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Objective To examine whether levels of physical activity or sedentary activity are risk factors for the development of depressive symptoms in early adolescence. Methods A representative sample of 2,464 12- to 15-year-old adolescents living in the middle of Norway was assessed twice, during the years 1998 (T1) and 1999/2000 (T2). The attrition rate was 4.3%. We assessed depressive symptoms (using the Mood and Feelings Questionnaire, MFQ) and levels of physical and sedentary activities at baseline and follow-up. Various potentially confounding factors, including demographic factors, were assessed at baseline. Results The MFQ scores at T1 were cross-sectionally associated with low levels of vigorous exercise. A possible buffering effect of vigorous exercise on the relationship between stressful life events and depression was demonstrated. In longitudinal analysis low levels of vigorous exercise and high levels of sedentary activities (boys only) predicted a high score (MFQ ≥ 25) at T2. Conclusions Low levels of vigorous exercise and high levels of sedentary activities (boys only) constituted independent risk factors for the development of a high level of depressive symptoms in a 1-year study of young adolescents. This knowledge should be considered by policy makers, preventative services, and health-care professionals.

The aim of this article is to provide a detailed description of the Youth and Mental Health Study (YAMHS),a population-based, representative (cluster sampling), prospective cohort study that was conducted to investigate risk and resilience factors for mental health conditions, specifically depressive symptoms and disorders, from adolescence to adulthood. The baseline data were collected in 1998 (T1) in two counties in central Norway from 2464 adolescents (response rate 88.3%, mean age 13.7 years). The first follow-up was conducted in 1999 (T2) (n = 2432, response rate of 87.1%, mean age 14.9 years). A subgroup of individuals was assessed at T2 (n = 345) with clinical interviews, and this subgroup was reassessed in 2005 (T3) (n = 265, 70.1%, 20 years). The last follow-up (of participants assessed at T1 and T2) was conducted in 2012 (T4) (n = 1266, 51.9%, 27.2 years). Demographics, depressive symptoms, general psychopathology, suicidal ideation and attempts and psychological and somatic factors were recorded. Among adolescents of both sexes, psychosocial variables were correlated with and predicted depressive symptom severity. The strongest predictors were sex (female), the levels of depressive symptoms the preceding year, and the total number of stressful events. The association between stressful life events and depressive symptoms was moderated by physical activity, while the relationship between stressful events and coping style was mediated by depressive symptoms. The rate of use of specialised mental health services among the depressed was low. The lifetime prevalence of depressive disorders was 23% at 15 years, and the most common disorder was minor depression. Adolescents who attempted suicide were more often victims of violence and less resilient than were non-suicide attempters. The existing longitudinal data from the cohort will be further analysed. Follow-up data will be obtained from existing national registries by links created with individual identification numbers.

Background Adolescence is a critical period with elevated vulnerability to suicidality. Despite the importance of protective factors in reducing suicidal ideation (SI) and suicide attempts (SA), research in this area remains limited. This study investigated the associations between protective factors in early adolescence and the subsequent outcomes of SI and SA a year later, while also examining sex differences in these associations. Methods This study utilized data from a representative sample at two timepoints, T1 ( N  = 2464, 50.8% females, mean age = 13.7, SD = 0.6) in 1998 and T2 ( N  = 2432, 50.4% females, mean age = 14.9, SD = 0.6) one year later, collected as part of the longitudinal Youth and Mental Health Study (YAMHS) in Norway. Individual, social and environmental protective factors were identified based on prior research and theoretical frameworks. We used linear (or ordinal logistic) regression analyses with SI (or SA) as dependent variable, and one protective factor, sex and their interaction as covariates. Results Positive self-perceptions (T1) were significantly associated with reduced SI and SA one year later (T2) for both sexes. Specifically, self-worth was more strongly associated with reduced SI in females ( B = -0.16, 95% CI: -0.20 to -0.12, p  <.001) than males ( B = -0.08, 95% CI: -0.12 to -0.04, p  <.001). The interaction between sex and social competence influenced the likelihood of SA, with males (OR = 0.24, 95% CI: 0.13 to 0.42, p  <.001) showing a greater reduction than females (OR = 0.53, 95% CI: 0.35 to 0.80, p  =.009), although this association only showed a trend towards significance ( p  =.083). Higher physical activity and school connectedness/wellbeing were associated with lower SI, and school connectedness/wellbeing to lower SA, with no sex differences. No significant associations were found between task-oriented coping, attachment, family functioning or socio-economic status and SI or SA. Conclusions Fostering positive self-perception, physical activity, and school connectedness/wellbeing is important for adolescent suicide prevention, as these factors contribute to reducing suicidality. Sex differences were observed in the associations between self-worth and SI, as well as social competence and SA. Future research should explore additional protective factors across sex and gender groups.

There is limited research on neurocognitive outcome and associated risk factors in long-term, adult survivors of childhood acute lymphoblastic leukemia (ALL), without treatment of cranial radiation therapy. Moreover, the impact of fatigue severity and pain interference on neurocognition has received little attention. In this cross-sectional study, we examined neurocognitive outcome and associated factors in this population. Intellectual abilities, verbal learning/memory, processing speed, attention, and executive functions were compared to normative means/medians with one sample tests or Wilcoxon signed-rank tests. Associations with risk factors, fatigue severity, and pain interference were analyzed with linear regressions. Long-term, adult survivors of childhood ALL ( = 53, 51% females, mean age = 24.4 years, = 4.4, mean = 14.7 years post-diagnosis, = 3.4) demonstrated above average intellectual abilities, but performed below average in attention, inhibition, processing speed, and shifting ( < 0.001). Executive functioning complaints were significantly higher than normative means, and positively associated with fatigue ( < 0.001). There was no interaction between sex and fatigue and no neurocognitive impairments were associated with pain interference, risk group, age at diagnosis, or sex. Long-term, adult survivors of ALL treated without cranial radiation therapy, demonstrate domain-specific performance-based neurocognitive impairments. However, continued research on the neurocognitive outcome in this population as they age will be important in the coming years. Executive functioning complaints were frequently in the clinical range, and often accompanied by fatigue. This suggests a need for cognitive rehabilitation programs.

Purpose This study investigated health-related quality of life (HRQOL) and psychological distress among young adult (YA) survivors of childhood cancer and the association of these measures with treatment, education, and demographic factors ≥5 years post diagnosis. Methods Participants included cancer survivors (n=91) recruited through the Cancer Registry of Norway (CRN) and healthy controls (n=223) recruited from a student population. All participants completed self-report questionnaires, and the Pediatrie Quality of Life Inventory (PedsQL™) 4.0 and the Hopkins Symptom Checklist-10 (HSCL-10) as a measure of HRQOL and distress, respectively. Results Survivors reported HRQOL at the same level as controls, except for poorer physical functioning. Survivors in general, and female survivors specifically, had higher odds than controls of reporting symptoms of distress above cutoff, but survivors did not have higher mean levels of distress compared to controls. Survivors reporting distress levels above the cut-off had significantly poorer HRQOL regarding physical functioning and lower total PedsQL scores than controls scoring above the cut-off. Age (for HRQOL only), female gender, low educational level, and perceived low economic status significantly predicted HRQOL and distress. Education interacted with the effect of cranial radiation in predicting HRQOL. Conclusions Survivors reported similar mean levels of HRQOL and distress as controls, except for physical functioning. For cancer survivors, demographic variables predicted HRQOL and distress. Some groups of survivors require closer follow-up, and more attention should be paid to factors associated with poor HRQOL and psychological distress in survivors, including female gender, lower education level, and lower income. Survivors treated with cranial radiation may be particular vulnerable in combination with low education regarding HRQOL.

BackgroundSeveral outcome studies have reported on the short- and long-term effects of migraine in selected clinical samples of children and adolescents. However, current knowledge of the course, incidence, and outcome predictors of frequent headaches in early adolescents in community populations is limited, and little is known about the long-term effects. Headache remains untreated in most of these young people. Here we examined the course, incidence, and outcome predictors of frequent headaches (at least once a week) over the long term (14 years) using previously assessed data at the baseline and 1-year follow-up of early adolescents.MethodsOut of an original sample of 2440 who participated in the first two assessments, a sample of 1266 participants (51.9% response rate) aged 26–28 years (mean = 27.2 years) completed an electronic questionnaire comprising questions about their headache frequency and duration at the long-term follow-up. These headache characteristics together with gender, age, parental divorce, number of friends, school absence, impairment of leisure-time activities and seeing friends, pain comorbidity, and emotional (in particular, depressive symptoms) and behavioral problems were analyzed.ResultsIn these young people, 8.4% reported frequent headaches (at least once a week) at the extended follow-up, while 19% of the participants having such headaches at baseline again reported such levels with a negligible gender difference. Over the follow-up period, 7.4% had developed frequent headaches, and a higher percentage of females reported such headaches (11.3% in females, 1.5% in males). In a multivariate model, frequent headaches at the baseline, gender (worse prognosis in females), impairment of leisure-time activities and seeing friends, and higher level of depressive symptoms significantly predicted headache frequency at the long-term follow-up.ConclusionsOur findings suggest that gender, greater social impairment, and comorbid depressive symptoms are important indicators for both the short- and long-term prognosis of frequent headaches in early adolescents in community populations.

Background Cognitive behavioural therapy (CBT) is recommended for attention-deficit/hyperactivity-disorder (ADHD) in adolescents. However, all CBTs are not created equal, and the guidelines do not specify which CBT interventions are the most effective for this patient group. This study examines the efficacy of a group CBT without parent involvement as follow-up treatment compared to no additional CBT in adolescents with persistent and impairing ADHD symptoms after a short psychoeducational intervention and medical treatment. Methods The authors conducted a two-arm parallel randomized controlled trial in two child and adolescent mental health outpatient clinics in Norway. One hundred patients aged 14–18 years with a diagnosis of ADHD (66%) or subthreshold ADHD (34%) were randomized to either a 12-week group CBT program ( N  = 50) or a non-CBT control condition ( N  = 50). Assessments were made at admission to the clinic, two weeks before and two weeks after treatment. The primary outcomes were parent-, teacher- and self-ratings of ADHD symptoms (ADHD Rating Scale-IV), and the secondary outcomes were ratings of ADHD symptom severity, executive function, functional impairment, and emotional problems. Evaluators blinded to group allocation rated ADHD symptom severity with the Clinical Global Impression Scale for Severity (CGI-S) at baseline and post-treatment. Results Analyses using mixed-effects models showed no difference between the treatment arms from baseline to post treatment in primary and secondary outcomes. Conclusions Contrary to our hypothesis, we found no incremental treatment effect on the part of a group CBT as follow-up to psychoeducation and pharmacological treatment on ADHD symptoms and accompanying impairments. Limitations with the CBT was the large number and low dosage of treatment components, causing restricted time for practice. Unlike evidence-based, individualized targeted CBTs with parent involvement, a group CBT directed solely at the adolescents with no parent involvement does not appear effective for treating ADHD. Trial registration NCT02937142 , 18/10/2016.

Objectives Parents play a pivotal role in child development and several parental factors have been identified as risk or protective factors for childhood anxiety and depression. To assess and target these parental factors in interventions, there is a need for a comprehensive, easy‐to‐use instrument. Method This study aimed to investigate the psychometric properties of an adapted version of the Parenting to Reduce Child Anxiety and Depression Scale, PaRCADS(N) in a Norwegian community sample (N = 163) of parents of children aged 8–12 years. Results Our findings indicate that PaRCADS(N) has acceptable psychometric properties. These results are comparable to those of the original study of the PaRCADS in Australia. Conclusion Based on these results, we recommend that PaRCADS(N) can be utilized by health care workers as a tool for assessment and identification of parental practices related to child anxiety and/or depression to target relevant risk and protective factors in treatment and prevention.

IntroductionPersistence of attention deficit hyperactivity disorder (ADHD) into adolescence is a significant burden to patients. Clinical guidelines recommend non-pharmacological therapies, but the evidence to support this recommendation is sparse. This study aims to evaluate the effect of a 12-week group cognitive–behavioural therapy (CBT) programme for adolescents with ADHD aged 14–18 years, who still have impairing symptoms after treatment with medication. We will study the effect of the treatment on ADHD symptoms and examine moderators and mediators of the effect of the treatment on ADHD.Methods and analysisWe conduct a randomised controlled trial of CBT group therapy in adolescents with ADHD recruited from child psychiatric outpatient units in Mid-Norway. 99 adolescents who met inclusion criteria and consented to participation have been randomised to a 12-week group intervention or to a control group receiving treatment as usual. Assessments are made at admission to the clinic, preintervention, postintervention and at a 9-month follow-up, obtaining adolescent, parent and teacher reports. Clinicians blinded to group allocation rate all participants as to their functioning preintervention and at the two postintervention assessment points. The primary outcome is change in symptom scores on the ADHD Rating Scale-IV.Ethics and disseminationThe Regional Committee for Medical and Health Research Ethics in South East Norway approved the study protocol (2015/2115). We will disseminate the findings in peer-reviewed publications and conference presentations, to user organisations and at courses attended by families and professionals. Two PhD students will publish and defend dissertations relating to the study. Planned publications include primary and secondary outcomes and patient satisfaction with the treatment. Furthermore, we plan to publish a manual of CBT group therapy in adolescent ADHD to benefit treatment of patients in Norway and elsewhere.Trial registration numberNCT02937142

ObjectivesEmotion regulation is thought to be an important transdiagnostic process across internalizing disorders in youth, and the regulation of emotions is believed to play a central role in both adaptive and maladaptive development. Several preventive interventions focus on improving children’s emotion regulation skills, but research regarding the outcomes of emotion regulation skills are scarce.MethodsWe therefore investigated whether a new transdiagnostic indicated prevention intervention for anxiety and depressive symptoms, the EMOTION program, improves emotion regulation skills as reported by parents of children aged 8–12 years. Data from a large national cluster randomized control trial (RCT) study, Coping Kids, performed in Norway were used, including data from 601 children and their parents.ResultsUsing mixed models, we found a decrease in dysregulation of emotions (Δ  =  .06, CI  =  (0.00 to .11), p =  .040) and an increase in emotion regulation (Δ  =  .11, CI  =  (0.05 to .17) p  <  .001) in the intervention group compared to the control group.ConclusionsThe EMOTION intervention has a potential positive effect on children’s emotional regulation skills. One opportunity in transdiagnostic interventions lies in targeting common underlying processes in internalizing disorders and thereby reaching a larger proportion of the youth population than is possible with single-disorder approaches.