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"Comer, Jonathan S"
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Extending Parent–Child Interaction Therapy for Early Childhood Internalizing Problems: New Advances for an Overlooked Population
Although efficacious psychological treatments for internalizing disorders are now well established for school-aged children, until recently there have regrettably been limited empirical efforts to clarify indicated psychological intervention methods for the treatment of mood and anxiety disorders presenting in early childhood. Young children lack many of the developmental capacities required to effectively participate in established treatments for mood and anxiety problems presenting in older children, making simple downward extensions of these treatments for the management of preschool internalizing problems misguided. In recent years, a number of research groups have successfully adapted and modified parent–child interaction therapy (PCIT), originally developed to treat externalizing problems in young children, to treat various early internalizing problems with a set of neighboring protocols. As in traditional PCIT, these extensions target child symptoms by directly reshaping parent–child interaction patterns associated with the maintenance of symptoms. The present review outlines this emerging set of novel PCIT adaptations and modifications for mood and anxiety problems in young children and reviews preliminary evidence supporting their use. Specifically, we cover (a) PCIT for early separation anxiety disorder; (b) the PCIT-CALM (Coaching Approach behavior and Leading by Modeling) Program for the full range of early anxiety disorders; (c) the group Turtle Program for behavioral inhibition; and (d) the PCIT-ED (Emotional Development) Program for preschool depression. In addition, emerging PCIT-related protocols in need of empirical attention—such as the PCIT-SM (selective mutism) Program for young children with SM—are also considered. Implications of these protocols are discussed with regard to their unique potential to address the clinical needs of young children with internalizing problems. Obstacles to broad dissemination are addressed, and we consider potential solutions, including modular treatment formats and innovative applications of technology.
Journal Article
Intensive Treatment of Chronic Pain and PTSD: The PATRIOT Program
Military combat can result in the need for comprehensive care related to both physical and psychological trauma, most commonly chronic pain and post-traumatic stress disorder (PTSD). These conditions tend to co-occur and result in high levels of distress and interference in everyday life. Thus, it is imperative to develop effective, time-efficient treatments for these conditions before they become chronic and resistant to change. We developed and pilot-tested the Pain and Trauma Intensive Outpatient Treatment (PATRIOT) Program, a brief, intensive (3 weeks, six sessions) integrated chronic pain and PTSD treatment. An overview and session-by-session outline of the PATRIOT Program is provided, followed by results from the first pilot evaluation of the PATRIOT Program’s feasibility, acceptability, and preliminary efficacy in a sample of eight participating Veterans with comorbid chronic pain and PTSD. There were no treatment dropouts. At post-treatment, there were significant reductions in PTSD symptoms based on the Clinician-Administered Assessment of PTSD (CAPS). Pain and catastrophic thinking also decreased from pre- to post-treatment. With continued investigations and support, the PATRIOT Program may offer a brief, cost-effective, and more easily accessible treatment option for individuals who could benefit from learning skills to manage pain and PTSD more effectively.
Journal Article
Caregiver perceptions of healthcare barriers across traditional and digital contexts: a mixed-methods analysis
As digital health expanded during COVID-19, understanding how caregivers perceive differences between traditional and digital care became critical. In a purposive sample of female caregivers of school-age children with elevated mental health symptoms (
n
= 47), we used a convergent mixed-methods design to compare reported experiences across modalities. Thematic analysis revealed that participants described different barrier patterns: financial concerns were reported in both contexts, but with different characteristics (insurance/copays vs. device/subscription costs). Participants reported distinct digital challenges, relational connection loss, digital literacy gaps, and privacy concerns, while facilitators also differed. Traditional care narratives emphasized interpersonal support, while digital care highlighted accessibility and personalization. Social identity intersections were referenced more frequently in traditional care narratives, though demographic correlations suggested continued relevance in digital contexts. These pandemic-era findings from female caregivers generate hypotheses for designing inclusive digital health approaches and highlight areas for longitudinal research tracking actual transitions between care modalities.
Journal Article
Developing personalized algorithms for sensing mental health symptoms in daily life
The integration of artificial intelligence (AI) and pervasive computing offers new opportunities to sense mental health symptoms and deliver just-in-time adaptive interventions via mobile devices. This pilot study tested personalized versus generalized machine learning models for detecting individual and family mental health symptoms as a foundational step toward JITAI development, using data collected through the Colliga app on smart devices. Over a 60-day period, data from 35 families resulted in approximately 14 million data points across 52 data streams. Findings showed that personalized models consistently outperformed generalized models. Model performance varied significantly based on individual factors and symptom profiles, underscoring the need for tailored approaches. These preliminary findings suggest that successful implementation of passive sensing technologies for mental health will require accounting for users’ unique characteristics. Further research with larger samples is needed to refine the models, address data heterogeneity, and develop scalable systems for personalized mental health interventions.
Journal Article
Future Directions in the Use of Telemental Health to Improve the Accessibility and Quality of Children's Mental Health Services
Objectives:
This concluding commentary offers a brief overview of progress to date in providing telemental health services to children, and then offers a critical vision for future research needed to provide the rigorous empirical foundation for telemental health to be considered a well-established format for the delivery of children's mental health services.
Methods:
We review how recent years have witnessed advances in the science and practice of children's telemental health, and the articles in this special series collectively offered a critical step forward in the establishment of a guiding literature to provide informed direction for child providers incorporating remote technologies to extend their practices.
Results:
Researchers must be cautious not to develop a “horse race” mentality and a misguided search for a decisive “winner” regarding the ultimate effectiveness of child telemental health versus traditional clinic-based treatments. Instead, research efforts are needed to examine key mediators and moderators of telemental health treatment response. The question should not be simply whether telemental health strategies are supported, but rather when, under what circumstances, and for whom telemental health formats may be most indicated. Barriers to the continued evolution of children's telemental health are discussed, and we consider issues of telemental health reimbursement and matters of cross-state professional jurisdiction.
Conclusions:
Continued efforts are needed in order to fully actualize the potential of children's telemental health to optimize the quality and transform the accessibility of mental health services for all children, regardless of income or geography.
Journal Article
Intolerance of uncertainty as a transdiagnostic vulnerability to anxiety disorders in youth
Anxiety disorders are the most prevalent disorders among youth and understanding cognitive vulnerabilities for these disorders is crucial for early prevention and treatment. The present study examined the role of intolerance of uncertainty (IU) in predicting the severity of anxiety disorder symptoms among a sample of Iranian youth. The relationships between IU and anxiety disorder symptoms among youth [
N
= 683, ages 8–18,
M (SD)
age
= 14.02 (2.43); 58.07% girls] with and without anxiety disorders, and their parents [
N
= 676, ages 27–58,
M (SD)
age
= 40.63 (5.72); 61.8% female], were examined. Significant associations were found between youth- and parent-report IU and youth anxiety disorder symptoms. Youth with higher scores on total IU and prospective/inhibitory IU dimensions had significantly higher levels of anxiety disorder symptoms. Furthermore, youth-reported prospective/inhibitory IU were significantly related to specific youth anxiety and related disorder symptoms including generalized anxiety, separation anxiety, physical injury fears, obsessive-compulsive, social anxiety and panic/agoraphobia disorder symptoms. Findings provide cross-sectional support for the role of IU as a transdiagnostic feature in predicting a wide range of anxiety disorder symptoms in youth. Implications for future clinical applications are discussed.
Journal Article
Functional connectivity of the anterior insula associated with intolerance of uncertainty in youth
Intolerance of uncertainty (IU) is a trait characteristic marked by distress in the face of insufficient information. Elevated IU has been implicated in the development and maintenance of anxiety disorders, particularly during adolescence, which is characterized by dramatic neural maturation and the onset of anxiety disorders. Previous task-based work implicates the bilateral anterior insula in IU. However, the association between anterior insula intrinsic functional connectivity (iFC) and IU has not been examined in adolescents. Fifty-eight healthy youth (mean age = 12.56; 55% boys) completed the Intolerance of Uncertainty Scale for Children (IUSC-12) and a 6-minute resting state fMRI scan. Group-level analyses were conducted using a random-effects, ordinary least-squares model, including IUSC-12 scores (Total, Inhibitory subscale, Prospective subscale), and three nuisance covariates (age, sex, and mean framewise displacement). IUSC-12 Inhibitory subscale scores were predictive of iFC between the left and right anterior insula and right prefrontal regions. IUSC-12 Prospective subscale scores significantly predicted iFC between the anterior insula and the anterior cingulate cortex. IUSC-12 total scores did not predict significant iFC of the bilateral anterior insula. Follow-up analyses, including anxiety (MASC Total Score) in the models, failed to find significant results. This could suggest that the associations found between IUSC-12 scores and anterior insula iFC are not unique to IU and, rather, reflect a broader anxiety-related connectivity pattern. Further studies with larger samples are needed to tease apart unique associations. These findings bear significance in contributing to the literature evaluating the neural correlates of risk factors for anxiety in youth.
Journal Article
Delivering Parent-Teen Therapy for ADHD through Videoconferencing: a Preliminary Investigation
Adolescents with ADHD demonstrate notoriously poor treatment utilization. Barriers to access have been partially addressed through tailored therapy content and therapist delivery style; yet, additional challenges to engaging this population remain. To leverage modern technology in support of this aim, the current study investigates parent-teen therapy for ADHD delivered over a videoconferencing format. In this preliminary feasibility study, teens and parents (
N =
20) received an empirically supported dyadic therapy that incorporates skills-based modules with motivational interviewing. The videoconferencing interface was deemed feasible with nearly all families completing treatment. Acceptable therapeutic alliance was reported and key mechanisms of change were engaged (i.e., adolescent motivation to meet goals, parent strategy implementation). Families reported high satisfaction, despite minor disturbances associated with delivering therapy via videoconferencing. Treatment integrity and fidelity were acceptable, though slightly reduced compared to clinic-based trials of the same protocol. Therapists perceived that videoconferencing enhanced treatment for 50% of families. Reductions in participant ADHD symptoms and organization, time management, and planning problems from baseline to post-treatment were noted by parents and teachers. However, open trial results of this study should be interpreted with caution due to their uncontrolled and preliminary nature.
Journal Article
The Case for Telemental Health for Improving the Accessibility and Quality of Children's Mental Health Services
Objective:
Children's mental health problems collectively impose a staggering public health burden. However, the quality of regionally accessible children's mental healthcare varies greatly, with youth in rural and other remote communities particularly underserved. Promoting knowledge and skill in telemental health (TMH) is critical to meaningfully overcoming traditional geographic barriers to children's mental healthcare.
Methods:
To introduce this special section, we review the increasing need for child and adolescent mental health services, the decreasing child mental health workforce, and the role that TMH can play in new models of care.
Results:
Authors in this special edition are experienced TMH innovators and providers, and offer expert perspectives on the current and evolving status of TMH practice in child and adolescent mental health. The articles in this collection draw on leading TMH examples, using a range of interventions implemented across diverse TMH settings, to systematically address the critical technical, ethical, regulatory, clinical, and service delivery aspects of TMH care. These articles strategically outline the key considerations requisite for effectively incorporating TMH into children's mental healthcare
Conclusions:
TMH is a rapidly developing service delivery model that is already beginning to innovate systems of care to meet the expanding mental healthcare needs of the nation's children.
Journal Article