Improving Our Understanding of Impaired Social Problem-Solving in Children and Adolescents with Conduct Problems: Implications for Cognitive Behavioral Therapy

Losing Control: Prefrontal Emotion Regulation Is Related to Symptom Severity and Predicts Treatment-Related Symptom Change in Adolescent Girls With Conduct Disorder

BACKGROUND

Emotion regulation skills are linked to corticolimbic brain activity (e.g., dorsolateral prefrontal cortex [dlPFC] and limbic regions) and enable an individual to control their emotional experiences, thus allowing healthy social functioning. Disruptions in emotion regulation skills are reported in neuropsychiatric disorders, including conduct disorder or oppositional defiant disorder (CD/ODD). Clinically recognized means to ameliorate emotion regulation deficits observed in CD/ODD include cognitive or dialectical behavioral skills therapy as implemented in the START NOW program. However, the role of emotion regulation and its neural substrates in symptom severity and prognosis following treatment of adolescent CD/ODD has not been investigated.

METHODS

Cross-sectional data including functional magnetic resonance imaging responses during emotion regulation (N = 114; average age = 15 years), repeated-measures assessments of symptom severity (pretreatment, posttreatment, long-term follow-up), and functional magnetic resonance imaging data collected prior to and following the START NOW randomized controlled trial (n = 44) for female adolescents with CD/ODD were analyzed using group comparisons and multiple regression.

RESULTS

First, behavioral and neural correlates of emotion regulation were disrupted in female adolescents with CD/ODD. Second, ODD symptom severity was negatively associated with dlPFC/precentral gyrus activity during regulation. Third, treatment-related symptom changes were predicted by pretreatment ODD symptom severity and regulatory dlPFC/precentral activity. Additionally, pretreatment dlPFC/precentral activity and ODD symptom severity predicted long-term reductions in symptom severity following treatment for participants who received the START NOW treatment.

CONCLUSIONS

Our findings demonstrate the important role that emotion regulation skills play in the characteristics of CD/ODD and show that regulatory dlPFC/precentral activity is positively associated with treatment response in female adolescents with CD/ODD.

Empowering Social Growth Through Virtual Reality-Based Intervention for Children With Attention-Deficit/Hyperactivity Disorder: 3-Arm Randomized Controlled Trial

BACKGROUND

Attention-deficit/hyperactivity disorder (ADHD) usually begins in childhood and is often accompanied by impairments in social functioning. Virtual reality (VR) has emerged as an adjunctive tool to embed in social skills training to enhance the social skills of children with ADHD, but its effectiveness requires further investigation.

OBJECTIVE

This study aims to enhance the social skills of children with ADHD by examining the feasibility and effectiveness of VR-based training in comparison to traditional social skills training.

METHODS

A 3-arm randomized controlled trial was conducted with 90 children with ADHD aged 6-12 years. Participants were randomly assigned to 3 weeks of 12-session VR-based social skills training, traditional social skills training, or a waitlist control group of equivalent duration. Outcome measures included assessments by a clinical psychologist who was blinded to group assignments, the Social Skills Improvement System Rating Scale, the Behavior Rating Inventory of Executive Function, and the Simulator Sickness Questionnaire, conducted at baseline and after the intervention.

RESULTS

The preliminary results support the feasibility and acceptability of VR training for children with ADHD aged 6-12 years. Analysis showed that the VR and traditional social skills training groups experienced a statistically significant improvement in the clinical psychologist assessment of social skills and parent-rated self-control, initiative, and emotional control after the intervention compared with baseline. The VR group performed significantly better than the traditional social skills group on social skills assessed by clinical psychologists (F2,85=76.77; P<.001) and on parent-rated self-control (F2,85=18.77; P<.001), initiative (F2,85=11.93; P<.001), and emotional control (F2,85=17.27; P<.001). No significant between-group differences were found for parent-rated cooperation and inhibition (all P>.05).

CONCLUSIONS

The findings provide preliminary evidence supporting the feasibility and superior effectiveness of VR-based social skills training compared to traditional approaches for enhancing social skills and related executive functions in children with ADHD. These results suggest that VR may be a valuable tool to embed within social skills interventions for this population. Further research is warranted to explore the long-term impacts and generalizability of these benefits.

TRIAL REGISTRATION

ClinicalTrials.gov NCT05778526; https://clinicaltrials.gov/study/NCT05778526.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

RR2-10.2196/48208.

Involving Parents in Cognitive Behavioral Therapy for Children and Adolescents with Conduct Problems: Goals, Outcome Expectations, and Normative Beliefs About Aggression are Targeted in Sessions with Parents and Their Child

Children and adolescents with conduct problems participate in Cognitive Behavioral Therapy (CBT), either in individual or group format, in view of learning social problem-solving skills that enable them to behave in more independent and situation-appropriate ways. Parents must support their child's learning processes in everyday life and therefore these processes need attention in CBT sessions in which parents and their child participate. The social problem-solving model of CBT previously described (Matthys & Schutter, Clin Child Fam Psychol Rev 25:552-572, 2022; Matthys & Schutter, Clin Child Fam Psychol Rev 26:401-415, 2023) consists of nine psychological skills. In this narrative review we propose that instead of addressing each skill separately in sessions with both parents and their child, therapists work on three schemas (latent mental structures): (1) goals, (2) outcome expectations, and (3) normative beliefs about aggression. Based on social-cognitive and cognitive neuroscience studies we argue that these three schemas affect five core social problem-solving skills: (1) interpretation, (2) clarification of goals, (3) generations of solutions, (4) evaluation of solutions, and (5) decision-making. In view of tailoring CBT to the individual child's characteristic schemas and associated social problem-solving skills, we suggest that children and adolescents participate in individual sessions with their parents. The therapist uses Socratic questioning in order to find out characteristic schemas of the child, encourage reflection on these schemas, and explore alternative schemas that had previously been outside the child's attention. The therapist functions as a model for parents to ask their child questions about the relevant schemas with a view of achieving changes in the schemas.

From personification abuse to normal expression: emotional treatment for language disorders in schools

Introduction

The escalating prevalence of personification abuse in language disorders among students poses a substantial challenge for autistic students in the domain of language disorders. While prior research has mainly focused on the cognitive hurdles faced by autistic students, ongoing debates persist about the onset, severity, and roots of these challenges in their classroom behavior, with limited exploration of how preconceived notions impact personification abuse. This study aims to delve into emotional treatments for language disorders, specifically targeting personification abuse, to facilitate the shift from distorted perceptions to normative expression. It seeks to pinpoint the primary emotional interventions linked to instances of personification abuse and scrutinize the emotional factors influencing therapeutic approaches for language disorders.

Methods

The research encompassed a cohort of 110 autistic students, aged 2 to 5 years, diagnosed with language disorders, all clinically determined to have autism by developmental pediatricians at a prestigious medical facility. Among these children, 95 were attending specialized schools, while 15 were situated in community settings.

Results

The outcomes disclosed that children across all developmental phases displayed instances of personification abuse in language disorders, showcasing noteworthy enhancements in personification abuse following emotional treatment. Significantly, the discernible disparity in personification abuse performance and emotional treatment can be linked to the simultaneous cognitive advancement of autistic students across four grade levels, with variations noted based on normative expressions.

Discussion

These findings underscore the insufficiency of solely relying on intrinsic trends to comprehend personification abuse within an emotional treatment context. The study accentuates the potential pitfalls associated with emotional treatment for language disorders and stresses the imperative need for additional research and psychiatric intervention strategies.

An affective assessment: incarnate biases in picture captions for autistic children

Previous studies have explored cognitive disabilities experienced by autistic children between the ages of 2 and 5 who attend special schools. However, there is still debate regarding the onset, scope, and causes of these problems, particularly when considering incarnate biases that may arise from affective notions. Early affective issues could potentially be a key factor contributing to observing such biases in picture captions. In this study, we employed an affective approach-simultaneous observation and questionnaire-to investigate how incarnate biases impact picture caption activities. Specifically, we looked at the performances of autistic children across four grades: PreK, K1, K2, and K3. We found that autistic children across all grades demonstrated instances of incarnation-biased interpretations in picture captions, although K3 performed better than the other grades. Furthermore, their incarnate biases tended to be negative rather than positive in affection, depending on the level of activity involved. Ultimately, the sources of these incarnate biases may stem from three spheres: school, society, and family. Thus, it is essential to consider these factors when designing educational programs for children with autism. It highlights the potential dangers associated with negative biases in picture captions. Unlike previous studies that focused on identifying discrepancies in picture caption, our research suggests that over time, as we take into account the onset of incarnate biases from the three affective spheres discussed in this study, picture caption may improve among autistic children as their incarnate biases decrease.

Commentary: Cognitive stimulation and executive functions in the prevention and treatment of childhood disorders - reflection on Phillips et al., 2023

The study by Phillips et al. (Journal of Child Psychology and Psychiatry, 2023) shows that preschool executive functions (EF) are a transdiagnostic mechanism through which deprivation increases the risk for psychopathology in adolescence. In addition, deprivation appeared to be a key mechanism through which economic adversity (i.e., lower income-to-needs ratio and maternal education) undermines EF and increases the risk for psychopathology in adolescence. In this commentary, implications for early prevention and treatment of childhood disorders are discussed. In view of optimal EF development attention is needed to cognitive and social stimulation both in: (a) selective prevention targeting preschool children at high risk for childhood disorders due to low socioeconomic status; (b) indicated prevention targeting preschool children with minimal but detectable symptoms from low socioeconomic status families; and (c) treatment targeting preschool children with a clinical disorder from low socioeconomic status families.

Moral Thinking and Empathy in Cognitive Behavioral Therapy for Children and Adolescents with Conduct Problems: A Narrative Review

Cognitive behavioral therapy (CBT) for conduct problems in children and adolescents aims to decrease behaviors which may be considered moral transgressions (e.g., aggressive and antisocial behavior) and to increase behaviors that benefit others (e.g., helping, comforting). However, the moral aspects underlying these behaviors have received relatively little attention. In view of increasing the effectiveness of CBT for conduct problems, insights into morality and empathy based on studies from developmental psychology and cognitive neuroscience are reviewed and integrated into a previously proposed model of social problem-solving (Matthys & Schutter, Clin Child Fam Psychol Rev 25:552-572, 2022). Specifically, this narrative review discusses developmental psychology studies on normative beliefs in support of aggression and antisocial behavior, clarification of goals, and empathy. These studies are complemented by cognitive neuroscience research on harm perception and moral thinking, harm perception and empathy, others' beliefs and intentions, and response outcome learning and decision-making. A functional integration of moral thinking and empathy into social problem-solving in group CBT may contribute to the acceptance of morality-related issues by children and adolescents with conduct problems.

Developing a CBT-Based Intervention Program for Reducing School Burnout and Investigating Its Effectiveness With Mixed Methods Research

This study sets out to develop a cognitive-behavioral therapy-based psychoeducation application to reduce the school burnout levels of secondary school students and to test its effectiveness with the mixed methods research design. For this purpose, qualitative data have been included in the process at three different steps, before, during, and after the experimental application involving an intervention application. The application of the intervention of the research has been carried out with an experimental design with pretest-posttest control group, which is one of the true experimental designs. Experimental and control groups have been determined with 30 students reached by nested sampling method, and the CBT-based psychoeducation practice developed during the research process has been carried out for 9 weeks in the experimental group. During the research, descriptive analysis and content analysis methods have been used in the analysis of qualitative data, normality analysis, and One-Way Analysis of Covariance have been used in the analysis of quantitative data. Findings obtained from the study show that CBT-based psychoeducation practice is an effective approach in reducing school burnout. It has also been determined that the findings obtained from the analysis of the documents obtained during the application and findings from the interview process done after the application coincided with the findings of quantitative methods, and the qualitative findings adequately explain the quantitative findings.