometric evaluation combining cross-sectional and longitudinal designs among 307 adolescents with myopia (including newly diagnosed and follow-up cases). Baseline assessments evaluated feasibility, reliability (internal consistency and test–retest stability), and validity (construct and discriminant validity). Follow-up surveys after myopia correction were used to assess responsiveness and establish the MCID using anchor-based methods.ResultsThe SDQ demonstrated acceptable internal consistency (Cronbach’s α = 0.71) and good test–retest reliability (ICC = 0.73). Construct validity was supported by strong correlations between problem-related subscales (peer problems, hyperactivity/inattention, conduct problems, emotional problems) and difficulty scores (r = 0.51–0.72, p < 0.001), with moderate-to-strong correlations for total SDQ scores (r = 0.36–0.75, p < 0.001). Discriminant validity was confirmed by significant differences in prosocial behavior (p < 0.01). While responsiveness was modest [effect size (ES) = −0.26, standardized response mean (SRM) = −0.28], the MCID was determined to range between 2.00–2.38 points, with a threshold of 2 points recommended for group-level discrimination.ConclusionThe SDQ is a reliable and valid tool for assessing psychological well-being in adolescents with myopia. The established MCID of 2 points enhances its clinical utility for screening and monitoring mental health changes in this population.

Children born preterm often have anatomical and functional visual abnormalities, even in the absence of retinopathy of prematurity. This includes suboptimal visual acuity (VA), defined as binocular VA between 5-6.3/10 and 8/10. We examine relationships between suboptimal VA and neurodevelopment in children born preterm. Secondary analysis of the French EPIPAGE-2 cohort with children born between 24+0 weeks and 31+6 weeks of gestation, eligible for follow-up at 5.5 years. Children were classified into three VA groups: 5-6.3/10, 8/10 and 10/10 as reference group. Neurodevelopment was assessed with the Wechsler Preschool and Primary Scale of Intelligence-Fourth Edition, the Movement Assessment Battery for Children-II (MABC-2) and the Strengths and Difficulties Questionnaire (SDQ). Comparisons between groups were adjusted for neonatal and socioeconomic characteristics using generalised estimating equations models. Among 1787 included children, 62% had suboptimal VA. Compared with the 10/10 VA group, the mean full-scale IQ decreased by -3.09 (95 % CI -4.75 to -1.42) and -4.97 (95 % CI -6.47 to -3.46) points, the mean MABC-2 total score by -0.66 (95 % CI -0.71 to -0.61) and -1.06 (95 % CI -1.09 to -1.00), and the mean total SDQ scores increased by 0.40 (95 % CI -0.16 to 0.94) and 0.60 (95 % CI 0.10 to 1.1) in groups with VA groups at 8/10 and 5-6.3/10, respectively. In this French population-based cohort of children born preterm, suboptimal VA was frequent and associated with increased risk of neurodevelopmental difficulties. A comprehensive neurodevelopmental and neurovisual assessment is warranted in children born preterm with suboptimal VA.

AimSuicide is a leading cause of death among adolescents. Several studies have reported higher suicidal ideation (SI) rates in individuals with autism spectrum disorder (ASD) than in those without ASD; however, risk factors for SI remain unclear, especially among adolescents. This study aimed to investigate the factors contributing to SI among junior high school students with ASD in Japan.MethodsWe conducted a cross‐sectional observational study of junior high school students who visited the Center for Child Health, Behavior, and Development, Ehime University Hospital. Medical records from April 2015 to March 2022 were examined. Participants completed the Strengths and Difficulties Questionnaire (SDQ) and General Health Questionnaire 30 (GHQ30), while their parents completed the Autism Screening Questionnaire, Attention Deficit Hyperactivity Disorder Rating Scale, and Social Responsiveness Scale. SI was assessed using item 28 of the GHQ30: “make away with yourself.” Multiple logistic regression analysis was performed with SI as the dependent variable.ResultsParticipants were categorized into ASD (n = 84) and non‐ASD (n = 166) groups. The prevalence of SI was similar in both groups (p = 0.478). In the ASD group, multiple logistic regression analysis revealed that the SDQ subscales “Peer Problems” and “Emotional Symptoms” were significantly associated with SI (odds ratio [OR]: 1.63, 95% confidence interval [CI]: 1.22–2.19, OR: 1.44, 95% CI: 1.14–1.83).ConclusionApproximately 40% of junior high school psychiatric outpatients had SI, irrespective of autistic tendencies. Our study suggests the importance of enhancing peer connectedness among students with ASD who experience SI.

The location of mental health services in schools increases access for children and youth. This may be especially important in rural communities, where youth have more significant mental health needs and less access to services. Yet, few studies exist that explore the outcomes of student participation in school-based services. The present study evaluates student behavioral health needs and outcomes, as measured by the strengths and difficulties questionnaire (SDQ), of students (N = 43) participating in therapeutic mental health services (Tier 3) provided in three rural Midwest communities in the United States. At baseline, SDQ scores indicated that over half of students' total difficulties scores fell in the Borderline or Abnormal categories, and over 40% of students demonstrated high needs related to emotional problems and hyperactivity. At the conclusion of services, students experienced statistically significant improvements in mean scores (compared to baseline) in total difficulties, externalizing problems, and internalizing problems, and on subscales measuring emotional problems, conduct problems, and hyperactivity. Significant differences were not found in the subscales measuring peer problems and prosocial behavior. High levels of satisfaction with services were also reported. Limitations and conclusions are discussed.

BackgroundEmotional problems represents a prevalent clinical manifestation in pediatric populations with attention-deficit/hyperactivity disorder (ADHD), exacerbating functional impairments and complicating treatment outcomes. While pharmacological and behavioral interventions target core ADHD symptoms, structured approaches addressing emotional dysregulation through executive function training remain underexplored. Ecological executive skills training (EEST) has emerged as a promising intervention. This study systematically evaluates the multidimensional impact of EEST by integrating behavioral, cognitive, and emotional metrics to establish an evidence-based framework.MethodsA total of 65 primary school children diagnosed with ADHD for the first time were recruited for this study. Children with ADHD were evaluated by Achenbach Child Behavior Checklist (CBCL), Strengths and Difficulties Questionnaire(SDQ), Conner’s Parent Symptom Questionnaire (PSQ), Vanderbilt ADHD Diagnostic Parent Rating Scale (VADPRS), Behavior Rating Inventory of Executive Function(BRIEF) and Weiss Functional Impairment Rating Scales-Parent Report (WFIRSP). Statistical analysis was conducted using SPSS software (version 19.0). Categorical variables were presented as counts (n) and percentages (%). Improvements in Inattention were analyzed using Generalized Estimating Equations (GEE) with robust standard error estimators.Results1.Efficacy of Mood Regulation: After three months of treatment, the experimental group exhibited significantly greater improvement than the control group in anxiety and depression subscales of the CBCL, SDQ teacher emotional symptom ratings, PSQ (Anxiety), VADPRS and VADTRS anxiety/depression items, and the BRIEF Emotion Regulation Index. 2. Core Symptom Severity: The experimental group demonstrated significantly greater reductions in inattention and hyperactivity/impulsivity symptoms compared to controls, as measured by the VADPRS and VADTRS. 3.Executive Functioning Improvements: The experimental group showed significantly greater enhancements (P < 0.05) across all BRIEF executive function domains, with particularly significant improvements observed in working memory. 4. EEST can improve Social Functioning Outcomes.ConclusionsEEST significantly alleviates emotional probloms in children with ADHD, including symptoms of anxiety, depression, and impaired emotional control. Furthermore, this intervention demonstrates measurable improvements in core ADHD symptoms, executive functioning, and social competency. Clinical trial registryThe Chinese Clinical Trial Registry (ChiCTR). Trial Registration Number:2,200,062,513​.Supplementary InformationThe online version contains supplementary material available at 10.1186/s12888-025-07748-6.

Plasma proteome demonstrates sex-specific associations with mental health risks in adolescents.

ABSTRACT The Strengths and Difficulties Questionnaire (SDQ) has been validated across many cultural settings, yet evidence from Taiwan is scarce and derives mainly from metropolitan populations. No data are available from Changhua County, central Taiwan—an area with a strong agricultural profile and socio‐demographic characteristics distinct from the more urbanised north and south. After exclusions, valid data from 1008 elementary school students (ages 7–12) were analysed. Parents and teachers completed questionnaires for all children, and students in grades 5–6 provided self‐reports. Normative data and percentile‐based cutoff scores were established. Reliability was generally satisfactory, though weaker for peer and conduct problem subscales, particularly in self‐reports. Inter‐rater correlations were modest ( r = 0.15–0.48), with especially low agreement between teachers and other informants on emotional symptoms. Exploratory factor analysis partially supported the intended structure. These findings demonstrate that while the SDQ is a practical tool for school‐based screening in Taiwan, peer and conduct domains require cautious interpretation and socio‐demographic context should be considered when applying the instrument across different regions.